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.

Monday, September 30, 2013

Protecting a space for parenting in an age of expert advice

In my behavioral pediatrics practice, it never ceases to amaze me how, given the space and time, parents come around to making sense of their child's "difficult" behavior without my giving "advice" about "what to do." They may recognize that they share a trait with their child that has troubled them their whole life. They may become tearful, thinking of how that child represents a lost loved one.  There are countless variations. The process of telling the story, of finding the meaning in the behavior, is often itself the treatment. Once parents have these insights, "what to do" follows naturally. In contrast, if I give advice without a full understanding of the story, things may not go well.

Recently in working on a new book, I have had the pleasure of returning to a close look at the work of D. W. Winnicott, pediatrician turned psychoanalyst and a kind of British Dr. Spock. In my review of his writings on the subject of advice, I came across a wonderful piece from this past spring in The Guardian: Mothers on the naughty step: the growth of the parenting advice industry, that references Winnicott.
Winnicott abhorred the idea of giving advice. He believed that when mothers tried to do things by the book – or by the wireless: "They lose touch with their own ability to act without knowing exactly what is right and what is wrong." Yet today there are far more parenting advice books (each with their own regime to promote) than 30 years ago, and the radio and TV schedules are full of programmes such as Supernanny, which train a critical eye on what are generally called parents but most of us understand to be mothers. It sometimes seems it is mothers, rather than children, who are being dispatched to the naughty step...
Winnicott feared that focusing on pathological families rather than "the ordinary devoted mother and her baby" (the title of his most famous series) could excite anxiety in listeners without access to therapy. "I cannot tell you exactly what to do," he said, "but I can talk about what it all means." And so he did, extolling the role of the good enough mother – one who can be loved, hated and depended on – in enabling the baby to develop into a healthy, independent, adult. While many of today's parenting gurus focus on a child's deviant behaviour and the contribution of supposed misparenting, Winnicott tried to help mothers understand the significance of their child's behaviour, whether it was "cloth-sucking" or a display of jealousy, and the ways that they instinctively contained their child's anxieties.
The author refers to the British program "Supernanny," the "high priestess of behaviorist parenting."
Tracey Jensen, lecturer in media and cultural studies at Newcastle University, says Supernanny reverses Winnicott, offering up the spectacle of the "bad enough mother", usually working-class, who is shamed before she is transformed. Jensen watched the programme with a group of mothers, relieved that it was not their parenting practices being scrutinised, but those of someone else onto whom all their own worries and fears could be displaced. But they also shouted back at the programme, discomfited by the judgment and humiliation meted out to the mothers featured. Such series foster the very anxiety they claim to assuage, and substitute "training" for thinking and feeling.
This last phrase captures the essence of the issue. I shudder whenever I see the term "parent training."  But this phrase, as well as others such as "management of symptoms" or "parent education" are pervasive in our culture. These kinds of interventions may improve behavior in the short term. But if they substitute for "thinking and feeling" it is likely that symptoms will re-emerge at a later date, in a different form. 

When we talk about parents and children, we are talking about passionate love relationships. The feelings are deep, intense and sometimes painful. It makes sense that we might choose to avoid them. But this is not a long-term solution.  We would do well to instead make a space for them, starting from birth.

I borrowed this phrase "protecting a space" from my good friend Gale Pryor, who's wonderful book Nursing Mother, Working Mother was also heavily influenced by Winnicott. In such a space parents can connect with their natural intuition. It is in this space that we give room for healthy development of parent and child together.

2 comments:

  1. As a Developmental special educator in Early intervention using a comprehensive DIR based approach, the problem of perception surrounding the term, "Parent Training" is much more systemic than often realized at first blush. The phrase, in fact, is but a pebble throw away from the more unfortunate and problematic term, "Child rearing practices." What they both both unfortunately share in common is a type of daily existential distance and disembodiment; a similarity, if you will in managing and controlling "surface behaviors" without attempting to (and sadly/often without understanding how to) understand the language and the possibilities of more meaningful dyadic engagement and interaction beneath the surface.

    If professionals spent more time in guiding primary caregivers on Not the "how to manage, control redirect problematic behaviors" (the symbolic surface), but instead listen to and guide primary caregivers on how to slow down and thus more effectively and deeply enable an understanding and entering into a dialogue with their child's current behaviors or current affective intentionality (i.e., specifically, what X "behavior" means from the child's perspective and how to begin to empathically convey and enter into a dialogue with the child, as part of a two-way meaning-making process) then we would begin to have a much healthier overall dynamic where true Development could begin to flourish.

    The coinage of "child rearing practices" is arguably rooted in hostile and pathological practices based upon diseased pedagogical beliefs (i.e., postmodern modifications of the axioms of "children should be seen and not heard"; "Give a child an inch and s/he will take a mile"; or worse still give a child on the spectrum an inch and s/he will take ten-miles; spare the rod spoil the child, etc.).

    The unconscious archetypes associated with the latter thinking is so socially/culturally systemic that the great mythical, and we say Non-developmental appeal of Behavioral based methodologies (e.g., ABA, etc) consequently often holds great sway to what (at first blush) appears to be immediate visceral and common-folk sense.

    If we instead begin to allow primary caregivers to begin to feel safe, comfortable in voicing what is occurring for them with their child - instead of (egregiously) begin to instruct and deploy "management schema" or techniques for them and their-child to redirect and control "problematic behaviors", we can begin to enter into a deeper dialogue with the child's "externalizing behaviors" (and the parents' concern, which would invite further self-reflection). This would be an expression and integral part of a meaning-making process rather than "parent/child training", which would would not needed but instead through empathic insight and nurturing process growth and Development would begin to integrate and flourish!

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  2. Hi Neil

    I love this comment!!!!

    Thank you

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