Personal Thoughts of a Psychologist working with children

Meaning making and emotion regulation

“Seeing ourselves form the outside and others from the inside”.

How do we make sense of our own feelings and the behaviours of others? How do we learn to soothe others and ourselves? Our understanding of an event and our capacity to deal with it are two sides of the same coin. Adjust your understanding, and you will react differently. Much personal distress and relational difficulties are the result of painful meaning-making.

Through the experiences that we had of being understood and being soothed in our earliest care-giving relationships, we learn to mentalize (to have in mind, to make meaning of) our own reactions as well as those of others. The ways in which we experienced this “having in mind”, will comfort us, or scare us, or make us anxious, or make us want to run away from it. How we respond today is very much imbedded in the early reactions of our caregivers.

A simple, common  example is parents who become highly upset when a child is upset. This soon sets a pattern of becoming highly upset when you are upset (and often, blaming the other).  Another example, frequently observed, concern adults who scold and blame children for doing what all children do naturally: jump into puddles, get dirty, squirm in their seats, make a mess, and shout out of sheer joy. The stressed adult is unable to access the childhood mind, berating the child for not acting like an adult.

Anyway, children so readily accept the blame for being in the wrong, parents are easily vindicated, or so they think at that moment. Unfortunately these children tend to become increasingly naughty – the exact opposite of what the parent desires. In time the children themselves begin to shout and blame – and land in trouble at school, from where they are referred to people like me to “be fixed.”

It is important to understand that the ability to name and to manage emotions (or not) is learnt (this is therefore the bedrock of some therapies). If your parents had seldom experienced themselves being understood, and rarely had their experiences reflected to them by caring others, they will not find it easy to pass these capacities on to their children. If we are not kept in mind, if we are not related to as a person with an intentional mind, then we will find it hard to keep some rational, thinking mind and to self-regulate when we ourselves are in distress, or when we have to soothe another.

Sometimes an adult can upscale so alarmingly, that a child adapts by downscaling their own emotions, becoming “sweet” and  “good as gold.”. Or parental.

The world of feelings can threaten to overwhelm us. We then do not really want to listen when another becomes emotional, because it evokes unmanageable feelings in us.

How to restore balance

When a parent says to a baby, “Hey, I am sorry that I am irritated with you. It is not your fault. I am worried about work, and now I take it out on you; you are just a baby”, the baby gets to understand that feelings have reasons – even if they are sometimes unreasonable. The child learns that the emotional world, and its problems, has its own meanings, even if they do sometimes spill over – and that these can exist separately from the self. Combined with humour and compassion, powerful tools of distress management are thus being developed, as humans learn that people have separate minds and can use meaning making as tools to use when they need to cope with our own problems and the difficult behaviours of others.

Adults, who were not sufficiently kept in mind as children, fail to keep others in mind as separate, meaningful beings. They tend to interpret events negatively, and fail to consider how their lives influence others, and often show no real compassion for the other, except maybe when they think of the other as like themselves.

This is not only a personal development; whole societies can act like this. Having your mind in my mind has as much to do with how we think of others, as about ourselves. It plays itself out when we meet people who are different from us, and wherever we find expressions of power. Much better to be aware of it than to be unconscious of it, where it can become a power of destruction.

Emotional dysregulation is inherent in all sustained distress and harmful behaviours. It is the bedrock of fractious relationships. Being in distress after an upsetting event is normal. Not being able to recover from your distress months, even years later, is not. Responding with focused anger to a real threat is healthy, raging at imagined threats, is not. Love and elation are wonderful feelings, but not when they become obsessive, and lead to destructive decisions. In learning how to regulate our emotions, first it is our family members who instil our habits, later it is our peers, and then the cultures that we live in sanction and shape our responses.

To be able to express your own emotions, and to be able interpret the emotions of others, both the negative and the positive, in ways that lead to the restoration of harmony and joy, this is a life-long challenge, seldom perfected, but always worthwhile to pursue.

Having your mind in my mind

A little girl of six, two neat brown plaits standing away from her head is brought to my practice because of her bed-wetting. Her mother is having an affair. The parents are whispering behind their bedroom door, clearly in distress. When the little girl asks about this, they reply that she should not worry, this is a grown-up problem, and they will sort it out. The little girl continues to worry. I understand her bed-wetting to be her inability to cope with the tension that lives behind the closed bedroom door.

“Little girls worry when their parents argue behind closed doors, “ I say.

“Yes”, she replies. “But what does it mean? Does it mean murder?”

The capacity to see things from the child’s perspective is an essential ingredient of sensitivity[1]. This means that the child can be safely held in the parent’s mind. For a child to experience ‘thinking about’ as a safe and inherently useful experience, the parent has to sufficiently often name the child’s experience appropriately without criticism or judgment; just accepting and naming the child’s mind, as it is. Parents who react in ways that a child cannot make sense of, or cannot have in mind, or are unsuited to the child’s developmental stage, creates unknown anxiety and an avoidance to keep things in mind. In extreme cases, a state of “mindlessness” is created.

A few years ago I visited a woman who worked in our house when I was a child. I was curious about why I had felt so safe and free with her, and had cried such bitter tears when she left. We were having tea in her lounge, when her granddaughter, aged about six, and whom she looks after during the day, was called in from outside where she had been playing with others. She stood at the entrance to the door of the lounge, sulking. “What is the matter?” asked her grandmother, with a note of slight concern in her voice. Then promptly remarked, “Oh you are upset because you have to come in already.” The little girl’s posture relaxed (grandmother was right, and had read her mind correctly, and accepted this without fuss, and without blame or the need for a sermon). “Come”, said her grandmother in a soothing voice, “let me fetch you a yoghurt, and then I will tell you who this lady is who is having tea with us.” They left for the kitchen, hand in hand. When they returned the granddaughter joined us, sitting on the carpet, closer to me now, eating her yoghurt, curious about the stranger.

I understood that this woman has the wonderful ability to see a child, and to care about what she sees, and to name what she sees in such a manner that it contains the child, and to take ordinary practical steps to ‘make things better’.

The little girl in the first example, the one whose parents were experiencing problems, has parents who love her, and who care about her. But they did not feel safe to name her fears. Unnamed they lived inside her. She tried to make meaning by thinking of the worst thing she could think of – did they commit an act of murder? Would this mean they would have to go to jail? What would happen to her? Not coping, she wets her bed.

[1] Research on Maternal sensitivity shows that all mothers, independent of culture or context, tend to respond in similar sensitive or insensitive ways, which can be precisely defined. Simply look up the term, which was coined by Mary Ainsworth. Jon Allen of the Menninger Clinic has open resources on the lifelong impact of Mentalizing, mentioned above.

Where there is a will there is thé way

What is will? A person’s choice or desire in a particular situation. Merrriam-Webster

Free will?

 Within your will you experience yourself. This is already noticeable in a two-year old: The experience of an injury to the will as an injury to the self. The two-year old is taking on a momentous battle with the desire of its family to shape this child to their own expectations, to the cultural pressures bearing down on the family, and the Zeitgeist that envelops all. A Freudian battle ensues between id, an immature ego and the superego, would be one way of putting it. [1]The most effective parents have impressive skills of sublimation and redirection, shaping the child’s will gently yet firmly, but without the threat of annihilation of the child’s will and therefore nascent identity – or even worse, distortion of the child’s expression. The former usually leads to rebellion and/or depression, the latter to mental illness.

A tired child is an irritable child. We all know that. “What do you want?” asks an exasperated parent.

To give a tired child a hiding for being irritable means to confuse tiredness with ‘being naughty’. When enough of these experiences add up, the child begins to confuse his (or her) own inner signals, and in time, those of others. Thus happens distortion – or what is known as ‘a lack of emotional intelligence’.

Attachment research is based on thousands of hours of observation of the interactions between infants and toddlers and their caregivers, all coded from video. One of the findings refers to the tendency of a caregiver to follow a child. The colour of this one simple skill provides us with a peephole into the world of humanity. If frustration and anger are brothers, then being followed is the magic wand that evokes harmony.

Following (Harmony vs. Irritation)

A baby and an adult are cooing, faces close together. The mother is mimicking the infant. Suddenly the infant stops, turning its face slightly away. Mother stops, is quiet, watching baby. This is a mother who intuitively ‘gets’ that the infant is taking a break, is regulating the interaction. The baby turns its face back, and the interaction continues. A response like this is natural, and occurs independent of culture or socio-economic class. Mothers in shantytowns do this as often as mothers in upmarket apartments. A different mother interferes, tickling baby’s face to get its attention back. Baby becomes restless, squirming. This is also natural human behaviour, occurring everywhere. The outcome for baby and mother is O.K., but here will be a tenser baby and a tenser mother. Largely consistent early experiences of sensitive flow or curt interruptions create different patterns of being. Bath times and play times provide everyday examples of allowing a child to set their own pace, or not. This is also at the root of the development of self-regulation. Stopping or interfering with a child’s normal inclinations for exploration and play on a regular basis, is one way of undermining self-regulation as well as inner motivation. If you had sufficient experiences of being in flow as a child, this becomes part of your body memory. This memory is something that you can tap into at times of distress as an adult; inner experiences of being in harmony and of the world being a good place, and so the people in it.

Interruption is the opposite of flow. I have often wondered if some children with ADHD have not been constantly interrupted since they were babies to such an extent that the neurological substrates for focused attention never had sufficient opportunities to develop.

Intrusive and critical parenting: The opposite of smooth, flowing interactions are interruptive, intrusive and critical interactions. This is one clear link that has been replicated: the link between severe psychological difficulties in adulthood and having experienced intrusive, critical parenting as a child.

Intrusion has become pervasive

The loss of the large extended family and safe communal neighbourhoods has resulted in near constant adult supervision with much less freedom for children. Over-involvement has become the norm in many families. This has also lead to the over-psychologisation of childhood. The will of the parents and the will of the child are becoming one thing; a claustrophobic enmeshment that well-intentioned parents try to solve by increasing their engagement.

And then there is the general lack of quiet and of space.

Two sides of a coin

I watch as a father opposes the will of a son, who looks about seven years old.

We are on the beach, and the son has put out a sandy hand towards the apple on offer.

“Go and wash the sand of your hands first”, barks the father.

“It’s ok, I will eat it like this”, responds his hapless son (Does he not know by now?)

“YOU WILL GO AND WASH YOUR HANDS FIRST. OTHERWISE THERE WILL BE NO FRUIT FOR YOU.

Why oh why is the human so stupid? Can he not see that he is stoking a rebellion?

The other side of the coin

The meme of “choice” that is en vogue with many aspirational parents, combines free will with immature power – a well-meant, but unfortunate combination that results in exhaustion, frustration and despair. In a local grocery shop my ears pick up a conversation between a couple standing in the aisle with frozen goods. The man makes a food suggestion, and the woman responds with a worried look, ” I don’t know if she will eat it.” She is about 18 months old,  sitting in the shopping-trolley looking smug and tense, as mother holds up two boxes with frozen products, ” Would you like this?” Mother’s voice is pleading and anxious. The meme of choices gone wrong, wreaking its havoc on this family.

When I started out my practice in 1990, the most common referrals by parents were bed-wetting (usually a symptom of a child not coping with what could be a difficulty within a wide range from learning difficulties to parental enmeshment or discord to abuse), anger (read frustration) or lack of motivation (often related to insufficient autonomy granting).   In the years between 1990 and 2004, I had two referrals of a parent not coping with a two and half year old. In the past three years a parent not coping with a pre-schooler is a weekly occurrence. At the core: An imbalance of power. A young child who has been given too much power, clings to it like an addiction, and develops an immature form of it, a type of pseudo maturity, which causes unrest and stress, not only in the child, it fans out into the family and the school. A child with too much power too early, is an unhappy child, who can own all there is to own, but craves more because the hole in the middle where security is supposed to be (adults are in charge and all is well), is uneasy. This is also an ironical consequence of the practice of “giving choices” in the belief of empowering children. “Do you want the yellow plate or the blue plate?” Do you want to wear the t-shirt with the truck or the puppy?” Soon a child comes to believe that these things really matter. That is of great consequence. So that when the child demands the yellow plate and it is in the dishwasher, parents look at each other: Calamity! These beliefs tend to grow tentacles, so that children can become potentially unhappy about a myriad of truly inconsequential things, with the potential for unhappiness residing in a multitude of what should have been smooth interactions. A world in which a young child is in charge is a scary world that the child tries to control by exerting childish control over childish things.

Power is addictive, even a toddler feels that. Power over food – a primary survival need – is enormous. Our children are increasingly robbed of spaciousness, freedom and security, ironically also by the imposition of too much power, too soon.

As I watch adults giving tiny children power over their diets, I have to suppress sarcasm, and a sense of powerless despair rising in me: What do they expect their children to base their food choices on, knowledge of nutrition? What used to be named Adult-onset Diabetes is increasingly diagnosed in children under the age of nine. Is nutrition not supposed to be a non-negotiable adult terrain, like not running into the street and never putting your finger into a power socket? At the World Association for Infant Mental Health conference in Leipzig in 2010, I noticed for the first time a separate category for “Eating Disorders”. (Infant mental health is for 0-3 years). I watch surreptitiously as slinky mothers order grilled free-range chicken for themselves, and pizzas with processed ham and cheese for their children.

When adults are not in charge, a childish power surges through demanding instant gratification, unhappiness spreading through families like marmite on their daily bread.

Am I advocating the return of authoritarianism? No, just sanity.

To honour the will of a child

Autonomy

“Self” “

“I want to do it myself”

“Me did it!”

Achievement. Satisfaction. Pride.

Personal accomplishments are the bedrock of satisfaction. Joy. Peace in old age.

A child will express its own will naturally through play, and in the small choices that they make spontaneously. The child who wanted to eat the apple with a sandy hand was saying, “It is ok with me this way.”

“Put your books in the bottom shelf.”

“But I want them in the middle one.”

This is not a threat to your authority. It is a simple expression of choice that can easily be honoured.

Children will spontaneously play “house”. They will play out good and bad, will mimic funerals and festivals, will have pretend guns and babies, wear funny clothes, be happy on their own in no longer warm baths, splash clean clothes in muddy puddles, attempt things on their own impulse. All we need to do is to let them be.

Self-regulation and the Internet

Whole books are written on the topic of self-regulation. Many regard it as thé mental health topic of our time, with both children and adults struggling equally. To add a penny’s worth: We are living in fluid times. Solidity is increasingly found in fundamentalism. What to do when life becomes one big uncertainty? When stress is pervasive?

A new generation is on the uprise. This is the generation that has two identities: one in the here-and-now and one online. There they have families, friends and enemies, they have an alter ego, a whole persona with a different personality, wearing different clothes and a different set of skills. Why not rather live there? Over there life is far more in control, it is more predictable, possibly more exciting, and certainly more soothing than life out here. The World Wide Web has become a soother, an escape route, of note.

Our will tells us that we have the potential to make a free choice, to be. To will is to be. Without some will you won’t be able to get up in the morning. Can it be that a will is one of the central forces of being alive?

Will and Dignity: Is a person without a will not a person without dignity? Is the fight for our will to be done, not also a fight for our own dignity? Is forcing our own will onto others not a denial of their dignity? So that we have an interconnection of will and dignity and power; a web of liveliness or a web of destruction.

“But what do you want’? Many have asked this in despair. “I don’t know”. “ I am not sure”.

So many injuries from willing wrongly. And from others willing you wrongly.

Yet the persons who walk into my room are quite sure of what they want: To be better. To be cured. Not to be so anxious. To have a relationship saved. Not to be so sad. This is a will in which they have faltered, despite their best efforts, and often also the efforts of those around them. This is the most plausible reason why help is sought. They walk in with their shame and despair at having failed at their own will for their lives to be different.

What is depression and grief but an injury to will. To become separated from your own will. What is anxiety but an attempt to control a potential threat to your will. Willpower is a neglected term in Psychology (we prefer softer terms such as motivation and resilience), but without a will to power, how would you make your way in a world that is inevitably an obstacle course over different terrains, how will you stand your own ground, and how will you feel truly alive? Will, ambition and positive self-pride are intricately connected: As the song about love and marriage goes, “You can’t have one without the other.” And as there can exist no perfect kind of willpower (as in the story of the three little bears: too small, too soft, too hard), what would be “just right”? I don’t claim to have the answer. I can venture that if you look into your own life, you can take your own measure.

Will, as you can gather, is a tricky bugger. Who knows what the will is of someone with severe despair or anorexia or hypochondria or addiction – to die or to live? We have to find the will to create. To be.

People often say that this or that person has not yet found himself. But the self is not something one finds, it is something one creates.                  Thomas Szasz, Psychiatrist

 

 

  

[1] id refers to our natural instincts or drives, they are often unconscious, ego is the “I”, the self that is known, whom we will conceive ourselves to be (we also have an ego-ideal). Superego refers to the development of conscience; the internalization of moral standards.

Some days I think we have all gone missing in this overkill of information and options. To use nutrition as a metaphor: if we all just ate three meals of real food every day, would that not quite simply suffice and liberate us all from the plethora of debates? So as for “Mental Health”: Speak out, speak up, work constructively, play constructively, build  constructive relationships,  and be spiritual in some way… (oops that was what Freud and Jung also said)…

Theft

 I hear the child’s voice and then I see them. The mother is crisply urban. With platinum white hair expensively snipped to look boyish, her heals go clickety clack on the glossy tiled floors of the shopping mall. “We forgot to pay for it.” The little girl, all pink, is clutching a Barbie book in her left hand. Her voice rings out, as she looks up at her mother. Mother grasps her right hand tighter, clickety clack she is walking faster, pulling the little girl behind her. I keep on looking at them, not because I care about the theft, but because I care about the little girl, who is flailing behind, the same pinched look of the mother now in her face.

That night I wonder, is the joy of getting something for nothing more than the joy of a book or looking up to your mother? I also wonder about my own ambivalence. I do not really care that they stole that much (it is Barbie after all, such a contaminated symbol, does she not deserve to be stolen?) If it was Winnie-the-Pooh or Alice in Wonderland, would I not have been outraged? Is that not why we have become who we are now: too much Barbie and too little Pooh bear?

Mostly my heart breaks for the little girl who, in order to stay connected to her mother, will have to take on her mother’s moral code which, as in the mother, will result in the same pinched expression on her face.

 

 

I have been trying, this past ten years or so, to do therapy without using any jargon. No words such as depression or bipolar,  nothing like inner child or soul or inner critic or sentences like, “You can be anything you like”,  or  ” Do whatever feels right for you.” To be frank, I disliked all of that anyway. It sounded like brainwashing combined with  wishful thinking, and who knows,  is any of that “true” at all?

So, I try to stick to ordinary verbs – doing words – and adjectives. If you push “Depression” out of the room, longing and sadness will usually take its place. Tell me about your longing and your grief. We can talk about that. And tell me about your loss of power too.

Yesterday I was at a creative workshop. A lovely older woman, a teacher of English, spoke about her agony when having to take big decisions as she does not trust herself, and she is sad about a life that is lacking in joy.  “It is because of the lack of love in your life” , a successful therapist replied. “Yes”, the teacher responded, agony on her face, “that is exactly what I don’t have.”

Here is my take on it: When you are a small child,  you will explore. You will do your best to discover things and to have joy.  You will only be stopped for three main reasons: 1) Absence of opportunity (a barren environment) 2) Rigid rules and boundaries (don’t make a mess, be clean, be tidy, be dutiful) and/or 3) Overprotection.

When you are an adult, you cannot wait for trust and love to be there before you begin to explore and to experience joy.  You cannot waste more time mourning for what you do  and did not have. You may have to wait for ever and then more if you want to have  before you begin living. You begin by risking, by taking chances, by taking a walk on the wild side. You will learn to trust and to love once you are out there –