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 developmental science 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.

Sunday, May 8, 2011

Supporting Successful Communication Between Parent and Child

Recently, at the UMass Boston Infant Parent Mental Health Post Graduate Certificate Program in which I have been participating for the past year, we heard a wonderful talk by Carole Gammer, a family therapist who lives in Paris, France. She has written a book entitled, The Child's Voice in Family Therapy. Among the more remarkable things about her presentation was that she spoke to us in English while showing video tapes of observed therapy sessions conducted in French and German.

In one case, a young single mother who struggled with serious depression was having constant battles with her five year old daughter. In a way typical of many families I see, she asked Dr. Gammer "what to do to make her listen." Dr. Gammer works with child and parent together in a very focal way to help develop more healthy ways of relating. I found her work similar to mine but rather than have parents tell their story, she has parent and child act it out with puppets. In the segment she showed us, she asked them to act out a typical morning. It was remarkable that despite the fact that they were being observed by psychology students, both became absorbed in the play and really showed what it was like. The mother made repeated demands of her daughter-get out of be, get dressed-which her daughter did not do. The mother finally ended up threatening to abandon her child if she did not get up and get ready for school. It left us thinking that it was no wonder the child also had severe separation anxiety.

Then Dr. Gammer did her intervention, which involved selecting one very specific interaction to work on. The one they chose was eating breakfast. After some discussion with Dr. Gammer, the mother offered a couple of choices and she and her daughter eventually agreed on cornflakes. It was the first moment of successful communication between mother and child. By chance, Dr. Gammer stopped the video at this point to answer some questions, so we got a good long look. The mother had up until this point looked very tense and angry, but in this moment of cooperation her body seemed to relax. She was smiling, and her pleasure at her success was evident. Her daughter looked directly at her, smiling at her as she agreed, "OK, cornflakes( a word that is shared by all three languages!)

This was a lovely example of supporting parents by helping them" be" with a child rather than telling them "what to do." When things are out of control as was the case for this mother-daughter pair, both parent and child are angry and sad, yet they are longing to connect. I have found that meaningful change happens in my behavioral pediatrics practice when we share these powerful moments of re-connection. One can imagine that the levels of stress hormones in this mother, likely at a constant high level as she battles with her child over every little thing, decreased in that instant. In turn, the same probably happened for her daughter.

It is only a tiny moment, but at least they both know what is possible and what to work for. This focal intervention, along with others like it in the context of the supportive, non-judgemental relationship Dr. Gammer has with this family, is likely to transform the unhealthy dance of mutual dysregulation, in which these two have been engaged, into one of mutual regulation, as they accumulate successes like the one we saw in this video. In my opinion, while it is clearly more work, this is a far better approach than giving a parent advice about "what to do."

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