These five seminars give an introduction to the main branches of theory, research and practice that inform clinical interventions in the field of early relational health. The course begins looking at attachment, both in children and adults, and covers when this relationship becomes seriously insecure. There is an overview of babies’ brain development, including how this is affected by maltreatment. The adverse factors that may distort the caregiving relationship are examined, as well as the range of clinical practices that may be applied to help a vulnerable family. The course ends with considering some of the events in the early years that may lead to violent behaviour in adolescence and adulthood, providing a recapitulation of all previous topics.

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The Course will cover:

Outline:

These seminars will last about three hours each. It is expected that participants will ask questions during the presentations (not just at the end) and that there will be periods of discussion, so this will affect timing. Every seminar ends with a suggested book reading list and the final session has a slide with links to a few useful websites.

Attendees will be given Dropbox access to electronic handouts of important papers on each topic and a pdf version of the presentation after each seminar.

The sessions will cover:

Seminar 1 – Thursday 9 April 2026

1) After a general introduction the initial two sessions concentrate on what has been learnt from attachment theory and research. They begin with an introduction to how relationships affect development; leading on to the background to attachment theory and the way this enables us to examine the importance of early relationships, for many different domains of development. Attachment is placed in context of Bowlby’s other motivational systems and how this is an evolved behavioural pattern that contributes to infant survival and homeostasis. There is an introduction to how the attachment relationship sculpts the social brain and how, in optimal circumstances, this both benefits from and leads on to adult parental reflective function. The neurological correlates of attachment are introduced so they may be expanded upon in a later seminar. We examine the phases of the development of attachment behaviours, with this leading on to a detailed description of how the different patterns of attachment behaviour depend on the quality of the relationship with the caregiver while unpacking the concept of sensitivity and responsiveness.

This includes the phases of abandonment (mourning) and how attachment to behaviour alters as the baby matures and gains more skills. Fathers and the concept of the activation relationship are there for a balance. The different patterns of internal working models corresponding to the attachment categories are considered, showing how these are a mixture of activating and deactivating strategies for maintaining proximity to the caregiver in times of stress. This seminar ends with a stylised description of the developmental pathway to adulthood that may be associated with each attachment category, leaving the more problematic disorganised attachment to seminar 2.

Seminar 2 – Thursday 16 April 2026

2) This begins with traumatic attachments, looking at what happens when the attachment relationship becomes a source of stress or fear for the child. Disorganised attachment and the background to this set of responses is examined in more detail, including how it manifests in the Strange Situation Procedure, with the caveat that this does not invariably stem from maltreatment as is often assumed. This includes the internal world of the child and the possible grave developmental consequences. As a practical example we briefly look at how the different behaviour patterns of the three insecure attachments can affect both child and parents when the former has been fostered or adopted. This leads on to how the different attachment patterns, or internal working models, are represented in adulthood (including partner choice and patterns of relating) how this is measured in the Adult Attachment Interview plus the manner in which these might impact parenting in a way that may partially explain the continuity of attachment patterns over generations.

Seminar 3 – Thursday 23 April 2026

3) This seminar follows on from the previous mention of attachment and neurological development, emphasising the importance of relationships throughout the life cycle. We begin with the evolutionary background to neuroplasticity as the defining characteristic of human brain development. The central point is how the baby’s brain adapts to its environment of significant relationships, as the first 1001 days mark the 3 phases of maximum neuroplasticity. There is a brief description of the science of epigenetics before a more detailed look at brain anatomy and the sequence of development, including the concept of sensitive periods, during the first few years of life. We will examine synaptic structure and growth during the formation of neural networks and how the latter become stabilised, sometimes leading to vulnerability for future problems for a minority of children. There is a short mention of the second phase of neuroplasticity during adolescence. The first three years of life have been artificially split into six months periods of brain development and correlated with the infant’s increasing skill set. Then we look at the downside to plasticity and sensitive periods, or rather windows of vulnerability, and how the brain will also automatically adapt to a harsh environment. This begins a more detailed description of the neurobiological consequences of maltreatment, including neglect, and attachment related trauma in general. This will include more in-depth information on the autonomic nervous system and the stress / survival responses, ending on a more positive note by hinting that children can change in the right circumstances.

Seminar 4 – Thursday 30 April 2026

4) Here we begin by examining the concept of infant mental health, or rather early relational health, and how so many factors (as covered in the previous three seminars) contribute to this in both positive and negative ways. Again, the centrality of relationships is stressed throughout, looking through a transactional perspective to illustrate this and bringing in the related ecological/demographic issues that impact a family and consequently the infant’ development. This means that the stressors that impact vulnerable families (or risk factors) that are examined here need to be always kept in the mind of early years practitioners. We briefly cover sociodemographic factors, interactional or parenting variables, parental past experiences (‘ghosts in the nursery’) and, finally, any medical problems the baby may present with. The impact of maternal stress during pregnancy on foetus and subsequent child development is also addressed. This leads on to data from the ACE studies and how this research may be used to emphasise the importance of 4 preventing maltreatment in the early years. A final overview of how the early attachment relationship affects development leads on to the many different ways that practitioners may prevent later social and emotional difficulties with early intervention. The fundamental beliefs and practices behind infant mental health informed work are set out as well, stressing a strength-based approach, as are some of the economic research and arguments for early intervention. After looking at these specialised therapeutic aims a number of different evidence-based therapeutic interventions are described.

Seminar 5 – Thursday 7 May 2026

5) The final session recapitulates some of the central information from all the previous ones by examining how violent behaviour, or rather a lack of self-regulation, and many forms of mental illness have their roots in the experiences of infancy. (Not invariably of course.) This also covers some of the possible early background to self-harm and suicidal behaviour. We begin with a reminder that aggression should be viewed as normal human behaviour within certain contexts, as it is a natural response to insecurity or threat. Aggression and violence are different, and usually the latter reduces as the child matures and internalises mechanisms for self-control, or affect regulation, both of which stem from the quality of early caregiving and find their home in the prefrontal cortex. The rise of empathy, an aspect of the attachment relationship also plays a central role in inhibiting anti-social acts. These skills may be compromised by the experience of stress and fear during the first few years of life, the time of maximum neuroplasticity. The parent’s capacity for reflective functioning or mind-mindedness (mentalising in action) is important to consider, and this also is knowledge that can be applied to intervention (as was briefly mentioned in the previous seminar) as well as contributing to emotional awareness as a protective factor that can be encouraged. We look at childhood adversity as a concept that covers many different stressful and dangerous experiences, leading on to another consideration of how this might affect the infant’s internal working models of relating. Developmental threat should also be seen within an ecological model, returning to the past consideration of risk factors.

This leads on to a more detailed consideration of the effects of maltreatment during infancy, including witnessing violence in the home: covering a range of mental health problems, relationships, anti-social plus violent and inappropriately aggressive behaviour and finally a more detailed examination of suicidal impulses and the common traits shown by those young people at risk. Violence, in conclusion, has many contributing factors stemming from actual and avoidable experiences, including those experienced pre-birth; it may indicate both poor reflective function (as found in borderline personality disorder) and be an example of ego defences set up during the early years. We separate threat from deprivation and go on to briefly look again at how these forms of maltreatment may influence brain development in the early years, with neglect often a greater risk for a later lack of self-control. This is gloomy to say the least, so we end with a reminder that intervention can be as useful as it is necessary.

This series of seminars was originally developed at the request of the Sure Start manager in Cheltenham. Over the years attendees have included health visitors, paediatricians, social workers, midwives, GPs, CAMHS staff, foster and adoptive parents, nursery and community workers, child and adult psychotherapists and even the odd manager.

Reading list.

These are resources listed during the course. None of these books are essential, more suggestions for further reading. Search for any more up to date books first. A selection of relevant papers will be made available to attendees following each seminar and many of the slides have links to relevant research.

1 & 2. An introduction to attachment theory and research.
• Karen, R (2024) Becoming Attached: First Relationships and How They Shape Our
Capacity to Love. Oxford University Press.
• Goldberg, S. (2000) Attachment and Development. London: Arnold.
• Holmes, J. (1993) John Bowlby & Attachment Theory. London: Routledge.
• Prior, V. & Glaser, D. (2006) Understanding Attachment and Attachment Disorders.
Jessica Kingsley.

• Beebe, B. & Lachmann, F. M. (2014) The Origins of Attachment. New York:
Routledge.

3. Early brain development and relationships.
• Joseph LeDoux. (2002) The Synaptic Self. London: Penguin Books.
• Susan Hart. (2006) Brain, Attachment, Personality. London: Karnac.
• Daniel Siegal (2020) The Developing Mind (3 rd ed.) New York: The Guilford Press.
• Lisa Feldman Barrett, (2021) Seven and a Half Lessons About The Brain. London:
Picador.
• Sarah-Jayne Blakemore, (2018) Inventing Ourselves: The Secret Life of the Teenage
Brain. London: Transworld Publishers.

4. Risk factors and examples of therapeutic intervention.
• Penelope Leach (Ed.) (2017) Transforming Infant Wellbeing. London: Routledge.
• Joy Osofsky, Philip Stepka & Lucy King. (2017) Treating Infants and Young Children
Impacted by Trauma. Washington DC: American Psychological Association.
• Mares, Newman, & Warren, (Eds) (2011) Clinical Skills in Infant Mental Health. (2 nd
ed.) ACER Press, Australia.
• Alicia Lieberman & Patricia Van Horn. (2008) Psychotherapy with Infants and Young
Children. New York: The Guilford Press.
• Alicia Lieberman, et al., (2020) Make Room for Baby. New York: The Guilford Press.

5. The background to violence: Impact of early maltreatment.
• Prior, V. & Glaser, D. (2006) Understanding Attachment and Attachment Disorders:
Theory, Evidence and Practice. Jessica Kingsley.
• Van Der Kolk, (2014) The Body Keeps the Score. New York: Viking.
• Joy Osofsky, (Ed) (2004) Young Children and Trauma: Intervention and Treatment.
The Guilford Press.

• Robin Kar-Morse & Meredith Wiley, (2018) Ghosts From the Nursery, (2 nd edition)
New York: The Atlantic Monthly Press.
• Robin Karr-Morse, R. & Meredith Wiley, (2012) Scared Sick: The Role of Childhood
Trauma in Adult Disease. New York: Basic Books.

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