Last week I had the privilege of reconnecting with Anna Ornstein, a brilliant child psychiatrist and one of my original mentors. In preparation for our meeting, I re-read a paper she had given me back in 2004* (written with her husband Paul Ornstein, MD about 20 years before that), when I was just beginning to develop the ideas now described in my book, Keeping Your Child in Mind. While I do not reference the paper in my book, it is filled with such wisdom that I felt compelled to quote large segments of it in this blog post. Interestingly, much of what she says is similar to what in the current world of developmental psychology is referred to as “reflective functioning, ” or what I refer to in my book as “holding a child’s mind in mind.” While in that language, empathy is included as one component of the more complex task of reflective functioning, in Dr. Ornstein’s language “empathy” encompasses the many components of reflective functioning. She writes:
The parent who is capable of parental attunement is one who developed an adult form of empathy-a capacity in which an adult man or woman can immerse him or herself into the inner life of a child without this threatening his or her own sense of separateness and without the parent injecting his or her needs into the interaction with the child. This is a more complex and difficult task than is generally acknowledged.
She goes on to be more specific:
In other words, empathy involves the recognition of the child’s motives for the behavior. Since in the case of a young child only the behavior is available for observation, it is more likely that this will be interpreted in terms of meaning that it has for the caretaker rather than the meaning the behavior has for the child. This is particularly true once the child’s motive has been partially or completely ignored and the behavior has been responded to only in terms of its meaning to the caretaker. By the time the child becomes demanding, hits or bites because his intent has been originally misinterpreted or ignored, an interaction has been set in motion that precludes the possibility of recognizing and responding to the child’s original motives.
But the beauty of Dr. Ornstein’s paper is that not only does she capture this idea so clearly, but then goes on to articulate why this happens and how to work empathically with parents to help them to change these unhealthy patterns of interaction. She writes, ” we consider parenting as on of the most important challenges in the consolidation and esteem of the adult’s self.” She gives an example of a toddler:
Toddlers experience themselves as the center of the universe; they are now filled with a sense of initiative and healthy vigor. They want those around them to see, recognize, and acknowledge their intoxicating sense of what they discover to be their own powers and abilities. To an environment[parent] that is fearful of losing its control over the toddler’s developmentally exaggerated sense of power, this behavior will be threatening. Under these circumstances, the environment[parent] attempts to reinforce its control, battles ensue, and a child’s self assertion disintegrates into the aimless and frequently destructive forms of aggression…In terms of overt symptoms, we witness an increase in the intensity of separation anxiety; the toddler becomes clingy and whiny and develops nightmares and other forms of sleep disturbances.
Dr. Ornstein then goes on to brilliantly address the implication for child therapy.
As a brief aside, Dr. Ornstein told me, over our glass of wine, that she was fired from her job for writing a paper that espoused similar ideas in the mid 1970’s. In the heyday of psychoanalysis, children were treated without involvement of the parent, and Dr. Ornstein’s assertion that one could not treat the child without including the parent was considered heresy. She writes:
Listening to case conferences in which families and their troubled children are being discussed, it appears extremely difficult for the professional not to create or reinforce guilt in the parents for their child’s emotional difficulties…we would suggest that therapists of children of all ages, but certainly those of young children, focus their attention on the specific features in the parents’ personalities that have made the parenting of this particular child at this particular time in the child’s and parent’s lives, difficult for them.
She goes on to say:
Parental dysfunctions are symptoms that require exploration as do other psychological symptoms…When the therapist does not appreciate the narcissistic mortification that parents experience [narcissism in relation to a child is a healthy thing in-as-much as one views the child as a part of oneself] that parents experience for having a troubled child and when parents feel further reduced in their self-esteem because they are not included in the therapeutic effort, it is then that they are likely to remove the child from treatment or look for an explanation other than a psychological one for the child’s difficulties.
I believe Dr. Ornstein’s elegant words speak for themselves. The contemporary world of developmental psychology, as I have said, espouses the same ideas but with two differences. One is that Dr. Ornstein’s paper is filled with psychoanalytic language that can be hard to relate to. Second, and perhaps most important, is that the significance of “reflective functioning” or “holding a child in mind,” in facilitating healthy emotional development, has been demonstrated by years of high quality longitudinal research. Dr. Ornstein’s ideas, however eloquent, are, in contrast, based on clinical experience alone. Going back to read her paper after all these years made me recognize the importance of not only including clinical experience in development of new ideas, but also addressing the poetry and passion of parent-child relationships, which can be diluted out in pursuit of “evidence” in the research setting.
*The paper is a chapter in a book entitled Parental Influences in Health and Disease, eds James Anthony and George Pollack