Sunday, 17 February 2008

CONDUCTIVE EARLY INTERVENTION

(Parent and child)

A psychodynamic perspective from Belgium

As promised in an earlier posting (‘A little less of the ‘vieil’ thank you’, Sutton, 2008) here is an introduction for English-speakers to the approach to Conductive Education or young children and their families, developed by Yves Bawin, Marie-Louise Leclerc and their colleagues in Brussels, Belgium, at Centre La Famille (Sutton, 2003).

The pivotal figure in the development of the emerging French-speaking school of conductive pedagogy is Yves Bawin at the Centre La Famille in Brussels. By original profession he was psychologist and physiotherapist. He first encountered Conductive Education in 1977 and set to developing his own conductive practice at La Famine, as part of which process he became the only foreign practitioner to complete a bespoke professional training as a conductor at the Pető Institute in Budapest. Development of Bawin's approach has been shaped by three major considerations (Bawin, 1997):
  • early intervention where there is a motor disorder
  • psychological forces within the relationships between babies and their parents
  • practical demands of the real-life social situations of families in Brussels.
Early developmental intervention 

Motor disorder 'loads the dice' (pipe les dés) of child development and of the 'natural' human developmental process.
The problem of the child who presents a motor disability of cerebral origin is not limited to motricity. From birth the motor disorder interferes permanently with the whole of the child's development, in his emotional and cognitive relationships. The early course of development, which constitutes the first mutual adaptations between the child and the parents, is profoundly disturbed; it is as if the process is inverted and that out of the very early block brought about by the motor disorder, it is the reciprocal inadaptation which comes cunningly to mortgage the child's development towards autonomy and family integration: the manner in which he will be subsequently integrated into social life will be largely compromised. The parents' natural landmarks are put to harmful effect by the motor dependence: this educative dependence brings about a 'misunderstanding' in the basic educative relationship (in which the parents 'lead' their child towards autonomy).  
(Bawin, 1998, p. 1, present author's translation)
If the problem is developmental – asserts Bawin, invoking Vygotskii – there is only one way to approach it, through education, development and education being but two faces of the same coin (Bawin, 1997). The task for early conductive pedagogy is to create situations for active educational experiences for parents and children together, in which parents discover – or rediscover — how to interact on a day-to-day basis with a child with a baffling motricity. The goal is to help parents assume the role of parents in a situation that is strange to them because of their child's motor disorder...
...because of the handicap the parents don't know how to interpret, to evaluate the child's signal, nor how to answer; sometimes they don't see the child's attempts, or they are not able to put the child in the situation suitable for expressing himself, or they misinterpret some pathologic signs as being progress, adapted voluntary expression or, on the opposite, this misinterpretation can lead them to believe their child doesn't want to do anything etc... 
(Bawin 1997, p. 30)
Psychological forces

Bawin is most conscious that he works within a culture much more influenced by psychology and psychoanalysis – both positively and negatively – than is the country in which conductive pedagogy was first developed. His point of reference in this respect is removed from the experience and understandings of many in the United Kingdom too: to the present author's knowledge concepts such as castration symboligène (Dolto, 1984) are not current in practice with the families of children with motor disorders in the Anglophone world. In normal child development castration symboligène refers to the process whereby parents set rules and say 'no', even when they know it to be difficult for their child, because they also know that this is important in helping their child grow up: it leads to the progressive distancing and autonomy of their child as a human being. Where there is a motor disorder, however, the disability acts as it were as an in-built interdiction and it is often difficult for parents to say 'no' to a child whose disability already prevents so many things. In psychoanalytic terms...
...regarding the child with cerebral palsy, the handicap is lived (perceived) by the parents as a real 'castration' [they avoid] to give him one more castration at a symbolic level at different stages of his affective development; they don't give him the necessary interdicts. Most of the time it leads the child to keep an infantile and regressive position of sterile pleasures. He then stays in affective dependence and he suffers because he cannot assume becoming a responsible adult. The system of Conductive Education and the conductor's attitude support the development of the parent-child relationship and ... help the parents do the so-called 'castration' necessary for leading the child to an affective and effective autonomy.
(Bawin, 1997, p. 66)
Bawin considers the psycho-dynamic aspects of early parent-child conductive pedagogy so powerful and important as to merit external psychological supervision of the practice and consultation for the conductors.
Nevertheless, I want to be very clear: the conductor has to be a conductor and not a psychologist! The purpose is for her to find right and adapted ways in order to be efficient as a conductor! Her main aim is the child's development. Forgetting it is losing the essence of her work. 
(Bawin, 1997, p. 119, original author's emphasis)
Practical reality 

Bawin works in Brussels. The medical authorities often refer late, if at all. Many parents live a long way off, or they work, and can attend only for short blocks or intermittently. For such children and their families the best compromise that can be offered is parent-child sessions over a week, three or four times a year, with the child's local therapist invited along to observe one of the two hour conductive sessions and discuss what is being done with the staff at La Famille. Other families live nearer, in Brussels, but for social, economic or psychological reasons cannot care for their child during the day. For these La Famille offers a crèche but this situation proves the least suitable of all for arranging early conductive pedagogy:
...very often those parents are wound up and they cannot understand or accept that we ask them to coming regularly with their child for active sessions!
(Bawin, 1997, p. 121)
The arrangement developed here has been an initial 'transition week' in which it is necessary for parents to attend each day during the week for a two hour session with their child and the centre's social worker visits the family at home. The centre's psychologist is also involved. By the end of the week it is usual for parents to understand the goals of the process and to see the learning now taking place. They are then usually confident enough also to attend a weekly open day at La Famille's crèche which their child wiI1 now attend and which is organised 'conductively' with a daily routine adapted to each child and staff acting as parent substitutes for the day. Bawin urges the necessity to hold on to the essence of Conductive Education, while at the same time rigorously adapting the actual practice to answer real-world practical problems.
Above all it is necessary to relate permanently to what is the essence of CE... One has to ask oneself what is really possible in the concrete context and specify what is there: in each concrete situation an innovative practice has to seek the particular transmission belts which permit one to mobilise the energies and the structures not suddenly, gently. One must not cease to ask oneself (without complacency) about the real benefit which the children and their families are effectively deriving from this attention - to assure oneself that what has been arranged diminishes suffering, brings about a plus and justifies the investment. Finally, one must never stop or believe that one has arrived, once and for all. One must never cease to ask oneself about the next little step: we are on a permanent advance... the confident step-by-step patience that we need with the children we need just as much with the adults and the teams who surround them.
(Bawin, 2003, original author's emphasis, present author's translation)
Over long years Bawin has developed a thoughtful synthesis between early conductive pedagogy and a strong intellectual tradition within his own society, to address an aspect of development that often lacks explicit attention, not least within the conductive movement itself. Given his pivotal contribution to that movement in the Francophone countries this new orientation may prove influential in defining a distinct French-speaking school of conductive pedagogy.

Conductive practice with very young children —
present reflections

The above material, referring specifically to Centre La Famille, has been extracted from the journal Recent Advances in Conductive Education (RACE) where it comprised the concluding few pages of an article called ‘Conductive Practice for children in their first years: development and adaptations’ (Sutton, 2003).

The article traced the history of Conductive Education for young children and their families. It began by reiterating the (still now current!) crisis in early intervention for young children with significant developmental disorders, which is in short that interventions have accumulated no substantial evidence one way or the other to confirm their effectiveness. The implications of this may have to be radical changed in respect to the very orientation of services. Surveying the efficacy of early intervention programmes in general, and writing particularly from the perspective of the mandated situation in the United States, two reviewers concluded as follows:
The therapeutic model may have to be remodelled or perhaps abandoned and replaced with a family-social model for early intervention planning. 
(Lipkin and Schettz, 1996, p. 545)
What in Conductive Education is now generally known in English as ‘parent-and-child’ working has been going now for more that fifty years, clearly manifests modern-day understanding of the centrality of parent-child transactions to child development, and remains nonetheless largely unknown outside of Conductive Education.

The article in RACE recounted the story of very early intervention at the State Institute (subsequently the Pető Institute) in Budapest, from an inauspicious start working directly with babies and young children to the radical change of focus to parent-working somewhere around the end of the nineteen-sixties. Such practice then went on to form part of the classic pattern of service-delivery at the State Institute over the late Socialist period in Hungary.

The article continued by describing reported innovative developments and adaptations made outside the original Institute in Budapest: 
  • the long-distance parental education of Károly and Magda Ákos
  • the family-orientation of Tsad Kadima is Israel; and
  • the psycho-therapeutic understanding of La Famille in Belgium
The radical change that was parent-and-child work around the end of the sixties, happened only after the death of András Pető. What brought it about? Three possibilities come immediately to mind to explain the change, the removal of András Pető from control of the Institute, the general ‘feminisation’ of the Institute that had been going on throughout the sixties, with particular credit due perhaps to Mária Hári or others yet unsung – and the influence of Károly Ákos who had his maximal contact with the State Institute at just this time. Perhaps some combination of the three, perhaps something completely different: just one more puzzle from the long and largely hidden history of Conductive Education.

Although the article was written some five years ago, nothing substantially new seems to have developed in this sector in the intervening time – or at least nothing new has been described. This is not to say that this highly necessary and adaptable mode for delivering conductive benefits is not being vigorously applied by families and conductors around the world, with all sorts of important innovation occurring as a result. Perhaps the sometimes maligned ‘conductor-nannies’ have a thing or two to tell us – if only they would. Not telling, in this and every other context where Conductive Education is being developed, means that those who come after have laboriously to reinvent the wheel, yet again, reaping no advantage from the experience, the disappointments and the triumphs of those who have gone before.

Sorry if this appears to put a bit of a blight on things but without a written tradition, a ‘literature’, Conductive Education can never become a proper ‘discipline’, conductors will not be a ‘profession’ and parents are going to be stuck with conductive services that are always on the fringe.

I am not advocating Bawin’s psychodynamic understandings – or the particular formulations of the Ákoses and of Tsad Kadima. Rather, at a time when people within ‘early intervention’ for developmental disorders are willing to acknowledge that their movement may have rather lost its way, I urge conductivists to recognise that they already practice a different paradigm – and get out there and articulate in word that their societies will understand.

Notes and references

The diagnosis of IMOC (infirmité motrice d’origine cerebrale) is rather broader than that of cerebral palsy current in the English-speaking world.

‘Castration’: Bawin states the different stages of affective (i.e. emotional) development in classic Freudian terms, oral, anal and phallic, with detailed accounts of how motor disorder may affect proper transition from one stage to the next, and how conductive pedagogy can help in this process.


Ákos, K., Ákos, M. (1991) Dina: a mother practises Conductive Education. Birmingham: Foundation for Conductive Education (NB There are also editions in German, Chinese and Russian)

Bawin, Y. (1997) The relationship between the parents and their baby as a principle of the early Conductive Education. Unpublished dissertation, Pető András Institute, Budapest.

Bawin, Y. (1998) Education Conductive précoce et integration familiale. Unpublished paper.

Bawin, Y. (2002) L'education conductive en evolution: rigeur et creativité. Presentation to the conference L'Education Conductive de Pető et l'IMOC: des fondements aux applications. Unesco: Paris.

Dolto, F. (1984) L'image insouciante du corps. Paris: Editions de Seuil.

Lion, U., Schenker, R. (1997) 'Conductive Education': adaptation of Hungarian system to the Israeli context 'Tsad Kadima' - a case study. In Schenker, R., ed., Conductive Education Occasional Papers, nos 3-4. Budapest: International Pet6 Institute, pp. 59-78.

Lipkin, P. H., Schertz, M. (1996) An assessment of the efficacy of early intervention programs. In A. I. Capute and P. J. Accardo (eds) Developmental disabilities in infancy and childhood. Volume I, Neurodevelopmental diagnosis and treatment (second edition). Baltimore: Paul Brookes, 525-548.

Schenker, R. (1994) Parent-child groups: an intervention model for parents and children (ages 0-3) with motor disorders based on the Tsad Kadima system (Pető method). Presentation to the Fourth Conference of the Israeli Association of Occupational Therapy, University of Tel-Aviv, October, Jerusalem: Tsad Kadima.

Sutton, A. (2008) Not so much of the 'veiel', thank you: more awed than old, Conductive World, 28 February

Sutton, A. (2003) Conductive practice for children in their first years: development and adaptations’, Recent Advances in Conductive Education, vol.2, no 1, pp. 62-69

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