Infant Mental Health Practice and Reflective Supervision: Who We Are Matters

Abstract

The issues of race, ethnicity, or differences arise in Reflective Supervision (RS). The author, long experienced in RS, describes both personal and professional reflective process through the lens of race and ethnicity. Her early experiences with hair combing provided a centerpiece for her reflections on the role of race. The author offers practical guiding questions to engage in authentic conversations on race as a reflective supervisor. She describes her process as a Black clinician and working relationship with a young, White supervisor who understood the principles and practices of relationship-centered reflective supervision. Together they established trust to engage in meaningful and personal conversations about diversity, ethnicity, family rituals, and racism. The author offers personal reflections as she and her supervisor cocreate a safe space for meaningful self-reflection and continuing curiosity.

As a Black woman, the author once thought that issues of race, ethnicity, and culture should be private and not necessarily talked about in the workplace. She describes her realization that supervision within a trusting relationship offers opportunities to grow and gain a deeper understanding of herself, to engage and form cross-racial therapist–client relationships.

Introduction

The examination of race and its impact on relationships is a crucial part of working within the Infant and Early Childhood Mental Health (IECMH) service community. It can be challenging to address those parts of ourselves that feel uncertain, painful, or embarrassing as they relate to effective work with very young children and families. It is especially important to feel comfortable sharing our clinical vulnerabilities with another through supervision. To be truly open and honest about one’s work and one’s response to the work, a supervisee needs to feel assured that the supervisor can honor unique personal experiences without judgment and invite reflection thoughtfully and with sensitivity. Discussions regarding differences, culture, ethnicity, and race, essential to IECMH practice, require special courage and commitment. Some of the language that has been viewed in IECMH work as being attuned may feel dismissive in conversations regarding race and culture. It wasn’t until I became a supervisor that I realized that saying, “I can’t imagine what this is like for you,” can create boundaries between a supervisor and supervisee that shut down honest conversations about cultural experiences, difference, or race. Intended to be supportive and empathetic, the message received may be that our differences are so great that I can’t identify with how you might feel. The supervisor and supervisee may wonder how each could possibly understand how the other feels about race or cultural traditions or family values when neither one has had experiences that would have allowed our paths to cross.

As a Black woman, I thought that issues of race, ethnicity, and culture should be private and not necessarily talked about in the workplace. Failure to have coversations about our social identities creates missed opportunities to examine relationships whith families being served, colleagues and within RS. Equally important, misunderstandings about race can result in a disruption in the supervisory relationship, and, without an opportunity for repair, leaves the supervisee with regret for having tried to share her story. This parallels how families can feel when they share stories of vulnerability, including trauma, abuse, or neglect, and are not heard or understood. Like families, I felt at times rejected by my supervisor’s silence or failure to respond to stories or feelings shared. Wondering if they were too difficult to handle, I tucked the stories away without any further discussion. I later learned, unless tackled, the supervisee will carry this feeling of rejection into future RS relationships and conversations that include race. My hope as a supervisor is to invite reflection and to be brave enough not to sweep these moments under the rug and talk about them. I suggest the following when issues of race, ethnicity, or difference arise in RS:

• 1. “I don’t know what this is like for you, but I do know what it is like to feel judged or misunderstood.”

• 2. “I know what it’s like to have assumptions made about me. How can I support you?”

• 3. “I really want to understand. That sounds hard. I’m sorry that you have been feeling that way.”

Unique cultural practices within the Black community have at times been embraced, imitated, misunderstood, and criticized. Hair and hair combing rituals have sparked conversation, admiration, curiosity, and, on occasion, an invasion of personal space. Because rituals and traditions reflect who and how we are, it is imperative to remember their importance. Personal memories, family rituals, and practices can trigger many thoughts and feelings. As well, there is a risk of feeling misunderstood when these moments are explored.

The following story is a personal one, describing an interaction I had with a mother and baby referred to me for IECMH services. I didn’t share this experience with any of my previous supervisors. It wasn’t until I entered into a relationship with a young white supervisor who was willing to be authentic vulnerable and genuinely interested in who I am, that I began to offer deeper reflections. The relationship we developed proved to be sturdy enough to engage in a conversation about diversity and family rituals. Sharing this story was not easy. I still worried about how my supervisor might perceive my reflections even though that had not been part of our experience together. As a Black woman, I know that Black hair and its history can result in emotionally charged conversations.

My Wonderings

I asked myself, “Would my White supervisor understand what I had struggled with during that interaction even though it was years ago? Would she recognize it as being important to me? How much grace should I give her if she doesn’t understand?” These questions are important to think about in any RS relationship. As well, “How much of an investment am I willing to make to deepen the RS experience?” It would take courage.

The Story of Anita, Kathy, and Me

I am a Black social worker with many years of experience as an Infant Mental Health therapist. At the time this story took place, I was working in an Infant Mental Health (IMH) Home Visiting Program. Anita,¹ a 5-month-old White child and her young mother, Kathy, were referred to me for services. Kathy had been experiencing postpartum depression symptoms that had progressed over time and were making the care of her baby difficult. Kathy described feeling anxious about the increasing demands of having a baby who seemed to need so much. Even though Kathy felt she was developing a routine with her baby, she found herself feeling angry with her baby for wanting to be held, played with, and comforted. She said that she felt that she was responsive to her needs, but did not have the feelings of joy she always imagined having. She said, “I keep waiting for a connection with her that hasn’t happened.” As I listened to her story, I marveled at her reflective capacity to put into words some of her feelings about mothering and being a mother. After that, her baby, as if having understood her, reached up and touched her face with a chubby hand and a toothless smile. What appeared to be instinctive was Kathy’s response, which was to take her baby’s hand and gently kiss it.

Witnessing this gesture was comforting to me and gave me hope, but also made me wonder what had been making it hard for Kathy to fully enjoy the relationship that was developing between her and her baby, Anita. As I continued to sit with Kathy and Anita, the baby looked at me as if I had really caught her attention. To me, it felt as if she was taking in my face, my features, my skin, my hair, so unlike her mother’s, and she reached out and grabbed one of my dreadlocks. Her grip was strong and determined. She looked very pleased with her accomplishment. I smiled at Anita and was going to pat her hand and note her curiosity, but before I could say anything, her mother grabbed Anita and told her, “You don’t do that! I’m sure she doesn’t like people touching her hair.”

Assumptions: Disruptions and Repair

Mom looked visibly upset and I was taken aback, not understanding the intensity of the exchange. I assured mom that her touching my hair was ok, but her statement about not wanting people touching my hair struck me. I wondered why what I saw as an innocent interaction caused her so much discomfort. I wondered, what about me had made her uncomfortable. Anita, startled by mom’s response, began to cry and mom looked annoyed. My own internal working model was telling me there was something odd about my appearance and that even though mom appeared to be very courteous and welcoming initially, she may have been uncomfortable with me as a Black woman. I could feel my body grow tense. I began to feel defensive as I remembered times when I felt misjudged or discriminated against because of how I looked. I wondered if my feeling was one of anger with myself for forgetting that everyone isn’t comfortable with Black people. I had felt comfortable with her and had assumed that what she had shared meant she was comfortable with me. At the time, I was flooded with memories of times when I felt rejected. I also thought about how I felt when I came into her home and sat down to talk with her. The vulnerability she expressed felt genuine. Thinking now, how could I have been wrong about her when my initial experience felt so genuine? Holding my initial feelings toward her in mind, I took a deep breath and said, “I noticed your reaction when Anita touched my hair and I’m wondering if you would tell me what you were feeling in that moment.”

I braced myself feeling that mom would become defensive and end our visit. I was surprised when tears formed in Kathy’s eyes as she said, “I had heard that African Americans don’t like for White people to touch their hair, and I didn’t want you to be angry and not come back.” I was touched by her sensitivity to our differences and by her bravery to bring up race as I assumed this wasn’t a topic easily entered into but is so much a part of who we are. Also, I was struck by seeing and understanding how much she needed and wanted support for her and her daughter.

Seeking Understanding

I told her “I thought Anita was just being curious.” I said, “My appearance is very different from yours and Anita’s, maybe she’s trying to make sense of this new person in her space.” I found myself feeling less defensive but still unsettled as I felt there was more to the story, and I wasn’t quite sure how to proceed. I was working hard to regulate my own emotions and feelings. Before I began, I took a deep breath and asked if there was anything else that was bothering her. Kathy paused and said, “I remember being a little girl and I used to love to play in my mom’s hair because it was long and curly. My mom would always push me away or tell me to go play. She wasn’t affectionate at all.”

I said, “You wanted to be close to your mom and it was really hard for her to give you what you needed.” “Yes,” Kathy said. “I thought her hair was so pretty and I was sad that mine wasn’t as curly as hers. When I found out I was having a little girl, I was so excited. I imagined combing her hair and being so happy.” As she spoke, she glanced at her daughter’s hair that looked like a crown of tiny ringlets. I said, “Anita’s hair is so curly. What’s it like for you to comb her hair? Kathy replied, “I love her little curls and I thought I would love brushing her hair. I pictured adding tiny ribbons and bows and I would show her how she looked in the mirror. I just don’t have the feelings I thought I would have. Sometimes I feel sad when I’m brushing her hair and sometimes I feel angry!” I listened carefully as Kathy spoke. I held in mind how it might feel to want to create positive experiences with your daughter, but unresolved feelings of loss and regret inhibit the opportunities for mutual enjoyment. We continued to talk. Kathy shared more information with me while her baby moved back and forth between us. When her baby tentatively touched my hair again, Kathy smiled. Kathy longed to have her mother’s affection. Her feelings of longing were unresolved and had intruded into her present relationship with her daughter.

My Awakening

The awakening of my own feelings of rejection and discrimination emerged from my conversation with Kathy and impacted the new relationship I was building with Kathy and her baby. The above interaction sparked memories of having my hair combed by my mother and grandmother. I remember the smell of the pressing comb and holding my ear hoping to not get burned. I remember going to the beauty shop at 5pm and sitting in the chair surrounded by the ladies in various stages of hair grooming feeling so grown up and pampered. At home, my grandmother would hum as her fingers worked through my hair and I would lean into her legs as she massaged, braided, and brushed saying that she was making my hair strong. My mother would straighten my edges with the hot-pressing comb for special events and between visits to the beauty shop. I had to hold my ear to protect my skin from the heat of the comb. They were always so careful to avoid burning me but on the rare occasions when they did, I tried very hard not to cry, because it seemed to hurt them more than me. My hair was very thick; I perspired easily. I hated getting my hair pressed and longed for a permanent so that my hair would be straight with Shirley Temple curls.

I didn’t like the pressing comb, but I loved the touch of my grandmother and mother’s hands. I felt safe with these women and I knew how much I was loved. They would tell me how much they loved my pretty brown skin and thick hair. I didn’t realize until much later that they were preparing me for a world where my dark skin and hair of wool would not be seen as beautiful in everyone’s eyes. When I was discriminated against, I remembered the messages I received as a child. I would need to give these same messages of love and acceptance to my son and daughter as a protective shield of armor when they were faced with social injustice and systemic racism. It wasn’t until I was married with children that I felt brave enough to wear my hair naturally. Each strand of hair holds stories of pain, shame, comfort, and joy. Although different in many ways, Kathy, Anita, and I connected in our desire to feel seen, heard, valued, and accepted. I hoped that in time I could support Kathy in freeing herself from the “ghost” that had invaded her relationship and create opportunities for fully delighting in her child.

As society has alternately been accepting and rejection of Black hair, so has my recognition of the importance of engaging in conversations to gain understanding to support diversity and honor culture. It takes a lot of effort and can be exhausting, but these conversations are too important to ignore.

Being Brave Can Be Difficult

My initial ambivalence about sharing this experience with my first RS supervisor made me a little uncertain about how to put into words with my new supervisor what I felt about the experience with Kathy and her baby and all that it awakened for me personally? What would she think about my early experiences and how they have impacted my work? Did it even make sense to share an experience that happened years ago? I was again reminded of some of the insensitive and intrusive questions I have been asked about my hair. Questions that made me feel as if I were on display. For example, “Why does your hair feel like wool? Why do you burn it with that comb? Why do black women have so many hair styles? Sometimes their hair is long, sometimes it’s short. What’s up with that? Can I touch it?” Would she understand the discomfort I feel and at times continue to feel? Would she defend or dismiss my feelings by saying that was just the sign of the times or would she be able to embrace how I might feel being thought of as “odd”? What I did feel with this supervisor was her deep compassion and desire to understand, which made each conversation easier. Over time my supervisor shared ways in which she felt like she had not always fit in and how inaccurate assumptions had been made about her. We were able to enter a space of generosity that has continued throughout our relationship.

Sharing in Vulnerability

What sparked my desire to share the above interaction I had with Kathy and Anita with my reflective supervisor was a case that had been presented to me by my current supervisee regarding a child’s hair. My supervisee needed to talk about how this Black mom whose child was in foster care felt when she noticed during a visit that her child’s hair was dry and breaking. This mother cried because despite the reasons for removal, this mother had always taken pride in her child’s hair and appearance. I talked about how I offered support to my supervisee regarding the child’s hair and how she talked about her own hair combing ritual. She shared that she would have been angry, too, if her child’s hair had been damaged. My supervisee cried because the mother’s pain had felt palpable. When I shared this story, my supervisor noted my compassion for my supervisee. We discussed how the supervisee had offered the same level of compassion and empathy to the mom. My supervisor then asked with interest about cases I might have had regarding hair combing. It was that simple question that reminded me of my experience with Kathy and Anita.

Feeling Heard

It felt as if I had been waiting to share the interaction. I wanted to be understood and hoped our carefully created rhythm would support what I wanted to convey. I began by talking about my observations regarding Kathy’s postpartum depression symptoms and how she became more responsive to Anita’s cues and developmental milestones. I talked about the pillars of Infant Mental Health I used and my affection for Kathy and Anita. I struggled to express what had been aroused in me regarding race and ethnicity. My supervisor sat patiently, quietly, present in our protected space, and invited me to think about my own history, early attachment relationships, and thoughts about diversity. Again, I reminded myself of the comfortable space we had created, and her genuine desire to know me and my work as a social work clinician and supervisor. Remembering this felt experience fueled me to share thoughts about my childhood, my parents, and the rituals I embraced. When I shared the interaction with Kathy and Anita, we wondered together about what might have been triggering for me. We talked about how memories of the past can sabotage our present, requiring attention and understanding.

Sharing Perspectives

As we continued to explore the interaction, my supervisor asked permission to offer her own initial reactions to what I shared. She said that she would not have thought about the mom feeling uncomfortable with her baby touching my hair or my race. She would have assumed that the mother was trying to prevent her baby from invading my space. I thought about how race and culture are so much a part of the lens in which I view the world. Sometimes it feels exhausting to be in settings where I am the only Black woman. I shared that my words and thoughts are always filtered to determine how I might be received and perceived. We were able to think together about our individual experiences as related to privilege and what it has meant to my relationships with families and in supervision. We also acknowledged how comforting it felt to have important conversations, because it has served to inform our work as supervisors. I thought about how I may have avoided conversations regarding race and missed opportunities to support families in more meaningful ways. We discussed the importance of not making assumptions and being brave enough to ask for clarity when there is a disruption and what I would need during our time together that would feel supportive. This space of emotional safety is not fixed but needs to be re-examined either internally or together when feelings of uncertainty and insecurity arise. It is the responsibility of both the supervisor and supervisee to make sure that safety remains consistent within the relationship (Noroña et al., 2012).

Concluding Thoughts

Predictability, reflection, and reciprocity are an essential part of reflective supervision (Wilson et al., 2018). Supervisor and supervisee cocreate a space for reflection, curiosity, and safety. We considered questions (see Reflective Questions) as we worked together.

Reflective Questions

• 1. How do my cultural and racial beliefs impact how and who I am in this RS space?

• 2. What cultural beliefs, biases, and misperceptions do I hold that may contribute to relationship disruptions in my work with families, with other professionals, or with people I supervisee?

• 3. What are my expectations and what do I hope to gain through an RS relationship?

• 4. How will I honor differences between us in this RS relationship?