Hello San Francisco - part 1

A Beautiful Load

Our USA journey started in Michigan, where parent-infant psychotherapy was birthed through the work of Selma Fraiberg, and will end in California, San Francisco, where Selma died. Selma was a social worker who trained as a child psychoanalyst at the Anna Freud Centre in London. She developed her approach to working with families in Michigan, and relocated to San Francisco at the invitation of the University of California, San Francisco, where she served as a professor before her untimely death. Three colleagues relocated with her to help her to carry the beautiful load; the practice of parent infant psychotherapy to California, and to embed its principles into the curriculum at the university. I learn from my hosts of the traumatic outcomes for all four women and how; from the trauma; the work of parent-infant psychotherapy bloomed again. It is a beautiful load, and you will see from the above painting that it is not carried alone.

Tuesday 23rd May

We Wake Bright and early to prepare for our five-hour flight to San Francisco, California. Our host returned from her long weekend away last night and she has announced that she would like to cook for us to send us on our way. We sit for a leisurely chat and a hearty breakfast, before closing our suitcases, posing for a last photo and setting off to catch the Michigan Flyer bus to the airport. Again our kind host offers to give us a lift.

Unlike our first entry to the USA, this time, there’s no drama at the airport and we enjoy a smooth flight to San Francisco. We know we’ve arrived when we see the impressive Golden Gate Bridge.

Our Uber taxi whisks us from the airport to our next Airbnb stopover. I’m taken by surprise at the steep hills of Potrero area, San Francisco, and wonder if I will have the courage to leave the house the next day. Our host; a distinguished elderly musician and conductor, assures me that we will get used to it and we’ll love the views. He seems to have put everything we could possibly need in our room for a comfortable stay. We’re exhausted so straight to bed to prepare for the next day.

Wednesday 24th may

We unpack and venture down the hill to check out the local scene and the whereabouts of the hospital where my hosts, Kadija Johnston and Maria St John are based. I connect with Maria and Kadija to let them know we’ve arrived and Kofi and I spend the day finding our way around the area.

We're relieved to discover that the Zuckerberg San Francisco General Hospital and Trauma Centre is just a ten minute walk from the house, albeit down a steep hill. This hospital is unique in San Francisco as it serves the poor, elderly people, uninsured working families, and immigrants. Most patients receive Medicare. The homeless, are also welcome at the hospital and it is the only acute hospital in San Francisco that provides twenty-four-hour psychiatric emergency services.

The hospital was re-named after Facebook founder Mark Zuckerberg and his wife, Priscilla, who donated $75 million to help refurbish it. In the picture I'm sitting on the steps in front of the new building. The statue is very much in line with my Infant Mental Health theme.

On Thursday 25th May I start the day bright and early. I’m due to attend a meeting with Maria St John, Associate Clinical Professor and Director of Training at the Infant-Parent Program (IPP). I will be accompanying Maria to a presentation at the local child welfare agency, where she will be speaking on the intake process & clinical work of the IPP. I am keen to experience the normal day to day life of the IPP, without any frills added. Maria picks me up in her car (to my relief) and saves me from the steep hill.

It's generous of the child welfare team to welcome me behind the scenes as they discuss in-house business; giving me insight into the work of the social workers and the fostering process. The referral process is very similar to ours in London and the pressures faced by the social workers also seemed similar… high staff turnover, constant restructuring, shortage of carers, etc… I'm impressed by the team leaders’ ability to keep the team spirit high. Apart from Maria about five other projects share their work. Diversity seems really high on the agenda and services cater for the different language groups of San Francisco.

Friday 26th May and I’m due to spend the morning with Kadija Johnson, Director of U.C.S.F. Infant-Parent Program/Daycare Consultants. The plan is to meet until noon.

I have a sense that Kadija has prepared for me., as she welcomes me to her office with an artistic and luscious display of fruit, pastries and drinks .

What an animated discussion we had, sharing a lot of history about key people like Selma Fraiberg and her colleagues that you would not find in books. I learned from Kadija that Selma was invited to the University of California, San Francisco due to her parent-infant expertise. Three other colleagues (Alicia Lieberman, Jeree Pawl & Judith Pakersky) uprooted themselves from the University of Michigan to accompany her in her mission. Within two years Selma died from a brain tumor. Without Selma, the original plan could not go ahead so her three faithful colleagues were left high and dry, without the funding and support that Selma attracted. Can you imagine what that must have felt like for these women and their families? Somehow, from this traumatic situation the work of the Infant Parent Programme emerged and has been located at the hospital’s trauma centre until now.

Talking to Kadija, makes me realise that it was not so long ago that parent infant psychotherapy was birthed, because Judith Pakersky, one of Selma's faithful colleagues, was One of Kadija’s professors. Alicia Lieberman, also one of Selma's faithful companions and pioneers of the IPP, still continues her trauma based work in San Francisco. Later on in my visit I had a brief, impromptu chat with Alicia. I had hoped to spend more time with her when I planned my itinerary but she was out of town. I did not know at the time how closely she works with Maria and Kadija.

Kadija explains the infant parent program to me and later sends me some more details, from which I have quoted here.

The U.C.S.F. Infant-Parent Program is a multifaceted infant and early childhood mental health program specializing in serving children birth to five years of age with a particular commitment to underserved, vulnerable and at risk populations. Services provided to this population include infant-parent psychotherapy, perinatal mental health service, case-centered and programmatic consultation, therapeutic play groups and therapeutic shadowing. The aim of the Infant-Parent Program’s relationship-focused interventions is to protect and support the natural capacity of very young children to grow up valuing themselves, caring about others and competent to contribute to society. These capacities are shaped in the first few years of life by the way in which children are treated by those responsible for their care. From these relationships, they learn how to feel about themselves, how they fit into the world and what the world has to offer them.

Taken from The UCSF Infant-Parent Program, 2017

About 100 families are treated each year by the programme and nearly 90% of the work is done in the home, unless the family chooses otherwise. As an offshoot of this work, a mental health consultation programme was started about 30 years ago to bring the principles of infant mental health (IMH) care to early care and education sites. These principles can be found in this book by Kadija (out of stock on Amazon at the moment. I'm waiting for a reprint of the book because it has some useful concepts for my work in London.

The book aims to show carers in education settings the importance of transforming relationships. These concepts have been introduced to about 50 agencies in San Francisco that work with 0-5 year olds. Professionals include home visitors, midwives, Neo-natal Intensive Care Unit, Obstetrics.

Kadija was also interested to hear about my work in London. I was able to share my experience over the past 35 years which grew out of of spiritual foundations and inter-generational patterns of caring for the vulnerable, that Kofi and I learned from our parents and grand parents. I touched on my experience of fostering for nearly 15 years, my training and work at the School of Infant Mental Health, work at West London Action for Children and Croydon Best Start Parent Infant partnership. By the way, Kadija, I promised to send you the link to the books of my mentor, Dr Stella Acquarone, on the practice of parent-infant psychotherapy: Here it is: http://us.karnacbooks.com/product/infant-parent-psychotherapy-a-handbook/16459/.

We go from our animated discussion in Kadija's office to a case presentation by a first year psychiatric resident. The presentation will focus on a parent of an infant who was a patient on the in-patient psychiatry unit at the hospital. Kadija is the discussant for the (very complex) case.

After the presentation, Kofi joins us for lunch in a local restaurant. You can see from the picture that we had a great time, with a lot of laughter.

We are sad to part with Kadija but she has to visit another state with her work. She will miss the famous Carnival over the holiday weekend.

San Francisco Carnival Weekend

I think this post is long enough, so I will tell you about the Carnival and the rest of our stay in San Francisco in the next blog. I also receive a surprise gift from the archives of the university. See you next time.