2025 • Developmental Observer • 13 Introduction Working with NIDCAP Trainers-in-Training has offered an unparalleled learning experience and an opportunity for enhancing the more traditional NIDCAP training approach. Commitment to the NIDCAP model as well as to what the trainees have brought to the process has been enlightening, energizing and thought provoking. Typically, NIDCAP Trainers-in-Training are accomplished NIDCAP Professionals who wish to further promote NID- CAP with other learners. They bring their own experience and clinical acumen to the process as well as their own adult learning styles and a sense of responsibility for using appropri- ate mentoring strategies. The NIDCAP training model focuses on reliable observa- tion and interpretation of the baby’s behavioral communication taught in a dyadic and structured supervision model. Train- ers-in-training become NIDCAP Professionals as their stepping- stone to become trainers. Achievement of proficiency to become a NIDCAP Professional has been described as a daunting pro- cess, often taking months or years, given that their training may have been intermittent with feedback from their trainer delayed. Regardless of the challenges with their initial training, many have the desire to replicate with others the training they receive. It may be opportune to consider an augmented model of training, given that those who have achieved proficiency in their professional lives and have functioned as NIDCAP Pro- fessionals have suggested other models for learning, especially when dealing with human interactions and relationships. Self-expansion as a theoretical perspective for relationship-based learning. Here we describe a theoretical perspective that applies to how individuals strive to expand their capacity--not only for their own learning, but also for how they might bring along others to the integration of NIDCAP into their clinical repertoire. It centers around relationship-based learning, the importance of providing safe spaces for learners, and the effective use reflective process to support those who will be responsible for training the next generation of NIDCAP Professionals. Self-expansion is a model developed by Arthur and Elaine Alon1,2 which articulates a framework for experience and behavior in close relationships. Although their initial studies were done for dyadic intimate relationships, it can be applied to the relationship-based work with babies, families and pro- fessionals. Promoting relationship-based learning is at the heart of the NIDCAP model and is arguably one of the more difficult aspects to “teach” to new trainees. The self-expansion model could be an important perspective to incorporate into the training of NIDCAP Trainers-in-Training so they can better understand their role in relationship development, modeling and mentoring. The self-expansion model has two core principles: (1) The motivation principle refers to an inherent desire to improve oneself and produce others of like thinking around them. Self-expansion perspectives posit that individuals wishing to expand their capacities and competencies reflect a need for social approval and acceptance1,3 even if they do not have the foundational skills for achievement at a more complex level. Often learners strive to embody the spirit, knowledge base and persona of trainers whom they respect and admire. In this manner, they emulate similar training approaches as their trainer and demonstrate the parallel process of training approaches, from Master Trainer to trainer-in-training to the trainees. Training approaches thus become evident in practice as well as in ongoing policies. Striving for self-expansion reflects a conscious effort, how- ever it is typically an unconscious motivation. In the context of NIDCAP Trainers-in-Training, those who are motivated to become trainers often underestimate their current skillset and what they can use to meet the rigors of engaging in training others, adapt to a more complex and comprehensive view of the work, and develop effective approaches to systems change. (2) The inclusion-of-other-in-self addresses close rela- tionships as the most effective way to expand a sense of self. Individuals who take on perspectives, identities and experiences of others do so through relationships.2,3 As it relates to train- ers-in-training, those who take on this next step in the NIDCAP Reflections on the Nurturing of NIDCAP Trainers-In- Training: Creating Safe Relationships, Safe Spaces and Using Reflective Process to Enhance Self-Expansion Joy V. Browne, PhD, PCNS, IMH-E, Senior Master NIDCAP Trainer; Angeline Parez, Nurse, NIDCAP Professional, NIDCAP Trainer; Eveline Van Dijk, Nurse, NIDCAP Professional, NIDCAP Trainer; Annelies Keymeulen, MD, PhD, Neonatologist, NIDCAP Professional and NIDCAP Trainer-in-Training NICU, Ghent University Hospital, Belgium DOI:10.14434/do.v18i3.42179 14 • 2025 • Developmental Observer process are not only motivated to effect change in themselves, but also in others whom they wish to take on as trainees. Those who take on the trainer-in-training role commit to a rigorous process of learning with a master trainer who has a focused skill set that includes effective mentoring. Active listening, empathy, providing encouragement and practical support are some of the strategies master trainers use. They also involve insuring a safe and encouraging environment for learners to explore individual personal growth. As each per- son’s learning process and achievements are individual, making room for their own learning and coping styles is important. Celebration of their individual small and large achievements provide encouragement and reinforcement for growth. “She consistently confirmed her belief in us and frequently acknowledged our good work. I felt truly seen for who I was – and that was enough. She recognized my insecurities, which made them discussable, and I found the courage to work on them and accept support.” –AP Creation of trusting relationships Establishment of a trusting and encouraging environment for individuals is necessary and may not be limited to professional aspects of individuals’ lives. Individuals’ abilities to learn and be productive include revealing personal information regard- ing areas such as learning new skills, hobbies, family dynamics, or other personal activities that can contribute to a broader sense of self. Aron's research into self-expansion is about gen- erating intimacy in relationships, including mutual informa- tion sharing, vulnerability and responsiveness of those engaged in the relationship. “Because NIDCAP is not just about observing well, under- standing the baby’s communication, and writing reports – but also involves personal growth – I believe that a trusting relationship is essential for optimal development…creating a safe space for questions and doubts.” –AP Checking in with trainers-in-training to be sure that they are managing self-care and personal family situations allows them to feel it is safe to express concerns other than in the training relationship. However, awareness and respect for the trainees’ boundaries and assurance of confidentiality is es- sential. Care should be taken when personal or mental health issues are addressed and referral to other specialized profes- sionals should be suggested when appropriate. Sharing personal and professional experiences with a master trainer provides a model for trusting relationships with others whom they are training. For trainers-in-training, devel- oping trusting relationships with their trainees can sometimes be complex, as trainees bring their own background, learning styles and mental health issues, creating a potential challenge for trainers-in-training to establish open communication and trusting relationships with their trainees. Disorganizing conversations and/or interactions can challenge their self-con- fidence and lead to feelings of vulnerability and incompetence in nurturing others. Often providing solutions to training challenges is less effective than exploration of strengths and opportunities for problem solving that occur within a safe relationship. “By nature, I tend to be an 'overthinker', but through the guidance and support I received, I have grown in applying self-reflection in a more conscious and balanced way. The safe environment and the trust our Master Trainer provided helped me feel comfortable being vulnerable and allowed me to look at myself with greater compassion — embracing challenges as part of the learning process.” –EVD Creating safe spaces for learning and training others A safe space is a supportive and safe environment that encour- ages open-mindedness, respect, a willingness to learn from others as well as physical, mental, and social safety. In a safe space, the power structures and privileges affecting our every- day lives are consciously considered. “Since this learning process is so different from what we know from our medical training, it can bring out feelings of insecu- rity. And then it is important that you have a trainer where you feel safe with to share those feelings of insecurity without being judged.” –AK How one creates a safe environment includes respect for an individual’s pace and boundaries, as well as measurement of self-expansion. Individualized, sensitive, strengths based, thoughtful and relationship-based feedback is essential for growth. Active listening, empathy, encouragement, practical support and celebrating trainees’ achievements are foundation- TABLE 1 Examples of reflective questions for trainees: • How do you think the baby experienced this? • How do you think the nurse experienced it? • What would you like to say to this baby? • How was it for you? What did you feel or think? • What do you think the baby wanted to tell us? • What do you think the nurse felt when the baby’s oxygen saturation dropped? • The feelings that came up for you – where do you think they came from? 2025 • Developmental Observer • 15 al components to establishing safe spaces for self-expansion. It's also important to respect individual journeys and process- es, allowing them space for self-discovery. The importance of trainers-in-training having a safe space in which to express their vulnerability when facing the challeng- es of training others cannot be underestimated. NIDCAP work values .the establishment of safe spaces for growth, especially in emerging trainers, as they are responsible for passing on these values to their trainees, the next generation of NIDCAP Profes- sionals. “ I do believe that feeling safe with your trainer is a must to be able to reflect on yourself, the baby and the process and feeling confident and secure enough to share this with your trainer. I have had a really good example on how to support your trainees in the best way by my own trainer.” –AK Using the reflective process in safe spaces to enhance self-expansion with trainees The process of self-expansion is often enhanced through en- couragement to engage in the use of the reflective process. Use of reflective questions allow for self-examination of strengths, vulnerabilities and successes and can lead to more insightful and successful professional and personal growth. “The safe environment and the trust our Master Trainer provided helped me feel comfortable being vulnerable and allowed me to look at myself with greater compassion — em- bracing challenges as part of the learning process.” –EVD A reflective approach encourages the trainee to under- stand the experience of the baby, the family and other profes- sionals. It typically does not come naturally, nor is it typically included in professional education. Although the reflective approach is key to understanding the NIDCAP work, how to “teach” this aspect of training takes development of a trusting, nurturing relationship between trainer and trainee. Without this reflective approach, learning typically is slow, task oriented and filled with misunderstandings. Just as the NIDCAP work encourages observers to interpret the baby’s communication and to infer their goals, reflective questions allow for under- standing the baby’s experience from the learner’s point of view. For the trainer-in-training, it is helpful to first appreciate reflective questions about their own observations as NIDCAP Professionals (Table 1). As they incorporate these questions into their own approach to understanding the baby’s commu- nication, they then can pass on the perspective of the baby’s point of view to their trainees. Similarly, they can see the NIDCAP observation from the caregiver’s point of view with- out judgment of how the care was provided. “A large part of this learning process is the reflective work. This didn’t always come natural for me to do. But during the process, I grew to appreciate what reflection could achieve: for me as a person during my process as trainer-in-training but also for my trainees and their own process.” –AK “These questions really helped my trainees progress. And I, too, grew, partly thanks to reflection. My Master Trainer provid- ed us with reflective questions and invited us to brainstorm together. I think this offers a valuable framework for supporting trainers-in-training in their self-reflection. You naturally reflect spontaneously once you graduate from NIDCAP training, but there are always aspects you don't automatically think about or write down. That's precisely why those targeted questions were so helpful in tracking my own growth.” AP Using reflective questions, rather than being offered solutions or assignments, allows the learner to use their own capacity to think deeply about their experience, reveal feelings of vulnerability, create solutions to problems, feel successful and celebrate successes. In essence, it has the capacity for con- firmation and expansion of their professional role. “I’ve found that inviting someone to reflect is much more meaningful and impactful than simply “giving feedback”. When you encourage others to reflect on the experience of the baby, the family, the caregiver, their own thoughts, actions, and emotions… it creates a much deeper learning process and insight. One that often doesn’t end when the conversation ends, but continues in the hours, days, and experiences that follow.” –EVD Using the reflective process in safe spaces to enhance self-expansion with trainees-in-training Although the reflective approach is key to understanding the NIDCAP work, how to “teach” this aspect of training takes development of a trusting, nurturing relationship between NIDCAP Master Trainer and NIDCAP Trainer-in-Training. Without this relationship-based approach, learning typically is slow, task oriented and filled with misunderstandings. “In a way, being offered reflective questions helps you grow a lot because you feel space for learning and trust from your trainer. It would be easier to get responses on our questions that would enlarge our knowledge but with reflective ques- tions we enlarge our knowledge and our self-confidence!.” AP Trainers-in-training who have had the opportunity to ex- perience the reflective process with a trusted mentor then have the capacity to provide aspects of the reflective process when working with their trainees. “What I noticed is that people often reflected on how care moments had gone, but much less on how it affected them personally. For me as a trainer, that personal layer was the most interesting, because it offers a window into the trainee’s personal development. For many, reflecting on their own emotions in specific situations is not easy or natural. That’s why offering reflective questions has been a major step for- ward.” –AP As the reflective process for trainers-in-training is just that…a process, it is important to provide reflective questions 16 • 2025 • Developmental Observer before, during and as they progress in their capacity to mentor others. Several questions (Table 2) can be used for self-reflec- tion with the trainers-in-training as they develop their skills. “I believe that being aware of one’s own emotions, strengths, and challenges is essential to fulfilling the role of a NIDCAP Professional and trainer effectively.” –EVD A safe space for using reflective questions provides a sense of trust that allows them to safely talk about their own experi- ences with training others. Creating safe spaces where individ- uals feel comfortable sharing their strengths and vulnerabilities through reflective questions can then lead to growth of the individual and influence how they see themselves fostering others’ growth. “I would have found it very valuable to receive these reflective questions from the very beginning of the trajectory. Reflecting on each interaction and examining your own role in it helps you grow. Sometimes it feels like something you don't feel like doing but in retrospect, it always provides learning opportu- nities.” –AP Evaluation of the continuum of self-expansion Evaluation of an individual’s self-expansion assesses how the individual perceives their own change and growth within the relationship. In the context of NIDCAP, self and Mas- ter trainer generated reflective evaluations can provide the trainer-in-training with valuable insight into their own indi- vidualized professional and personal growth as well as what encouragement and support they need to further their training effectiveness. “Having felt the importance of the ‘safe haven’ your trainer should be, I have tried to provide this safe space for my own trainees. Not judging, a lot of listening and using reflective questions during feedback, has proven to create a safe atmo- sphere for both me and my trainees. It has opened my eyes on how reflection should be part of any training program, not only NIDCAP and I notice that I have started to use reflective questions in my daily work as trainer of pediatri cians-in- training.” –AK Conclusion An individual striving for self-expansion is evident in those who wish to become NIDCAP Trainers. Application of the self-expansion model to NIDCAP training emphasizes the need for a trusting relationship with a NIDCAP Master Trainer, a safe space within which to share vulnerabilities, challenges and training successes, and the use of a reflective process to enhance their capacity for training others in the NIDCAP approach. In contrast to a stringent pass/fail and policy driven approach, application of these approaches can result in opti- mization of personal and professional development. As such, it encourages parallel process from Master Trainer to trainers in training to their trainees so that all can successfully emulate the vision for NIDCAP care and thinking. The parallel process would then influence the care provided by NICU professionals and ultimately affect the care of babies and families. “Because this approach supports learning that comes from within, it feels less judgmental or hierarchical. You’re not evaluating or assessing — you’re supporting a process. And that brings so much more than just a sense of 'right' or 'wrong'.” –EVD References 1. Aron A, Aron EN. Love and the expansion of self: Understanding attraction and satisfaction. 1986. Hemisphere Publishing Corp/Harper & Row Publishers. 2. Aron A, Aron EN. Knowledge structures in close relationships: A social psychological approach. Garth J. O. Fletcher, Julie Fitness. Lawrence Erlbaum Associates. 1996. pp. 325–344. ISBN 0-8058-1431-0. OCLC 32859244. 3. Aron A, Lewandowski GW, Mashek D, Aron EN. The Self-Expansion Model of Motivation and Cognition in Close Relationships. 2013. Oxford University Press. DOI:10.1093/ OXFORDHB/9780195398694.013.0005 For further reading see Talmi A. and Browne J.V. Regulation, Relationships and Reflection: Developmental care in the NICU. In: Dempsey AG, Cole JCM, Saxton SN, editors. Behavioral Health Services with High-Risk Infants and Families: Meeting the Needs of Patients, Families, and Providers in Fetal, Neonatal Intensive Care Unit and Neonatal Follow-up Settings. New York: New York: Oxford University Press; 2022. p. 359-74. TABLE 2 Reflective questions for trainers-in-training: • What strengths have I demonstrated in supporting trainees? • What tailored recommendations have I made, and how have they contributed to their growth? • What did I miss in my trainees' abilities or challenges? • How did I create and maintain a safe space for open dialogue about successes and difficulties? • Which interactions with trainees would I have handled differently or sooner? • What does my own reflection teach me about my trainees' progress? • What have I learned about my own development as a trainer? • What frustrates me most about being a trainer or trainer-in-training? • What gives me the most energy in this process? • How do I score myself (1 = most organized, 9 = least) as a trainer within my trainees' trajectory?