Last blog I introduced the four domains that influence our I-M, our current maximum potential, the idea we are always doing the best we can.  The four domains are our Ic, (our current concept of ourselves and the way we think other people see us, or Theory of Mind), our biological domain of our brain and body, our home domain, and our social domain or the rest of the world.

Joseph Shrand The I-M Approach
Source: Joseph Shrand The I-M Approach

An I-M Approach Example

Imagine a little boy is playing by himself in the sandbox.  He is three years old, healthy, happily playing with his toys.  Gradually a feeling starts in his belly.  At first he ignores it, faint, distant, familiar but uncomfortable.  He moves his body a little in case his tummy hurts just from the way he is sitting.  For a moment it goes away, and he turns his attention again to his play.  But then it is back, a little stronger, and stronger still.  He has felt this before, and he knows what to do.

Inside his house life goes on.  Parents are doing what parents do, siblings are doing what siblings do.  The little boy leaves his sandbox, a discomfort that can no longer be ignored or avoided by his games.  He finds his mother.

 “Mom, I’m hungry.”

“You’re hungry?  Then I’ll feed you.” 

What has happened here?  The child has identified a feeling that he thinks may be hunger.  It’s in his belly, a little uncomfortable, but he’s felt it before and it went away with food.  Any food.  Still not quite old enough to satisfy the discomfort himself, he has gone to his mother, a person who has taken care of this problem before, sometimes even before he knew he had the problem. 

He doesn’t ask, “Am I hungry?”  He makes a statement and then waits for confirmation.  “You’re hungry?” asks the mother, “Then I’ll feed you.”  The child is now saying to himself, “Yes, this is hunger.  I thought I was hungry and my Mom said she would feed me so I must have been hungry.  Cool.”  And catalogues the feeling of hunger for future reference.

In this simple example, the entire I-M Approach is demonstrated.  At first, the boys’ I-M is quietly playing with his toys.  He is alone yet comfortable.  He is able to play by himself knowing his family is inside.  (A child who can play by himself is usually a securely attached child, one who feels safe, valued, and respected.)

There is a shift in the Biological domain.  He becomes hungry.  A cascade of biologic mechanisms begins to send a signal to his brain, beginning a fluid transmission between Domains, altering his self-image and Ic.  This change in how he perceives himself, from contently playing to the mild discomfort of hunger, propels him into his house.  He has already learned that his home and family are a place where this discomfort can be appeased.  His Home Domain is responsive to his needs, and confirms his Ic.  He thought he was hungry, his mother confirmed he was hungry, and then she fed him. His Home domain had a direct impact on his Ic and his Biological domain.

This interaction in the Home domain will have lasting dynamic on how he engages in his Social domain.  As he gets older, the types of attachments he makes at school, with friends and then lovers, with employers and employees, will have as part of its foundation interactions such as these: if you are hungry I will feed you.  This core event fundamentally affects one’s Ic.  When a need as basic as hunger is met, the individual’s biological barometer is set at a different I-M, the Ic becomes one of a person who sees themselves as valued and respected, and is more able to trust. When you trust you can take more creative chances. This sense of self-value influences the choices this little boy will make in the home and social domains, now and in his future. In the vast majority of homes, this simple interaction follows the same path.  I’m hungry.  You’re hungry?  I’ll feed you. 

There are many times when a parent cannot immediately meet the needs of the child.  Sometimes a parent may say, “You’re hungry?  OK, I’ll feed you.  Right when I finish what I’m doing.”  In this example the initial confirmation is still powerful, confirming the internal experience of the child with an external validation.  But the parent has also asked the child to appreciate their own internal point of view, their own Ic.  The parent’s I-M is changed when a child asks for food. Their Biological domain has been primed to expend energy to feed their child.  Their Ic activates as a parent who feels capable, knowing they can take care of this child needs, and that they are, therefore a “good” parent.  But they may be paying bills, tending to someone else in the home domains,or interacting at a different level with their Social domain.  Now the Home domain, in the form of their hungry child, is exerting an influence: you control no one but influence everyone.  The small change of the little boy feeling hungry and going to his mother has had an effect.

By asking the child to wait without invalidating the child’s Ic of hunger, the parent has been able to interact with the child in a way that models mutual and reciprocal respect, value, and trust.  “I will feed you because you are hungry, but I have confidence in you that you will not die of starvation in the next five minutes, and that you can tolerate the discomfort of hunger without resorting to disrespectful and unsafe behaviors. Trust me now.  I will feed you in the future.”  While the child may remain hungry for a few minutes, it also enhances the child’s Ic that they are seen as a person who can tolerate difficult feelings.  He has learned that everyone has an I-M deserving of value and respect.  He has learned to trust that people will follow through on their promises.

The little boy was validated by his mother.  He felt hungry, she said I’ll feed you, thereby affirming his internal experience.  The next time he felt hungry he would be able to identify it and seek the resources needed to get rid of it:  another person to give him food.  As he gets older and more independent he will be able to feed himself as well as others who tell him they are hungry.  He is more likely to be a productive and valuable member of the group.  He is learning that helping others feel respected and valued leads them to trust him, increasing his own value. For when other people trust him he feels respected, valued, and can trust others.

Small changes can have big effects.

You control no one but influence everyone.

It’s an I-M thing.

Joseph Shrand, MD, The I-M Approach
Source: Joseph Shrand, MD, The I-M Approach


Shrand, J. with Devine, L. (2014) The Fear Reflex. Hazelden Press.

Shrand, J. with Devine, L. (2015) Do You Really Get Me?. Hazelden Press.

About the Author

Joe Shrand, M.D.

Joe Shrand, M.D., is an instructor of psychiatry at Harvard Medical School.

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