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, August 24, 2014

Dancing Lessons: Metaphor for Healing Through Relationships

Dancing Lessonsnew play recently premiered at Barrington Stage Company, is ostensibly about an actual dancing lesson. An injured dancer reluctantly agrees to give a one-hour dance lesson to a young man with Asperger's syndrome who lives in her apartment building.

At first the two characters are cast in conventional roles, he awkwardly defining himself by DSM criteria and she drinking too much while spewing bitterness over her sudden unexpected disability. Over the course of the play's single act, as their relationship deepens, we appreciate the complexity of their characters. As they grow closer, sharing painful stories of loss from their past, they discover they are in many ways not that different from each other. In a wonderful fantasy sequence at the end, the two shed their respective disabilities and dance gracefully together.

The play, itself an act of creativity, can be seen as a metaphor for the value of play and creativity in healing. 

D.W. Winnicott, pediatrician turned psychoanalyst, is known for the playfulness he introduced to his work with children and families. I am not referring to "play therapy" but rather time and space to sit on the floor and see what unfolds.
Every summer the Austen Riggs Center in Stockbridge, MA hosts a creativity seminar in which mental health clinicians and a range of artists come together to explore the creative process. In the introduction to A Spirit That Impels, a collection of essays that grew out of the yearly seminar, editor M. Gerard Fromm shares a vignette told to him by a colleague who had the good fortune to observe Winnicott at work.  

Winnicott would see a family for one or two consultations; this one involved a young mother and her 3-year-old son.
He sat on the floor playing with the child, while also talking with the mother, who was sitting on the couch. She told Winnicott that her ordinarily sweet little boy had suddenly become quite ill-tempered and obstreperous. Worst of all, toilet training was completely set back, and the lad was now worrisomely constipated. The father in this working-class household spent long hours at two jobs, and the boys mother was at her wit’s end.
The trainee described to Fromm how she had no idea what was going on, but at the end of the visit Winnicott turned to the mother and said, “So how long have you been pregnant?” She revealed that she had not told anyone, but Winnicott suggested that the boy did in fact know and suggested she speak with him about it. When the mother returned a few weeks later, she reported that not only was her son “great fun again,” but his constipation had completely resolved.

In his book Playing and Reality, Winnicott writes:
This gives us some indication for therapeutic procedure- to afford opportunity for formless experience, and for creative impulses, motor and sensory, which are the stuff of playing.
This playfulness that Winnicott employed in his clinical work stands in start contrast to today’s system of mental health care replete with assessment tools and standardized forms.  Our reliance on DSM classification and medication may not leave room for this kind of creativity and healing through relationships.  

For example, in standard treatment of postpartum depression, the "problem" is seen as residing squarely in the mother, who may be offered nothing more than psychiatric medication. The role of the baby, the way fussiness, sleep and feeding difficulties affect the mother, may not be addressed. Similarly when we diagnose ADHD based on standard symptom checklists, and treat with "behavior management" or medication, there may be no room for creativity, either in making sense of or in treating the "problem." In the play space there is opportunity to understanding the meaning of behavior in the context of relationships.

Parent-child relationships are a complex intricate dance. At times this dance can be full of mismatches and stepped on toes. Sitting on the floor with parent and child together, rather than diagnosing disorders or managing problems, I prefer to think of my work as a form of dancing lessons.  Through playfulness and creativity, parent and child learn to dance gracefully, and as St. Germain’s characters discover in the final scene, to find beauty and joy in their relationship


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