How Psychotherapy Works: Learning from Infants

Repair Theory has significant implications for treatment of emotional suffering. It offers a model of mental health that differs dramatically from the medical model of mental illness. Rather than being fixed, our emotional wellbeing evolves in a continuous process over time. Early interactions lacking in robust repair create meanings of hopelessness that lead to emotional suffering and derailed development. New sets of relationships with different quality of interactions can promote healing and growth across the lifespan.

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The Exquisite Pain of a Child’s Sadness: Finding Confidence to Bear It

Toni held the drawing up to the Zoom camera. for me to see A stick figure stood in the middle: big blue tears the size of her head lined the page reaching from her eyes to the ground below at her feet. Even through the screen I could feel the heart wrenching pain portrayed in the picture. Toni surprised me by then saying, “I want her to be able to feel sad.” I asked if she would tell me more. She vividly recalled experiences from her own childhood when she sensed that her parents could not accept her feelings. Sadness transformed to anger and then uncontrolled rage. The frustration of not being seen felt alive in her now as she held her daughter close.

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What is Children’s Mental Health Care? An Expanded View*

Emotional well-being and emotional distress both grow out of variations in the repeated moment-to-moment exchanges that make each of us who we are. On one end of the spectrum, robust interactions lead a person to experience the world as safe and filled people who can be trusted. At the other extreme, fear and mistrust inform a person’s understanding of himself and the world around him. The two extremes help us make sense of the more typical experiences that fall somewhere in between. Rather than being fixed, the meanings you make in your earliest experience are continually changing in new relationships in an ongoing process of making meaning of yourself and the world as you grow and change.

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Becoming Unstuck: Listening for Meaning in a Child’s Behavior

In my years of practice it never ceases to amaze me how effectively young children can communicate the source of a problem through their behavior. Of course Harry did not know or understand the role of unmourned loss in his parents lives and in their relationships. But he absorbed the distress and “acted out” as if to say, “I need you to deal with this so you can see me as myself.”

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Born Into Violence: Listening as Prevention

In that moment of connection, Calvin made hopeful meaning of himself. If he had words, he might have said, “I can change my world to make it better.” He communicated with his mother in a way that also changed the meaning she made of his behavior. Her negative attribution based on her experience of violence shifted. Psychoanalyst Lou Sander referred to this kind of interaction as a “moment of meeting.” Parents and infants make meaning of themselves in the world through hundreds of thousands of moments. Unfortunately for this family, their circumstances did not allow for the calm space for listening offered that night in the hospital.

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Peter and the Bear: Finding Hope in Child’s Play

3-year-old Peter and his family were referred to my behavioral pediatrics practice for help with “managing his aggression.” In the second session, having taken a full hour to listen to the story from his parents Jonathan and Jalissa the previous week, we are all sitting on the floor. Peter drapes himself across his father Jonathan’s lap, wriggling around while drawing with markers on a pad on the floor. His mother quietly observes. There is a long moment when it feels like nothing is happening. I notice in myself that feeling of not knowing what’s going on, but will myself to tolerate the discomfort of uncertainty.

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Trust: A Book Review

Why is trust vulnerable in America today? Pete Buttigieg asks this question midway through his brilliant new book Trust: America’s Best Chance. In it he lays out a clear, concise, and compelling argument for the urgent need to rebuild trust in order for our country to heal and grow. Not only his extraordinary wisdom but also his unrelenting sense of hope make his voice one we must listen to at this time of unprecedented uncertainty. As a pediatrician and infant mental health specialist I read his book from the perspective of developmental science, with the knowledge that trust has its roots in our earliest relationships starting from birth. What relevance does this knowledge have, I wondered, to Buttigieg’s core thesis? Does it help us to understand why trust is vulnerable? And if so does that knowledge guide us into any specific form of action?

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Through Shame to Belonging: Confronting Racism as Developmental Process

I will never know the experience of a Black person living in a world where people in power condone your murder simply because of the color of your skin. My family wearing a yellow star is the closest I can come to some kind of understanding. But unlike the Holocaust, which was a defined moment in history and is generally well-recognized, today many White people remain largely oblivious to the centuries of brutal violent systemic and structural racism perpetrated on Black Americans.

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Can We Heal Our Country by Listening to Babies and Parents?

We learn to listen by being listened to. Our ability to find our way into another person’s experience begins to develop in our earliest months of life when caregivers naturally respond to our wordless communication. Our ability to listen is enhanced in a setting of connection and communication. Alternatively, our ability to listen can atrophy in an environment that does not model or value listening. When we protect this time to listen to the baby’s unique voice and support parents at this transformative and often disorganizing time, we set babies and families on a healthy path right from the start.


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A Listening Curriculum: School Radically Re-imagined in the Time of COVID-19

The meanings we make of ourselves in the world as hopeful and capable of empathy or, in contrast, as hopeless, fearful, and closed off evolve in countless moment-to-moment interactions. Social emotional learning, for all ages, is the only thing we need to preserve. I propose doing away with all academic curriculum for 6-12 months. All kids will “fall behind” at the same rate, releasing parents from the anxiety that seems to be driving a lot of decision-making.We can replace academic curriculum with what I would call a “listening curriculum.”

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