The mother-child bond: a dance of looks, touches and harmonies

Written in collaboration with Dott.ssa Martina Abalsamo

Introduction 

The relationship between mother and child is a bond that arises well before words. In the first months of life, in fact, the main language is not made up of sentences but of contact, glances, and shared rhythms. The caregiver's touch, containment, and sensitive responses not only reassure the newborn but also lay the foundation for building his internal world and his ability to regulate emotions. Psychological studies and theories have highlighted how these first bodily and emotional experiences have a profound impact on development: they are the ground on which the sense of security and trust that will accompany the child throughout his life is formed.

From soma to psyche: the birth of the self

Touch is the main sensory modality used in communication exchanges between caregiver and child from birth and is essential for the psychophysical development of the newborn. Several studies, such as those by Harlow on macaques or by Spitz with hospitalized newborns, have shown that affective care, also mediated by physical contact and tactile stimulation, represents a primary need like that of nourishment. These findings have led to an increasing focus in neonatal practices on interaction and physical contact between caregiver and child. An example of this is the introduction of Kangaroo-care for premature infants. This intervention, which consists of skin-to-skin contact between caregivers and newborns, showed important positive effects on the growth and well-being of both newborns and caregivers, reducing the adverse effects of early detachment and isolation of the premature newborn in the NICU.

Tactile stimulation is fundamental for the passage of the newborn from the state of nonintegration to that of integration (Winnicott, 1945): at birth, there is no bodily unit that allows the newborn to experience sensations, but he becomes the sensation itself: he is not hungry, he is hungry. Thus, it will be immersed in a negative affective state that the caregiver remedies with the functions of “holding” and” handling” (Winnicott, 1945) to allow the newborn to move from absolute dependence to independence and to make it reach a state of “continuity of the self”. 

The most recent research confirms Winnicott's intuition: body contact and the sensitive response of the caregiver are not only a form of comfort, but also stimulate neurobiological processes that favor the regulation of stress and the maturation of the nervous system. Skin-to-skin contact, as in the practice of “Kangaroo Care”, improves thermoregulation, reduces crying, and supports the synchronization of physiological rhythms between mother and baby (Aaltomaa-Michalias, Dahllof, Lintula, Nissen, & Widstrom, 2010).

In particular, holding refers to the containment by the caregiver of their child, which is understood both in a physical sense, as it supports them in their arms, and in a psychological sense, as it manages to protect and calm them in moments when they experience negative affectivity, responding to their needs. Handling is the manipulation of the child's body that helps him distinguish the boundaries of his body and integrate the psyche into the soma; this process is defined by the Author “personalization” in that the infant learns to distinguish between self and non-self and understands that he is a subject other than the caregiver Through both these containment functions, both physically and emotionally, the parent will promote the transition from heteroregulation to self-regulation in the child. 

The mother-child “dance”

The first form of regulation that appears in the child is the emotional one: the function “mirror” of the caregiver, which consists in reflecting the child's state of mind on their face, is central to the development of emotions in children and their ability to self-regulate: if the latter have rudimentary means of regulating their internal states, such as sucking the finger or moving the head, there is agreement with respect to the fact that the quality of maternal interactions has a strong regulatory impact on changes in the affective states of the newborn: if at first the regulation is mediated by the caregiver, gradually the child will learn to modulate his emotions, cognitions and behaviors according to what happens in the environment in which he is inserted.  At birth, newborns are not able to experience real emotions but experience affective states that can be positive or negative depending on whether their needs are satisfied with a sensitive and contingent response from the caregiver. The caregiver empathetically reflects the affective state of the child on his face, it makes him aware of what he is feeling and helps give meaning to his level of activation. The caregiver's response is, therefore, an organizer of the child's internal states who gradually acquires awareness of his own affections. Tactile stimulation is also involved in this process, as the caregiver uses touch to regulate the internal states of his child.

As Stern (1985) argued, caregiver-child interactions can be compared to a dance in which both activate and engage each other with a play of glances, tactile stimulation and sounds and, as the interactions progress, both members of the dyad will learn to know each other and their actions in response to each other become predictable. The coherent caregiver's response to the child's signal is part of the synchrony that is created between the two, which however is not maintained throughout the interactive moment; moments in which synchrony is lost are normal, but what matters is the caregiver's ability to regain synchrony and return to engaging their child. 

Tronick in 1998 wrote that “human beings are incapable of responding with perfect contingency. An orientation towards the social world implies great tolerance for imperfect contingencies, so that the parent fails to respond to a large portion of the child's signals” (Tronick, 1998, cit. in Gergely, Fonagy, Target & Jurist, 2002, p.129). 

Daniel Stern (1985) described the early relationship as a “dyadic dance” in which mother and child tune into each other through micro-interactions of looks, sounds, and gestures. This “affective attunement” is the basis of the development of the intersubjective self, that is, the child's ability to recognize emotions similar to his own in others. Even in moments of misalignment, what matters is not the absence of error, but the possibility of repairing the emotional connection (Tronick, 1998, cit. in Gergely, Fonagy, Jurist, & Target, 2002).

The establishment of the attachment bond

The caregiver-child relationship described above, which is fundamental for the acquisition of regulatory skills, is preparatory for the establishment of the attachment bond between the two members of the dyad. Attachment theory, an indicator of the quality of social relationships, has been applied as a framework for understanding how early life experiences can contribute to biological and psychological responsiveness to stress throughout life (Kidd et al., 2011, 2013; Maunder & Hunter, 2001).  According to attachment theory, humans are born with a need for social connections, and this need has an important evolutionary function, ensuring the child's survival (Bowlby, 1969). It is, therefore, an adaptive process that develops in response to the social environment and the type of care received in times of distress (Fonagy, 2011; Granqvist et al., 2017). In moments of intense arousal and physiological activation, the child will seek physical proximity to the caregiver in such a way as to be “contained” physically: when he receives signals from the environment that make him feel insecure, he therefore activates the attachment system to get closer to the parent. It is a biological predisposition that has the function of protecting the newborn from dangers, guaranteeing his survival.

The establishment of the attachment bond

Affective neuroscience has confirmed the view of Bowlby (1969): Attachment is a biological system of regulation, the purpose of which is to maintain proximity with the figure of care. The caregiver functions as an “external regulator” of the emotional and physiological states of the child, until the latter internalizes these functions and makes them autonomous (Cassidy, 1994). Experiences of attunement and early caring shape the activity of brain circuits related to safety, confidence, and empathy (Fonagy, Gergely, Jurist, & Target, 2018). Therefore, as long as a child feels safe, he will be able to explore the environment and distance himself from the caregiver; otherwise, he will implement a series of attachment behaviors aimed at getting closer to the caregiver who has the task of reassuring him. The behaviors adopted for proximity purposes consist of keeping the caregiver close to the child; the latter will adopt smiling or crying as tools to his advantage, will tend to physically approach the caregiver or will implement behaviors aimed at receiving the caregiver's attention to achieve a goal, which emerge around the age of three (Fonagy, 2001; Granqvist et al., 2017). Attachment, therefore, is a homeostatic regulatory system in that the parent acts as an external regulator of the emotional and physiological state of the child. The latter finds in the adult response a representation of his mental state that is internalized and used as an effective regulation strategy. Among the means used by the caregiver to be able to return the child to a calm and relaxed state, there is certainly touch, physical contact, which represents a privileged communication route between caregiver and child when the latter is still in a preverbal phase. 

Attachment styles and the Strange Situation paradigm

Depending on the quality of the interactions with the caregiver, the child will develop different attachment styles: the safe, anxious/avoidant, anxious/ambivalent, and disorganized style, which can be observed through the paradigm of the Strange Situation. This is a procedure developed by Mary Ainsworth that is intended to verify the child's attachment style and how it relates to strangers. It is made up of 8 phases lasting 2/3 minutes each. In the first stage, the caregiver and the child are taken to a room with toys and the child is placed on the floor; in the second stage, the child begins to explore the environment and interact with the caregiver; in the third stage, the foreign figure who tries to enter into a relationship with the child and the parent takes over; the latter in the fourth stage leaves the room, leaving the child alone with the stranger; in the fifth stage the parent re-enters the room while the stranger leaves and it is observed how the child reacts to the reunion; in the sixth stage the child is left alone in the room again; in the seventh stage the foreign figure re-enters the room and it is observed whether the child uses it as a substitute caregiver figure; in the eighth stage, there is the definitive reunification between caregiver and child and it is observed how the latter reacts.

Mary Ainsworth and colleagues (1978) observed that in children with secure attachment, maternal touch is more frequent and sweeter. This type of contact promotes the release of oxytocin, a hormone associated with well-being and confidence, facilitating calm and stress regulation. In children with insecure attachments, however, touch can be perceived as unpredictable or intrusive, increasing levels of activation and discomfort (Jakubiak & Feeney, 2017).

If, about the first three styles, a certain consistency can be noted with respect to the way in which the child reacts towards the parent within the setting of the “Strange Situation”, the disorganized style is characterized by the lack of coherence of the child towards the parent and vice versa. Ainsworth and colleagues (1978) reported differences in the frequency and quality of touch during tactile interactions between caregivers and children within the Strange Situation: children with secure attachment were touched more by caregivers, unlike those with insecure attachments, who received fewer touches and less comforting. In this regard, touch has a stress-reducing effect in children with secure attachment; in other cases, in fact, touch can be perceived as intrusive because it is not desired (Jakubiak & Feeney, 2017). Among attachment styles, only the “safe” one is the result of successful containment; the child will have a secure internalized base, will be able to implement self-regulation and problem-solving strategies. The others may represent the identification of the child with the defensive behaviors of caregivers. Based on the repeated interactions between caregiver and child, the latter will elaborate Internal Operational Models that allow him to differentiate the self from the other and create expectations with respect to the behaviors of others that become, therefore, predictable. These are relational patterns that the child internalizes by repeatedly interacting with the reference figures, to predict his own and others' behaviors, taking into consideration the given situation and, at the same time, to prepare for a physiological activation consistent with the type of perceived threat (Bolwby, 1969). Repeated interactions with the caregiver lead the child to create expectations that can generalize to other forms of social interactions with others - the ability to interpret human behavior, which is defined as “Interpersonal Interpretive Mechanism”, IIM, (Gergely, Fonagy, Jurist & Target, 2002) ‹‹it is also a product of complex psychological processes arising from proximity in childhood to another human being - the primary object or attachment figure›› (Gergely, Fonagy, Jurist & Target, 2002, p.124). IMM is a concept closely linked to that of “theory of mind". Knowledge of the self as a mental agent is not innate but is an ability that evolves thanks to early interactions. The context of attachment, in fact, is a context within which the child can develop a sensitivity towards his own states of the self.

Attachment and its regulatory function

Thanks to the attachment relationship established with the caregiver, the child will be able to acquire self-regulatory abilities based on the emotional availability of the one who looks after them (Cassidy, 1994). If at first the regulation is mediated by the caregiver, gradually the child will learn to modulate his/her emotions, cognitions, and behaviors based on what happens in the environment in which he/she is placed. In attachment theory, emotional regulation by the caregiver towards the child serves to pass co-regulation to self-regulation, such that the infant's regulatory system transitions from being “dyadic” to “individual”. 

Attachment and its regulatory function

Children with secure attachment can optimally balance the behaviors of exploring the environment and those of attachment at times when they perceive danger, as they place their trust in the emotional availability of the caregiver It follows that these children will feel free to express a wide range of emotions, positive and negative, as well and they will receive a comforting response from the caregiver which consists not only in providing the physical proximity they seek but also in verbalizing emotional states (Waters et al., 2010). The anxious/avoidant style tends to minimize emotions and can be understood in terms of upregulation: usually, in fact, avoidant children have parents who cannot tolerate the expression of needs, which is why the child will tend to repress emotions and show hyperactivity towards both positive and negative ones. This strategy is often associated with feelings of isolation and mistrust, which may result in aggressive behavior or a feeling of less competence in problem-solving tasks (Arend, Gove & Sroufe, 1979). The anxious/ambivalent style tends to increase affect, so it can be understood in terms of dysregulation of affect; in that case, we find parents who prevent the child from exploring the environment, for which he will react with hyper-activating strategies of anxiety and fear to more easily obtain a response, with few opportunities to regulate himself (Thompson, 2015). Such a mode of regulation makes children less competent and able to find autonomous solutions in moments of anxiety and predisposes them to the development of internalizing disorders such as anxiety and depression (Thompson, 2015).

Attachment and its regulatory function

Thanks to the attachment relationship established with the caregiver, the child will be able to acquire self-regulatory abilities based on the emotional availability of the one who looks after them (Cassidy, 1994). If at first the regulation is mediated by the caregiver, gradually the child will learn to modulate his/her emotions, cognitions, and behaviors based on what happens in the environment in which he/she is placed. In attachment theory, emotional regulation by the caregiver towards the child serves to move from co-regulation to self-regulation, such that the infant's regulatory system transitions from being “dyadic” to “individual”.  I bambini con attaccamento sicuro riescono a bilanciare in maniera ottimale i comportamenti di esplorazione dell’ambiente e quelli di attaccamento nei momenti in cui percepiscono il pericolo, in quanto riposano fiducia nella disponibilità emotiva del caregiver. Ne consegue che questi bambini si sentiranno liberi di esprimere un’ampia gamma di emozioni, positive e negative, e riceveranno una risposta confortante da parte del caregiver che consiste non solo nel provvedere a dare la prossimità fisica che cercano, ma anche nel verbalizzare gli stati emozionali (Waters et al., 2010). Lo stile ansioso/evitante tende a minimizzare le emozioni e può essere compreso in termini di sovraregolazione: solitamente, infatti, i bambini evitanti hanno genitori che non tollerano l’espressione dei bisogni, ragion per cui i bambini tenderanno a reprimere le emozioni e mostreranno un'iperattività sia nei confronti di quelle positive che di quelle negative. This strategy is often associated with feelings of isolation and mistrust, which may result in aggressive behavior or a feeling of less competence in problem-solving tasks (Arend, Gove & Sroufe, 1979). An anxious/ambivalent style tends to increase affect, so it can be understood in terms of dysregulation of affect; in that case, we find parents who prevent the child from exploring the environment, for which he will react with hyperactivating strategies of anxiety and fear to more easily obtain a response, with few opportunities to regulate himself (Thompson, 2015). Such a mode of regulation makes children less competent and able to find autonomous solutions in moments of anxiety and predisposes them to the development of internalizing disorders such as anxiety and depression (Thompson, 2015). About disorganized attachment, on the other hand, it is characterized by the absence of strategies to cope with stress, there is no consistency with regard to the child's behaviors towards parents, and it is nervous and anxious. The child will activate both hyperactivating and deactivating strategies (Kidd et al., 2013).   This happens because disorganized attachment results from experiences of maltreatment and manifests itself in a paradoxical situation in which the parent, who should be the comforter, is actually abusive and frightening (Van Ijzendoorn, Schuengel & Bakermans-Kranenburg, 1999). The result is children with high sensitivity to stressful situations and an inability to self-regulate as they receive no reflection of their internal states and no physical containment, so they are left alone to face sources of distress. Abused children, according to attachment theory, are more responsive to negative emotions, significantly experience emotions such as sadness and anger, and exhibit behaviors indicative of such emotions (Gross, Katz, Lavi & Ozer; 2019). Difficulties can also arise regarding coping and problem-solving strategies, which always arise from parents who, in turn, are lacking. Abused versus non-abused children show high levels of aggression and, in fact, engage in violent and environmentally destructive behavior; however, among the most experienced emotions, there does not seem to be anger: the main ones seem to be sadness, fear, and hostility (Gross, Katz, Lavi & Ozer; 2019). What especially needs to be emphasized in these children is that, in addition to experiencing a high rate of negative emotions, they show significantly low levels of positive emotions such as joy and happiness (ibidem).

Conclusion

As Winnicott (1945/2018) argued, it is not the perfection of the parent that builds the child's safety, but the ability to be “good enough”: present, responsive, and capable of repairing the inevitable moments of rupture. This relational quality forms the basis of resilience and trust in the world. The most recent research highlights that emotional availability and shared regulation have long-term positive effects on psychological well-being and socio-emotional development (Tambelli, 2017).

Every small gesture of care – a hug, a smile, the way a parent consoles their child – contributes to building the newborn's sense of self and their ability to face the world. It is not perfection that counts, but the willingness to respond, to get back in tune even after a breakup. It is in this daily dance, made of closeness and repairs, that the child learns to self-regulate, trust, and feel safe. The mother-child relationship is not only the first emotional experience of life: it is also the matrix on which resilience, the ability to love, and the possibility of building authentic bonds in the future are based.

For further information:

• Aaltomaa-Michalias, P., Dahllof, A., Lintula, M., Nissen, E. & Widstrom, A-M. (2010). Newborn behaviour to locate the breast when skin-to-skin: a possible method for enabling early self-regulation. Acta Paediatrica.

• Crucianelli, L., Filippetti, M. L., Fotopoulou, A., Jenkinson, P. M. & Kirk, E. (2019). The mindedness of maternal touch: An investigation of maternal mind-mindedness and mother-infant touch interactions. Developmental Cognitive Neuroscience, 35, 47-56.

• Fonahy, P., Gergely, G., Jurist, E. & Target, M. (2018). Affect Regulation, Mentalization and the Development of the Self. Londra: Routledge.

• Winnicott, D. W. (2018). The maturational processes and the facilitating environment. Londra: Routledge.

• Tambelli, R. (2017). Manuale di psicopatologia dell’infanzia. Bologna: Il Mulino.

Biblio​graphy: 

• Aaltomaa-Michalias, P., Dahllof, A., Lintula, M., Nissen, E., & Widstrom, A.-M. (2010). Newborn behaviour to locate the breast when skin-to-skin: A possible method for enabling early self-regulation. Acta Paediatrica.

• Ainsworth, M. D. S., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.

• Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.

• Cassidy, J. (1994). Emotion regulation: Influences of attachment relationships. Monographs of the Society for Research in Child Development, 59(2–3), 228–249.

• Crucianelli, L., Filippetti, M. L., Fotopoulou, A., Jenkinson, P. M., & Kirk, E. (2019). The mindedness of maternal touch: An investigation of maternal mind-mindedness and mother–infant touch interactions. Developmental Cognitive Neuroscience, 35, 47–56.

• Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2018). Affect regulation, mentalization and the development of the self.London: Routledge.

• Gergely, G., Fonagy, P., Jurist, E., & Target, M. (2002). Affect regulation, mentalization, and the development of the self.New York: Other Press.

• Jakubiak, B. K., & Feeney, B. C. (2017). Affectionate touch to promote relational, psychological, and physical well-being in adulthood: A theoretical model and review of the research. Personality and Social Psychology Review, 21(3), 228–252.

• Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.

• Tambelli, R. (2017). Manuale di psicopatologia dell’infanzia. Bologna: Il Mulino.

• Tronick, E. Z. (1998). Dyadically expanded states of consciousness and the process of therapeutic change. Infant Mental Health Journal, 19(3), 290–299.

• Van Ijzendoorn, M. H., Schuengel, C., & Bakermans-Kranenburg, M. J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11(2), 225–249.

• Winnicott, D. W. (1945/2018). The maturational processes and the facilitating environment. London: Routledge.