Child Mental Health Week will take place from 3rd to 9th February 2025. The theme this year is "know yourself, grow yourself”, it aims to encourage children to explore the importance of growing their capacity for self-awareness and self-reflection. This article considers the theme through a psychoanalytic lens, supported by the works of Dr Donald Winnicott. We will consider what is required in infancy to lay the foundations for the development of a robust sense of self, and how developing these key skills during early years can be a fundamental tool in building resilience and supporting emotional and psychological wellbeing long term.
According to the World Health Organization (WHO), almost 1 in 5 children and adolescents globally experience mental health conditions.
The pressures of school, social media, family challenges and a rapidly changing world can all contribute to feelings of anxiety and overwhelm. Children may not have the words to describe what they are feeling, instead communicating through behaviours such as withdrawal, low mood, irritability, aggression or difficulty concentrating. The week serves as an opportunity to engage with children, families, schools and communities about child mental health, provide psychoeducation, help break down stigma and promote early intervention. Addressing mental health early in life is essential in preventing lasting difficulties, and in fostering a generation of resilient and emotionally healthy individuals who can grow up and lead full lives filled with adventure, creativity, connection and intrigue. A foundation of strong emotional health supports them in accessing the confidence and resilience required to take advantage of the endless possibilities life has to offer them.
The theme “know yourself, grow yourself” is such an important one, as a child and adolescent psychotherapist working with children and young people from age 4 to 18, this is at the heart of my daily clinical work. I strive to facilitate a journey of exploration of thoughts and feelings through to a place of acceptance and understanding. Along the way the child or young person will have the opportunity to learn more about themself, and gain insight into why they respond to people and their environment in certain ways. This is often based on past experiences, which provide a blueprint for future interactions and shape how they see both the world around them and themself within it. Do they see themself as a person who is easily accepted and liked, or do they experience themself as being on the outside fighting to be seen and understood? Maybe their self-esteem has taken such a hit they no longer fight to get in, instead existing on the outside in a state of loneliness, perhaps that manifests through isolation, self-harm or addiction as a form of escape or self-medication. These images of self will ripple out into the child’s life infiltrating everything from academic performance, friendships, and hobbies. How can a child with a negative self-view summon the self-belief needed to try new things like music or sports, how can they access the confidence to take risks and make mistakes, trusting they will be held together regardless of the outcome.
To fully understand what is needed for a child to develop a robust sense of self, I will take us on a short journey through infancy and early developmental stages and describe some of the typical bumps in the road that might be faced. To do this I will need the help of a hugely influential figure in the field of child psychology, Dr Donald Winnicott, a British paediatrician and psychoanalyst, one of the pioneers of developmental psychology and object relations theory.
After birth the mother and baby enter into a symbiotic relationship, there is a sense of oneness between the two and the baby sees themself as part of the mother. Dr Winnicott describes how the infant is born without a sense of self, they arrive in the world not knowing who or what they are. From the safety of their mother’s arms they look up to her face and through her gaze they begin to understand that they are seen and that they exist in the eyes of another. The mothers face and the expression it wears act as a precursor to a mirror in a child’s emotional development, this founding experience confirms the infants place in the world. During the first two months of life the infant begins to develop an identity and an emergent sense of self. Adequate containment and attunement from the mother supports the infant in internalising a sense of being loved and emotionally held.
The paternal role is also significant here, initially after the birth to support and contain the mother so she can provide the same to the baby, and then as the mother and baby begin to emerge from the symbiotic cocoon the father can gradually introduce reality to the pair. The baby begins to understand they do not only exist in the eyes of their mother, but in the eyes of their father too. Gradually this triadic relationship evolves, and the infant begins to grasp that not only do mum and dad see me, they also see each other. This can bring about intense feelings of rivalry and envy for the baby as their omnipotent illusion of possessing the mother is challenged, and they begin to understand they are on the outside of their parent’s relationship. This threat rocks the infant’s internal world and they experience, perhaps for the first time, the task of emotionally holding themself together. They are not yet equipped with the skills they need to do that, so faced with the subsequent terror of psychological collapse, they rely on their caregivers. Helping the infant to navigate these emotional challenges at such an early age requires adequate and attuned emotional holding and containment. The absence of this can leave the infant with a fractured sense of self, which if not repaired, can stay with them as they grow up and leave them in a state of what I can best describe as metaphysical homelessness.
The infant’s sense of self continues to develop based on these early interactions with their primary caregivers. These initial experiences provide a template for future interactions, how the child is looked at in their early life then influences how they see others, and how they believe themself to be seen by others. The infant quite literally internalises what they see reflected back at them, if they are looked upon with love and adoration, they absorb that as a core belief, that they are loveable and worthy of receiving this love. If there is a rupture during this early stage and the infant looks up to see a face which is angry, anxious, depressed or frightened, the infant may internalise a sense that they are not lovable and the world, and possibly their caregivers, are not safe or predictable, leaving their vulnerable emerging sense of self lost and uncertain. Dr Winnicott developed a theory which describes the concepts of the true and false self. The true self is a private hidden part of the personality that is connected to a sense of aliveness and feeling real. He believed that the true self stems from an infant's early self-perception, such as being aware of their body processes. Winnicott described how infants develop a false self to protect their true self and this can happen unconsciously at a young age. The false self can develop when an infant's spontaneity is threatened by the need to comply with the expectations of their caregivers or their environment. The infants primary focus is to maintain close proximity with their primary caregivers, without them they cannot survive, so the infant will sacrifice or split off from their true self identity to remain agreeable to their caregivers and to stay close to them, loosing fragments of themself along the way.
From the initial period of symbiosis, the infant grows through the trials and triumphs of separation, navigating the ruptures and repairs on the road toward individuation. This process of separation towards individuation can be viewed as the psychological birth of the infant, however their needs will continue to alter during different stages of their development. An important stage for us to consider here is object permanence, the understanding that objects and people continue to exist even when out of sight. It is a key cognitive skill that helps infants develop language, memory, and emotional attachments. Most infants develop this concept between 4 to 7 months old, although it may take up to a year in some cases, particularly if the infant experiences ruptures along the way. It is easy for us to tell when the infant has not yet developed object permanence, by the heart wrenching screams which occur when their caregivers leaves the room and they are left alone even if only for a few seconds. The terror and devastation the infant experience during this time becomes more understandable when viewed through the lens of object permanence. Mum popping out of the room to answer the front door or use the bathroom does not translate to the infant, to them you are gone from existence, lost forever, and they are left alone to survive the impossible. Games such as peek-a-boo provide the infant with the opportunity to develop these skills in a contained and manageable way. The ritual of the game and predictability of the pattern allows the infant to build tolerance for the disappearance of their caregiver, and they begin to build trust that they are coming back again. Signs that object permanence is beginning to develop are demonstrated by the infant when they drop a toy or food and then look towards the floor for it, this shows that the infant recognises that once the item is out of their sight it continues to exist and can be found again. Navigating the internal world of an infant can be a full time job, and even then many moments of micro rejection or developmental distress can be missed, the infant will be constantly communicating their needs and providing opportunities for missed moments to be met and repaired. An example of this are developmental regressions, perhaps the infant enters a clingy phase when previously they had seemed more comfortable with temporary independence, it’s possible a rupture has occurred for the infant that was undetectable or unnoticed by the caregiver. The clingy phase may be the infants attempt at repairing this rupture, if they could speak they might say “are you still here for me, I need you to stay close, I can’t manage on my own right now.” The early years are a dance, with caregivers often searching for rhythmic balance through mutual regulation and attunement.
Infancy is rarely smooth sailing, navigating this journey can be a stressful ride for both baby and caregivers, often exacerbated by sleep deprivation and unexpected challenges, support for a young family is paramount. Throughout his work Dr Winnicott showed generosity and support to mothers, recognising the, at times, impossible nature of their role. He described the importance of striking the right balance and coined the phrase ‘good enough mothering.’ While this doesn’t initially sound hugely complimentary, Dr Winnicott was an advocate for the ‘good enough mother’ and described how this experience is actually more helpful for the baby than the ‘perfect mother’. Dr Winnicott described how the infant needs to be gradually disillusioned to break to spell of their own omnipotence and prepare them for life’s challenges. To do this without the infant internalising a sense of abandonment or rejection, caregivers need to remain alongside them supporting their emotional growth and helping to psychologically hold them together through nurture and containment. Good enough parenting is encouraged to be imperfect, it just needs to be attuned and ruptures need to be repaired in a meaningful way, so the infant can grow into a child who understands that bad or difficult things can happen without it meaning something bad or difficult about them. As the child grows up they will still rely on the support of their caregivers, to varying degrees, to help them survive disappointment, loss and adversity while holding onto their sense of self and self-worth. This is invaluable in the child developing a robust sense of self and a rich inner world which they can carry through into adulthood.
Mental health is just as important as physical health, and this is especially relevant for children. Mental health impacts how children think, feel and behave, influencing their ability to learn, form relationships and cope with life’s challenges. The complexities of mental health often make it difficult for children to express their struggles, and many suffer in silence unsure of what they need or how to access support. I often hear it said that children are resilient, I disagree with this entirely, they are fragile, and they have the right to be. It is our role as caregivers, and supporters of caregivers, to provide them with the opportunity to become resilient, through nurture, containment and attunement. If we gift them the patience and time needed for them to develop a robust sense of self, gradually their resilience will grow, they can learn to take risks knowing that if they stumble along the way there is someone there to catch them with a loving gaze. Dr Winnicott believed that vulnerability is a big hurdle in being true to oneself and avoiding the clutches of the false self defence. We need to foster a community for our children where it is safe to be vulnerable and create a space where they have the opportunity to “get to know themselves” in an authentic and meaningful way.
I am delighted to announce that Portobello Behavioural Health will be running a 6 week parenting workshop. The workshops will provide psychoeducation on attachment, regulation and rupture and repair. If you have enjoyed the content of this article and would like to learn more, or know someone who might be interested in attending the workshops please get in contact at enquiry@portobellobh.com
