Restoring Parental Care
Just as knowing the neurobiology of bonding and attachment had made us less likely to blame children for their behavioral struggles, understanding the neurobiological foundations of parental caregiving helped us stop blaming parents who weren’t attuning to their kids. Applying the concept of blocked care, we began with the assumption that insensitive parenting is often linked to stress and deficiencies in key brain systems, including the dopamine and oxytocin systems. Parents with blocked care may want to like and enjoy their children, but don’t know how to activate the “good chemistry” that would enable them to do so. Understanding the neurobiological causes of blocked care helped us become more open and empathic to parents’ negative experiences and stories, more willing to listen and validate their experiences.
Since we now knew that the parents were using similar brain systems to those of their children as they struggled to connect with their kids, we thought that the same therapeutic interventions (playfulness, acceptance, curiosity, empathy) we used to engage children and create in them a sense of safety with us might work with highly stressed parents, especially in the early phase of family-focused treatment. Why not put aside our agendas of changing parents’ behavior long enough to provide a safe space for them to express their own needs for connection and activate their attachment functioning? If we wanted parents to provide for their child, we needed to provide first for the parents.
The paradox of integrating complex information about the brain, with all its multisyllabic terminology, into treatment is that it actually heightens the importance of openheartedness and safety as a precondition for change. Parents with blocked care first need the intense support of an empathic therapist to venture into the realm of forbidden feelings. But what the brain-based perspective makes clear is that this kind of therapeutic work takes time, because it requires not only bringing up challenging feelings, but helping parents strengthen the brain systems that support more productive processing of emotions and thoughts. Therapy must address the neural underdevelopment of the parental executive system in these parents. Otherwise, attempts to get parents to bring up and stay with difficult emotions and to trust the therapist will probably fail, as parents default to lower levels of brain functioning and “go defensive.”
Stressed-out adults are parenting in survival mode, using primarily the lower, more primitive brain systems, which automatically come into play during day-to-day existence. Such parents need to calm the overreactive limbic and stress-response systems and tame the amygdala before they can awaken the prefrontal cortex. In short, we must help them dial down their defensive reaction systems before they can access the higher brain systems needed for self-reflection, emotional regulation, and empathy.
Brain-Based Parenting in Action
What difference does incorporating this perspective make in the immediate experience of therapist and client in the consulting room? In joint sessions, Jon had seen Susan and her daughter, Kayla, 13, before, and he found himself siding with Kayla and disliking Susan. Now, armed with our model of blocked care, he met individually with Susan, determined to put this newer understanding of parenting into practice. As the session began, Susan’s facial expression was flat, and she held her body rigidly, as if ready for a fight. Jon, despite his intentions, began to feel himself tensing up and starting to move away from Susan. But before shifting into a full-blown defensive state, he caught his reaction and started breathing slowly to release his tension, regain his focus, and open himself more to her.
Susan was well into a long complaint about how selfish, ungrateful, and disobedient Kayla was, but as Jon started to engage his own approach system and open up to her negative story about the miseries of being Kayla’s mother, he felt more accepting of Susan and the validity of her experience. As his face and body language became more open and relaxed, he noted that her face began to relax and her shoulders dropped. Jon, mirroring the shifts in Susan’s face and body, found himself feeling closer to her, as if an invisible barrier between them were melting away. He looked deeply into Susan’s eyes, where a softening effect was apparent, signaling the lowering of the chronic vigilance that had lined her brow.
Feeling interested now in Susan’s story, Jon asked her to describe the triggers for her anger toward her daughter. She quickly replied, “Her stuck-out lip and that ‘whatever’ tone of voice! Makes me want to strangle her!”
“How have you kept from doing it?” Jon asked, truly curious to know.
“Sometimes, by locking myself in my room until my murderous feelings have passed,” Susan replied.
Jon nodded sympathetically, and said, “Somehow, you found the strength to get past your angriest feelings without actually going after her.”
Blocked care involves the shutting down of the parts of the cingulate where emotional pain registers as part of a parent’s empathic response to a child’s distress. If Susan was going to recover from her blocked care, she’d have to reopen the pathways in her brain that would allow deeper, more vulnerable feelings to rise into consciousness, the very feelings that she’d learned to suppress in self-defense.
In a quiet tone, Jon asked, “Susan, what was Kayla like as a baby?” After being silent for a moment, she began to cry softly.
“She was beautiful, perfect, everything I’d hoped for,” Susan said brokenly. She went on to describe the loving feelings she’d experienced in those early days and weeks, clearly remembering them for the first time in many years. Jon instinctively leaned closer to Susan, with some tears of his own welling up. At this point, he felt a level of attunement with her that he hadn’t been close to experiencing previously. Now he had to try to keep this small window of connection open.
Just as a parent needs to help a child regulate strong emotions and learn to “feel and deal,” Jon needed to stay present to Susan’s internal struggle to tolerate the conflict between her desire to have a loving relationship with Kayla and the defensive, self-protective wall she’d built to keep from feeling the pain of rejection and the sense of failure as a mother. “Maybe it’s hard and good, at the same time, remembering those loving feelings,” Jon said.
“Yeah, good and hard,” Susan said with a slight smile. “Or maybe you just like making people cry.”
“Well, it used to bother me, but now I feel like I’m not really earning my keep if there are no tears,” Jon joked gently.
Susan looked briefly into Jon’s smiling eyes and seemed to feel a bit of lightness herself, before she turned away and sighed.
With the brain model of blocked care as a guide, Jon had a roadmap for slowing himself down, taking the time to help Susan awaken the underused approach and reward systems she’d need to reconnect with Kayla. Jon would continue to build upon this tentative trust-building process with Susan, postponing a more cognitive agenda focused on parenting skills until she was ready for it. First, she needed the chance to get her parenting brain systems working again, particularly the executive ability to regulate the old negative feelings, thoughts, and impulses that would inevitably be reactivated when they began meeting with Kayla.
Taking the Next Step
Once Jon saw signs that Susan was ready and able to move outside her rigid, defensive patterns of interacting with her daughter, he invited Kayla to join Susan for family sessions. By then Susan’s anger was less easily triggered, and the next step was for her to learn to listen to her daughter more openly and less judgmentally. In the first session, Susan clearly struggled not to lose it as Kayla resentfully told her mother, “You yell too much and you never want to hear my side of the story.” Looking at Jon a little desperately, Susan said, “What do we do now? This is usually when I go ballistic.”
The bond that Susan had begun to develop with Jon—her sense that he understood her and was truly on her side—now enabled her to shift her response to her daughter. As Susan looked at him, she seemed fortified by his nonverbal support. Calmly, slowly, Jon said, “If it feels right to you, Susan, maybe now’s the time to tell Kayla that you’re sorry you haven’t been listening to her and that you really want to understand her better; that you love her and want to be closer.” Susan took a deep breath and turned toward Kayla. Tapping into the caring feelings she’d been recovering in therapy, her voice quavering a little, but warm, she told Kayla that what Jon had said was true.
“I really want to know what’s going on with you, and I’m sorry for the times I haven’t listened to you, but I’m going to try harder. I do love you very much, and I really want us to be closer.” At first, Kayla looked doubtful, but she instinctively moved nearer to Susan on the sofa and snuck a peek at her mother’s face, just enough to see the softening in Susan’s eyes that accompanied the softening of her voice. Kayla’s face then began to soften, too, as she mirrored Susan’s caring expression. “Me, too, Mom,” she whispered, without the slightest trace of teenage disdain. There was still much work to be done. This kind of interaction would need to happen again and again. But in that moment, Jon, Susan, and Kayla all shared a wordless sense of hope.
Perhaps the real lesson in this is that all of us—children, adults, and even aging therapists—are, to one degree or another, creatures of our limbic systems. All of us respond better to an approach encompassing playfulness, acceptance, curiosity, and empathy, conveyed with genuine smiles, soft eyes, gentle voices, an open posture, and a figurative hand held out in support. Few of us respond well to closed faces, defensive posturing, annoyed voices, or judgmental eyes. As therapists, we have the responsibility to rise above our limbic systems, to become the adults—even the parents—in the room, until we’ve managed to help our clients access their own better, more adult, more parental selves.
Jonathan Baylin, Ph.D., a clinical psychologist with 30 years of experience, offers the workshop “Putting the Brain in Therapy.” He’s coauthoring a book with Daniel Hughes on the parenting brain and treatment for parents experiencing blocked care. Contact: firstname.lastname@example.org.
Daniel Hughes, Ph.D., conducts seminars and provides extensive training in the treatment of children and teens with trauma and attachment problems. His books include Building the Bonds of Attachment, Attachment-Focused Family Therapy Workbook, and Attachment-Focused Parenting. Contact: email@example.com.
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