Keeping the inner world of the child in mind: Using the insightfulness assessment with mothers in a therapeutic preschool

Most parents who receive a diagnosis of a serious developmental disorder like autism for their child experience strong emotional reactions such as shock, sadness, despair, or confusion. Many have likened this experience to a metaphorical loss of the child: It is as if the wished-for, typically developing child has been lost, and instead parents are faced with many questions, anxieties, and fears regarding their child’s development. From the perspective of attachment theory, parents who successfully cope with the emotions evoked by their child’s diagnosis and who, over time, revise their view of the child, are considered “resolved” with respect to the diagnosis. Resolution is thought to foster acceptance of the child and to promote caregiving that is matched to the child’s unique
characteristics. Consequently, resolution is likely to contribute to children’s sense of being understood, accepted, and secure. Parental lack of resolution, on the other hand, involves difficulties in revising the view of the child in light of the diagnosis, and can therefore lead to responses that are not congruent with the child’s needs. Clinicians working with parents of children who receive diagnoses can play an important role in facilitating the resolution process, with likely positive effects for both parents and children. The goals of this chapter are to introduce both the concept of resolution and vignettes that illustrate how resolution (and lack thereof) is reflected in parental interviews. In addition we summarize research findings linking resolution status to parental and child characteristics as well as to parent– child interactions. We end with a discussion regarding the implications of this research for clinical work with parents. As the point of departure of our theoretical discussion, we consider the emotional experience of receiving a diagnosis as a loss, and we therefore begin by presenting Bowlby’s original formulations about loss and mourning.