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Mark Goulston M.D., F.A.P.A.
Mark Goulston M.D., F.A.P.A.

From Reactive to Reflective Parenting

The more reactive the parent, the more anxious the child

As a specialist in listening, I have to say that I see very little of it going on. Wherever I look, I see people reacting to each other: Wall Street to Main Street (now manifested as Occupy Wall Street to unfathomable, egregious financial CEO bonuses), European Union to Greece, Italy et al, Republican to Democrat, Republican to Republican, husband to wife, sibling to sibling, parent to child.

With regard to the last category, parent to child, I thought, "Once a reactive child enters adolescence and then adulthood, it is very difficult to turn that around." For evidence of that, look no further than your own children, adolescents and young adults. To not put the cart before the horse and catch that horse while it is still a pony, I turned to Dr. Regina Pally, psychiatrist and Co-founder and Assistant Director of the Center for Reflective Parenting in Los Angeles for her insights and recommendations on raising children to not be reactive, but instead to be more reflective.

Goulston: What do you mean by "reflective parenting?" And why do you think it is so important now in our current society?

Pally: "Sadly, I agree with your observation that the world has become much more reactive, which of course fuels the lack of cooperation and collaboration that is rampant around us. There is a big need in today’s society to support healthy parent-child relationships in order to counteract this reactivity. And unfortunately too many children suffer the kind of adversity that can impair this early relationship. What I mean by adversity is not only poverty, but also situations such as trauma, abuse, neglect, and mental health problems or drug abuse in parents. And, I might add, that these issues cross all cultural and socioeconomic barriers.

Goulston: What do you mean by a healthy parent-child relationship?

Pally: First, I want to emphasize that there is no one right way to parent. Since different parents raise their children in unique ways, there are all kinds of healthy parent-child relationships, with people coming from different cultures and backgrounds. But the one thing that all HEALTHY parent-child relationships have in common is that the child experiences the parent as a source of SAFETY, CARING, AND COMFORT. This means that the child feels the parent will protect them, take care of their physical needs and care about their feelings and experiences, and in particular, soothe them when they are distressed.

There are many examples of what this looks like. Let’s say 5 year old Johnny hits his younger brother; the parent may set limits, and provide consequences for this behavior. All of that is fine, as long as the parent does not frighten the child by expressing too much hostility or rejection in the process. In this process, discipline or limit setting is seen as a means to teach the child how they are expected to behave rather than to shame or frighten them.

Goulston: But doesn’t it weaken the effect of limits and consequences if you back off and start comforting the child?

Pally: Well, lots of people ask us just that question. So we say that in healthy relationships with their children, parents’ job is to ‘hold the line,’ but also ‘hold the feelings’. It’s a balancing act; we encourage parents to find a balance between containing their children’s behavior, and caring about their children’s feelings and self-esteem. We don’t think it weakens limits. Kids need limits. But limits should be set in such a way that preserves the relationship and actually supports the child in learning from the circumstance.

Goulston: Well that is great that you want to help people have healthier relationships with their kids, but I don’t understand what you mean by a ‘mindful and reflective approach to parenting’. Can you explain?

Pally: Mindful simply means being present in the here and now. Mindfulness has its roots in eastern practices such as meditation and yoga, which are incredibly powerful for calming the mind and body, but for our purposes, being mindful is a practice of slowing down and just paying to attention to whatever is happening between a parent and child—the actions, and also the thoughts and feelings that arise.

Reflective is a little more complicated to explain. Reflective thinking means recognizing that people have minds and that behavior is activated or motivated by something internal going on inside a person’s mind. In other words, the outward behavior that you can see is linked to something internal that can’t be seen—because it is a mental phenomenon, such as an emotion, an intention, a belief or a goal. So being able to make sense of people’s behavior in terms of mental states is what makes someone reflective. This is as true for the behavior of others as it is for our own behavior. In a way reflective thinking is a bit like mind reading…it asks and answers the question, ‘Why is someone behaving the way they are behaving?’

Like with the 5 year old Johnny. A parent might reflect on why Johnny is hitting his brother. There must be some reason. Is he feeling jealous of his baby brother? Did someone at school today hit him so he is taking it out on his brother or did his brother make him angry by grabbing his toy and he just does not yet have good enough impulse control not to hit? An important point to remember is that each person’s mind is ultimately separate and opaque. So, it’s not always possible to understand another person’s thoughts and feelings, but this effort to understand a child’s perspective is in itself valuable. It encourages a parent to think beyond reactions or assumptions they might have to their child’s behavior.

One mother told us her daughter was being picked on by the teacher and the mother was so worried that her daughter was feeling rejected and humiliated in class and needed the mother to intervene. It turns out the daughter did not really feel that bad, and said the teacher is like that, and she’d figured out that it was better just to take it in stride. In this situation, the mother was able to see that her reaction to the teacher’s behavior related to her own history rather than her child’s experience in the present.

We know that kids need both to be dependent and connected to parents as well autonomous and independent of parents. So by reflecting on her experience, this mother figured out that her daughter needed her to support her independence in this moment rather than the child’s need for dependence.

Goulston: You say these things are so important, but what’s the evidence?

Pally: All the research points to the fact that children tend to do better over the course of their whole life when they have a healthy relationship with at least one parent or primary caretaker. We always tend to use the term parent, however some children are raised by a relative or other adult. I should say here that in terms of the research the technical term for a healthy relationship is a “securely attached relationship.” And it turns out that you can measure whether or not the relationship between parent and child is ‘securely attached’. When kids are securely attached, they are more likely to do well in all spheres of functioning. They do better emotionally, socially and cognitively. This is because they are better able to regulate their feelings and contain their impulses. And what is remarkable about having a secure relationship is that it can protect a child from the negative effects of adverse experiences in childhood.

Goulston: Well the research says healthy or what you call Securely Attached relationships lead to better outcomes in children, but why the emphasis on being mindful and reflective.

Pally: Well we have known for a long time that securely attached children do better. But it took a while to figure out just what features of the parent-child interaction led to this kind of security. At first the researchers attributed secure attachment to the parents’ ability to be emotionally sensitive and attuned to the child, and the work with parents and children focused on helping parents be more sensitive and attuned. But this didn’t fully explain the data because sensitivity on the part of the parent did not always correlate with good outcomes in the child. It took a while to discover that, in fact, it was the parent’s capacity for Reflective Function that was much more likely to correlate with positive childhood outcomes. The evidence is strong that kids whose parents can think reflectively are more likely to be securely attached and do better in life overall. Mindfulness comes in because reflective thinking requires being calm enough in the moment.

For this reason about 10 years ago, 2 clinicians in LA, John Grienenberger and Diane Reynolds, each developed parenting groups designed to enhance mindfulness and reflective thinking. But Diane and John were operating on a small-scale separately in the community. So in 2008 my co-founder Paulene Popek and I decided to create the non-profit organization Center for Reflective Parenting in order to bring together these two programs with the goal of SCALING UP, and expanding services, so we could help even more parents in the community become reflective. The parenting groups they developed are the core programs we use at the Center.

Goulston: So your programs are designed to increase the reflective thinking skills of parents. How do you do this?

Pally: Our approach is to help parents shift from REACTIVE to REFLECTIVE. We all tend to have quick reactions to the behavior of others. A kid misbehaves, and the parent can react angrily or harshly. So we get parents to push the pause button, or as you say, to ‘put on their own oxygen mask first.’ To take a tiny moment to inhibit that reactivity, and to try and think reflectively about what is going on in their child, and in themselves, in the present moment. CRP uses parent groups to do this. We have two main parent groups. One program is called Mindful Parenting Groups and it is for parents with their infant or toddler, and the other is called the Reflective Parenting Program, and it is just for parents. Both programs emphasize the importance of ‘mindful awareness’ so that the parent is able to be calm and present in the moment. Both groups also teach parents reflective thinking skills within whatever interaction they are having with their children.

We have services for all kinds of parent-child situations. Our programs work with relatively well adjusted families where the parents just want to hone or improve their parenting skills. We do this work on our own premises and also through schools. But I must say our main focus is to work with parents and children in at-risk populations. So that means we put most of our energy into working with community agencies and organizations that work with the most needy and underserved families.

Another point I want to emphasize is that reflective function is a natural capacity that helps people in all types of situations be less reactive and also cope better with stress. But even though it is natural it still needs to be learned. Just like language. Kids will learn to speak, but they have to be around people who speak to them. They learn by imitation and by internalizing what is around them. It’s the same thing with reflective function. Kids learn how to be reflective by being taken care of by people who are reflective. So if we teach parents how to be more reflective, they will naturally pass this onto their children. This is one way to stop the cycle of abuse and violence that can be handed down from one generation to the next.

Goulston: Can you fill me in a little more on how these groups work? And while you do that can you explain why you use different names for your groups

Pally:Yes. Well let me answer the 2nd part of your question first. Diane and John developed their groups separately and therefore named them separately. We kept the original names to honor this separate heritage and also because the format of the groups is a little different. Mindful Parenting Groups have a group of parents (or other primary caretakers) and their babies who start out in a circle on a blanket. Groups are held for 1 ½ hours on a weekly basis for a minimum of 12 weeks. The group starts with quiet ‘mindful’ observation, but then follows the lead of what happens with the children. Parents in the group are encouraged to think reflectively about what they observed in their children and also about how they were feeling while watching their children. A parent might be asked ‘When you saw Sarah grab the toy from Alberto, what were you feeling? What do you think was going on in Sarah’s mind when she was doing that? How do you think Alberto felt?’ Other parents chime in with their responses as well. Group leaders serve as role models. So that parents can be relieved of some of the responsibility of taking care of their child’s needs during the group, facilitators will help navigate the interactions between children and handle children’s distress and do so in a reflective way. In the Reflective Parenting Program, we can work with parents of children of all developmental ages. So we have groups for parents in the pre-natal period, as well as groups for parents of kids in preschool, elementary school age, middle school and high school. We use a curriculum in which we discuss the usual concerns parents have, such as discipline, anger management, separation and temperament. There is a topic introduced, followed by various exercises, such as role play, in which parents are encouraged to think about these issues in a reflective way, meaning to wonder and be curious about what might be going on inside their child.

For example one mother brought up how hard it was to brush her daughter’s hair in the morning and how there was always so much tension in the morning around that. The mother just felt so frustrated and defeated. Well, the group took turns role-playing the daughter and the mother in that situation. All the parents and the group leaders tried to think through together what the mother was feeling and intending and what the daughter was as well. This group approach is so important because parents can often hear things from other parents that they can’t hear from group leaders.

Goulston: I know as a parent myself that we are a very sensitive bunch of people. We don’t like others to know about the mistakes we make with our kids. How do you deal with that?

Pally: That is such an important question. I want to emphasize that we are very clear that all parents want to be the best parent they can be, and that all of us, and I include myself here as a parent, can do things we are not proud of. So we work very hard in the group to be nonjudgmental. Parents are not criticized or told they did it wrong. Everyone is trying their best. But sometimes our feelings can get so strong that may we may become, for example, too angry or too hurt or too embarrassed by what our children do. One thing that is really important here is that we always remind parents that they don’t have to be perfect and that conflict is always inevitable in any relationship. The point is not to avoid conflict, but to recognize that it is normal. We are all different people, even children and parents will have different perspectives, different agendas, and different needs. The mother and daughter each had a different goal in the morning. The mother’s goal was to get out of the house in a timely fashion so she could get to work on time. But the daughter was self-conscious about her hair, and her appearance was very important to her, so she was very anxious and irritable about the whole hair-brushing thing. She wanted to look perfect. Her mother just cared if she looked neat. So we emphasize that conflict is normal, and it is not something that means there is a problem. But sometimes the conflict can get so intense that it can cause a rupture in the relationship. Or parents get too angry and say really hurtful things, or kids get too angry and say really hurtful things. Or what a parent says may make a child feel too shamed and therefore shut down. When these ruptures happen, they need to be repaired. Ruptures such as those caused by conflict or anger are not harmful as long as they are repaired. In fact, we tell parents that working these conflicts through and healing the ruptures provide kids with a source of resilience for managing and coping with the kinds of distress and conflict they will face in life in general.

We also remind parents that when the emotions flare up, it is really hard to reflect. In fact, from a neuroscience perspective, reflective thinking skills go down when stress and emotion go up. Since that happens, parents can’t always be reflective in the moment. Sometimes they have to go back and repair and reflect together with the child after the fact.

Goulston: Well you have given me a flavor of what you do in the groups is there any thing else you want to add that is important about what you do.

Pally: Yes, there is. We don’t give out a ‘one size fits all’ approach to parenting. We don’t tell parents what to do. Parents ask for answers, but too often just providing answers undermines a parent’s own sense of competence and effectiveness. We encourage parents to think situations through for themselves. We support them in doing this and to try to come up with a solution to the problem that best fits them and their child, in terms of temperament, family values and other personal family circumstances. Some mothers can handle more noise than others. Some children can handle more independence than others. The point is to help parents create solutions of their own.

About the Author
Mark Goulston M.D., F.A.P.A.

Mark Goulston, M.D., the author of the book Just Listen, is a Clinical Assistant Professor of Medicine at UCLA's Neuropsychiatric Institute.