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For Sat, Sep 30th 2000
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Daniel J. Siegel received his medical degree from Harvard University and completed his postgraduate medical education at UCLA with training in pediatrics, general adult psychiatry, and child and adolescent psychiatry. He has served as a National Institute of Mental Health Research Fellow at UCLA, studying family interactions with an emphasis on how attachment experiences influence emotions, behavioral regulation, autobiographical memory and narrative processes.

Dr. Siegel's clinical activities include work as a child, adolescent, adult and family psychiatrist. An award-winning educator, he formerly directed the UCLA training program in child psychiatry and is the recipient of the departmental teaching award and several honorary fellowships. He is currently an associate clinical professor of psychiatry at the UCLA School of Medicine and serves as the Director of interdisciplinary studies for the international nonprofit Children's Mental Health Alliance in New York. He is also the Executive Director of the Center for Human Development, an educational organization that focuses on how the development of individuals, families and communities can be helped by examining the interface of human relationships and basic biological processes.

Dr. Siegel's integrated developmental approach has led him to be invited to local, national, and international organizations to address groups of educators, parents, public administrators, healthcare providers, policymakers, clergy, and neuroscientists. He is the co-editor of a handbook of psychiatry and the author of numerous articles, chapters, and a recent text entitled The Developing Mind: Toward a Neurobiology of Interpersonal Experience. This book has been of interest to and utilized by a number of organizations, including the Council on Technology and the Individual, the Sundance Institute, numerous psychiatry departments worldwide, the U.S. Department of Justice, and the Vatican. The overall goal of these educational efforts is to provide a scientifically grounded view of human experience to a wide audience that can help facilitate the development of psychological well-being and emotional resilience across the lifespan.

Dr. Siegel can be reached at:

Center for Human Development
11980 San Vicente Blvd. ~ Suite 809
Los Angeles, CA 90049
(310) 447-0848
danieljs@ucla.edu

Dr. Cynthia Levin CL:Dan, your work in the field of psychiatry really offers one of the best integrative frameworks for understanding the connections between human relationships and neurophysiological functioning. Your work on this topic is beautifully presented in your recently published book called "The Developing Mind - Toward a Neurobiology of Interpersonal Experience". In your book, you discuss how interpersonal relationships affect the structure and functioning of the brain, which helps shape a person's emotional, social, and mental functioning.

Before we discuss some of the book's main points, can you first explain how you are defining the word "mind" as used in the title of your book?

Dr. Dan Siegel DS:Well, what's really fascinating, before the book came out and certainly since the book has come out, I've had the opportunity to go and teach to a variety of mental health practitioners all around the world. What is incredible to find is that even though they are mental health practitioners, very few people have had formal coursework on how to define what is mental; that is, what is the mind. Interestingly, very few practitioners have had formal lectures on what is mental health. They've certainly learned a lot about what is "mental un-health", but very few could define what is mental health.

For me one of the first steps in writing the book "The Developing Mind" was to ask the question you're asking, which is what is the mind? What does it mean when we say, "Well, let's help children's minds develop", or you talk about a relationship and you say, "Well, that person's mind is doing well in that relationship". What does that really mean?

In attempting to find an appropriate definition of the mind, I drew upon 10 different fields of science. In bringing all of these different fields of science together I realized there was one thing they all had in common; when reduced down to one element, the mind can be described as patterns in the flow of energy and information. The great thing about this definition is that it allows for you to look at how the flow of energy and information happens within one brain, as well as how energy and information flow between brains or among many brains, as in a family. You can see how the mind actually emerges not just from within one's skull, but the human brain is actually an extremely social organ.

So, the first principle in understanding the developing mind is that it is the patterns in the flow of energy and information. The second principle is that the mind is created within the interaction between internal neurophysiological processes and interpersonal experiences. Rather than saying the mind is just the same as a brain, we're actually pulling it out of a single-person psychology and putting it directly into a context that is potentially interpersonal. I think this framework really does much more justice to the reality that the mind is extremely social. Therefore, you could say that the mind, this flow of energy and information, is created within the interaction of both the neurophysiological, that is the brain of the individual, as well as the interpersonal, how two brains interact with each other.

CL: Would you say then that human development comes out of a fluid interchange between the development of neurophysiology along with interpersonal experiences or interactions we have with other people?

DS: Exactly, that's exactly what I would say. What's really striking about this is that there are a lot of really exciting findings in neuroscience that are coming out lately and some of them are in some wonderful books that I refer to in my book. But what's frustrating, as wonderful as they are, none of them touched on the fundamental principle that the mind doesn't just come from one brain. For myself, I wanted to find a way to really extend those neuroscience findings into the realm of what human experience is really about since it is so embedded in relationships and communications with others.

CL: That makes so much sense considering the fact that we each are so affected everyday by our interpersonal interactions; we certainly don't live within an isolated vacuum.

DS: Right, and I think the fact that we don't live in a vacuum really speaks to not just the subjective experiences that relationships are important to us emotionally or subjectively, but that when you look at the structure of the brain, it is hard-wired to be connected to other brains. This finding isn't just some phenomenon of modern life; it's an evolutionary fact about our brains that they are structured to connect to one another.

CL: So, if our relationships with others are so important in helping to shape our neurophysiology, which impacts our social & emotional development, how is it going to affect a child if, let's say, they grow up in an abusive household, where they're having very negative interpersonal interactions?

DS: We are learning a lot about how child maltreatment impacts on the developing mind of the child. We're even more recently learning about how early abuse affects the development of the child's brain in significantly negative ways. Research on a number of levels suggests that what adults do with their children has a profound impact on how the child's mind develops.

Since the time of the publication of my book, there have actually been a number of direct studies of the brain of children who've been maltreated, which further supports what my book has hypothesized. These studies support the fact that when an adult provides a secure attachment to a child involving a sense of safety and protection, that it allows the child's mind to do what genes intended it to do, which is to develop a rich and intricate, complex set of interconnections among different aspects of the brain. This supports the third principle of the book, which is that how the structure and functioning of the brain develops is determined by how experiences that are primarily social in nature shape genetically programmed maturational information that leads to the development of the nervous system.

Therefore, an abusive experience, especially by an attachment figure, provides a problem situation that the child cannot solve. The problem is that the brain of a child is looking to that attachment figure to be a source of soothing and comfort, but instead the attachment figure becomes the source of terror and distress. Not only is the terror and distress bad enough, but the child who is now terrorized needs to turn to the attachment figure for soothing, but that's the source of the terror. So, traumatic experiences are often overwhelming to young children. If they have some other attachment figure in their life who can provide security and safety, a feeling of soothing, a way of processing what happened, then children can adapt to very difficult experiences. When the attachment figure, on the other hand, is the source of that terror, then there's nowhere to turn.

In terms of how abuse can actually affect the physiology of the brain, our studies are suggesting a number of findings. The work of DeBellis and colleagues in Pittsburgh has shown that early abuse impairs the overall growth of the brain, in particular the growth of the connecting fibers that link the right and left sides of the brain to each other. This impairment can lead to significant difficulties in what lots of researchers and I call "neural-integration", which is the way the brain pulls information together to get a picture of, for example, how left brain processes and right brain processes are making representations of the world. Trauma seems to impact, at least on one level, the ability of the brain to integrate information.

CL:So, it sounds like the result for many children who are abused or mistreated and have no positive attachment figure in their lives would be that they lack certain important social and emotional skills as they develop into an adult.

DS: Right, and also that they may be at risk of not being able to continue their development even if the stressor has stopped, which is a really big concern. So, intervention may be a crucial feature for those children to develop some of those skills that they wouldn't naturally develop because of the trauma.

Now, the good news is the brain does appear to be "plastic", which means open to development based on experience. The brain continues to develop new connections among neurons in the brain and also there appears to be growth of new neurons. So, there's a lot of reason for optimism for people who are interested in intervention and treatment.

These findings also support the idea of prevention of child abuse even more than later intervention because the brain is developing the circuits responsible for social and emotional functioning very early in a child's life. Trauma at that early time can impact on the very structures that you need to actually develop emotional and social skills. So, if we can do prevention of abuse that would be best, but we shouldn't give up hope if we're really working at the level of intervention for someone who's already experienced trauma.

CL:In contrast to abusive situations, let's discuss how positive attachment relationships affect the development of neurophysiology and human development. In your work, you clearly identified what some of the key processes are in relationships that help a child develop psychological resilience and positive emotional well-being in order to become a psychologically and emotionally healthy adult. You categorized these five specific processes as: collaboration, reflective dialogue, repair, coherent narratives and emotional communication. What are these five processes about more specifically?

DS: Starting with collaboration, what you find in a lot of developmental research is the notion of something called contingent communication. This is basically the way in which 2 individuals collaborate with each other. So, collaborative communication happens when a person first sends off a signal to another person. This signal can take any form including a non-verbal signal like eye contact, facial expression, tone of voice, body gestures, or a verbal signal like a word. That signal is sent from the mind of person "A" to person "B" who receives the signal. A contingent response would be that "B" is not only able to perceive the signal sent by "A", but also that "B" is able to process it and make sense of it. "B" then would send back a signal that is not just a mirror of what "A" sent, but actually is a process interpreted signal that reflects that "B" has taken the signal in, made sense of it, and now is sending a signal back to "A" as part of this collaborative dance of communication.

This notion of the importance of collaboration exists in a wide array of sciences that look at relationships and that look at development. In infants, for example, they become extremely attached to people who are collaborative and not so attached to people who aren't collaborative. That's just a simple example. Why I think contingency is so important is that I believe there is a hard-wired set of structures in the brain that not only take in the signals from the outside world, but process how we respond to those signals, which is fundamental to how a sense of self is created. So, a person's whole sense of self can be enriched by collaborative kinds of communication. The bottom line is that when there is contingent collaborative communication, the brain functions optimally both within itself and within present and future relationships.

The wonderful thing about collaboration is that it can be taught to the parents of children, which includes having them focus on the non-verbal sharing of signals, such as the ones I mentioned previously: eye contact, facial expression, tone of voice, gestures and timing and intensity of response. These are the basic vocabulary words of non-verbal communication. Often, as adults we forget that non-verbal communication is so crucial and we focus too much on the content of words and the definitions of what's being said. But the non-verbal messages are the most important for contingent communication. Being able to engage in contingent communication about the verbal aspects of interactions also becomes important. But we have to remember that these non-verbal signals are exquisitely important, for they allow us to develop the ability for self-regulation and to have a narrative sense of self that is coherent.

CL: So, building upon the notion of collaboration, it seems from your writings that the process of reflective dialogue addresses more of the verbal signals of communication.

DS: The idea of reflective dialogue is based upon what I call "mind-sight", or the idea that the mind has the ability to actually think about and visualize the mind itself, both of other's minds and the mind of one's self. So, reflective dialogue would be an example of collaborative communication. But even more than that, I think it's about conversations that happen between any of us in our relationships; in particular, between a parent and a child where the content of the communication is about the mind itself.

Reflective dialogues could be just one kind of contingent verbal communication, but the way I use that term, is that the parent is actually talking to the child about the nature of the mind. More specifically, this means talking about thoughts, feelings, perceptions, memories, sensations, attitudes, beliefs and intentions. If parents can remember those 8 factors, or some of them anyway, and put them on a list and just remember to talk to kids about them, it would be so helpful.

These eight elements are what help kids develop compassion. It is the combination of just these 2 things, of contingent non-verbal communication and parents who promote the development of mind-sight (the ability to basically examine those 8 or more aspects of mental functioning in themselves and others), which really allows a child to develop a deeper understanding and empathic view of others. Kids who do well in school and in life have pretty well developed mindsight that allows them to develop an understanding of themselves and others.

CL: Developing these abilities almost seems like the ultimate manifestation of when someone asks you, "How are you?" and they really want to know how you, as a whole person, are doing. What is going on in you? What are you thinking, feeling, and experiencing?

DS: Exactly. I think it really enhances the functioning of the brain to have kids who have this "how are you?" and they can even ask that of themselves.

CL: The third process you identified that is important in building healthy human development is called "repair", which addresses what happens when people have emotional misconnections with one another. I love that you actually talk about the fact that these misconnections can be "repaired" and an emotional connection can be re-established. This process sounds like one of the most important dynamics parents can model for their children to facilitate healthy development.

DS: Exactly. Everybody in relationships has moments when there's a rupture in this contingent collaborative dance that we all try to engage in and never fully succeed. We can't fully succeed. We're preoccupied. We're having a bad day. We just didn't understand. Our minds were somewhere else. Whatever the issues, we're exhausted and just simply did not have the energy to respond as fully as someone needed us to. There are a lot of reasons why at a moment of needing collaboration, it doesn't happen.

So, the idea of repair is that during the rupture that happens, the individual who really needed to be connected to at that moment is often filled with a really horrible feeling of not only being alone when they want to be together, but also that they can start developing a feeling of shame. It needs to be clear that all of us go through cycles and periods when we need connection and then we need solitude. That's a natural oscillating rhythm throughout the day when you need to have moments when you're on your own. So this is not to say that everyone should be connected with everyone else all the time. Not at all.

It's just that when there are moments of wanting to connect, it can really affect someone when they send out signals to connect and they do not get acknowledged. For example, let's go back to person "A" and person "B" to demonstrate how a rupture in connection can lead to feelings of shame. Let's say "B" really wants to be connected at that moment and "A" is preoccupied with something else. "B" says, "You know, I really want to tell you about something", or "I'm really excited about something" or "I'm really scared about something." "A" just doesn't get the signal that "B" is really in need at that moment and turns away, or if "A" does catch the signal from "B", doesn't respect it. "B" will then develop first, perhaps, an agitation and a need to try to get connected even more. If that signal fails again, then it can often lead to a feeling of shame. Now, if the parent or the other person "A" is also angry at that moment that "B" is trying to reach out and connect, then in addition to shame, person "B" may start feeling humiliation. For extended periods of time, this shame and humiliation can be very toxic, not only to feelings that the person has, but even, I think, to their brain. Now, what I just described happens in more extreme cases of misconnection.

In more common cases what happens is there's a misconnection and some attempt at repair. Let's say person "A" doesn't even realize that the misconnection is happening. If "A" is the adult and "B" is the baby, it's on "A's" shoulders to say, "Ok, there's something that just doesn't feel right. Let me think what it is. Oh, yeah, I was reading a magazine and my kids came over and were really excited about something and I just ignored them. I didn't just say wait a minute and I'd come to them in a minute. So, now they're feeling bad about what happened. Let me make a reconnection, let me repair this." So, you go to the children and say, "I'm sorry. I was reading a magazine and I'm sorry I didn't pay attention to you."

Reaching out to the children, stating an apology, and expressing interest in whatever it was they were excited about is where the repair happens. It requires that the person "A" not be filled with pride that they do everything right all of the time. The person could say, "I made a mistake. So, here I'm telling you I think I made a mistake and I want to make a reconnection." The reconnection is not just an apology. It is saying I made a mistake and going on. It's really about trying to get back in tune with the other person, which often is expressed as "Tell me about that thing" or "Let's discuss what you're excited about" or "I'm really sorry". Now, the kid may be so pissed off that he can't get back to it. But, at least you make an effort to make what some people call an "interactive repair"; it's a dynamic interactive process of reconnection.

CL: Right, which is probably so critical for children to have.

DS: It is critical for all of us. I've seen the importance of this in my own marriage and the couple's therapy that I do. The success of most relationships does not seem to rest so much upon whether or not there are conflicts, but instead upon how those conflicts get resolved. That's the big difference. The notion of repair is all about how to resolve conflicts that are based upon missed connections.

This interview continues on Page 2:

 

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