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CHAPTER 4

A Caregiving Formula

Playfulness, Acceptance, Curiosity, Empathy (PACE)

We have emphasized throughout this book that the parenting brain is designed to create an ongoing, open, reciprocally enjoyable relationship between parent and child, a heart-to-heart connection that goes far beyond managing the child’s behavior. The five domains of parenting (approach, reward, child reading, meaning making, and executive), working in concert, foster a social engagement to facilitate the child’s development by creating a deeply meaningful parent–child relationship. While this is all well and good, how does the science play out in real life? What are the characteristics of this open, engaged relationship that the parent can intentionally, mindfully bring to it? We’ll take a closer look at these specific characteristics in this chapter.

Intersubjectivity is the term used by many theorists and researchers to refer to the reciprocal relationship between a parent and child. Within this mind-to-mind intersubjective rapport, both the parent and child are open to one another, receptive to and sharing each other’s experience of self, other, and the world. Each accepts the influence of the other in the here and now. For example, when a father experiences his son’s courage in handling a bully, the son is likely to become more aware of his courage by experiencing this aspect of himself through the mind and heart of his father. When the son responds to his father’s experience of him with increased self-confidence and pride, the father, in turn, is likely to experience a renewed sense of satisfaction and competence himself. When a mother and her infant feel mutual joy in each other’s presence, the infant experiences him- or herself as capable of eliciting Mom’s joy, and the mother experiences herself as capable of eliciting her infant’s joy. Through such reciprocal moments, each person becomes safely and deeply engaged with the other. The parent is better able to have a positive influence on her child’s development and, in so doing, is positively influenced by the child’s response (Hughes, 2006).

What can weaken these moments of healthy reciprocity? A need for self-protection and defensiveness. When either the parent or child shifts from openness to defense—often as a way to maintain psychological safety in the face of perceived evaluation by the other—the other is at risk of making a similar shift, and thereby jeopardizing the healthy reciprocal rapport. Mutual defensiveness moves parents and children away from intersubjective experience and joint influence and into a desire to gain control of the situation. To use Dan Siegel’s language, there is a shift from a “we” interaction to a “me” versus “you” interaction (Siegel, 2010). But if parents can use their executive power to stay regulated and “parental,” suppressing their own natural tendency to shift into defense in reaction to their child’s defensiveness, then the child is less likely to linger in a defensive state of mind. Parents’ ability to stay engaged and open helps the child recover faster from states of extreme emotion, distractible thoughts, and impulsive behaviors, and this recovery process helps to build the child’s resilience and emotional competence at the same time that it strengthens his or her trust in the parents’ ability to keep the relationship emotionally safe.

Parents, even those with blocked care, can improve their ability to stay parental, regulate their internal states, and promote intersubjectivity in their relationship with their children. In this chapter we present four key components of this process—playfulness, acceptance, curiosity, and empathy—and use the acronym PACE to refer to them as a unit. All four of these core components of intersubjectivity can be linked to one or more of the brain-based caregiving domains. The idea here is that through experiencing and practicing the processes of PACE, you can, in turn, strengthen your parental brain power.

Playfulness targets the components of intersubjectivity that mostly involve the Parental Approach and Reward Systems. Acceptance, a nonjudgmental attitude, also supports the approach system by helping to promote interpersonal safety and maintaining the parent’s and child’s mutual feeling of trust and connection. The nonjudgmental stance is made possible by the smart vagal system, the brain–heart circuit that forms the bedrock of open parenting. Curiosity links most directly to the child-reading and meaning-making systems, and empathy promotes the integration of all of the systems, connecting parental emotions with parental reflection and mindfulness. The four components of PACE function in an integrative manner, with considerable overlap, so that examples of one will often also involve qualities of the other three.

PACE applies equally to the parent–child relationship and to the therapist–parent relationship. The open and engaged stance that is crucial for effective parenting is just as vital to a strong therapeutic relationship. Without this openness, there can be no real trust and connection. At home, if a child approaches the parent in a defensive stance and the parent responds in an open, empathic, accepting way—that is, with PACE—the child will feel safer and the distress is more likely to diminish. In the therapist’s office, if a parent approaches the therapist in a defensive stance and the therapist responds from a position of open acceptance of the parent’s distress, the parent’s defensiveness diminishes and he or she is more likely to be open to explore the problems that he or she is having with his or her child. Let’s explore the components of PACE separately, looking at how they work in the parent–child relationship first, and then we’ll give some examples for how they can play out in therapy.

Playfulness

Playfulness is a frequent reciprocal attitude that occurs between the parent and child. It represents the moment-to-moment, fully engaged interactions involving facial expressions, eye contact, voice prosody and rhythm, gestures, postures, and touch. Within this fully present intersubjective space, both parent and child experience deep joy, pleasure, and fascination with the other and with the shared activity.

It is not hard to see how playfulness engages the approach and reward systems of parents’ brains. Indeed, playful interactions are known to stimulate the production of both opioids and dopamine, powerful chemicals that help to suppress pain and distress and promote feelings of enjoyment and pleasure (Panksepp, 1998, 2004). What an excellent prescription for helping a parent with blocked care begin to shift out of his or her defensive state and begin to experience some hope that things could be better! Blocked care is a stress-based condition, and stress suppresses playfulness in both animals and humans. Stress hormones literally block oxytocin and dopamine, the key brain chemicals for activating parents’ approach and reward systems. Playfulness is potentially a “stress buster” that can reawaken these essential parenting processes. In a playful state, with the help of oxytocin, defenses are inhibited and there is little desire to pull away and withdraw from the interaction. The pleasure associated with being playful together taps the power of the reward system in both parent and child, generating a desire to spend more time together. Parenting your child within this enjoyable, reciprocal state is not a chore but a delight.

Play is also known to activate the higher regions of the brain, enhancing cognitive functioning (Panksepp, 2004; Pellis & Pellis, 2006). Because the dopamine that is stimulated by play enters the prefrontal regions, play enhances executive functions as well as the core approach and reward systems in both parent and child. Keeping playful interactions “alive” and fun actually requires a lot of attention to the play partner’s nonverbal communication and the ability to make rapid adjustments in response to these cues, while also regulating emotional intensity to stay in the “right frequency” for sustaining this pleasurable connection. Panksepp and Burgdorf (2000) have shown, for example, that rats actually use a particular frequency of vocalizing to keep their play going with each other. Shifts in this frequency, much like changes in prosody in humans, can bring play to a halt instantly, along with a shift into freeze mode of mobilized defense.

In short, free play is actually a very creative process requiring a lot of people-reading and emotion regulation skills, a lot of “emotional intelligence.” When playfulness is suppressed in a parent–child relationship, both parent and child are robbed of one of the most powerful processes for strengthening their connection and both partners’ brains. The ability to play with a child strengthens the parent’s ability to handle the unplayful aspects of the relationship—those interactions that require high levels of parental tolerance, patience, and self-control. The creative use of play by Eliana Gil (2006) to promote healing from trauma is a testament to the serious power of playfulness. Play, then, has the potential to strengthen a parent’s approach, reward, child-reading, meaning-making, and executive systems, enhancing the integration of parental brain systems.

As playfulness emerges, it is characterized by:

1. An air of lightness, with a sense of relaxed, reciprocal enjoyment.

2. A sense of hope and increased confidence about the future.

3. A sense of unconditional acceptance of the other, regardless of any differences.

4. An awakening of the positive side of life, to offer a balance to the negative that characterizes their difficulties.

5. A reduction of shame for both.

6. An increased sense of trust and safety.

7. A confidence that one is liked by the other.

8. An increase in caregiving (and reduction of blocked care) for the parent and attachment behaviors for the child.

A central feature of playfulness is the sense of openness to possibility that it generates: Play can generate hope. The current situation, no matter how stressful it might be, is experienced as only one aspect of the overall relationship and the ongoing characteristics of the child’s development. The lightness of play enables both parent and child to keep the current situation in perspective, and it facilitates an attitude of reflection. In this way, playfulness fosters the very sense of lightness that is conveyed in writings about mindfulness.

This playful attitude is most evident in the parent–infant relationship. But it is just as important—and is definitely attainable—in the parent’s relationship with the older child. When playfulness is embedded into the ongoing parent–child relationship, it instills both parent and child with greater confidence about the depth and meaning of the relationship. Playfulness makes it clear implicitly, without words, that any conflict is manageable when experienced in the context of a robust, supportive relationship.

Example: Molly (the mother) has just told her 4-year-old son Ben that they cannot play outside any longer because it is time to get lunch ready. In anger, Ben shouts, “I don’t love you!” This dialogue followed:

Molly: Oh, Ben, you are very angry with me!
Ben: And I don’t love you!
Molly: Are you sure about that, Ben? Let me check. (Molly bends down and touches Ben behind the ears, under his chin, his knees and elbows.) Yes, Ben, your love for me is still in all those places on your body where it stays when you are angry with me. See, check out my ears. My love for you is still there when you are angry. And so is yours!
Ben: I don’t see your love.
Molly: Oh, Ben, because you don’t have Mama eyes, you can’t see it. But you can hear it, here (pulling him close)—put you ear on my chest. You will hear my heart beating. My heart is beating now in a happy way because of my love for you.
Ben: It doesn’t sound happy.
Molly: You can’t hear its happiness? Must be too noisy outside. After lunch we’ll snuggle on the couch, and it will be quiet and you will be able to tell that my heart is happy because of my love for you. You will hear it then.

Here playfulness immediately followed empathy for her son’s distress and proved to be a gentle and light way of assisting him in managing his anger. It is important not to confuse playfulness with sarcasm nor to laugh or joke in response to a child’s anger, which would dismiss the experience as not worth acknowledging or taking seriously. In this example Molly first acknowledged Ben’s anger before moving into a lighter exchange over his denying that he loved her. In the next example the father first relates to his 12-year-old daughter’s complaint with acceptance, curiosity and empathy, and only after she has been heard fully does he gently lead the relationship back to its foundations with the help of playfulness.

Stan: I’m really glad that you took the time to let me know that this was bothering you, Jenny. I thought something was on your mind and now I’m confident that we can work it out.
Jenny: I figured you didn’t know how important it was for me to be able to see Sue this weekend. Now you know.
Stan: I do. And I think you know why I want you to come with us to Gran’s house this weekend.
Jenny: I guess I do.
Stan: I should have approached you about it, but I dropped the ball. So thanks.
Jenny: I learned years ago that you’re not perfect, Dad.
Stan: Not perfect but I’ve raised one great kid.
Jenny: Mostly because you have a great kid who doesn’t need much help.
Stan: Mostly she doesn’t need much help now because I did such a great job for 12 years.
Jenny: So now you’re taking it easy?
Stan: Now, we’re in a transition stage. Next, you’ll be helping me put my socks on.
Jenny: OK. I’ll do that for 12 years and then you’re on your own. That’s fair.

As playfulness begins to make its presence felt in the parent–child relationship, it helps to maintain the sense of safety for both parent and child. Its lightness and laughter convey confidence that the relationship is much stronger than are any conflicts.

How Playfulness Works in Therapy

When parents first see a therapist about problems they are having with their child, it’s often hard for them to become immediately engaged in safely discussing their concerns. Feelings of discouragement, fear, anger, and shame may be on the surface. All of these emotional states are likely to lead a parent into a defensive state wherein a therapist’s routine questions and suggestions may be experienced as critical judgments about the parent’s caregiving behaviors. The open, reciprocal enjoyment and fascination that we just discussed in the parent–child relationship are not likely to be immediately present in the parent–therapist relationship. The therapist is wise not to try to force playfulness by minimizing the parent’s negative emotional state, nor by telling jokes or pointing out the “silver lining.” Early in the relationship it is wise for the therapist to stress the other three components of PACE and allow playfulness to gradually come alive once the parent’s need for full acceptance, understanding, and empathy have been met. Playfulness needs to emerge naturally within the relationship as the parent’s sense of safety with the therapist develops. In some sessions playfulness may never present itself. For this reason we sometimes speak of pACE (lower-case p) to indicate the prominence of the other three features, which are always present to some extent, whereas playfulness might not be. When playfulness does emerge, the parent is likely to be open and receptive to the therapist’s perspective and suggestions regarding the parent’s relationship with his or her child.

The following dialogue occurred in a parent’s fourth session with his therapist. During the first three sessions, the parent, Robert, expressed a great deal of anger and discouragement over the many problems that exist in his relationship with his 13-year-old son Luke. On a number of occasions Robert expressed criticism toward the therapist, Cindy, for seeming to blame him for the conflicts with Luke. He had expressed the belief that Cindy really did not appreciate how hard he had worked to be a good father for his son. As Robert gradually entered the state of safe, social engagement in the session, the supportive and integrative role of playfulness gradually emerged.

Parent: So do you know what that little turkey said after all that I did for him to make it possible for him to attend the concert? He told me that he really didn’t want to go very much but he was going because of all the work I put into it.
Therapist: Like he’s going to the concert for you and not for himself! Why do you think he said that?
Parent: I don’t know. Maybe the teenage way of saying “thanks”?
Therapist: Teenage, combined with masculine?
Parent: You’re not saying anything about men and their lack of emotions or gratitude, are you?
Therapist: Certainly not older-than-teenager men!
Parent: Yeah, like my generation were so much better with feelings than males are now!
Therapist: Yes, I think that men have come quite a long way in handling and communicating about emotional things in their lives. I don’t imagine that your father would have come to see a therapist if you and he had struggles like you do with Luke.
Parent: Believe me, if I challenged my father like Luke challenges me, I would have struggled a great deal. Not my father.

(Therapist and parent now engage in a long discussion regarding the parent’s difficulties with his father and how he wants more in his relationship with his son. This dialogue ends with this playful exchange.)

Parent: Don’t tell me that you are going to push me into that touchy-feely stuff with Luke.
Therapist: No, just enable your feminine side to naturally express itself.
Parent: Great! I got a feminine side now!
Therapist: OK, that may have been unfair. How about if we call it your affectionate side? Your caring side? Your love-for-your-son side?
Parent: Yeah, that’s better. Just don’t tell me to hug him in front of you.
Therapist: I’ll turn my back.
Parent: You might have a long wait.
Therapist: Or not.
Parent: Yeah, just don’t push it.
Therapist: I won’t. I’ll only nudge it a bit if I am sure that you are both feeling it. I would have to be sure that it would be successful.
Parent: I would like that.

As was true with playfulness in the parent–child relationship, it is also true in the therapist–parent relationship that playfulness conveys a sense of lightness, optimism, and confidence that whatever problems are being explored will be managed and the relationship will not be harmed.

Acceptance

When parents are with their infant, they tend to be unconditionally in love with him or her, accepting the baby as he or she is, with no strings attached. Parents do not evaluate the rightness or wrongness of their baby’s behavior or judge him or her to be “good” or “bad.” Evaluation exists only in so far as parents must determine the infant’s immediate needs for nourishment, sleep, a diaper change, etc. Parents’ primary attitude toward their infant is one of acceptance, not evaluation.

When infants—and later, children—experience acceptance from their parents they are likely to feel free to give expression to their feelings and desires, thoughts and perceptions, intentions and memories, safe in the knowledge that they will not be evaluated for aspects of their inner lives. As children mature, parents begin to evaluate their behavior, guiding and directing them toward engaging in behaviors that are safe and in the best interest of them (as children or adolescents) and others. Within the context of acceptance, this evaluation is purely behavioral and does not place either the relationships or the children in any psychological risk. Acceptance of children enables behavioral discipline to have an important, but limited, role in their development. The relationships with parents—the source of safety and intersubjective learning about self, other, and the world—remain the dominant influence that parents have on their children’s development.

In this relational context, correction (i.e., discipline) is linked with connection, helping both parents and children to know that their relationships stay strong even when parents need to set limits and be firm. In a deeply accepting relationship, when the inevitable parent–child tensions arise, the relationship bends rather than breaks. Although there is inevitable misattunement (Tronick, 2007), the misattunement does not trigger intense fears of abandonment and rejection in a healthy parent–child relationship. Indeed, the relationship draws strength from both parties experiencing the natural cycle of attunement, misattunement, and repair (Siegel, 2005).

The important role of acceptance in children’s development and in parent–child relationships is supported by Porges’s (2011) polyvagal theory of neurological development, which we first explained in Chapter 1. Acceptance—seen as central to the experience of mindfulness—is facilitated through the activation of the smart vagal system, the brain–heart connections that promote openness, empathic listening, and attunement. As described in Chapter 1, this circuit involves connections between …

• The heart

• The anterior insula (the “visceral brain)

• The anterior cingulate cortex (that vital brain bridge, which reptiles don’t have, that is so important for caring)

• The orbitofrontal cortex (that region of the prefrontal cortex vital to attachment-based learning)

• The medial prefrontal cortex (that region in the very front of our brains that we use for “self–other awareness,” a region much expanded in comparison to our primate relatives)

This is the brain–heart circuitry that we use when are making a concerted effort to deeply understand another person’s experience rather than judge him or her while planning our rebuttal. It is also the brain circuitry that has recently been shown by Michael Posner’s group to be strengthened by certain kinds of practices that emphasize a focus on nonjudgmental attentiveness and empathy (Tang et al., 2010). Acceptance, then, facilitates the kind of nonjudgmental awareness that is crucial for the robust functioning of the Child-Reading and Meaning-Making Systems and for promoting mindful parenting.

When infants are in the open and alert state of consciousness—in their smart vagal state—they are open and receptive to their experience of the world and especially to their interaction with their parents. Infants’ welcoming attitudes toward their experience of the world are present when they feel safe and have good “vagal tone.” They are deeply interested in being engaged in the social world as experienced in their interactions with their parents.

Even as the smart vagal complex links parents’ brains and hearts, promoting calmness and well-being, parents’ acceptance of children links the children’s vagal systems with the parents’, promoting the development of the children’s social engagement system, their heart–brain connections. This interpersonal, “intervagal” process, supported by the parents’ capacity to stay engaged and accepting, enables parents to hold their children in their minds, hearts, and bodies with tenderness, awareness, and a deep sense of connectedness.

When children’s lower vagal system—as opposed to the upper, smart vagal system—is activated, they lose connection with their parents, entering into a shutdown state. This defensive posture is thought by Porges (2011) to be frequently activated when children experience shame, when they feel judged and invalidated. This process of shutting down in shame is a growth-suppressing one that can promote a dissociative style of self-defense, creating a risk for later problems with intimacy and with parenting (Schore, 1994).

When parents experience acute or chronic conflict with their children, their overall experience of the parent–child relationship inevitably turns toward the children’s behavior, and acceptance, along with playfulness, tend to be minimal. Parents then tend to become increasingly focused on behavioral problems, evaluating their children and communicating their displeasure regarding their behavior as well as the consequences that they deem necessary. At the same time, parents are likely to experience their children as evaluating them, being angry with them or disappointed in them as their parents. Both parents and children have moved unintentionally into a defensive posture with each other in which the capacity for caring about each other is suppressed, blocked. Neither is open to the experience of the other. The children are likely to rely on anger, defiance, or avoidant behaviors to try to influence their parents or minimize their influence in their (children’s) lives. Parents are likely also to rely on anger, which can wrongly be used as a weapon parents come to depend on when they are actually feeling powerless. As issues of power and control become more important in these relationships than connection, discipline loses its meaning and effectiveness, becoming a battleground, an end in itself, isolated from concerns about the quality of the relationships. This kind of discipline is ineffectual over time, generating unwanted side effects such as submissiveness, withdrawal, secretiveness, or explicit acts of anger and defiance. One of the greatest challenges of parenting is blending limit setting with empathy, using discipline in the spirit of teaching, while keeping the parent–child relationship safe and intact. When parents are able to “correct in connection,” they give their children wonderful opportunities to practice emotion regulation and, when appropriate, negotiation.

Example: Nancy (the mother) had just asked her 11-year-old daughter Tracy to put the laundry away before calling her friend. Tracy screamed at her mother and ran out of the room. Nancy then went to her daughter’s room to discuss the incident with her.

Mom: You expressed a lot of anger at me, Tracy. What’s up?
Daughter: You never seem to give me a break. It’s always that I have to do what you want! What you want is more important than what I want!
Mom: So it seems to you that I’m always thinking of something that you should do for me and not just letting you do things that you want to do!
Daughter: Yeah! If not the laundry then the dishes, or the vacuuming, or watching my little brother, or … whatever. It’s always a …
Mom: Like I forget that you’re a kid! That I’m not interested in what you want. Only what you can do for me.
Daughter: That’s how it seems to me, Mom!
Mom: Then I can understand why you got angry with me—if you think that I only think of you when I want your help, and when your helping me seems to you to be my main interest in you—not what will make you happy.
Daughter: It does seem that way, Mom—sometimes, anyway. Today I just had a really hard day at school.
Mom: Tell me about it. (Tracy then gives a detailed account of some problems that she encountered at school.) So you have had a hard day.
Daughter: Yeah, Mom, I have … but I guess I shouldn’t have taken it out on you. I’m sorry.
Mom: Thanks, sweetie, for telling me what is going on.
Daughter: Sure, Mom, but I really want to talk with my friend about it. So how about if we stop talking so I can do the laundry now.

Here, by looking beyond her daughter’s outburst and trying to determine the underlying feelings or emotions that led to it, the mother discovers what’s on her child’s mind, becoming more accepting in the process.

How Acceptance Works in Therapy

When parents enter the therapist’s office due to ongoing problems with their children they may be experiencing blocked care toward their children. Relationship stress caused by behavioral problems tends to greatly reduce the activation of the five domains of the brain so central to providing ongoing care. Although they still may be able to engage their executive system in their interactions with their children, their ability to be with them and to enjoy the interaction—while being interested in them and their experience—is likely to be diminished. Parents’ sense of the meaning of caregiving tends to move from the positive to the negative. Their evaluation of their children also tends toward a negative perspective of their motives, values, thoughts, and feelings. At the same time, they are likely to have developed a negative perception of themselves as parents. This perception places them at risk for an ongoing sense of shame and defensiveness. All of this may lead parents to assume that the therapist will be critical of them, and the parents may perhaps have one or more of the following thoughts:

“He [the therapist] thinks that it’s all my fault!”

“He thinks that I’m a bad parent!”

“She [the therapist] thinks that I’m too hard on my son!”

“She thinks that I’m just being selfish!”

“He’s blaming me for what happened!”

“He thinks that I’m too easy on my son!”

“She thinks that I don’t love my daughter!”

“She thinks that I’m not trying very hard to be a good parent!”

“He thinks that I’m putting my own needs above those of my daughter!”

“She thinks that I’m just feeling sorry for myself!”

“She thinks that I’m not consistent [sensitive, caring, attentive] enough!”

When parents assume that the therapist is making these negative evaluations of them, they most certainly are not feeling safe. They are then not able to benefit from any ideas. They are not open to the therapist’s experience of them as parents, assuming that it is negative and that experiencing such a judgment would be very painful. Judging themselves, they assume that the therapist is judging them. They do not believe that the therapist thinks that they are good parents who would benefit from a new childrearing idea to which they had not been exposed. Rather, they assume that any suggestion is intended to make up for their failure as parents.

A therapist’s primary responsibility when meeting parents experiencing blocked care is to actively maintain and communicate an attitude of acceptance toward them and their efforts to raise their children. The therapist’s acceptance of them comes from an assumption that they are good people, doing the best that they can, and that they love their children to the best of their ability to do so. The therapist’s acceptance also comes from the assumption that parents’ current angry, pessimistic, and possibly punitive attitude toward their children may well not be longstanding. It is impossible for the therapist to know with certainty how the parents behaved a month ago, a year ago, or immediately after their child’s birth. Their caregiving behaviors in the past may well have been strong, positive, and consistent. If those qualities are not evident now, the therapist does not know why they are not and will not judge parents for any failure to provide ongoing care. As we discuss shortly, this foundation of acceptance leads to the equally important experience of curiosity and empathy for the parents who are now experiencing blocked care.

A therapist actively communicates acceptance by being entirely nonjudgmental regarding the parents’ inner lives in relation to their children. Whatever they think, feel, wish, remember, perceive, intend, and value is accepted as it is. A therapist strongly holds the intention of understanding an individual’s inner life, not evaluating it. The same is true, at least initially with regard to acceptance of the parents’ behavior. Even if the therapist believes that the behavior would be hurtful to the children (e.g., one or both of the parents swear at the children), the therapist focuses first on understanding the meaning of the child’s behavior, including how the parents view it, before deciding how to approach it.

If therapists approach all interactions with parents with the goal to suspend all judgments about what the parents are saying—to focus only on accepting and then trying to understand and to respond with empathy to the parents’ emotional responses to what is being explored—then parents are likely to begin to feel safer, and they are then more likely to open up to therapists’ experiences, including any possible recommendations. Therapists’ acceptance of parents may in turn create an opening within the parents themselves to accept themselves and then safely explore a particular experience or event without shame. In so doing, therapists help parents reduce their instances of blocked care and re-engage in the process of caring for their children.

An Example of Acceptance (Curiosity and Empathy Embedded)

In this example, the mother, Debra has had continuing difficulties raising her 10-year-old son Raymond. Her own childhood was marked by much family conflict and a lack of emotional intimacy. Her son’s defiance and perceived rejection of her has undermined her confidence and led to blocked care. This dialogue occurred in the first session with her therapist, Allison.

Therapist: So you’ve tried your best and now it seems hard to keep trying to make it better.
Parent: So you don’t think I’m good enough, is that it? It’s my fault!
Therapist: I am so sorry, Debra, if you experienced what I said as blaming you! I’m sorry that I wasn’t better at saying what I was trying to say.
Parent: What are you trying to say?
Therapist: Simply that you are trying so hard, and it seems to be wearing you out! You give, give, give, and it seems that you are feeling that it isn’t enough.
Parent: Why doesn’t he understand that? Doesn’t he know how much I love him?
Therapist: How painful that is when it seems that he doesn’t respond to your love.
Parent: He doesn’t! He thinks it’s not good enough!
Therapist: Ah! And you’re doing the best that you can!
Parent: And it’s not good enough! Sometimes I don’t want to try anymore! Sometimes … I don’t love him. Sometimes, I hate him! There, are you happy now? Sometimes I hate my own son! How disgusting is that!
Therapist: Oh, Debra, how painful … how very painful that must be for you … to be aware that sometimes you feel hatred toward your son.
Parent: I hate my kid! Aren’t you listening! Doesn’t that tell you something! Maybe you won’t admit it, but I know you agree with me! I’m a failure as a parent!
Therapist: Oh, Debra, again, I’m sorry that you experience me as judging you … as thinking that you’re a poor parent but just not saying it.
Parent: So, I hate my kid and I’m a great parent! I don’t buy that!
Therapist: And you love your kid, and have loved him, and haven’t given up, and are here now trying to get some help for him, for yourself, and for your relationship. And you still love him, even when he seems to reject all of your efforts.

In this dialogue the therapist accepted the parent completely without arguing with her or telling her that she needed to think, feel, or do something differently. The therapist accepted Debra’s perception of her as judging her. She accepted Debra saying that she hated her son. She accepted Debra expressing shame over her hatred. She accepted her discouragement and doubt without giving her false hope. And the therapist also found—and accepted—Debra’s strength embedded in her pain and her continuous effort to “get it right.”

If a therapist understands the dynamics of blocked care, it makes it easier to understand and accept parents’ anger, shame, and lack of loving feelings for their children. If parents understand the nature of blocked care, it makes it easier for them to both understand and experience empathy for themselves for feeling hatred toward their children and for their “unparental” responses. When there is a lack of reciprocal positive experience in the parent–child relationship for a given period of time—a sustained lack of playfulness and joy in the relationship—it is particularly hard for parents to keep the core parenting systems—approach, reward, and child reading—“on.” With these systems “down,” parents must rely heavily on whatever executive powers of self-control they can summon to keep from becoming blatantly abusive or neglectful.

Debra, in the example above, was somehow able to refrain from abusing Raymond by exerting executive power to keep her brakes on her intensely negative feelings and impulses. In the midst of blocked care, this is often the best a parent can manage to do. And since stress, especially chronic stress, can suppress executive functioning, there is a high risk for abuse and neglect in the context of sustained blocked care. When parents experiencing chronic blocked care also have weak executive systems, for whatever reason, preventing outright abuse and neglect may be extremely difficult.

Curiosity

From the moment of birth, parents and infants are typically intensely fascinated with each other. The eyes of infants search for the eyes and faces of their parents, and when they find each other, they begin to gaze into each other’s eyes in a way that is rarely replicated. The eye gaze reflects a deep interest in the other, a passion to discover the unique features of the other. Remember Oscar’s gleaming eyes as he looked into his parents’ eyes? Infants find what is unique about their parents—what distinguishes their parents from all others. Over time this preference for this unique adult develops into an attachment. At the same time the parents are discovering what is unique about their infant that distinguishes him or her from all other infants. What they discover, they treasure, value unconditionally, and fall in love with. Professionals might be tempted to describe these acts of discovery as positive delusions, thinking that parents see what is not there. Or is it that parents see what is there, and the rest of us, who have not gazed so lovingly for so long at this infant, do not notice? Most likely, parents discover the unique spirit of this infant, something of greater value, the roots of which may grow into abilities that can one day be measured, seen by all. Herein lies the power of nature’s loveliest obsession.

These acts of discovery are described here as curiosity wherein parents are fully immersed in getting to know their infant unconditionally. This is not a rational exercise but rather an act that fully engages parents reflectively, emotionally, spiritually, viscerally. As they get to know their infant, possibly more deeply than they have known anyone in their lives, their knowledge often has a profound impact on them. The word love may describe this impact. It is also known as a parental bond. At a core level, parents experience the infant as being a part of them, with their identities becoming interwoven for life. At the same time the infant’s discovery of the parents has a profound impact on the infant’s experience of him- or herself, others, and the nature of the world. This intersubjective experience between parents and infants involves all aspects of the parents’ brain. It is an emotional experience characterized by playfulness and empathy and a reflective experience characterized by curiosity.

Curiosity rests upon the functioning of brain regions involved in the child-reading and meaning-making systems. Within parents’ temporal lobes are regions dedicated to perceiving their children’s facial expressions, voices, and movements, noticing subtle variations over time. In addition, the parents’ mirror cells help them to subtly experience what their children are experiencing moment to moment. This combination of child-reading and mirroring processes helps parents tune in to the inner lives of their children—helps them to make sense of their children’s emotions, thoughts, wishes, perceptions, interests, and intentions. Parents are actively making sense of their infant’s expressions in the here and now as well as in the context of the past and future. Their ability to meet their infant’s needs is enhanced through their curiosity about their baby. Parents who are in this open-minded, curious state tend to give positive meaning to whatever their children are expressing. However, this early positivity bias may shift into a negativity bias in the face of ongoing parental stress. Under stressful conditions, the input from the child-reading process gets filtered through the parents’ amygdala in that rapid neuroceptive process we described in Chapter 1. When this information from the child-reading system reaches an amygdala that is mediating signals of threat, what was once seen as delightfully positive is in danger of now being seen negatively. When the amygdala is on high alert, it can bias the rapid neuroceptive process toward detecting threats over safety, making it very difficult for parents to distinguish between a real need to play defense and a false alarm. When parents become hypervigilant in this way, whether from chronic or acute stressors, their internal state regulation processes are impaired, and the parents then have great difficulty feeling safe enough to stay open, accepting, and curious toward their children. Their approach system, which is linked to the smart vagal system, gets suppressed in favor of self-defense. As they lose vagal tone, they shift out of their social engagement system into one of the two defensive systems, either mobilized fight–flight or immobilized fright. In these states, being curious and reflective are not options. The parents are now preoccupied with personal safety and are therefore taking very personally their children’s negative facial expressions, body language, and tones of voice.

Curiosity aims to maintain the positive mind-set in which parents continue to be fascinated by their children and energized by their efforts to understand them. Their eyes gaze upon their children with love, which enables them to see their children’s positive attributes and developing abilities while taking their problematic behavior in stride, as a natural part of being developmentally immature. Problems are vulnerabilities to be addressed and strengthened. Curiosity benefits from the release of brain chemicals such as oxytocin and dopamine, which help to keep the connections between higher and lower regions of the parenting brain open, supporting the integration of feelings and cognitive processes.

The meaning-making system, depending heavily on the upper regions of the prefrontal cortex (i.e., the medial prefrontal cortex and especially the dorsolateral prefrontal cortex), also can greatly reinforce the strength of parents’ curiosity. Activating these regions of the brain, with the help of the anterior cingulate cortex (the “brain bridge”), enables parents to suspend the narrow, rapid judgment of the amygdala and to stay open to their own feelings and thoughts, including reflections based on their history and the traditions of parent–child relationships to which they were exposed in their childhoods. Some aspects of their history might not reassure them of their safety, and these signals would cause the amygdala to shift back into defense and close down the potentially constructive process of reflection. But if parents can stay open to the feelings triggered by these memories, they can resolve old wounds and clear their minds more for parenting. This process of reflection and reappraisal, made possible by areas of the prefrontal and anterior cingulate cortex inhibiting the defensive reactions of the amygdala and maintaining vagal tone, strengthens parents’ capacity for “feeling and dealing” (Fosha, 2000), expanding the parental window for staying grounded and flexible enough to respond constructively to their children’s behavior. Curiosity, when it trumps defensiveness, promotes openness to a widening range of experience and the integration of parents’ narratives, whereby they blend past, present, and future into a coherent story. Thus, without curiosity a parent may react with anger and consequences to his or her child’s tantrum. With curiosity, the parent pauses to make sense of the child’s behaviors, considering the present circumstances as well as past, recent events and worries that the child may be having about the future. Only then does the parent decide how to respond to the child’s behavior.

Curiosity enhances intersubjective experiences in the following ways:

1. Parents who are curious are fascinated with their children, wanting to know as much as possible about their developing selves.

2. Parents who are curious simply want to understand their children, long before they think about evaluating them.

3. These parents stay within a not-knowing mind-set, wherein they remain open to trying to grasp the meaning of their children’s behaviors.

4. Curious parents inhibit their first reactions to their children’s undesirable behavior (unless there is a perceived emergency) and wait until they make sense of that behavior before responding to it.

5. As they come to know their children, curious parents do so from the inside-out. The inner lives of their children (how the children feel about themselves) are of greatest interest to these parents, with their children’s behaviors, successes, and failings seen within that context.

Example: Ken is the father of 15-year-old Kathleen who just started her second year on the high school debate team. She did well the first year and had been looking forward to being on the team again. Then she mentioned at dinner that she had decided not to join the team this year.

Dad: I had thought that you really enjoyed it last year and were planning to debate this year too. What made you decide not to?
Daughter: I don’t know. Just want to do some other stuff, I guess.
Dad: So you’re not sure yourself.
Daughter: Dad, I just don’t want to! Isn’t that enough! I shouldn’t have to if I don’t want to!
Dad: Sweetie, I’m sorry if I gave the impression that I’m annoyed with you or disappointed in your decision. I want you to do what you want to do. I’m just puzzled because just last week you said that you were looking forward to it.
Daughter: So, I changed my mind.
Dad: And my asking you about it seems pushy. I’m sorry because I don’t mean to be pushing you.
Daughter: Then why do you keep asking?
Dad: Because I’m surprised, and if you are at all mixed up about your decision to change your mind, I want to give you the chance to talk about it.
Daughter: I do like it, Dad. I really do. It’s just … I don’t want to be a know-it-all.
Dad: A know-it-all?
Daughter: Yeah! Some of my friends were laughing about my being so smart my head might explode. They were making fun of me for always asking so many questions and having an opinion, and they said that the debate team was made for me. And they laughed some more.
Dad: Ah! That would have been hard. And these were your friends laughing.
Daughter: Yeah! Would they like me better if I agreed with them all the time? Or if I wasn’t smart? It’s not my fault I think about stuff and have opinions and like to discuss stuff.
Dad: No wonder you’re not sure about debate. It seems almost like you have to choose between friends and being on the debate team.
Daughter: I know I don’t, Dad, but it does feel that way sometimes. I just wish my friends would accept me the way I am. If I’m a nerd, then I’m a nerd.
Dad: Do you think you are?
Daughter: Maybe, but I’m a fun nerd who makes a good friend.
Dad: And a wonderful nerd who makes a most special daughter.
Daughter: Maybe I haven’t decided yet about debating.

In this example, the dad expressed his curiosity about his daughter’s decision to stop debating, not to get her to change her mind, but rather to help her clarify her reasons. She assumed that if he was surprised by her decision, he might be trying to change her mind or be ambivalent about her decision. However, he remained nonjudgmental about her decision throughout the discussion, facilitating her ability to make sense of the factors that were influencing her decision so that she could arrive at the decision from a deeper, more reflective inner space.

How Curiosity Works in Therapy

When parents who are experiencing blocked care seek therapy for their difficulties with their children, they most often have difficulty separating their judgment about their children’s behavior from efforts to understand this behavior. They are not in a mind-set wherein they can safely explore the possible meanings of their children’s behavior; they just want it to change. At this point, the behavior is most likely experienced as wrong or inappropriate and the reasons for the behavior are either considered irrelevant or they are assumed to reflect “bad” motives, wishes, thoughts, or feelings.

If the therapist tries to stress the value in understanding what the reasons might be, parents experiencing blocked care might assume that the therapist is seeking excuses for their children’s behavior. If the therapist tries to understand the reasons for the parents’ behaviors, parents might experience this focus as an effort to uncover something wrong with what they are doing and so blame them. When parents are stuck in a blocked care mode, their goal is often to ensure that the therapist agrees with them that their children’s behavior is wrong and then to advise them regarding what they might do (specialized discipline) to correct the behavior. Anything else is likely to be experienced as being unsupportive.

If the therapist has been able to convey to the parents that their inner lives are completely accepted and that the therapist has a sense of urgency to simply understand—not evaluate—many parents may begin trying to understand as well. The therapist’s reflective stance evokes the parents’ reflection on their inner lives, their children’s inner lives, and the meaning of the behavioral events that are occurring. Stepping back to look at themselves and their children with curiosity, they may well begin to experience a return of the caregiving behaviors that had become blocked.

Example: Ann has been experiencing blocked care in relationship to her 16-year-old son who has been increasingly noncommunicative with her over the past 2 years. When he does talk with her, it is mainly to ask her to do something for him or to criticize her parenting. She sought treatment for this problem with her son from the therapist, Bill.

Mom: I just want basic politeness! Is that asking too much? If I ask him a simple question, it seems that I deserve—anyone would deserve—an answer. And I get nothing except maybe he sighs and walks out of the room.
Therapist: That does seem like such a small request that you are making … and yet he doesn’t give you a simple answer. Any sense of what that might be about?
Mom: What difference does it make? Are you looking for something that would justify what he is doing?
Therapist: Ann, I’m sorry if I implied to you that his behavior is OK and I want to justify it.
Mom: That’s what it sounds like.
Therapist: Then I need to be clearer. I’m not searching for an excuse for his refusing to answer a simple question, just what the reason might be.
Mom: What’s the difference between a reason and an excuse?
Therapist: With a reason, he is still accountable for his behavior. Finding a reason doesn’t imply that you need to be OK about the behavior—just that you can make sense of it better.
Mom: Again, what does it matter?
Therapist: So you know how to respond in a way that’s more effective. If your response isn’t working, then maybe you’re assuming a reason for his behavior that’s not accurate.
Mom: I just want him to answer my question. I’m not after a hug or even a smile.
Therapist: Has he given you a smile or a hug in the past few months?
Mom: Are you kidding! I’m a servant to him. I’m acknowledged only when he wants something from me.
Therapist: What’s that like?
Mom: What do you think it’s like? Am I supposed to be OK about it?
Therapist: I’m sorry if I seemed to suggest that it shouldn’t bother you. My sense was that it bothers you a lot, and I’d like to understand how it affects you.
Mom: It drives me wild. I’m his mother! He shouldn’t treat me that way! He should treat me with more respect!
Therapist: Ah, it seems like he doesn’t respect you!
Mom: Doesn’t it seem that way to you?
Therapist: It could be a lack of respect, I don’t know. That’s why I’m trying to make sense of it … to know what it means. If it is because he doesn’t respect you, what would that mean to you? (The therapist and mother continue to explore possible meanings of her son’s behaviors and their conflicts, with the mother more engaged in making sense of the behaviors.) And an even greater fear seems to be that he may not share your dream. You worry that he may not want a close relationship with his mom that lasts a lifetime.
Mom: Why doesn’t he?
Therapist: How are you sure that he doesn’t?
Mom: He doesn’t talk to me!
Therapist: And again I ask why … what might his reason be … what if it’s not disrespect? What, for example, if he thought that you were not proud of him … that you were unhappy with the young man that he’s becoming? What if he still shares the same dream that you do but senses that you don’t have that dream any more?
Mom: Why would he? Wait … he said a few weeks ago that I just want him to accomplish things so that I can brag to my friends and neighbors about him. That I’m really not interested in what he likes or wants for himself. But he’s wrong! I don’t think that.
Therapist: Ah … Ann. He says that he experiences you as being dissatisfied with who he is. That what he wants, who he is, is not good enough for you.
Mom: But that’s not true.
Therapist: Ann, please, I’m not saying that I believe his experience to be what you feel about him. I’m saying that if that is his experience, then it is easier to understand why he avoids you now. Maybe he hides his experience that you are disappointed behind his ignoring of you or being angry with you.
Mom: Why would he experience me that way when I don’t feel that way?
Therapist: I don’t know. Any ideas?

(The therapist and parent continue to explore the possible meaning of the son’s behaviors. Each new possibility opens the parent to possible options that might suggest ways to reduce the conflict and deepen their relationship.)

In this dialogue, the therapist repeatedly brought Ann back to exploring her own experience, so that she could understand it more deeply and gradually become open to wondering about her son’s behavior. Without curiosity, the meaning of the behavior will not enter awareness, for either the parents or the children. With safe, accepting, nonjudgmental curiosity, parents’ brains stay open enough to make better sense of the behavioral events that are the source of the problem. When the focus is only on evaluating and trying to control behaviors, the parents who are experiencing blocked care, with their brains in survival mode, are not likely to awaken their range of caregiving behaviors. Unless the children experience their parents’ care again, the children are not likely to openly address the behavioral conflicts. If the children do address them—with nonjudgmental curiosity—any changes that result are likely to be short-lived if the parents are not equally involved.

Empathy

Empathy is the other side of playfulness. When infants are in a relaxed, open, and engaged state of mind with parents, the enthusiastic, joyful, and affectionate interactions dominate, conveying a sense of delightful playfulness between them. When infants are in distress, they begin to feel unsafe and shift into a defensive state without the happy engagement that they were just experiencing. Their interactions with their parents are now characterized by “comfort seeking,” “goal-directed” behaviors (Cassidy & Shaver, 2008). When parents experience their infant’s distress and respond with empathy, communicating the experience of being with the infant in the distress, the infant’s attachment behaviors have been effective in getting the parents’ attention and activating their empathy. The infant turns to the parents for safety, wanting the parents to end the distress. Empathy conveys to the infant that the parents are aware of his or her distress, will not leave him or her alone, and will help him or her to manage even if the distress does not stop. The parents’ ongoing, emotionally regulated presence helps the infant to recover from the stressful state and to regain equilibrium. The infant’s frightening, possibly very painful, emotions are likely to be more manageable when the parents are present and conveying empathy for their baby’s difficult time.

When engaging in playfulness, the parents and infant regulate and enhance the experience of positive emotions together. With empathy, the parents and infant regulate and reduce the experience of negative emotions together. These two processes, one centering around joy, the other, comfort, strengthen each other, creating a more robust relationship that can handle the full range of human experience without breaking.

Empathy involves regions of the right brain (Schore, 2003) that enable parents and infants to be in synch, right brain to right brain, and so manage together any intense emotions that are emerging. The orbitofrontal cortex, insula, and anterior cingulate cortex, especially on the right side, are all involved in parents’ experiences of empathy for their children. The insula helps parents to have an intuitive, bottom-up sense of their children’s inner lives by receiving and transmitting input from the heart, lungs, and gut (visceral system) to the orbitofrontal cortex and anterior cingulate cortex—all of which may resonate with children’s bodily expressions. As you may remember from our earlier discussion of parental warmth and empathy, the orbitofrontal cortex, anterior cingulate cortex, and insula contain those special von Economo cells—present only in certain mammals—which provide a heightened awareness of the emotions of self and others. Mirror neurons also contribute to empathy by feeding output into the anterior cingulate cortex, where the conscious awareness of empathic feelings begins to emerge. When the anterior cingulate cortex detects something “amiss” with children, it sets off that “uh-oh” reaction that alerts parents to be even more attentive to them. Finally, empathy combines with mentalization, a more left-brain, cognitive way of understanding children’s experiences as parents’ brains connect the intuitive, bottom-up way of attuning to their children’s immediate experience with the higher-brain processes involved in thinking about their children’s “minds.”

This is the Parental Child-Reading System in full gear, promoting both a reflective process whereby parents understand their children’s experience, as well as an emotional component whereby parents sense their children’s emotional states and intentions. It is not surprising that empathy, broadly conceived, contains both features, activating the orbitofrontal–insula–anterior cingulate system that serves as a bridge to parents’ higher awareness and meaning-making functions. When parents’ empathy systems are “on,” the smart vagal system is “on,” helping to keep parents in this open, engaged, empathic state of mind. In this state, parents, without knowing it, have one “foot” on the amygdala as a brake on the self-defense system. Children then experience parents as tuned in, as “getting it,” and are with them, hopefully conveying confidence that they will go through it together and manage it successfully.

Example:

Boy [6 years old]: I want to play!
Mom: I know you do! It is so hard for you now that you have to go to bed!
Boy: No! I want to play some more!
Mom: I know you do, Son, I know. You don’t like having to go to bed now!
Boy: No! I don’t want to go to bed!
Mom: It is hard to stop playing! It really is. We’ll have to find an especially nice book to read in bed. That might help.

In this example the primary response of the mother is empathy for her son’s anger over having to go to bed. Redirecting his thinking to reading a book will be much more effective after the mother first acknowledges his wish to not go to bed.

Example:

Girl [9 years old]: I can’t do anything right! I’m so stupid!
Dad: You’re trying so much and you can’t get it! That is so hard!
Girl: I can’t do anything right!
Dad: Oh, sweetie, it must feel awful for you when it seems that you can’t do anything right!
Girl: I can’t, and I’ll never change!
Dad: I’m sorry that it seems that way to you now, honey. I’m sorry (giving her a hug).

In this example the father does not try to change his daughter’s mind about her abilities. By expressing his empathy for her distress about her inability to do something and her associated view of herself, he helps her to regulate her negative emotion. Because her emotion remains moderate and not extreme, her own reflective abilities will enable her to see the big picture and remember her overall abilities and successes. Trying to convince her that she has more abilities than she now feels is likely to meet resistance and be less likely to influence her and help her to manage her distress. After she experiences his empathy, she is likely to be open to his calmly reflecting about some of her recent successes—ones that at this moment she does not seem to recall.

How Empathy Works in Therapy

When parents are experiencing blocked care, they are likely to experience little empathy for their children. As they are not able to maintain a positive, reciprocal, and satisfying relationship with their children, parents’ approach and reward systems get suppressed, and they eventually begin to focus on behavior from a judgmental, critical stance. When this approach does not lead to success, they most likely become increasingly defensive themselves, experiencing failure and both resentment toward their children and shame and doubt toward themselves. Parental empathy, in contrast, requires an open receptivity to experiencing their children’s distress. Under intense stress, this openness is out the window. Despite good intentions, parents now find it extremely hard to experience their children in this manner. Their focus is mostly on self-protective behaviors and a singular goal: to change their children’s behavior.

As was the case with the other features of PACE, when parents are experiencing blocked care, they are unlikely to be able to experience the therapist’s empathy for them. They are not receptive to the therapist’s experience because they are anticipating his or her judgment and so they steel themselves with a distant, cautious attitude. Not feeling safe, they overlook or are skeptical of the therapist’s experience of empathy for their parenting problems. Their defensive attitude serves the purpose of protecting them from experiencing the vulnerability that arises from the failures that they are experiencing as parents. Empathy invites them to become vulnerable, and they may, understandably, resist that invitation. At this stage in the therapist–parent relationship, the parents’ threat detection system—their amygdala-driven vigilance system—is still on high alert, ready to detect the least signs of judgment and invalidation from the therapist. Since the amygdala is so sensitive to nonverbal communication—the raising of an eyebrow, the shift in gaze, the subtle change in the therapist’s tone of voice—it is quite a challenge for parents to feel safe with the therapist. They are getting many “false alarms” even as the therapist seeks to create a safe atmosphere.

If the therapist does not experience and convey empathy, but rather adopts a rational, problem-solving approach when parents are experiencing blocked care, the parents are likely to experience the therapist as pulling away and becoming judgmental. Many parents may basically decide to leave therapy at this early juncture. To preclude this unwanted development, the therapist must gently and persistently convey an empathic attitude even though many parents will mistrust it initially and find it difficult to tolerate. If parents become dismissive of the therapist’s empathy, the therapist needs to accept that response and then be curious about it, without judgment. If parents express disbelief regarding the therapist’s experience of empathy, the therapist again accepts their response and then wonders about the source of their disbelief. Through acceptance and curiosity, the therapist is able to slowly and gently convey safety to parents as they experience his or her empathy. (As was indicated earlier, the components of PACE are often very interwoven aspects of one, unified, intersubjective experience.)

As parents experience the therapist’s empathy, they gradually become able to regulate whatever emotions emerge that are associated with the problems between them and their children. These emotions may include fear, sadness, anger, or shame. As they are able to remain regulated in response to these emotions, parents become more able to safely explore the events that they are facing with their children. In short, their reflective functioning is engaged and exercised. At the same time they are able to begin to have greater empathy for themselves and eventually to experience empathy for their children. Their brains are opening up pathways to higher functions, beginning to lift the blockage that has been suppressing these functions (including the capacity for empathy. To borrow a phrase from a leading trauma-focused therapist, the relationship with the therapist is starting to awaken the parents’ prefrontal cortex (Ogden, Minton, & Pain, 2006).

Example: In this dialogue the mother, Linda, is feeling overwhelmed with the repeated arguments—often followed by defiance—that she is experiencing with her 11-year-old daughter Julie. Linda has begun to avoid contact with her daughter, focusing on maintaining the rules and routines of the house and interacting with Julie primarily when she is not doing what she should be doing. Julie, however, seeks Linda out to challenge the rules and express her displeasure with Linda’s judgments. Linda does not experience any sense of the joy and satisfaction that she had hoped for when her daughter approached adolescence. The therapist, Jim, focuses on experiencing and communicating empathy for her distress.

Mom: She just won’t leave me alone. Complain, complain, complain, that’s all that she does.
Therapist: So you want a break from the conflicts and she seeks you out. You just want some peace!
Mom: So I tell her to leave me alone, and we’ll talk about it later. She keeps talking so I leave the room … and she follows me!
Therapist: It’s like you’re being trapped in your own home! No way to just relax a bit, take a deep breath and then try to figure out a way to approach it. No way to just take a break!
Mom: So what should I do? Put a lock on the door? She’d probably stand on the other side and start kicking it! She’d make me open the door to stop what she is doing!
Therapist: Again, how hard! Like you’re not safe in your own home … with your own child. What a sense of feeling trapped … and hopeless that must create.
Mom: So what should I do?
Therapist: Before I try to come up with any ideas, could we stay a bit longer with the impact that this situation with your daughter is having on you?
Mom: I know the impact that it is having on me! It’s driving me crazy! I just want to know what to do about it! That would help me a lot more than talking about how hard it is!
Therapist: So you are becoming frustrated with me now that I haven’t given you any suggestions about this.
Mom: Yes! That’s why I asked to see you! I want practical ideas about what to do to make things better with Julie!
Therapist: My fear, Linda, is that if I gave you some suggestions now, they might not work. And that would be so unfair to you … another thing you tried that failed. I fear that you would only become more discouraged.
Mom: So if you’re not going to tell me what to do, why am I seeing you?
Therapist: Right now I want to know you better. I want to know how this very, very, hard time in your life is affecting you, as a parent, as a partner, and as a person. I want to “get it,” at least in a small way, what it is like for you now.
Mom: It’s worse than anything I’ve ever had to face in my life! I dread getting up in the morning! There! Is that what you want!

(The dialogue continues during which the therapist does not give the advice that the mother is asking for, rather laying a foundation of empathy that is necessary before any advice will have a chance of success.)

Therapist: I believe that if I don’t convince you that I understand, that I really know about this hardest experience that you’ve ever had in your life, than nothing I say will give you any confidence that it will make things better.
Mom: Maybe you’ll never get it.
Therapist: Please give me a chance. Help me to understand how hard this is for you now!
Mom: I’ve been her mother for 11 years. My life has centered around her! I held her when she was an infant! And played with her all the time when she was 2 and 3 and 4. And showed her how to become a young girl! Sometimes I loved her so much I would start to cry. I have never experienced what it was like to love a person like I loved her. And she loved me back! She loved me back! She was so happy to be with me! She brought things to me! She wanted me to carry her and snuggle with her in bed! And now she doesn’t! Now she doesn’t! I’m some stranger to her! I’m somebody that she doesn’t even like! (Begins to cry.)
Therapist: Love so strong that it made you cry. Love that you never experienced before. And now it seems that it’s over … that Anne does not want your love and does not love you. How painful that must be for you … how painful.

(Slowly the therapist and mother begin to explore the pain of her daughter’s rejection. As the mother expresses her distress more openly, she begins to feel uncomfortable with her vulnerable feelings.)

Mom: You don’t think that I’m just feeling sorry for myself.
Therapist: Just feeling sorry for yourself? You are grieving the loss of that most special relationship that you had with Julie for years. And you are experiencing the terror of thinking that it might be gone forever. And you worry that your grief and terror suggest that you are weak?
Mom: I should be stronger.
Therapist: I see you as being very strong to face this pain, to trust me with it, to show your vulnerability—facing the hardest thing that you’ve ever had to face in your life—I see your strength. Stronger than pretending that it does not bother you. Pretending that you can parent without feeling anything. Without being vulnerable. Without feeling love anymore.
Mom: You spoke of terror. That is the most terrifying thing of all. I might some day stop loving Julie. I would not want to live if that happens.
Therapist: As I said … you are so brave to face this terror … and all the pain that it carries … and you do it … because of the immensity of your love for your daughter.
Mom: What if I can’t do it anymore?
Therapist: Because of the mother that you are, I don’t think that you will stop loving her and caring for her. Maybe you won’t feel close to her, you might really feel disconnected, but the core of love will still be there. And at some point in the future—we don’t know when—at some point the feelings will get stronger again too. You’ll feel that intense love again.
Mom: Do you mean that?
Therapist: I mean that.

In this example, the therapist patiently and persistently tries to experience and communicate empathy for Linda so that she can experience more fully the pain and confusion that she feels about the increasing distance and conflicts in her relationship with her daughter. The therapist is convinced that if he presents behavioral strategies to Linda at this point, she will probably not be motivated to try them for any period of time if they do not show immediate signs of producing results. Also, the therapist is unlikely to be able to give her any appropriate strategy because he does not know what is creating the conflicts and distance between Linda and her daughter. Through allowing herself to experience the therapist’s empathy for her pain, Linda is more likely to find the strength to experience the pain again—now with him experiencing it with her. This is likely to increase her readiness to work to make sense of the conflicts—again, with his active presence—through an open curiosity about their meaning. Throughout this process, Linda is more likely to be able to accept whatever emotions and thoughts emerge, rather than focusing on what either she or her daughter should think, feel, or do. Now she is using her parental brain much more fully than before, getting ready to begin the task of reconnecting with her child.

Affective–Reflective Dialogue

In presenting the four components (PACE) of intersubjective experience we have repeatedly demonstrated them through dialogue. In stressing the relationship between parents and children, we have emphasized the central role of communication in conveying safety and fostering new learning and so that the relationship then develops in a deeper and more comprehensive manner. Communication is much more than “just talking,” which may simply involve lectures and information giving. Communication has nonverbal and verbal components that contain the whats and the hows: what is being communicated and how it is being communicated. In conversation between parents and children, the deepest, most personal meanings are conveyed nonverbally, through voice prosody (modulations and rhythms), facial expressions, eye gaze that repeatedly makes fleeting contact and then looks away, as well as gestures and movements.

The kind of communication that we are describing involves the utilization, development, and integration of the five parental brain systems. It facilitates both emotional regulation and reflective functioning within parents and children. It involves the components of PACE, usually with more than one of them at a time. We call this way of communicating affective–reflective dialogue. With practice, it becomes a remarkably effective way to improve the parent–child relationship by developing and strengthening the interacting brains of parents and children.

The affective–reflective dialogue that we are describing can be found in the various examples of dialogue throughout this chapter. In our experience, affective–reflective dialogue (with the embedded components of PACE) is the most direct means for activating and maintaining the functioning of the social engagement system. The smart vagal system that supports and enables the kind of open and engaged parenting that we have highly valued throughout this book is given robust support by affective–reflective dialogue. Within this specialized dialogue our emotions are allowed to influence our thinking, and our thinking is allowed to influence our emotion. Within this form of communication we are likely to approach (the Parental Approach System) and enjoy (Parental Reward System) being with the other person. We are more able to express clearly and understand more fully the emotional meanings being conveyed by each other. We both read each other better (Parental Child-Reading System) and are more able to experience the ongoing relationship as having deep and rich meaning (Parental Meaning-Making System). Finally, within such dialogue we are more likely to be fully present to each other, open and balanced in a state that might be described as intersubjective mindfulness, a state that links our highest brain powers with our bottom- up affective core. This linkage allows us to experience what is unique about the other and the situation and to be able to initiate a flexible, “best-fit,” response to the other, using our executive capacities, as needed, to stay in the “right” state of mind (Parental Executive System).

When we are communicating via an affective–reflective dialogue there is a strong storytelling flavor to our conversation. That is, we are not giving a lecture or dispensing information. We are communicating meanings—emotional, social, historical—that express our inner lives and enable us, feeling safe, to be open and receptive to the inner life of the other. Within this dialogue voices are rhythmic and modulated, fully expressive of the subtle, unique meanings of self and other in ways that the words themselves cannot convey. With such rich voice tones and inflections, with heightened affective emphases and soft states of wondering, we are more likely to remain interested in each other and the conversation itself. Such dialogues hold the attention of both participants while each safely explores the inner world of the other. In such dialogues your children are more open to your clear—gentle or strong—influence and you are more open to being influenced by your children’s expression of their experiences of their world (including the world that they share with you). This degree of open engagement is less likely to occur when you are giving a lecture.

The qualities of PACE are frequently present within affective–reflective dialogue. There is often a quality of enjoyment—quiet or exuberant—in the sharing of one’s experience with your children, even when there are differences. There is an overriding sense of acceptance of the experience of your children, even when you disagree with their behavior. You assign priority to understanding—deeply and fully—the meaning of your children’s thoughts, emotions, wishes, and behaviors, and you place much less emphasis on evaluating their behaviors. You are truly interested in your children and their world, and your curiosity about them results from being fascinated by who they are and who they are becoming. Finally, you are likely to be able to experience their experience emotionally to the degree that they feel “felt,” as Dan Siegel so beautifully describes this aspect of interpersonal neurobiology (Siegel, 1999). This is empathy. When you experience empathy for your children, your interactions are guided by compassion and understanding much more than by power and authority. When your children experience your empathy, they will be much more likely to accept your perspective and guidance, knowing that you “get it” and truly have their best interests in your mind and heart.

Summary

Working hard to engage all components of PACE brings all of the five systems of brain-based parenting into a more real-world realm. By practicing PACE and affective–reflective dialogue, parents can gain more intentional control over how their brains work. In moments of stress and frustration, when the amygdala and limbic system want to “go it alone,” practicing PACE will help you move away from defensiveness and blocked care and utilize the systems that regulate your emotional responses and allow you to reflect on what is transpiring to get you back on track.

This good news is even better when you consider that as you practice PACE and involve all of the five parental systems in the brain, they all begin to become stronger and more integrated. As is true for other parts of the body, when you use your brain it improves in both structure and function. It is not simply a matter of “use it or lose it.” A more apt phrase is “use it to improve it.” We believe that PACE and affective–reflective dialogue will do that. In the next two chapters we will explore further the twin components of emotion regulation and reflective functioning.