Book Review: Getting to Know You by Claudia M. Gold, MD

The author of this book has been working on the understanding and treatment of attachment issues between infants and very young children with their parents for a long time. I followed her blog, Child in Mind. Her writing touches on many of the same issues I have been studying and writing about that affect adults in psychotherapy with repetitive self-destructive and self-defeating behavior.

I believe that these issues do not receive any where near sufficient attention from the majority of psychotherapists. They include:

• ·        The nature of shared intrapsychic conflicts within extended families and how they develop over at least three generations. (Psychoanalysts still think this type of conflict is just within the minds of individuals).
• ·        Our tribalistic tendencies to stick with particular behavioral rules regarding love, work, and play.
• ·        How these rules change as culture has developed over time with a stronger emphasis on individuality and its balance with collectivist tendencies, and that individual families can have trouble changing their own rules due to what sociologists call cultural lag. We all have a tendency to stick to old rules and yet secretly admire people who can be more self-actualizing. People can be highly ambivalent about the current rules by which they operate but often won’t admit it because they would be invalidated by their own parents and extended family, and because of guilt and shame over their own problems.
• ·        The effects of traumatic incidents on individuals and families, which can make adapting to current situations more difficult. This problem can then be passed down inter-generationally so that some people conform to old rules which would have (but no longer) made them safer. This process starts with infant attachment processes but can continue on through an entire lifetime.

In treatment, the author takes a stance toward her patients’ behavioral issues that is quite similar to the stance I took with my patients at the beginning of psychotherapy: not knowing – being comfortable with not knowing in advance or making a judgment about what’s “wrong” with a patient’s behavior, and not offering any immediate solutions to problems they bring to the office. Non-judgmental curiosity combined with active listening. Only asking questions when what is said is ambiguous or confusing. Giving them the benefit of the doubt regarding the reasons behind seemingly irrational behavior.

I strongly believe that child psychiatrists really need to start paying more attention to such things as brain development, the intergenerational transmission of trauma, and how the interactions of family members affect the behaviors of its various member. And, of course, how to work with new parents when they seem to be having problems related to these things.

She points out that ambivalent, somewhat dark feelings are very common in new parents. She adds that when these feelings must be hidden “…because of shaming cultural prohibitions, the effect can be a downward spiral of missed cues and disconnections as caregivers struggle with feelings of self-doubt and guilt.” (p.67) This also touches on  cultural lag.

Some other vital phenomena explained in the book include epigenetics and how the brain develops in an interpersonal environment. Babies know absolutely nothing about how the world operates and learn to interact with the environment through various interactions with caregivers. This applies particularly to learning how to behave within their own social environment. Their sensory and emotional experiences are linked from birth.

The book looks at these phenomena from the perspectives of the infants, caregivers, family relationships, and culture.

I highly recommend this book to anyone interested in these phenomena.