Cultural Humility as Listening: The Power of Not Knowing

As a physician in training, I learned the concept “cultural competence.” The term suggested that by acquiring knowledge and information we could become experts in people different from ourselves. The current term “cultural humility” reflects a kind of humbleness of not knowing; a necessary time when we feel awkward and uneasy.

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Celebrating Pediatricians’ Embrace of Early Relational Health

The Frameworks Institute (that also developed the term “toxic stress”) wrote in a recent report: “Early relational health, although a new term, does not designate a new field nor a series of new discoveries. In fact, early relational health builds upon decades of research from the fields of child development, infant mental health and neurodevelopment that has established the centrality of relationships between caregivers and very young children for future health, development and social-emotional wellbeing.”

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A Child’s Joy in Growing Up: A View from the Pandemic

Typically, the process of separation of child from parent takes place both gradually and relentlessly. The pandemic put a long pause on this natural progression. As we begin to resume “normal” life many will manage re-entry without significant difficulty and get back on track. But for those with a variety of vulnerabilities, the expanse of time to live in the ambivalence may lead to developmental derailment. Whether 2, 12, or 20 these children and their families will need an extra dose of listening and support to find their way forward.

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Creating Space to Discover a Baby’s Intentions

In a fascinating book Becoming Human, research psychologist Michael Tomasello sees the ability to recognize each other’s intentions as central to our humanness. He proposes that “the ontogeny of human cognitive and social uniqueness is structured by the maturation of children’s capacity for shared intentionality.” To highlight the significance of the process he writes: “Social Bonding via the sharing of emotions, attention, actions and attitudes is an evolutionarily novel phenomenon: individuals feel closer to others as they share experiences with them. This is foundational to virtually all forms of uniquely human cooperation and shred intentionality.” He names the age of nine months, when this behavior first becomes easily observable, the “birth of shared intentionality.”

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Sensory and Emotional Experience: Linked from Birth

Recently in my role as faculty with the University of Massachusetts Boston Infant-Parent Mental Health Program I had the privilege to learn from Erna Blanche, a leader in the field of occupational therapy who trained with Jean Ayres, the mother of sensory processing theory and sensory integration therapy. She described the connection of movement with many different sensations: body position, internal workings of our bodies (interoception), and even the pull of gravity. A number of the fellows, who come from a wide variety of disciplines and from all over the world, expressed a wish to “be an OT in another life.” Since I first became aware in my journey from pediatrician to infant-parent mental health specialist of the depth and breadth of knowledge in the field, I too have had the same thought.

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What Babies Can Teach Us About Repairing the World

Recently I was asked to give a presentation for an audience of early childhood educators about the Adverse Childhood Experiences (ACE) Study. I jumped at the opportunity to frame this powerful research linking early adversity with long-term health consequences into a message of both hope and action. Thus I was particularly pleased to receive an email from an audience member with the following message: “Thank you for your work, the workshop left me with hope. It makes me think of tikkun olam.” I looked up this familiar phrase from Judaism to find its exact meaning: “World Repair.”

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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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