How People Change

RECIPROCAL INTEREST AND care are wonderful things with regard to good conversations as well as to good relationships. The world of each person is both known and felt by the other. It is hard to imagine a good relationship that does not develop and thrive without good conversations. It is hard to image good conversations that we might have with a person over a period of time that do not lead to a good relationship. There is a strong consensus that the therapeutic relationship is at least as important to the outcome as the specific model of therapy employed (Norcross & Wampold, 2011). There is an equally strong consensus that one of the most important components of a therapeutic relationship—empathy—has a central place in successful treatment outcomes (Elliott, Bohart, Watson, & Greenberg, 2011).

It is next to impossible to separate acts of empathy from acts involved in being with the child in discovering the nature of herself and others in her world (Elliott et al., 2011). Curiosity represents the open and engaged stance of the therapist who, jointly with the child who is coming to trust the process, is in the act of coming to know the child and her experiences of the events of her life. This stance represents the core of the social engagement neurological system that is central in our coming to know ourselves and others (Porges, 2011). The therapist’s curiosity activates the child’s curiosity about her relationships and her life. The therapist is communicating to the child that it is safe—going along with the mind of the therapist—to wonder about shame and doubts as well as pride and joy. The therapist’s curiosity facilitates the child’s integration and development of her reflective mind so that she may begin to make sense of her world and begin to explore its challenges and opportunities (Siegel, 2012). Cozolino states that “children need their parents’ curiosity about them as an avenue of self-discovery” (2006, p. 322). Children in therapy need the same from their therapists.

This chapter specifically focuses on good conversations, relationships, and how curiosity and empathy facilitate the development of both between a child and therapist. When they develop, the therapy leads to significant change for the child, and, possibly to a lesser extent, for the therapist. But this process may be difficult for the child and hence for the therapist. Being known? Many children would rather not be known when they anticipate that the adult will discover that they are lazy, dumb, selfish, or bad. Being cared for? Many children would rather not evoke an emotional response from an adult when they anticipate it is likely to involve anger, disgust, pity, ridicule, indifference, or dislike. So children in therapy often hesitate to have their experience (and their self) be known and felt by the therapist, and so they avoid reciprocal conversations. They distract, ask repetitive questions, remain silent, disagree, and simply don’t listen, again and again.

So what is a therapist to do? Ask repetitive questions? Remain silent? Disagree? Not listen to the child’s expressions, which the therapist thinks aren’t relevant to solving the problem? The therapist might even lecture, though it would be given in mild, therapeutic terminology: “I know you have the ability to work this out if you would just trust me and let yourself get involved with the process.”

If we want a relationship with children, let’s acknowledge that we need to be able to have a conversation with them, not lecture them as to what is best for them nor try to fix them. Let’s acknowledge that this is going to be hard for them to start with, and hard for us too. Most therapists are great at experiencing empathy for children when they express their sad and vulnerable parts. Most therapists are deeply committed to helping children to feel safe and to grow. But how to get into that conversation with children who just don’t know how, or who are too angry or terrified to do so? How can we commit to finding ways to get conversations going?

And we must get conversations going because although we might have some good ideas, we don’t know what is best for a child. We must discover what is best together with the child, within the unique features of his world, and we must do so by joining in his experience of his world. We need to join him with our minds and hearts so that he is known and felt. Will he let us join him in his world? He might, if we openly share our experience of his world; our experience that develops and deepens through our not-knowing stance of curiosity and unconditional empathy. If we want to help children to develop coherent narratives that serve to give direction and organization to their lives, we need to become engaged with them in good conversations. These conversations, also known as affective–reflective dialogues, are central in the treatment of children who have experienced abuse and neglect (Hughes, 2011). Curiosity and empathy are core components of these dialogues.

Not-Knowing Curiosity

Often children who are seen for psychological treatment have weak reflective functioning. This deficit is especially noted in maltreated children where chronic terror and shame greatly impede their ability to wonder about the inner life of either themselves or their parents (Toth, Cicchetti, Macfie, Maughan, & Vanmeenen, 2000). They do not have the habit of noticing their thoughts, feelings, and wishes, and they have even less ability to communicate their inner life to another person. This may be due to their having had parents who were not sufficiently interested in what they thought, felt, or wanted. It may also be due to their core sense of unspeakable shame as to who they are, so they are reluctant to turn their gaze toward qualities that they assume are inadequate, bad, or unlovable. These assumptions limit their curiosity about themselves and cause them to avoid conversations that focus on their thoughts, feelings, or wishes. Too often, when adults try to lead them into such conversations, the adults’ comments involve judgmental questions such as, “WHY did you DO that?”; “WHAT were you THINKING?; “WHAT did you WANT?” Such efforts to understand often assume negative, inadequate reasons to account for the child’s negative behaviors (and even if they don’t, the child is likely to assume that they do). No, the child is not likely to follow that line of questioning. (Asking “why” is not, in itself, judgmental. It is, though, when the tone in which “why” is asked conveys annoyance before the child has a chance to answer. Asking, “I wonder why you did that?” in a tone that is relaxed and rhythmic contains no assumptions, and does not imply that a wrong choice was made.)

For too long, asking questions of children in therapy has been considered intrusive (“He’ll tell us when he’s ready!”) or shaming (“If she can’t answer, she’ll feel that she should be able to”) or developmentally inappropriate (“He was too young to remember” or “Children can’t express their emotions with words—they need to use play”). These assumptions might be valid if the therapist is entering into a conversation with a child that is judgmental and rational with the intention of teaching the child something rather than getting to know her. But that is not the conversation that I am describing here.

Children in therapy may not know the answers to our questions because their reflective functioning may not be well developed. (This reality was made clear to me by my three children, who could answer questions at home that children in therapy, who were years older than them, could not.) Questions in therapy will not evoke shame if there is no judgment made about the child not knowing.

Words alone are not likely to contain much psychological meaning for most children. Words presented in a monotone are even less likely to hold meaning. Words joined with nonverbal expressions involving voice, face, and bodily movements, conveyed with descriptive terms and wondering about their meanings, are another thing entirely! And yes, most children are not likely to tell us about events that happened when they were 2—but they are likely to listen most attentively when we begin a conversation with them about those events in a storytelling manner, so that they become actively engaged with us in co-creating stories of possible meanings of those events. Through this process, we get a gut sense of how those events impact the children today.

Too often, in life if not in therapy, children are told “Use your words” when they do not have the words to use. That three-word injunction could easily become a shaming experience, and the answer is not to give them words to parrot. Nor is the answer simply to assume that they do not have the ability to enter into conversations. That assumption is likely to lead to another assumption that the best approach is to influence them either with behavioral reinforcers or through giving them the opportunity to express themselves only with metaphor. It may be that an important therapeutic goal for children would be to empower them by developing their ability to communicate their inner life with trusted adults and peers. The way to attain such a goal is through engaging these children in therapeutic conversations so that they are able to engage trusted others in similar conversations.

Therapeutic curiosity that is more likely to evoke children’s curiosity about themselves and lead to a reciprocal conversation about their inner world has the following characteristics:

1. No assumptions. No matter how many children have similar histories and similar symptoms, each child is unique and we cannot assume that we know what was the child’s experience of abuse, loss, failure, or conflict. When we are curious about a child’s story, our curiosity truly reflects a state of “not-knowing.” Any guesses are tentative and conveyed only as possibilities, with the child being the only one who knows what her experience might be. If we assume the child has a given experience of an event, we may be restricting the child’s curiosity to the limits of our assumptions about children in given situations, and in doing so, fail to provide her with the opportunity to discover what is uniquely hers.

2. No evaluations. A child’s experience of an event is his best way to make sense of it, given the limitations of his life and relationships. It must never be evaluated as being right or wrong. It simply is. The moment a parent or therapist suggests that a child should not think, feel, or want something, the child is likely to become defensive, have no interest in discovering another way to experience the event, and be less likely to have further conversations about his inner life. The child’s experiences—his inner life of thoughts, feelings, dreams, and intentions—are accepted as they are, truly accepted. Only then will the child begin to openly explore these areas with his therapist and share in the discoveries that he is making.

3. No conversation-induced shame. Many children lose curiosity about their inner life because of their assumptions that what they would discover there is wrong, selfish, bad, or deficient in one way or another. Every experience that the child has needs to be met with acceptance and understanding. This attitude reflects the belief that whatever the content was it was, in her mind, the best or only possible response to the overall situation. When this is clear within the conversation, the child’s mind will greatly expand into new possibilities, no longer restricted by shame.

4. Storytelling voice. When we tell stories, our voices naturally vary in rhythm and intensity as we place emphasis here or there, building suspense and surprise, with our voices attempting to convey an experience of the event being described. Such a storytelling voice also tends to be the best way to engage with another in a personal conversation about the events of each other’s lives. The content of the storytelling conversation is more interesting and engaging, and thus reduces distractions and defensiveness. This voice is the opposite of a serious lecture voice, which, for children (and adults), tends to create distancing and discouragement. When we are truly engaged with co-creating the child’s story—making sense of it together—we will be using this voice. Our engagement will be evident to the child in the subtle and obvious inflections in our tone and rhythm. We will be lively and gentle, excited and subdued as we move through the events of the child’s life and help him to develop a coherent story. Such stories make sense of the child’s life and are created together in a way that reduces shame and fear.

5. Elements of wonder, suspense, and surprise. We need to help the child increase her interest in her own story. We can do this naturally through our own deeply felt fascination with that child’s inner world and through conveying this interest to the child as events are being explored. The child is unique and the therapist is committed to understanding her. The therapist is conveying a wide-eyed desire to know the child, who she is under her problems, and who she was before the traumatic events entered her life.

Case Examples of Curiosity in Conversation

The therapist’s wondering mind gazes both broadly and deeply for the meanings held by the child of the important events of her life. The following example shows what might result when the therapist is able to gently lead a child into wondering about the events of her life and developing an awareness of how she experiences those events. An 11-year-old girl had frequent conflicts with her mother that had been escalating over the past few years. As the child entered into a conversation with the therapist, many themes emerged, with both child and therapist discovering the nature of and reasons for the acute distress that the child felt. These included (grouped according to similar themes):

• “She [Mom] thinks I’m a baby. She doesn’t care what I want. I’m not important to her. She loves my little sister more than me. She’s disappointed in me.”

• “Nothing ever seems to go right for me. I have so many things that I have to do that I never have time for what I want to do. I don’t even know what I want to do anymore. I wish that things weren’t so hard.”

• “Sometimes I think that there’s something wrong with me. I’m stupid. I’m lazy. I’m a loser. I wish I was more like other kids. I’m afraid that I’ll never have any friends. I’ll never amount to anything.”

• “I never realized that I think that my dad loves my little sister more. I guess that I’m lonelier than I thought. Sometimes I think that I hate my sister, and then I think that I’m just awful for feeling that way. It just occurs to me that the worst part is that I don’t think it will ever change.”

As the story develops, co-created by child and therapist, and the child’s mind is wandering over these various themes, some seem to strike a chord whereas others have less felt meaning. The child is sensing, through this conversation with the therapist, that any aspect of her inner life is safe to explore. Her thoughts, feelings, and wishes are not right or wrong. They do not seem too hard for her to be aware of, and they seem to be helping her to feel that things are starting to “make sense.” She feels safe enough in conversation with the therapist to feel vulnerable, rather than to have to hide the experiences that make her feel vulnerable behind anger, distractions, or indifference.

Ideally, after helping the child develop a coherent story that makes sense of her struggles and enables her to experience her sense of vulnerability, the therapist then assists her in communicating this story to her parent or caregiver. But this next step only occurs if the therapist is confident that the parent will respond to the child’s newly developing story with a similar attitude of curiosity and empathy that is conveyed by the therapist. When the therapist has this confidence, the parents are present when the therapist is developing a conversation with their child. Most often, the child quickly senses their open and nonjudgmental attitude and their presence does not interfere with the child’s willingness to co-create a story with the therapist. The therapist will have had one or more prior sessions with the parent to ensure that he or she is willing and able to accept the child’s experiences that reflect the meaning of her behaviors about which the parent is concerned. The parent is assisted in becoming able to respond with curiosity and empathy to her child’s experience before beginning to bring reassurance, information, and/or a nonjudgmental problem-solving mind into the conversation.

When parents or other caregivers are not willing or able to have such conversations with the child, the therapist may need to go forward in individual therapy. This format may well be of considerable value to the child even if his parents are not willing or able to assist him with developing his story, which now contains less fear, shame, or loneliness and an increased sense of hope, confidence, and pride. Part of the value of individual therapy in that instance is for the child to develop a story that makes sense of his parents’ inability or unwillingness to assist him in this process of discovering new qualities about his self and his world. He may develop a new story where the meaning of the family conflicts no longer contain the belief that he is a bad and selfish kid, but rather that the new meanings reflect his parents’ struggles that are indicative of other hardships in their lives, stretch back into their childhoods, or simply reflect the routine challenges and conflicts of family life.

The following case example hopefully demonstrates how a therapist helped a traumatized child to begin the process of developing a new story to make sense of the different type of care that he is receiving in his adoptive home compared to his previous homes. His adoptive parents are actively present to assist him in wondering about the meaning of his place in their family.

Andy, now 8 years old, was adopted at 4, following 2 years of neglect and 2 years in which he lived in five foster homes. He spent many of his days living a story that he organized as well as he could, given the assorted traumas that he experienced. These might primarily be characterized as the trauma of absence. The self that he lived was unremarkable, being special to no one. Periodic efforts to develop significant relationships were met with failure. It dawned on him that he was unlovable, so there was no value in trying. After 4 years of being rejected by their son, his adoptive parents, Arlene and Tom, had difficulty in continuing to try to relate to him. He was not interested in joint activities, cooperating, learning from them, or taking comfort from them.

During the seventh treatment session, Andy’s therapist, Susan, conveyed a sense of sadness that Andy did not seem to trust his parents.

SUSAN: Andy, living with your parents seems to be so hard for you. It seems that you don’t like most of what they do for you or with you. Sometimes it makes me wonder if you don’t like them very much . . . like you wish that you had been adopted by someone else.

ANDY: I do like them! You don’t know me at all! I even love them! I don’t know why I fight with them all the time. I don’t know why.

SUSAN: (with an intensity that conveyed a sense of urgency to understand) What could it be then, Andy? What could it be? It seems sometimes when they set aside time to do things with you that you like, even when they work hard to find out what you might like, you ignore them more! Or don’t talk with them when they try to find out what’s happening.

ANDY: I don’t want them to!

SUSAN: What, Andy, you don’t want them to what?

ANDY: I don’t want them to love me!

(There was a sudden silence. Susan, Arlene, and Tom looked at Andy, and he looked down.)

SUSAN: (very slowly and quietly) Why, Andy . . . why don’t you want them to love you?

ANDY: It’s too scary! I’ll start to want it . . . and it will just go away.

SUSAN: Why will it, Andy, why will it go away?

ANDY: It always does. There must be something wrong with me.

SUSAN:Tell your parents that, Andy, tell them.

ANDY: You’ll change your mind! Someday you’ll get tired of loving me and you’ll just stop.

ARLENE: (with tears) We will never change our mind. We will always love you!

TOM: You are our son, we are your parents, now and always.

For the next several months Andy seemed anxious, trying to be good, trying to please. He seemed to now want his parents’ love, but he still thought he had to earn it. If he let out the ‘unlovable Andy,’ he would only be rejected again, of that he was sure. But there was doubt now . . . and hope. Doubt and hope were allowed in because he had shared something that was so important with his parents about his inner world: his belief that unconditional love could not exist for him and his deepest fear that one day his parents would give up on him. It was a few years before his hope turned to confidence and to a new realization: His parents did love him unconditionally. He was lovable.

Andy’ s experience of self-discovery was a gradual thing, first in his mind, then his heart, and finally settling throughout his body so that he knew it with his heart and soul. During this puzzling, working-it-out time of exploring who he was and what love was while his old and new learnings were coming together in new ways, he was likely to have experienced a great deal of confusion. This period of discovering the new while still living in the shadow of the old is beautifully articulated by the author Marilynne Robinson in her book Lila. Following an extremely hard childhood, the protagonist, Lila, marries a man who offers her unconditional love. After several years of marriage, Lila says to her husband: “I guess there’s something the matter with me, old man. I can’t love you as much as I love you. I can’t feel as happy as I am.”

Unconditional Empathy

Often, children who are seen for psychological treatment have developed a life of self-reliance, which restricts their range of emotional connections with others. Avoiding conversations about their inner lives, they feel alone and lonely. They avoid emotions of vulnerability—sadness, fears, doubts, and shame—because these feelings are painful, especially when they are felt alone. When they rely on someone, they feel vulnerable, so best not to rely on anyone.

If therapy is to assist these children to begin to rely on someone else, it will have to convince them that it is safe to be sad. This sense of safety will only develop when the children realize that they will not be alone in their vulnerability. The therapist’s unconditional empathy helps children feel safe, knowing that if they share their distress with their therapist, they will no longer have to carry it alone. They might be able to experience life without continuous sadness and fear.

Therapeutic empathy that is likely to evoke children’s empathy for themselves, leading to compassion and self-acceptance, is likely to have the following characteristics:

1. It is an end in itself, not a means to an end. Empathy is seen as a central component of the child’s treatment, not a technique that is done to the child in order to make the later problem solving more effective. It is a way of being with the child that is expressed, not something that you give to him.

2. It involves both observing and participating in the child’s world. Empathy involves being fully open to the world of the child and experiencing it along with the child. The therapist is not a detached observer, but rather is experiencing the child—alongside her—through whatever events the child is experiencing.

3. It involves being touched by the child and his world. The child and his world have an impact on the therapist, and this impact, in turn, has a greater impact on the child than if the therapist simply understood the child’s world. This is the nature of intersubjectivity, in which being together becomes a joint experience that has an influence on both child and therapist. If the therapist is a detached observer of the child’s experience, the child’s experience becomes diminished—it is not significant enough to truly affect the therapist.

4. Empathy involves being able to remain emotionally strong and present in the child’s pain. The therapist needs to be able to remain emotionally present while the child explores her pain or she will avoid experiencing it further. If it seems to be too much for the therapist to contain, then most likely the child will think it is more frightening or shameful than she had previously imagined. Empathy involves being able to remain in the child’s pain as long as it is being experienced by the child. The therapist is not working to pull the child out of the distress, but rather to stay with him while he is in it, walking with him out of it when he is ready. The therapist needs to be able to assess if the child’s experience of his pain is being regulated and remains therapeutic, and then remain with the child in the experience as long as it seems to remain important and integrative to the child. The therapist needs to closely observe the child’s nonverbal expressions to determine if the level and nature of the distress are continuing to be therapeutic.

5. Empathy is conveyed primarily nonverbally (bodily) with facial expressions, voice prosody, and movement. While the empathic words convey understanding, the nonverbal expressions enable the child to experience the therapist as also experiencing the event being explored.

6. Empathy is unconditional. The therapist does not experience and communicate empathy for a child only when the therapist thinks that the child’s distress could not have been avoided and that it matches the seriousness of the event. When the child is in distress, the therapist experiences empathy, with no strings attached. Later, with nonjudgmental curiosity, the therapist might wonder with the child about the nature of the distress and if it might be changed. With curiosity, the therapist is wondering about the child’s experience, and with empathy the therapist is experiencing it with the child. In neither case is the therapist judging it.

Case Examples of Unconditional Empathy

In the following excerpt of a session between a child and her mother, the power of empathy to start the process of creating new meanings is evident. This excerpt also demonstrates how the therapist may instruct the parent in experiencing and communicating empathy for her child, without reducing the impact of the parent’s empathy for her child. Of course, the therapist needs to first establish a trusting relationship with the parent to prevent the parent from becoming defensive.

Sarah, 12 years old, was finding middle school to be a challenge—a big challenge. Sarah had done well in her first 6 years of school, both academically and socially—so well, in fact, that that her relatives were comparing her to her mother, Rachel, who had been a high-achieving student, along with being popular and athletic throughout all of her childhood and adolescence. Currently, however, Sarah was not only falling behind in her studies but she also was increasingly reluctant to go to school. Efforts from her parents to talk with her about this problem were met with further withdrawal and anger. She seemed to need to deal with whatever troubles she was having on her own and she was not doing very well.

When Rachel and Sarah met with Jon, a therapist who specialized in family therapy, Sarah was not very verbal or cooperative. Jon had spoken with Rachel and Sarah’s dad, Dave, the week before, and had a general sense of Sarah’s history and recent troubles. Initially, Jon spoke about Sarah’s interest in soccer and her recent acceptance onto the school team. Sarah responded briefly, then seemed to catch herself becoming more open than she intended to be, and she spoke with annoyance.

SARAH: Why don’t you just say it—I’m a loser! I’m not doing well, and Mom wants you to fix me!

JON: Oh, Sarah, I’m sorry if you think that you’re here for me to fix you. That would not be something you’d want. No one wants to be fixed!

SARAH: Then why am I here? I didn’t want to come!

JON: Because you seem to be unhappy and your mom was hoping that I could help you, and her, to figure out what was going on for you. I want to understand you, not fix you.

SARAH: Maybe you do, but she doesn’t! She wants me to be perfect! She’s never satisfied with how I do!

RACHEL: That’s not true, Sarah, there’s much that you do that I could not be more pleased about.

JON: I wonder, Rachel, if you would be OK just understanding Sarah’s experience and supporting her in whatever feelings she’s having, before giving your view of things. That’s what I meant last week when I spoke with you about the importance of empathy. She just said something very important, and now she needs us to get what she is feeling, not reassure her. (turning toward Sarah) If you think that your mom wants you to be perfect, that would be hard for you!

SARAH: She does! Sometimes I feel that she wishes she had a different daughter! That she’s disappointed in me!

JON: Would you tell your mom that, Sarah. And Rachel, would you just tell your daughter you understand how hard it would be for her if she thought that.

SARAH: You are, Mom! You are disappointed in me because I’m not like you! I’m not as good as you were!

RACHEL: Oh, honey. I’m so sorry if you think that! If you think that I’m disappointed in who you are! I’m very sorry if I’ve done something to make you think that. I’m not disappointed in you at all.

SARAH: What do you think then, Mom? I’m messing up a lot! I can’t get anything right and no one thinks I’m any good. And I don’t either.

RACHEL: I know it’s hard now, honey, I know it’s hard. We’ll get through this together. We’ll make sense of it and we’ll work it out. I love you now as much as ever.

SARAH: You do?

RACHEL: Yes, I do. (Rachel now moved over on the couch and held her crying daughter in her arms, rocked her back and forth. Soothing sounds from her mother matched Sarah’s cries.)

Over the next few weeks, Sarah realized that she could talk about her struggles at school with her mom and that her mom was not disappointed or annoyed with her. Her mom gave her comfort, helping her to get through the hard times, and within 2 months, Sarah had discovered herself at school again. She was less wobbled by the differences and the new challenges and was able to enjoy school and learning once more, struggles and all. She did not have to be perfect, safe in the knowledge that her mother’s love for her did not change regardless of whether or not she was successful.

Empathy for the child in pain is central in treatment regardless of the severity of the child’s problems or the traumatic experiences that led to the problems. Experiencing the pain with the child reduces the child’s experience of the pain. Pain shared is pain reduced by half, or maybe more. Once that occurs, whatever challenges remain tend to be smaller and the way forward clearer.

In the following excerpt, the transforming power of empathy to reduce a child’s sense of shame is demonstrated. Shame often is a central contributor to a child’s inability to construct a new story of his life.

Carl was 7 years old, adopted at age 3, after severe neglect while living with his parents. He was particularly aggressive toward his adoptive mother, and he would take food whenever he was not being supervised and gorge himself if he could. He lied intensely when any of his challenging behaviors were addressed. His pervasive sense of shame made it very difficult for him to face anything wrong that he had done.

The therapist was able to evoke a strong emotional engagement with Carl in his story first through animation and then gentleness as he explored what he knew to have been the reality of Carl’s early years. Carl appeared very sad when he heard the therapist’s deeply moving description of how lonely he must have been when he was home alone for hours and how he most likely felt that no one thought of him or cared for him. The therapist then made a connection between the loneliness during his years of neglect and how alone he feels when his adoptive parents scold him for doing something wrong:

THERAPIST: Oh, Carl, how hard that would be when your parents are correcting you for your behavior. Your brain knows that they love you, but, when you do something wrong, your heart probably does not feel it! (Carl looked very sad and nodded his agreement.) Tell your mom, Carl. Tell her that what I said was right. (Carl said that it was right and then he fell into his mom’s arms and she held him and rocked him.)

THERAPIST: (continuing and a pause) Now, Carl, I’d like to see if you could feel your mom’s love another way. Would you look into her eyes for a few seconds? (Carl sat in his mom’s lap and looked into her eyes. Then he burst into tears and held his mom tightly.) Oh, Carl, what did you feel when you looked into your mom’s eyes. What did you feel?

CARL: My mom loves me no matter what! (They continued to rock, with Mom’s arms around Carl and her tears joining his.)

This was the beginning of a long journey toward trust and self-worth for Carl, with the strong, accepting presence of his adoptive parents. This conversation enabled Carl to experience the shame that he felt whenever his parents corrected his behavior. He was able to experience how this threat to his relationship awoke his prior sense of being unlovable when he was being neglected. This awareness led him to recognize that although he knew that his parents loved him, he did not feel it when they corrected him. This awareness, emerging from the experience of both curiosity and empathy over his story, enabled him to experience the restorative power of being comforted by his adoptive mother.

The Dynamic Story: Weaving Together Curiosity and Empathy

Children who are seen in therapy are often likely to have a fragmented and disorganized story that lacks coherence because of frightening and shameful emotions associated with many of the events of their developing lives. Their story is not coherent because many of the events that they have encountered are terrifying and shameful. These events remain terrifying and shameful because they lack the restorative meaning that would make them coherent. It is not enough to prevent the events in the child’s life that have been traumatic from recurring. It is necessary to revisit those events with curiosity, while regulating the associated emotions with empathy. These are interwoven processes. Curiosity is limited without empathy, and empathy will not lead to new possibilities without curiosity.

However, curiosity and empathy do not exist as techniques, whether separately or interwoven. They are words that reflect our intentions to understand and be with the children we treat. We need to communicate our intentions within conversations that will engage these children so that they invite us into their world. Yes, we must become invited guests who help these children discover who they are once the cover of shame and fear are lifted from the stressful events of their lives.

Our conversations with the children we treat have the components of good stories, filled with suspense and surprise, moments of fear, and struggles to heal and grow. We communicate both our not-knowing curiosity and our unconditional empathy through the rhythms of our voice, the expressions of our face, and the movements of our hands and arms. All of these bodily expressions show vividly that we are experiencing their world with them and, most importantly, that our experience of their world is safe and accepting—completely accepting—without shame and fear. Being with them, our experience of their world will help them to re-experience the events of their past. The presence of our minds and hearts within their world will enable them to re-experience their world in a manner in which they are able to accept, reflect upon, and have compassion for themselves as they discover new ways to understand and resolve the various obstacles of their life.

When we have good conversations with children, we are not simply sharing stories but co-creating them. We are entering the child’s world and using our minds and hearts to assist the child in developing her story so that it is safer and more coherent. We are assisting her in developing a story that involves more pride and less shame, more joy and less fear, more confidence and less doubt. We are assisting her to develop a greater sense of acceptance of her story—and herself—while at the same time having the confidence to develop abilities that are needed for new meanings to be discovered.

When we have good conversations with a child, we are providing his inner world with a companion whose curiosity opens the way toward greater reflection and whose empathic presence provides safety for any emotions that result. With curiosity we are co-creating the child’s story and with empathy, we are co-regulating any emotion that is emerging.

References

Cozolino, L. (2006). The neuroscience of human relationships: Attachment and the developing social brain. New York, NY: Norton.

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