Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Thursday, August 18, 2011

Having Empathy for Parents: An Essential First Step

I continue here with the theme of my previous post. I was inspired to write by a conversation over dinner last night with a friend who is a prominent psychoanalyst. He was describing a case that had been discussed at a conference. Yet another well respected psychoanalyst presented an analysis of a five year old boy. Already my bristles were up, but I tried to listen with an open mind. As a kind of an aside to the main story about the child and his analyst, my friend relayed that the parents "were awful in some way." The analyst had described to the group how the little boy had become fixated on the whereabouts of his wife, to the point where he could not stay in the room and had to go and look for her. The idea, my friend explained, was that a five year old child needs to hold in his mind a relationship not only with each parent, but with the parents in relation to each other, in order to feel emotionally at ease. Fair enough, I said (though this classical model needs some careful rethinking in the face of many different family constellations seen today.)

But however important this analyst's observation may be, this case felt to me more like a use of the child as a lab specimen in the study of child development than an effective form of treatment. As I have said in multiple blog posts, and describe in detail in my new book Keeping Your in Child in Mind(in stock at Amazon now!) what is most important for a child's healthy development is that he feel understood by the people he loves. At the age of five, being understood by a therapist, should, in my opinion be part of the larger goal of supporting the parents in their understanding of their child. For this to happen, as Dr. Ornstein so wisely describes (see previous post), the parents must be an integral part of the treatment of a young child.

When a therapist judgmentally dismisses parents as, "awful in some way," it precludes any meaningful participation. Having worked with countless young children and families, I do understand where this reaction comes from. Recently I saw a four year old girl with her parents. Her fathers rage at this young child was barely contained. He spoke of her in highly negative terms while she sat playing on the floor. It was painful to listen to. But when I met with the parents alone, he broke down and cried, telling of his own abusive father and how he struggled daily with his own internal rage. He hated himself for directing it at his young daughter, who he loved more than anyone in the world. When he recognized that I was not judging him but rather was empathically listening to his struggles, he could accept a recommendation for his own therapy without becoming defensive. While the parents had come to me for advice about how to manage their daughter's behavior, now they could think about her perspective. They could ponder her experience as the recipient of her fathers displaced rage.

On my Psychology today blog, I received an interesting comment in response to my post Dyadic Therapy: Working with the Parent-Child Relationship This writer questioned my position of empathy. He had been abandoned by his mother at birth, his father died when he was nine and he was raised by a member of the Hitler youth who fled war torn Germany. She had threatened him with being sent to an orphanage for any bad behavior and admonished him not to cry at his father's funeral. He concluded his comment with "Dyadic therapy with the long-dead Nazi warlord is not likely gonna work?"

My first response was that, in the absence of frank abuse or severe mental illness, I believe one can always work with parents to support efforts to think about their child's mind and subjective experience. In another post I refer to the beautiful work of psychoanalyst Carole Gammer, who works with parents and children together in the face of with significant parental mental health problems. Not a treatment for the parents, it is instead a focal intervention whose aim is to, in a sense, support the parents' efforts to hold their child in mind. She has amazing results under highly adverse circumstances.

However, I had to rethink my response to his comment. On second thought, I wrote, "Unfortunately one could argue that, at that time in history, large segments of German society were exhibiting behavior consistent with abuse, severe mental illness, or both." The empathy I am advocating for assumes a certain level of sanity in society. Respect for parents, offering help for those who, like the father in my story, are struggling, and valuing this critical yet highly challenging task of raising the next generation, is part of that sanity.

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