Transcript: Empathy and emotional intelligence


Professor David Howe, one of the UK's leading social work academics, talks about how attachment theory is informed by research and how this translates into practice, and why attachment is a key element in effective and appropriate practice.

Podcast Episode: Empathy and emotional intelligence

Category: Attachment 

Speaker(s):


What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

DH - David Howe

David Howe - Emeritus Professor in the school of Social Work and Psychology at the University of East Anglia - one of the UK's leading social work academics specialising in adoption, emotional intelligence, empathy attachment theory and child abuse and neglect. On 10th May 2012, he addressed a packed audience of academics, students and practitioners at a meeting of the resiliency, risk and vulnerability research network in the school of education, social work and community education at the University of Dundee. In a wide ranging and fascinating lecture, Professor Howe talks about how attachment theory is informed by research and why attachment is a key element in effective and appropriate practice.

DH So I decided to do a fairly ambitious talk trying to weave together all sorts of bits and pieces that are very fashionable and very trendy to try and make an argument that may sound as old as the hills but I think is going through something of a revival, and that's the importance of the relationship in all professional practice. So I wanted to try and just give you an updated version of why people feel this is a key element in effective and good and appropriate practice. In order to do that I am going to go through some quite exotic areas and try and weave together a story by the end of which I hope you will feel there is some merit in the argument that the kind of talents and histories that you bring to the job, to the profession, to the discipline are still valued not just by the world at large, but particularly by researchers currently at the cutting edge of these kind of thoughts. I suppose in a very crude sort of way we can say that a lot of the work that we do when we work with people is just simply looking at how people do social life, how do we interact, how do we do relationships, how do we engage with other people both personally and professionally, often in quite complex and stressful situations. Of course those that can't do social life with great skill either feel troubled or they become troublesome, these are the kind of people that become patients and clients of all the services represented in this room today. Paralleling that kind of insight is a huge growth of interest in this whole area of mind reading, how we know and think about what other people might be thinking and feeling, and it undergoes all sorts of interesting reflections when we talk about empathy, emotional intelligence, mind mindedness, social cognition, social understanding: it's a wonderful human talent this ability to sense that other people have things going on in their heads and that knowing that what you might think is going on in their heads might predict their behaviour, cause you to behave in a particular way and it begins to govern all the to and fro of complex interaction. So there's been a huge growth of interest in this whole business of things like empathy and emotional intelligence and social cognition. People who are gifted with these particular skills in high measure tend to show higher resilience whenever they meet stress and risks and challenges in their everyday life. If you don't have high emotional intelligence, good empathy, adequate social cognition, then social life does get difficult: it's hard to fathom, it may not make sense, you are going to get frustrated, you are going to find life generally much more challenging. So these people tend to become the troubled and the troublesome.

So basically each of these components, empathy, emotional intelligence, act as resilience factors, so I suppose at one level we are in the business of trying to increase people's ability to develop good empathy, social cognition, good social understanding. To an extent that they can get better at this and act as a buffer when they deal with lives ups and downs, to's and fro's, when they meet risks, stresses and strains. If you have got good emotional intelligence, good social cognition, then you are possessed of a degree of resilience in the to's and fro's of everyday life.

So I am now going to just dip into a number of different disciplines just to see where people are coming at with these kind of ideas. For a long time now, people who had an evolutionary perspective have been interested in how the human race, human beings as a species developed this thing called mind reading or empathy or emotional intelligence. Anthropologists, particularly those with a strong evolutionary bias have looked at historically how human beings evolved from the plains of East Africa, and how small group living, tribe living individuals - the idea of beginning to work as a cooperative group began to give our species huge evolutionary advantages. So what they begin to do is argue that as a species, when we began to move into the savannah lands of North East Africa in small hunter, gatherer tribes, usually around about 20 to 50 to 60 people, it was key for survival for those groups to begin to develop a cooperative style of living. Not just to, as it were, survive at the physical level but also to survive in terms of the threats that that environment would have posed. Going back 150,000, 200,000 years ago which is roughly when we as a species had our beginnings, there were real dangers out there, wandering around in small bands of community groups of hunter gatherers, there were real predators and real dangers out there. So there was safety in numbers and generally safety in numbers meant that the group would begin to survive. But you could also argue, as indeed the anthropologists do argue, is that one of the other talents of human beings is to begin to take advantage of all the different skills that any individual member of that group has, but in order to, as it were cooperate and collaborate at this community level, again we have got to be able to anticipate, predict and mind read other members of the species. So they felt there was evolutionary pressure for those who were gifted at this particular skill of thinking about, anticipating, wondering about other people's thought processes, feeling processes, plans, beliefs and intentions, that this would give the species an evolutionary advantage. So it allowed not only safety in numbers against predators so that essentially out there were real dangers, I gather from the literature, that leopards were probably the biggest danger to human beings, particularly for young children; that living cooperatively meant that safety in numbers meant that small young would receive some degree of protection from those around them. We are going to revisit that in a minute when we look at attachment. But also trying to take advantage of the multiple talents that are found in the community group meant that we had to learn to cooperate. So individual differences get exploited by the group to the extent that we are good at mind reading each others abilities, skills and attributes. But in order to do this thing called mind reading and in order to do this thing called social cognition and emotional intelligence requires a huge amount of brain power. It's one of the most sophisticated things that the brain can do. Think about the mental states of other people and as you are thinking about other people's mental states, also being aware that they are thinking about you in exactly the same way. Now this to and fro of weighing up each others mental condition, mental state - Peter Fonagy calls them mentalisation - is a very trendy, fashionable term, a lot of people are cottoning onto it and using it to think about how we do social life, how we do social relationships. So we are going to come back and just look in a bit more detail about how we acquire mentalisation, empathy and social cognition, develop mentally in young children.

There's a rather nice book written a few years ago by Sarah Hrdy, she's an evolutionary anthropologist, and it's called 'Mothers and Others' and essentially what she is doing is taking a feminist perspective and just looking at how important early care giving was in these very early human groups, and the role that women in particular played in getting young children to make sense of the cultural, social context in which they found themselves, and she makes a great deal of play about the importance of grandmothers. From an evolutionary perspective once we have reached the end of our reproductive potential... from an evolutionary perspective we shouldn't carry on, we should just be redundant and evolution should just basically get rid of us because we are neither use to ornament once we have achieved our reproductive potential. But what she argues is that the reason that particularly females live way beyond their reproductive age is that they play an important role in maintaining the species at this group tribal level. Grandmothers have wisdom, they have knowledge, they can act as supplementary care givers, they begin to introduce a lot of experience into the social group to support mothers looking after their young in these rather difficult, challenging circumstances of the savannah lands of North East Africa, 150,000 or 200,000 years ago. So safety is in the group, just as a little quick footnote that we will revisit from time to time. The message is also there that to be outside of the group is to be in real danger. So anything psychologically that feels as if the group is either rejecting us, abandoning us or we're lost from the group (we're ostracised from the group) feels a very unsafe place to be. So anybody who feels apart from the group feels in a dangerous place. Okay we are 200,000 years later down the line, but it still feels psychologically dangerous, unsafe, threatening to be apart from the source of safety protection, that is the groups of other people. We all know how deeply shameful and painful it is to feel abandoned by a close group, and certainly when you are growing up through childhood of course, to be rejected by the group is a terrible place to be, it just feels absolutely awful. But that carries on echoing throughout the lifespan, so one of the things that we need to think about developmentally is the psychological impact on children who feel rejected or abandoned by the most important members of the group, that is, their own primary care givers. So we are going to come back to that in a few minutes time.

I am now going to go into another field that's taken a great interest in all of this kind of thinking and that's the neurosciences, the brain scientists. And again you will probably know from your general reading that the brain is very sexy and very important across a whole range of developmental sciences these days, and of course the whole business of just looking at children's growth and development in the early years has been really rejuvenated by the way neuroscientists look at early brain development, so just a very quick little bit about the brain and its early development.

Well that's the human brain sliced from front to back and you will see that there's a very macro structure going on there. At the bottom coming up from your spinal column is the brain stem, that's the bit that enters the bases of your brain, at the back of the brain, behind the brain stem is the cerebellum, the little brain, it does all sorts of complicated things, very dense, rich part of the brain. The brain stem grows into this rather complex structure that does many, many things, called ... very roughly called a limbic system, and sometimes very loosely it's called the emotional centre of the brain. It does far more than deal with emotions, but one of the key things that the limbic system does is receive senses, messages from our senses that gives an emotional experience and emotional valence. Now I don't know if you have ever thought about emotions, they are very strong things emotions, feelings, we have so many of them. Simon Baron Cohen has identified over 200 different emotions that human beings can show: terror, fear, anger, sadness, happiness, disgust, exasperation, shame, there are so many different emotions and they are usually triggered by processing information from the external will through our senses, and it begins to excite specialist bits of this thing called the limbic system, and we get an emotional experience. Now most emotional experiences are actually triggered before we can actually start to think about them, we tend to have feelings first and think about feelings second. Now the most primitive of all the feeling states is fear, generally fear is important as an emotional response to threatening, dangerous situations, because it's the one that triggers our bodies to react in order to survive. So lets think of an example, if you are walking down a, let's say you have been late at work and you are walking down a street late at night and the street lamps suddenly switch off for whatever reason, you have been thinking about your shopping list for tomorrow or something like that, the street lights go out and you start to hear footsteps behind you. You are on your own, its pitch dark and there are footsteps behind you, I mean most of us in that situation are going to feel, well a degree of fear, some of us might feel terrified in that situation. You certainly stop thinking about your shopping list: your body goes into a fight or flight mode, probably a flight mode at that stage, how to get out of this dangerous place to a place of safety where there are people and street lights and other things going on. Fear is the most powerful and important of all the emotions: it's to do with our continued survival. So I am emphasising fear deliberately because when we come back to look at children's development, particularly in situations of abuse and neglect, we will see that fear is perhaps one of the biggest drivers to how children begin to develop along suboptimal developmental pathways. And as the limbic system is processing this sensory information to give us our emotional experiences - emotions give our everyday activities what's called emotional valence, it gives them a kind of a charge over and above what we might just normally think about. And then lying on the top of that, occupying around 8% of the volume of the brain is the cortex, the bit we traditionally think of as the brain, the crinkly bit around the whole of the top of your head, it grows into that rather crinkly, crumpled look because as the brain expands into the skull as you are growing up, it needs to occupy as much space as it can so it begins to curl up in on itself, and because early anatomists thought it looked a bit like tree bark and the Latin for tree bark is cortex, they called it the cortex. It's amazing what you learn on these things, isn't it? (laughter).

So roughly you have got these four different divisions of the brain very crudely speaking. Now the next thing to note is that the brain is extremely complicated, up to 100 billion nerve cells or neurons. Each of those 100 billion neurons on average is connected to between 5,000 and 10,000 other neurons, so do the maths. 100 billion cells, each cell is connected on average to many, many thousands of other nerve cells. The networks, the neural networks that that creates is just astronomical - extraordinary complicated. And that's the bit that's doing vision, language, thinking, feeling, the whole works that makes up you and me at a psychological complex neurological level. But in order to do all of that processing, the brain needs to start connecting all these neurons together to make up all of these vast numbers of networks that we are talking about and a lot of this has already happened before you are born but so much more continues after you are born.

So here's just a couple of little aphorisms that will just get us into the mood for this kind of thinking. The brain is a self organising, developmental structure: self organising developmental structure. In other words it beings to organise itself, it begins to hard wire itself as it develops. So that's the first aphorism to bear in mind. The second one perhaps is even more interesting. The brain is programmed to make sense of experience but in order to make sense of experience it has to be exposed to the experience of which it needs to make sense. I will repeat that one, the brain is programmed to make sense of experience, but in order to make sense of that experience it needs to be exposed to the experience of which it needs to make sense. Now what that means is the brain is exquisitely adapted to, as it were, understand a world in which it finds itself. So depending on the nature of the world in which it finds itself, it will begin to make sense of that very world. Just think about language, if you are born into an environment where everyone speaks distingual English, then the particular bits the brain are programmed to make sense of sound and noises, you will learn and understand English. Different again if you are born in Japan or South America, learning Spanish, that's a cultural environment that will determine what kind of organisations the brain develops to make sense of sound, speech sound in particular. So that general little bit of wisdom the brain is programmed to make sense of experience but it needs to be exposed to experience in which it needs to make sense was tested many years ago by two guys who got the Nobel Prize for their work, Hubel and Wiesel, okay they said we can't do this kind of experimentation on human beings, its not ethical, so lets do it on kittens: very similar kind of brain organisation to human beings but on a much smaller scale with a smaller cortex, but let's try this on kittens to test whether that is actually true. So what they did was they decided to test it on kittens looking at vision, visual stimuli, it's the back of your head, the occipital lobe that deals with vision, its your brain that's seeing, your eyes are just simply a mechanism to get, as it were, messages via the optic nerve to the back of your head, and its the back of your head that unscrambles all of those messages to give you a sense of the visual world out there.

If you damage the back of your head seriously, you go blind: it's the brain that's doing the seeing, but in order to learn to see, to make sense of visual stimuli the brain has to be exposed to visual stimuli before it can make sense of it. Now visual stimuli is very complicated, it's colour, contrast, texture, movement, perspective: think of all the different components that make up being able to see. Well the brain has to learn to make sense of all of that, to give us that sense of a visual world out there, so what they did was they introduced kittens at birth to different visual environments. The most extreme thing they could do was raise some kittens from birth in total darkness: okay that means the brain is deprived of all visual experience. If their predictions are right, then the bit of the brain at the back of the kitten's head that should learn to process visual stimuli was never exposed to that stimuli in the first place, so they should find that then they look at the neurons, the nerve cells at the back of the head that are sitting there waiting to be excited by visual stimuli, they never get that excitement, so they never make the connections that help the brain to learn to see. And indeed roughly speaking that's what happened. The kitten's brains that were not exposed to visual stimuli failed to develop those thousands and thousands of neural pathways that help the kittens process visual stimuli. Some kittens were raised in environments where there was just very strong stripes, black and white stripes and not much else. The kittens brains as it were could process strong vertical black and white stripes, so when the kittens had aged 3 or 4 months and were introduced to a normal environment, the kittens could cope well with things that were vertical, they could move around them, but if you put a horizontal bar in front of them, they would trip over it. It's that subtle, that sophisticated.

So basically they were demonstrating indeed the brain learns from experience but it needs to be exposed to the experience before it can begin to make sense of it. So you could take the same argument and say what happens if you were raised as a baby and you never heard human speech? Well the prediction would be that the bit of the brain on the left hand side of your head that would normally process language, speech, would never be stimulated and therefore you would not learn to be able to talk and speak backwards. The brain is quite efficient in some ways. If it's not being used, it's not being stimulated by one sense, lets say vision, very often other senses will start to take over bits of the brain, so you develop as it were, hyper sensitive awareness of let's say touch or sound if you are getting no vision stimuli. So you can as it were, make transfer value from different areas of the brain.

Okay you may think why is he going on about this? Well the reason I am going on about it is that it turns out that what's really excited brain scientists, is that one of the key things that children have to be exposed to in order to make sense of it and cope with it and do it, is emotions and social life. So what we began to argue was, well let's just think about how the emotional centres of the brain begin to get experience of emotions, how the brain begins to process and make sense of that and how the cortex, the bit at the front, particularly what's called the right pre-frontal cortex, that's the front of your head here, how does that begin to connect to the emotional centres of the brain to be able to make sense of feeling and social interaction. In other words very crudely, how does the brain begin to think about feeling, how does the brain begin to think and be aware of and reflect on its own feeling states?

Now many feeling states are triggered by day to day interactions with other people: jealousy, shame, anger, disgust, shyness, so many emotions are triggered in our day to day interactions with each other. But how does the baby, the child, the young toddler, begin to make sense of these things that are happening to him or her at this visceral level, because emotions are not just psychologically subjective experiences, we feel so many emotions in our bodies as well. If you think about major emotion fear, it's not just what you feel in your head: fear is in the body as well, you get knotted in your stomach, you go pale as the blood drains from your skin into the long muscles in order to help you flee or fight. Or if you're angry, we talk about getting hot and bothered because the blood then suffuses to the skin as you get all charged up for an attack, fight response, in that situation. So the body also reacts to emotions just as much as the brain does, and of course there's a huge amount of connection, synergy between the brain and the body in our modern understanding of the brain sciences.

So let's then take that argument and see where it takes us in terms of how people learn to do social life, because if you take Hubel and Wiesel ' thesis and apply it to what we have just been saying, in order to do social life and regulate our own and other peopless emotions, we must be exposed to experiences in which we are being introduced to emotions and social life in a regulated measured way. And we find that most of that will take place in the early years in the context of parent child, family child relationships. So the quality of that experience in the early years will govern how the brain begins to make sense of those key experiences as young children in order to do social life.

If you get lousy experiences or difficult, stressful experiences at the social emotional relationship interpersonal level, it will compromise the brain's ability to organise itself to make sense of those experiences and it will compromise a child's ability to regulate their own and other people's emotional states. That is, they will find social life stressful, difficult, challenging and generally they will come to the notice of authorities at surprisingly young ages. That's where you guys come in, you will start to pick up people are getting anxious about Jack's aggression at nursery or Jill's withdrawal and wetting herself, even though she is now 5 or 6 years old and she's in reception class in her primary school.

Now this diagram here is very simplistic, but someone you might have come across, he's certainly been in Scotland recently - I think he was in Glasgow last year - was Bruce Perry, so a lot of you will have seen Bruce and heard him: he's a very charismatic guy, he's a brain scientist, he's a child psychiatrist and he's got this child trauma academy over in the States that does great and interesting work. So he takes this brain diagram and simplifies it to produce the following model. So that's that's the kind of triangular image of the brain, cortex, limbic system, brain stem cerebellum. He then turns it into this diagrammatic form but then reminds us actually what happens is, that in order for the brain to be exposed to the experience of which it needs to make sense, the child also has to learn to regulate its exposure to these experiences to begin to handle it in the least stressful way possible. And he reminds us that what parents are doing as they raise children from birth throughout the early years of life, is that they are helping the child be exposed to experiences in a measured, regulated way so the brain has the best chance of making sense of those experiences in order to handle them well throughout life.

And one of the first things that parents do is help children regulate themselves at the sensory, physiological level. Are you too hot? Are you too cold? Do you need a sleep? Are you tired? Lets get you into some kind of rhythm with feeding. So bit by bit over the first few weeks and months of life, both parents are helping their children to begin to regulate themselves physiologically and sensorily, and by 12 months most children are beginning to have sleep patterns that are regular, eating patterns that tend to be regular, sensing when they are too hot, too cold, when they are hungry, not hungry, when they are thirsty, not thirsty, all of those experiences parents initially do on behalf of the baby, but bit by bit as the baby is exposed to those good quality experiences, the brain stem that generally, as it were, coordinates and conducts those activities begins to get its act together. So the child becomes self regulating at this physiological, sensory level.

Now we know from working with many kids who have suffered trauma, abuse and neglect in the very early weeks and months of life, they can't even regulate their bodies. These are the kids who are accident prone, these are the kids that have all over the shop sleep patterns, their cortisol levels - which is a measure of stress - most of us have high cortisol in the morning and it fades away during the course of the day. Take a 7 or 8 year old who has had a good experience, high corisol in the morning and gradually by bedtime, its dipping down, the body is quietening down and its ready for sleep. If you take kids who have suffered abuse and neglect, their cortisol levels are just all over the shop: they have never been regulated in these early weeks and months and years of life. So when you look at many kids who have suffered abuse and neglect, one of the first indicators that things haven't gone well in the early years is just getting a sense of how they work at this physical, somatic level. What do we know about their rhythms? Do they have any rhythms for each day? Do they have any patterned, regular experiences to which they can begin to adapt and develop optimally? So he begins to look at all of these at this very basic level, but then he reminds us all of this is taking place, not just in the context of physically bringing up your baby and child, but also at the same time, most parents are in a relationship with a child.

They are talking and chatting and touching and thinking about the child. So when we get to the middle levels, the emotional levels and the top thinking levels, the cognitive cerebral levels, then he's looking for the quality of interaction between parent and child to see what kind of experiences children have at this level. So when we get to the higher levels, we are beginning to see how important it is the quality of the care giving relationship, and he calls this whole thing, 'Neurosequential Development': how the brain begins to organise itself in the light of the kind of experience to which it has been exposed over the early years of life. Neurosequential Development. And for most kids that suffer good enough care, sorry, ...suffer .... (laughter), enjoy good enough care - what does that say about me? - then these things are generally running in an optimal fashion and bit by bit the brain gets more and more complicated. Because this is a very short lecture I would love to show you lots of diagrams about how bit by bit the connections begin to grow from the bottom up and spread throughout the whole brain, so the top bit of the brain, the thinking, reflective bit of the brain begins to understand these deep physiological bits of the brain, so all the bits of the brain begin to get connected and coordinated and bit by bit the child becomes coherent, psychologically, physiologically, emotionally and socially. And we have a degree of coherence at all these different levels social life actually is quite doable and you are not going to be troubled or troublesome: you will be okay, you won't come the way of clinical psychologists or social workers or police officers or all the other folk who are likely to get interested in you should you become troubled or troublesome.

So this then links Hubel and Wiesel stuff with little kittens who they tortured basically, and then killed and looked at their brains 3 or 4 months later - I will just rub that in for all those ethicists amongst you - you can't do this with children (laughter), but of course these days with modern brain scanning techniques you can do some extraordinary refined things by looking at early effects of experience on the brains early development. Now because the relationship is so important for all of us, the brain scientists suddenly got very excited about attachment theory. Here was an existing theory that seemed to have some very interesting things to say about the quality of parent child relationships, so let's start getting interested in that to see how it affects the kind of arguments we have been making so far. So that's just a summary of what we have been saying so far, so you have got this bottom, what Bruce Perry calls 'bottom up, inside out': start at the bottom, work your way up from the inside to the outside. That's what most parents instinctively do when they are raising children, but all the time they are doing it, they are in a relationship, they are communicating and interacting with their child. So at this stage then we start to think about how do children develop emotional intelligence, empathy, mentalisation.

Bowlby in fact was the person who coined the phrase 'the environment of evolutionary adaptedness', so he began to get very excited by what the evolutionary scientists were thinking about in terms of how we developed over the last 200,000 years, and one of the key things was looking at how we begin to regulate our emotions in the context of these very complex relationships that are critical if the human species is going to thrive and survive in these small hunter gatherer groups. So here was Bowlby beginning to make an argument, how can we think about the kind of behaviours that will increase children's survival over these early vulnerable years in order for the species to thrive and survive, and out of this emerged what he called attachment theory. So just a very quick little digest of that and then we will see where the story goes next. I am racing through this so I am trying to knit together all sorts of different things, so if I am slightly going too fast, apologies, but I thought I would do something a little bit ambitious and try to pool together all these diverse fields to make a general argument.

So here's Bowlby, he's been beavering away at why children and their parents early care giving relationships so often predict later mental health and behavioural problems. Why does early adversity more often than not predict later life problems, particularly in terms of emotions and their regulation and the ability to do relationships. Well one of the disciplines he looked to to make sense of this was evolutionary theory. So again just like the anthropologists, he began to get really interested in our species origins back on the North East Plains of Africa, 200,000 years ago. Okay its a dangerous environment, there are natural predators and the most vulnerable member of the tribe were babies and young children: they are small and they are tiny, they can be picked off very easily by large birds of prey, hyenas, leopards. Its absolutely critical for the child not to be lost to the group: to be apart from the group you are dead. So to be abandoned, to be separate, to be not thought about is to risk your very life. So what kind of inbuilt behaviours would a young infant need to have to increase their chances of survival?

Well he looked at all sorts of different things and one of the disciplines he looked at was ethology, that's the animal scientists who looked at animal behaviour and of course what they had discovered many years earlier was that most young mammals in particular stayed close to the source of safety and protection in their early years: stay close to mum, stay close to the family, stay close to the group or tribe, that's where safety lies. But in order to do that you have got to have some instinctive responses, some inbuilt behaviours that will trigger staying close behaviours whenever you feel under threat, in danger, anxious, confused by the world around you. So whenever you feel that the world is potentially threatening or dangerous, there must be some automatic trigger of behaviours that propel you back to the source of safety, that is your mother, your immediate family or the social group at large. The other example I give on this occasion is, just think about sheep. Baby lambs are small, very vulnerable, your average wolf would love a baby lamb for dinner, but for the baby lamb, safety lies in staying close to mum or the flock. So if a little lamb is busy eating grass and inadvertently wanders off further and further away from mum and the flock, it's in real danger.

So suddenly it stops eating grass and looks up and discovers that mum is 50 metres away, the flock is halfway up the hillside and its, on its own, exposed. Now its not thinking there's a wolf out there going to eat me, just that sense of being apart from will trigger a physiological arousal of fear and distress and that will then trigger, what Bowlby called the attachment system, an inbuilt evolutionary adapted system that will then cause attachment behaviour. In the case of the baby lamb, in that situation, attachment behaviour is bleating first of all, a distress signal, 'help mum, I am over here and you are over there, take notice of where I am' because lambs can walk at birth, it will then run back to mother and the first thing it will do when it gets back to Mother is suckle. So there's 3 classic attachment behaviours in sheep, bleating distress signal, running back to Mother and suckling when you return, 3 classic attachment behaviours. Now many mammals at birth don't have locomotion, so they can't run to mum. Sothe next best thing you can do is to get mum or dad to come to you.

So most young mammals when they feel in some sense of danger, the world is not feeling quite right, that all is not well because you are tired or you are hungry or you are ill, or there's a stranger suddenly looming towards you or there's a dark object or there's a loud noise, anything that might trigger that sense of alarm or danger will physiologically arouse and distress the child and that will trigger the young mammal or infants attachment system, leading to attachment behaviour. So most young mammals that don't have locomotion at birth will attempt to get the carer to come to them in the early weeks and months of life. Loud cry of course is the most effective way to do this, most sensitive parents will respond to a very loud, crying baby. But very quickly parents can distinguish between genuinely frightened cries and those that are just whiny or moany cries: most of us as parents can kind of ignore kind of whinging kind of crying for quite a long time, but if you suddenly hear that yell when everything is at full volume, instantly your care giving responses are on high alert. So basically if you can't get to the carer, get the carer to come to you.

So very simplistically, all attachment behaviour is, is under conditions of distress, anxiety, fear or danger, is to exhibit behaviours that get you back into close proximity with the source of safety: usually your primary care giver, mother, father, immediate family, or in the case of a sheep, the flock where you will feel once again protected and safe. But remember the lambs suckles when it gets back to mum, so what do human infants and the human carers do in that situation? Well this where we start to make connections between the brain sciences, the developmental psychological sciences and Bowlby's idea of attachment. So survival, getting back to the source of safety is the bottom line, now in the modern world of course, don't know about Dundee, but there's not many leopards in Norwich, there are not many real dangers, but nevertheless physiologically - we are only 200,000 years old - biologically we are the same today as we were 200,000 years ago roughly, hardly changed at all. So all the mechanisms that came into play through evolutionary pressures 200,000 years ago are still present in our make up today: so anything in the present that feels like those distance echoes of dangers in the past will trigger attachment behaviour.

So any sense of abandonment, rejection being apart from the source of safety, even though there are no leopards in Dundee, will still trigger in young children, real feelings of fear and danger and stress. So of course the environment is likely to trigger feelings of abandonment, rejection, being ostracised, being apart from, is the quality of that care giving relationship. A lack of interest, lack of connection, a lack of attunement will still trigger those very primitive ancient feelings of distress and danger even though we live in a modern world.

So survival is a bottom line of attachment, but what most parents do when they deal with a distressed infant is regulate the child's distress. So most sensitive parents are interested in babies and young children in order to regulate them. Now as children get older of course they can walk so attachment behaviours carry on through childhood, they carry on right through into adulthood, but they begin to fall off, most attachment behaviours are at their most intense and most frequent between the ages of about 10 months and 2 years, that's when you are most vulnerable and that's when you have the greatest locomotion in terms of accessing your care giver, so you will see the most intense and frequent activations in the attachment system between around about 8, 9, 10 months and about 2, 2 and half years of age. After that when children begin to get the hang of the world around them, they can cope for longer and longer without necessarily making physical or even psychological contact with their care givers because they know by then that should things go seriously wrong, my mummy or daddy will be there for me. So you don't actually need them physically present all the time, you can begin to as it were, mentally represent their availability knowing that if something terrible did happen, then mummy and daddy would literally very often come running to you to do something about it.

So with maturation children can cope with more and more separation, knowing that in principle parents are available. That rather wonderful concept that Bowlby and Mary Ainsworth generated of the 'secure basin, safe haven function', are you familiar with that? Essentially attachment behaviour assumes that the parent is acting as a safe haven at times of need, so you know that when things go wrong there is a safe haven to go to. But the more confident you are in the availability of the parent to be that safe haven, the more you can explore the world around you and interact with it and find out about it and how it works, because you know that if things do go wrong out there in the big wide world, there's a safe haven to go back to. So primary care givers can also act as a secure base from which to explore, safe haven, secure base. It's a nice concept and we will see that in fact not only does it work well with in thinking about parent child relationships, as I will come onto at the very end of the lecture, it works quite well for your relationship with the clients and patients with whom you work: are you a secure base and a safe haven? Can the parent use you as a base from which to explore?

So lets just go back to physical regulations. Oh my gosh, I am running out of time already. Just a quick few thoughts then about this, going back to the brain learning from experience, one of the key things that parents do is begin to allow the child to explore the world of feelings, relationships and emotions in the very context of doing parent child relationships. So I will just very quickly play out a ... this is Helen right, sorry I am miles away ... this is Ann, she's my baby, so say hello to Ann. See I have forgotten her name already which is a terrible, what kind of parent am I? (Laughs) I have just spent an hour with Ann. Anyway let me just try and play it. When we talk to babies, what happens to our faces, how do we basically deal with babies facially? [AUDIENCE: 'smile'] But more generally than that? We exaggerate, that's the key thing, so I am talking to Ann, I am not going to talk to Ann as I am talking to you, I will talk to Ann [puts on baby voice] very differently, I will, I really will. Very mobile, animated expressive faces. Human beings have very expressive faces, and one of the things that we express with our faces is feeling states, emotions, we have very mobile faces. And interestingly we exaggerate that mobility when we interact with babies and young children. Why do we do that? Well the infant brain is particularly tuned into human faces, the human infant is programmed to make sense and learn from experience and blow me, what do we do without any training, is exaggerate that very channel of communication with young babies. Voices, what do we do with our voices when we talk to babies? ... High pitch, sing songy, rhythmical, slow, repetitive, we do Ann, don't we ... I can't do this very well ... (laughter) I have done this so many times, I always go red when I am doing it, I'm hopeless! So the human ... infant brains are also tuned into human voices preferentially, particularly female voices interestingly. After all they have been hearing mum's voice even before they are born. And what do we do with that particular channel of communication, again we exaggerate it, we give it lots of emotional tone and valence, and we interact with babies with this huge amount of traffic, facially and verbally along these particular channels.

So let's now take a particular situation and the one I find myself using the last 2 or 3 years is the one that made a big impression at the time. It was a young mum with a little girl who is 10 months of age, the mum's sister had bought the child, a little mechanical toy, and this mechanical toy had wheels and it rolled along the floor, but it had a spring in it and every so often it would suddenly do a flip unexpectedly like that. So Ann has never seen this toy before - it's not a frightening toy but mum winds it up and it rolls along the floor and it does its first slip, and Ann is looking at it, so when it does its first flip, what's Ann's likely reaction going to be to that first flip? What's the look on her face going to be? [inaudible audience response] No, I said its not a frightening toy: I'm not here to traumatise Ann ... this is fun, it's a toy ... she is going to look surprised, but how do I react to her? This is my baby who's reactively surprised ... actually initially not delight ... most of us actually mimic what we believe the child's emotional state to be. Ann, what did it do? So what the parent is doing, is it we're tuning into the child's mental state, feeding back their understanding or what I believe is happening to the child who's brain is programmed to make sense of experience which I am now supplying in this little mini interaction as we play out this little emotional communicative exercise of flipping toys going along the floor.

So Ann is learning from that, both about how the world can affect her, but how to make sense of that emotional effect so she can begin to think about it in order to begin to regulate it. Now these things happen many times every day. You don't have to do them in every instance, I mean the child would probably freak out if every little emotional reaction you were reacting to. But in principle most parents are interested in their child's minds, and Elizabeth Meins is the psychologist down at Durham, has this rather nice phrase of 'being mind minded'. Most good enough parents are mind minded parents; they have in their minds their child's mind, and when I interact with my child, I am as it were, trying to imagine the world from their point of view. I am being empathic, emotionally intelligent, attuned. I am mentalising, sensing how Ann is feeling but also how Ann is reading me as I react to her feeling the way that she does. So it's a wonderfully complex interaction. Stern called it that 'Dance' that we have when parents and child interact together. So Ann is beginning to make sense of the world and her role in it on these day to day interactive levels, and she knows in principle I am interested in her burgeoning mind.

Now here's an even more high level thought that Peter Fonagy offers us, 'parents who are interested and connect with their child at this mind to mind level bring about mindfulness, minded states in the child.' So the brain if you like at birth isn't a mindful thing: it's not aware of itself in a self conscious reflective complicated coherent way; it needs to be on the receiving end of the relationship that credits it with those complex, coherent, mind minded, integrated states. And because the brain is programmed to make sense of experience, blah, blah, blah, you have heard all that before, lo and behold it becomes that very complicated, integrated, self reflective thing, a mind in its own right.

Now that's an extraordinary thing to happen and our species, along with many mammals, but our species in particular does this to a wonderfully sophisticated degree, but it only happens in the context of these day to day interactions. And again just anticipating we will be going, if you suffer abuse and neglect then all of this is hugely compromised. You begin to suffer in terms of your ability to reflect upon your own and other people's mental states. So this is Fonagy, Professor of Developmental Psychology at the University College London, 'the parents capacity to understand the child's mind seems to facilitate the child's general understanding of minds. Children find their minds in the minds of other people.' And he has this rather nice diagram, the yellow circle is the parents mind, and a mind minded parent has in mind their child's burgeoning little mind. So the white oval in the yellow circle is the parent having in mind the child's developing, emerging, personality mind little attributes and foibles.

That little white circle in the blue circle is the beginning of Ann's own psychological self, and the more I connect with it and enjoy it and celebrate it and recognise it, the more the white circle will get bigger and bigger and bigger, until the child themself becomes an independent fully fledged psychological being and entity, because they have been thought about in that way, they will become that very thing. Of course complicating that is the child's own inbuilt attributes, temperament, genetic characteristics, so its not the product of me imposing some kind of version of what I want in Ann. All of you as parents will know that children just come, you meet the individual at birth. Those who have got more than one child will know that child number two is nothing like child number one: f you have cracked it with child number one don't get too complacent, because child number two is going to be so, so different. So if you meet friends who are very cocky about how good they are as parents with their child number one, you just know that when child number two comes along, they are going to totally lose the plot with them.

So let's now just try and tie a few threads together, so what happens when all of that doesn't work well, when you have suboptimal care, suboptimal care giving. Well this is where attachment theorists again have things to say, this is the work of Mary Maine over in Berkeley, California, she says that if the parent comes across to the child as frightening, hostile, dangerous, abusive, impatient, aggressive with you or whatever your needs are directed ... sorry I am going to abuse you now Ann, so whenever Ann starts to, as it were, have needs that arouse in me distress, then that distress will cause me to want me to dampen down the thing that's causing it, that's Ann, I will do it either verbally or even physically by suppressing the thing that's causing ... and that's a hostile aggressive and possibly even abusive, verbally, maybe physically abusive, reaction. Ann is now frightened by my behaviour to her. I have frightened her, that will trigger her attachment system, but the goal of the attachment system is to seek proximity with the ostensible source of safety, that's me, the attachment figure. So the thing that's caused her distress, in theory should be the solution to her distress, but there's no way out of that dilemma.

This is why Mary Maine calls it a 'disorganised attachment': there's no behavioural strategy that Ann can find when the cause of her distress is actually the attachment figure himself or herself. But equally frightening for children is actually to have a frightened, helpless, distressed, panicky, hopeless, helpless parent high on drugs, alcohol, beaten up by their partner in domestic violence. To have your primary care giver not able to care for themselves and lost in their own worries and fears, distresses and panics, means that I have been abandoned, and to be abandoned is a frightening place to be, remember, and to be in a frightening place will trigger my attachment system, the goal of which is to recover proximity with my attachment figure, but she's not available: she's drunk, she's drugged, oh sorry ... it should be me, sorry, not you ... but you get the idea, in either case the attachment figure is the cause of the child's distress. So she sums it up with this rather graphic phrase, 'we see the simultaneous activation in these situations of two incompatible behavioural responses', fear, get the hell out of this dangerous situation, this relationship, get to a place of safety which of course should be your attachment figure, but all it does it send you back to the very thing that's caused it in the first place. So there's no strategy to calm you down, there's no regulation, the brain gets hyper aroused and in this hyper aroused state, the brain can't get its act together, it can't learn from experience. All it knows is that closeness and proximity and intimacy actually is a potential source of danger and threat. And these are just the kind of care giving environments that increase the risk of all of that as you might expect, physical, emotional, sexual abuse, neglect, deprivation, serious abuse of alcohol and drugs, domestic violence, multiple placements ... and the one in italics and underlined probably is a driver for most of the other categories.

One of the things that Ann and I were talking about before we met was that one of the things we should be much more interested in than we are I think is to get a good feel of the care givers own relationship history. Because what we invariably find in the abuse, neglect and trauma cases, is that the care giver themselves has had a very troubled, traumatic background of abuse and neglect and these issues from childhood remain unresolved in the present. The key word is resolved or unresolved. If you have been abused or neglected, it doesn't mean you are destined to become a poor parent. If along the way you can somehow begin to make sense of how early life adversity still gets to you, and it's still left you vulnerable, but if you are aware of your own vulnerabilities, this is a definition of mentalisation or good social cognition. I know what my trigger points are, I know what my weak spots are, I am now aware of them, I can think about them. So children generally develop a resolution of abusive and neglectful experience in the context of a relationship outside the relationship that was abusive or neglectful. It could be an Auntie who looks after you after school, it could be a good school teacher who recognises you are a bit of a lost soul and that you hang around at the end of the school day just for a chat, or it could be that you have got a good mate in adolescence or a good foster carer might do the trick.

A relationship somewhere along the line that allows you to feel safe enough to think about why life feels so shitty and awful. But the more you can think about feeling, the more you develop mentalisation. The more you develop mentalisation, the more you become, as it were, resilient to life's slings and arrows. But if they remain unresolved then these unresolved memories of danger, threat, fear, hurt, loss, rejection will constantly get retriggered and reactivated in any current stressful situation. Now a stressful situation for most adults is looking after children. Children are just little stress monkeys: they will trigger stress in adults very easily. But these are parents who can't handle stress, because stress catapults them back into these unresolved states of mind, where essentially they are in a fight or flight mode. Again very simplistically, if you are stressing me and doing my head in, then I have 2 or 3 ways of dealing with that. I can stop you doing my head in by attacking you and suppressing you: that's some kind of abusive response, a fight response, to put down the thing that's doing my head in, or I can switch off and abandon and just zone out because I have no idea how to handle this; I might take a drink, I might just switch off, who knows what I might ... I might walk out of the house and leave you, that's abandonment, that's a neglectful response, but either way it leaves Ann in a heightened state of hyper arousal. And no one helps to regulate that and that will leave her in a very stressed state, physiologically, psychologically and neurologically: bad, bad news for children.

But with maturation, most children begin to develop some strategies to try and cope with the world in which they find themselves, so even abused and neglected kids will begin to develop some kind of adaptive behavioural strategies. Again this is not the time to go through them all but some kids, particularly helpless parents who are drug addicts or alcoholics, they might begin to care for the carer: parentification. If mum can't care for me then I have got to start worrying about mum, the only way I can maintain this relationship is to make sure that mum basically doesn't kill herself or my step dad doesn't beat her up, I have got to be there, but all the kid's energies are on worrying about mum or dad and the parentified care giving relationship.

Compulsive compliance is when kids know that he adult world is dangerous: don't mess with this dad. Iif you do, you are in real danger. So these are the hyper vigilant, watchful kids who don't mess with adults. All they learn is the strong survive, so they become bullies and aggressors themselves. Some kids just give up on the adult world: adults are bad news, don't trust them, they let you down, they hurt you, they disappoint you, they threaten you, give up on them, do it yourself, become compulsively self reliant. So these are the kids who basically take themselves off to bed, walk to school even though it's two miles with busy roads, aged five or six years of age. If they are ill they don't make a fuss: these are the kids who just kind of get on with it.

They are sort of tough. Don't confuse them with being resilient because they are not. They are not getting anything out of the relationship, they are learning no lessons basically. And then Pat Crittenden has this rather nice category of controlling punitive coercive strategies where children, as it were, learn that the only way to access the adult world is to provoke it, challenge it, annoy it, exasperate it, seduce it. Essentially these are kids who can't not be in a relationship, but when they are in a relationship they make heavy, emotional demands on it: they exhaust people, parents, foster carers, teachers. Tthey can't cope with being alone but when they are in a relationship they exasperate people in the relationship. They need to be needed, they are frightened of being abandoned, so the only way to stop being abandoned is to constantly make demands upon the relationship environment.

But of course the danger of that is, that the more demands you make on other people, the more likely it is they are going to give up on your and say, 'oh sod this, I have had enough of this, you are exhausting me, I am out'. So your worst fears come true. So she calls this a coercive strategy where kids, when they have going too far, will then collapse in what she calls the 'seductival coy mode', so sorry Ann, its you again, you are now my terrible mum. So let's say I have been really playing you up, messing you around and you are just fed up to the teeth with me, so you have said 'sod it, I am off, I am out', now at that point my fears will really escalate, so I am likely to say 'oh I am sorry mum, I didn't mean it, love you lots, you are the best mum in the world'. Now I wrong footed you there because suddenly I am, as it were, appealing to your good nature and the fact that maybe when I am vulnerable and down, you can't possibly hurt me because I am so pathetic and so helpless. Either way I have either provoked you into reacting or seduced you into staying in the relationship, Crichton calls that 'switching tactics', aggression to seduction, a coercive strategy. And often adults will use it with you as workers as well of course. But a lot of kids will actually use compound strategies, mixtures of all of the above in rather elaborate, complex ways.

So many children under stress can't do mentalisation. So this means that they find relationships difficult and it's at times of hyper arousal that we are all vulnerable, and we need the buffer to protect us and the buffer is resilience and resilience comes from mentalisation, good social cognition, good empathy.

So for many, this is Peter Fonagy's phrase and I really like it, 'under stress many children who have suffered abuse and neglect, many parents who have unresolved memories of abuse and neglect, for them under stress, mentalisation goes offline'. Even some of the most damaged parents under low stress can mentalise, but as soon as the stress goes up, mentalisation goes offline and for many of the parents that we work with, mentalisation goes offline at a very low threshold of stress. Most of us can, as it were, cope with quite a lot of stress using mentalisation techniques but these parents lose it very early on in the stress, particularly in relationships with their children, but also with you as professionals as well.

Back to Bruce Perry: remember this is the neurosequential development, he says 'okay, well lets now think about what interventions we can learn from this' and here is just a very quick Mickey Mouse version of what he says, he would die a death if he heard me talk about it in this way ... if these things were missing in the key developmental neurosequential stages, we have got to supply them, so what he builds up is, okay if you have suffered real deficits from the word go, even at the physiological sensory level, you have not been able to regulate yourself. So here's an example, so he might say that we need to develop lots of techniques with children particularly, but also with adults that, as it were, introduce the first time many of the experiences that kids would normally get in secure care giving relationships. So he's a great fan of all of these techniques, centre integration techniques, rocking, touching, massage. If there's a vet in the audience, if he is here, or she is here, animal assisted therapies, he's a great fan of those, working with animals, particularly large animals like horses, horses are prey.

They are ultra sensitive to danger and threat. So if you don't feel comfortable with them, they are going to be very flighty, very nervous. But also if you have been abused or neglected yourself, you might begin to understand that animal's nervousness and anxiety, so who knows what kind of relationship you could get with a horse. Go buy a horse if you want to look into that [laughter]. Music and dance, he's a great fan ... I wish he was here, because he would then show you how ... I can't do this at all, but the rhythm, the sound, it's integrating many basic senses, think about how parents interact with their children. You play pat-a-cake, you rock, you sing, all of those things that you do with kids are building up the sense of rhythm and order and regulation in you at the sensory, physiological, communication level. And then as we go beyond that, we are into play therapy, I am particularly fond of play therapy for those who are in that area, great stuff, it doesn't require language, its all symbolic, it's all interactive, it's all beyond ... it's all outside of the normal dialogue that we attempt with children. And then above that we are into the relationship proper. So that's what you do with kids: a massive simplification there. For adults and this is where I will just close now, for adults we are back to why the relationship between you and your clients and patients is so important. Modern research is confirming what I suspect most of us have known for a long time, that the quality of the relationship between you and your patients and your clients is probably the most powerful ingredient in therapeutic change: we lose it at our peril.

Many modern organisations of course beat it out of you: they try to, as it were, define the relationship in terms of proper procedures. You can't relate to people through procedures, you relate to people at the level we have been discussing over the last hour or so. So all of these things if you like, have to be revived, so one of the key things that modern researchers are finding is that people who are good at mentalisation, emotional intelligence, empathy, tend, whatever technique they are using, tend to have more success than those with the same technique who don't have these particular qualities. Or their organisation doesn't encourage and allow them to be expressed.

So this is Richard Bental, he's a research Professor of Psychology, and concludes ... he attacks psychiatry - sorry for the psychiatrists in the audience, but you probably know his work - he is quite notorious in having a go at so much of modern psychiatry in terms of drug treatment. So what he says after all his net analysis of research reports, is that 'good relationships it seems are a universal, therapeutic good, and yet may turn out to be the single most important ingredient of effective psychiatric care.'

So what I am arguing is that, what you want parents to do, who are not coping too well as parents to their children, is to develop the ability to connect with their children at the mind to mind level, to realise their children are complex, interesting, psychological little beings, and the more you can connect with that, the more rewarding, interesting and fascinating and effective parenting will be. So in a sense you are hoping that parents can develop these skills with their child to help their child understand and make sense and reflect upon their own and other people's emotional states. But in order to help the parent to do this, you, the worker- I have put social worker up there just for illustration - you the social worker, have to do the same with the parent, what you want the parent to do with their children you have to do with the parents, you have to be mentalising with them. But in order for you, the worker, to do that with parents, your organisation has to do it with you, your supervisor, your team leader and beyond that, the whole organisation itself, emotionally intelligent organisations.

Dan Goldman's stuff is very resonant with this kind of thinking. So there's a kind of cascade going on here, if the research tell us frontline workers have to work, sorry if research is telling us parents who are effective have to engage with their children with these qualities, then workers have to do the same with parents, but you can't do that unless your organisation is also allowing you to express these very same relationship talents with those of whom you work.

What we try to do is integrate all of these factors, that no longer do we talk about nature or nurture: it's a dynamic relationship between the two, and the thing that mediates the two is the brain in the way that we have discussed. So we talk about nature via nurture and the modern science of epigenetics, and I would love to develop this, but your chief medical officer of health, Harry Burns, is big on this. If you have ever heard Harry talk, he is very funny, very amusing, but essentially he is recognising that the quality of early relationships has the ability to turn on and switch off genes, genes that lie on the surface of our DNA that affect literally, not just our psychological development, but our health, medical and physical development. So for any given population who were exposed to a life risk, those who have suffered early adversity will be at higher risk of medical symptoms than those who have not been exposed to the same risk. That is a shorthand way of saying that actually neglect and abuse, independent of their psychological effect, will also affect your life chances at the physiological level in terms of risk of cancer, diabetes, cardiovascular problems, you name it, because under stress, genes get switched on and get switched off that increase your risk to the exposure to key life experiences at this health level.


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