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.

Friday, February 13, 2015

The Place of Love in Child Therapy



4-year-old Ella climbed on to the couch, into Susan’s lap, wrapping her arms tightly around her mother as Susan lovingly stroked her hair. They sat together in quiet loving embrace before beginning to pick up the toys, as the hour-long visit was coming to an end.

Weeks earlier Susan had wept in my office in anger and frustration. “She never listens,” preceded descriptions of explosive scenes where Ella kicked her mother, and Susan, in a haze of agitation, grabbed her daughter by the shoulders and shook her. At this visit, while Ella played quietly on the floor, Susan described a scene when Ella had told her mother, “I get so sad when you yell at me.” Susan now spoke, both to me and to her daughter, about how they were both having a hard time. Susan understood that just as she was feeling out-of-control in those moments, Ella was similarly stressed, and needed help from her mother in managing her intense feelings. This new understanding led to the moment of loving connection.

At the end of her graphic memoir, Are You My Mother?, Alison Bechdel describes a scene from a well-known case of psychoanalyst D.W.Winnicott., The Piggle. Winnicott sits on the floor with his little patient, Gabrielle, with whom he had worked for almost three years, starting when she was two. “I know you are really shy, “Winnicott says, ”and what you really want to tell me is that you love me.” He writes, “She was very positive in her gesture of assent."

Bechdel, in her last session with her own therapist, who during the course of their years of work together had gotten analytic training, has a similar experience. Her therapist says, “A lot of what we’ve done here has to do with love.” And then, “I know that you love me.” Bechdel sits quietly for a frame, and then says, “I … I do. I love you.”

Ours is a culture of advice. When parents come to me with their young children, they implore me to “tell me what to do.”  Recently I was interviewed on the radio by a child psychiatrist at a well-known New York teaching hospital. He told me that he had written a manual of “parent training” that offers “behavioral tools.” He claimed that when parents struggle with their child’s behavior it is because they “haven’t been taught” and they “don’t know what to do.”

I told him that I begged to disagree. Instead, I adhere to the wisdom of Winnicott, who wrote, “ No theory is acceptable that does not allow for the fact that mothers have always performed this essential function well enough.” As with Susan and Ella, problems occur when parents, for a range of reasons, sometimes including a child’s innate temperament, are stressed, and lose touch with their natural intuition.

Classical psychoanalytic theory supported work with an analyst alone with the child, even as young as two. Contemporary developmental science, with abundant evidence showing that the brain grows in relationships, offers a different perspective. While much of the conceptual framework of a discipline known as infant mental health is founded in psychoanalytic thinking, with the relationship
 being central to growth and healing, it offers a different model of treatment.

In the case of the Piggle,  her mother stayed home, a train ride away, with her new baby while Gabrielle traveled with her father to meet with Winnicott. In contrast, this relatively new and growing discipline of infant mental health supports working with parent and child together. While the brain can change in relationships throughout the lifespan, working with parent and child in the earliest years of life offers the greatest opportunity for change, as the brain is most rapidly growing.

In adult therapy, expressions of love, by the patient for the therapist, can be transformative and healing. But the aim is different when working with young children. As with Susan and Ella, the aim is not for the patient to express love for the therapist, but rather for the child and parent to be re-connected in love.


As Valentine’s Day approaches, I think of the deep transformative feelings of love that occurred during the visit with Ella and her mother.  It occurs to me that the work I do, along with my colleagues in the field of infant mental health, is neither parent training nor classic psychoanalysis. It is about facilitating, in the words of Simon and Garfunkel, a mother and child reunion.

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