On Not Giving Advice

"Parenting behaviors impact young children's development'" says an interesting study by Frances Glascoe, PhD and Shirley Leew, PhD in the February issue of the journal Pediatrics. Using well validated measurement tools, they demonstrate that the way a parent interacts with her child has an impact on language development as early as six months of age. In addition, specific risk factors, including multiple moves, more than 3 siblings and parental depression are associated with interactions less likely to promote language development. In the discussion, the authors suggest that "future research in parenting behaviors that affect child development is crucial," and that "in the interim, clinicians should advise parents routinely on the value of talking frequently with their children... and describing what they are doing."

This is an important study, supporting extensive existing research demonstrating the critical role of early parent-child relationships on brain development. But I wonder, if in the discussion, pediatricians might do well to borrow some ideas from our psychoanalyst colleagues.

Pediatricians are trained with a model of "giving advice." We are the experts and people look to us to be told what to do. Psychoanalysts, on the other hand, are trained to listen.

Being understood and having your feelings recognized by a person who is important to you is one of the most powerful experiences there is. When our feelings are validated, we know that we are not alone. I wonder if these parents in the study whose children were not on a healthy developmental path, parents who are clearly stressed, might benefit more from time spent sharing their feelings with an attentive and non-judgemental person, than they would from being given advice about talking more to their child.

As a scholar of psychoanalytic thought, I have applied a psychoanalytic model in my pediatric practice. Recently I sat with Ashley, the mother of 4 month old Brian, while her husband Tom held the baby and walked around the office. Ashely cried as she spoke of her debilitating depression. She shared her feelings of inadequacy as a mother when she was too overwhelmed to respond to Brian's crying. She did not want to increase her medication because she was breastfeeding, but she longed for some relief. She spoke of a strained relationship with her own mother, who she found to be cold and unhelpful. Two weeks later I again met with Ashley and Brian. Ashley described a complete transformation in their relationship. I watched the two of them exchange joyful smiles. I asked her what had changed. She explained that at our last visit, she had felt understood, both by me and by her husband. This understanding gave her the strength to be more responsive to Brian. In turn, she said, he seemed to be more calm.

Pediatricians, who are on the front lines with growing children and families, may understand child behavior and development better than any profession. Psychoanalysts understand how to use relationships to help people make meaningful changes in their lives.

I have been to several conferences with such titles as "Pediatrics and Psychiatry: An Essential Partnership" many of which end up being primarily discussions of how to work together around prescribing medication. My wish is for a collaboration entitled "Pediatrics and Psychoanalysis: An Essential Partnership." We have a tremendous amount to teach each other.