William M. Schafer Ph.D.

6th Institute on Infant Toddler Mental Health

Phoenix, AZ

September 21, 2001


I can still recall the afternoon when I received the phone call inviting me to give this talk. The precise date escapes me, but it was that time of year in Michigan when winter seems interminable and spring just an illusion. I happened to be preparing for our own state infant mental health conference—an important one, for it was our twenty-fifth anniversary conference—the call came, and my immediate thought was “Wonderful! I will have this grand opportunity to write about everything I have learned about babies in the last 30 years and present it to a large audience in a far away land where winter is non-existent.” The next voice in my head was slightly more sober: “You haven’t prepared your workshop for the Michigan Conference yet; you probably haven’t learned anything in 30 years that others didn’t already know; even if you had, you couldn’t convince anyone else that it matters; and besides, Arizona does too have winter.” While all of this was going on in my head, I managed to maintain a polite conversation with the caller, ask a few semi-intelligent questions about your conference, and signal my interest in giving the talk without seeming indecently over-eager. The caller probably never suspected that she was not the only, nor perhaps the most important party with whom I was conversing at that moment.


          So now you know something about the type of conversations that go on in my head. Perhaps they sound vaguely familiar to you. I will return later to the topic of these voices, for I believe it is central to a proper understanding of infancy. For the moment, however, I would simply like to say that what follow are personal reflections about my work with infants and their families over the past three decades, and the lessons I have most deeply learned along the way. In so doing I hope to have something useful to say about the ways in which we understand (or fail to understand) human development, infant mental health, and our own experience as its practitioners.


Three Elements of Infantile Experience


          I will begin by describing three elements of infant experience, elements that I believe can be observed during the first two years of life, but that are often overlooked or misunderstood. For the moment I will simply label them for you: I call them Presence, Joy and Awareness of Others’ Awareness. I will first describe each of these elements, and then I will outline how they undergo subtle but profound transformations during childhood. Out current theories of development typically either ignore these transformations or accept them as inevitable by-products of development. I will try to point out how this leaves us with a number of potentially disastrous illusions about ourselves, our fellow human beings, and life itself. Lastly I would like to address the adult task of unmasking these illusions, and how it relates to our work as infant mental health practitioners.


          The first element is the quality of Presence. It is difficult to describe Presence, because as adults we seem so rarely to experience it. Presence is the experience of being utterly, simply, and without distraction present to the moment and to one’s experience of it. Before one can be fully present, the voices in one’s head (like those I described a few minutes ago) have to be still. Before one can be fully present, all comparisons of this experience to previous similar experiences have to cease. Before on can be fully present, every vestige of wanting this moment to continue or to change has to disappear. One must voluntarily consent to not know, to not fully understand. There can only be awareness—awareness that is bare of internal commentary, judgment or desire. Such is the awareness I think I observe in calmly alert infants who are being held in their caregiver’s arms and minds. Their tiny bodies often seem reduced to a pair of eyes, eyes that seem totally absorbed in sights that are still fresh, unlabeled and unburdened by the weight of prior experience. It is also the type of awareness adults sometimes experience when they take a quiet moment to consider a very young infant—and allow themselves simply to wonder.


          This attitude of awareness without prior expectation or prejudice, of observation without comparison or judgment, of interest without feelings of repulsion or desire is the experience of Presence. A calm, alert newborn possesses it because he has no other choice. His experience is of necessity devoid of memories of previous similar experiences, expectations of what this new experience should or should not be like, desires of wanting it to go on or to end. The infant, without knowing it, is simply present to the miracle of being which is occurring right in front of him.


          The adult has largely lost this capacity because he or she is so wrapped up in internal commentaries about this moment being interesting or boring, or good or awful, about how well or how badly one is handling it, about what went on last night or what one is going to do once this moment is over. All of this mentation makes it impossible to be utterly, simply, and without distraction present to the moment. Indeed, we are so accustomed to live like this that we rarely notice that anything is wrong. Oh sometimes—when the internal voices grow loud and raucous, attacking us or attacking our loved ones, or when the boredom or pain grow so intense we cannot bear to wait for tomorrow, or when the hopelessness lies so heavily upon us that we can no longer even contemplate tomorrow—then we know something is wrong. Then we experience in our own lives what many of our clients are trying to communicate to us when we visit them. When the absence of Presence grows this intense we call it a disease, give it a diagnosis, and offer a treatment. The duller more daily lack of Presence we call ordinary life. Perhaps that calmly alert newborn is inviting us to challenge this complacency.


          The second element of infant experience is Joy. Joy is the natural consequence of Presence. Joy is different from pleasurable excitement, or even strong happiness. It is the experience of feeling opened up and drawn toward something or someone with a strong sense of wonder, curiosity and interest, in the absence of any fear or feelings of rejection. I think you can see its beginnings at least by three months in the face of an infant greeting her mother. It seems even stronger by five months, when you can witness a baby using his eyes almost like another pair of hands to keep from falling over while he sits watching his older brother play. It is undeniable in the eight-month-old investigating a new toy, or in the thirteen-month-old experiencing for the first time what it feels like to just run.


          In adult life, this sense of Joy is often noticeably lacking. The immediacy and openness of being fully drawn toward whatever experience is at hand is rarely felt by us. In its place we find we have accepted a somewhat duller substitute, which we call “feeling happy”. Even this we usually experience either as a memory of some past pleasure or as a daydream of some future one. In fact, many of us would think it weird to meet a person who was simply happy to be “here”. I mean, what would you really think if the person sitting next to you leaned over right now and whispered “isn’t it wonderful simply to be here this morning?” We seem to believe that that kind of joy is suitable only for small children. Even our best theories of development are remarkably silent about its loss over time.


          The third element is Awareness of Others’ Awareness. This is the realization that I am not alone, that there are other centers of conscious experience out there, that they are very much like my own in that they sense and think and plan and choose just like I do. Most significantly, it is the realization that others are aware of my presence to myself. This ability is often touted to be the crowning achievement of human development, the psychological tour de force that sets us apart from all other species. A fair amount of attention is devoted to it in the developmental literature. We are fairly sure we observe its rudimentary presence in the facial resonances of a four-month-old and his mother shown on split screen TV. These synchronies of shared affect will soon develop into a capacity for shared attention. I remember once watching this blossom at seven months in a little girl who waved her arms like a choir director while her mother sang a familiar song. Whenever the mother stopped singing, the little girl stopped moving her arms. Two weeks later I saw the little girl introduce a fascinating variation to the game. She stopped waving her arms five seconds after her mother’s song got underway. Her mother obliged her by falling silent in mid-syllable. The little girl would grin, wait, and then wave her arms again to make her mommy begin singing again. Five seconds later she would stop waving, and laugh when her mother once more stopped singing.


          This awareness that “you-are-also-aware-as-I-am” seems to commonly sprout forth at about eight or nine months. It is accompanied by a burst of purposeful communicative signaling by the baby, and a strong parental sense that “she has become a person!” Its full flowering will be achieved with the advent of symbolic communication a year or so later. Think of the Helen Keller Story. Do you remember the dramatic moment when she pointed to the fountain and signed to her nurse: “water”? In that brief gesture was contained a whole treatise on symbolism. What Keller was demonstrating was that she was aware that the experience of water was for her and for her nurse the same experience, gathered under the symbol “water” This is the profound difference between words as symbols and words as signals. Signals are just switches turning on pre-programmed responses. Symbols presuppose the awareness of another’s subjective experience. Say “ball” to a dog, and he might go and fetch it. Say “ball” to your husband, and he will ask “so…what about it?”


          From shared affect to shared attention to shared understanding, the development of the awareness of others’ awareness is a crowning human achievement. It is nothing less that the birthing of a mind. Of the three elements of infant experience I am describing to you today, it is the only one western psychology has extensively investigated. Yet even so, many theories pay little attention to the manner in which this wonderful achievement is routinely diverted into something not so wonderful. The fact is that for much of our adult life we don’t experience this awareness of others’ awareness in the manner of the little girl I was describing a moment ago. We don’t feel it as a joyful sharing of our common presence to one another. Instead we routinely undergo it as a rather painful set of internalized preoccupations with what others think of us, want from us, might do to us, or what we think about them, or need from them. There might be a few fortunate souls here in this hall who met this morning after some months of separation, hugged one another and exchanged words about how wonderful it was to be together again. But most of us probably just smiled at our acquaintances while our attention was being distracted by the running commentary in our heads about what they thought of the report we turned in last week, whether we were being sufficiently helpful or welcoming to them, or just plain whether our hair was right. And most of the time we accept this state of affairs as normal.


          I think that babies are meant to show us that we should not be so blasé about our adult experience. I think that if they could talk they might ask us to challenge some of our ideas of what “normal” is. After all, why are babies born? On the biological level, the reason is fairly clear. They are born because cellular life is genetically programmed to senescence and needs periodic re-freshening. What is the parallel reason on the psychological level? What are babies suppose to re-freshen within the human spirit? I am suggesting to you today that it has to do with Presence and Joy and Awareness of Others’ Awareness. I am suggesting that a complete theory of human development cannot uncritically assume that the mental life of the infant is a state of deficiency waiting to be remedied, and that the remedy is the set of cognitive and emotional skills that enable the infant to become an efficient but hassled adult just like us. Such a theory needs to pay more attention to the ongoing tasks of adult life, of which parenting is only the beginning. In particular it needs to pay more attention to what infants can tell us about what we have lost during our own childhood, and to what we can do about recovering it.


          I do not mean by this we should over-romanticize infancy. The infant experiences Presence without even knowing that he is doing so. The infant’s Joy at being here quickly dissolves into disorganized panic if others fail to provide his basic necessities or to hold him gently in their minds. His Awareness of Other’s Awareness does not allow him to take the other’s point of view, or even to realize that there are points of view. The infant is not yet reflectively aware of himself. The development of a coherent sense of self is a major task of childhood. I simply want to emphasize that in the usual process of developing that self, something precious is routinely lost. Let us take a closer look at what and how.


Development and Loss of Infantile Experience


          The calmly alert infant is present: that is she is utterly, simply, and without distraction present to the moment and to her experience of it. Yet it cannot be long before she begins to realize that her experience of being present always happens from the point of view of her particular body. The scene is always viewed from behind her eyes, from the place occupied by her body, in the moment of time defined by her physical action. With each interaction there is registered a double neurological trace: that of the perceived stimulus and that of the perceiving organism. Slowly, inexorably these networks consolidate into familiar patterns. The patterns are then interpreted by the brain as signifiers of apparently solid and stable objects: her body, and all the things impinging on it. One day these brain-elaborated “objects” will seem more real to her than the flow of interactions that generate them. This is the nature of the human mind. It takes what is at root a dance of cosmic energies and turns it into apparently solid and stable objects—mommy, daddy, bottle, me. Eventually it will do the same thing to itself, turning what is fundamentally a shared awareness into a self-enclosed solitary consciousness which is first labeled, and then desperately defended as “my identity”, “my mind”, “my Self”.


          One way to summarize this process is to say that over time the baby establishes a basic identification with the body. Presence, which is simply awareness of Being’s interplay and movement, is gradually veiled. Without even noticing the transition, the infant’s experience changes profoundly: “I who before was Presence am now just a Body, perceiving other Bodies.”


          From one perspective this is quite an accomplishment. A functioning body map, a sense of myself in space and time as a source of movement and coordinated activity, a set of effective expectations about how other bodies move about and impact mine—these are no minor achievements. We are right to devote time, effort and money to the study of how they occur, and what to do about it when they occur unevenly or with difficulty. But we should not forget that they also come at a price. If I am only my body, then I may be in trouble. Perhaps it is just a minor trouble: “They can pick me up and move me and put me wherever they want!” Perhaps it is major: “They can hurt me.” Over time, the impression of trouble grows subtler yet deeper: “I can be here, but I cannot be somewhere else; I am now, but at some future moment I will no longer be.” One day my first child will be born, and in some deep place way back in my consciousness the thought will register: “My body’s replacement is here.” Then I will no longer be able to avoid the truth of the situation. If I am only my body, I am indeed in trouble.


          The gradual loss of Presence has inevitable consequences for the experience of Joy. As interaction becomes organized into the body and the surrounding world, it becomes impossible to remain open to every experience without fear or feelings of rejection. The brain automatically compares each present experience to all similar past ones. These are categorized as pleasant or noxious, desirable or unwanted, ones to be extended or ones to be ended as quickly as possible. This ability to compare current to previous experience based on the effect such experience had upon the organism in the past is again extraordinarily important to development. Without such a capacity our very survival would be threatened. It may even be the basis of conscious itself. Gerald Edelman, in his evocatively titled book The Remembered Present, proposes that such immediate and extremely rapid comparison of actual to past experience is a kind of neurologically programmed déjà vu, and that it underlies all self-awareness.


          Yet once again, there is a price: the mind’s automaton-like habit of making comparisons. Within milliseconds each moment’s experience is judged and the verdict rendered: “This is good, I want this to continue” or “This is bad, I want this to end.” It all happens so fast that we are usually unaware that there is actually a space in between the perceiving and the judging. We are only conscious of the wanting or not wanting. And the wanting erodes the capacity for Joy. If it is a bad experience, we can’t wait for it to end. If it is a good one, we want more of it and worry that it might stop. Either way, Joy, the sense of being drawn to our actual experience in wonder and curiosity without fear or repulsion, is veiled. We end up living a life in which most of our time is spent wanting to be in some other moment than the one we inhabit.


          The veiling of Presence and Joy in turn affect the infant’s developing Awareness of Others’ Awareness. He notices that not every experience of being seen by another is a joyful attunement provided by a parent who is simply allowing the infant to have his own experience. Sometimes he notices disapproval or anger, or worse yet, that he is not being seen at all. Since there is no strong sense of Presence or Joy to fall back upon, the infant does the only thing he can—he finds ways to maximize his chances for others’ approving awareness while minimizing his chances for disapproving or failed awareness. This is the beginning of the search for love. And once again, we find that development, even what we call normal development, is two-sided. The capacity to allow, to notice and to enjoy the loving attention of others is a powerful force in human development, and we need to experience it often in order to grow. But the search to locate, acquire, and maintain that loving attention is something else again. Once the infant gets the idea that he has to earn loving attention, he is in trouble. In order to maintain his relationship to those who are important to him, he becomes someone he is not. He learns not to cry, or not to laugh, not to run too fast or talk too loud. He learns what to say and what not to say, what is good or beautiful and what is bad or ugly. He even learns what to feel and what not to feel. By the time he has learned this last lesson he no longer needs parents to keep him in line. He has developed his very own false self, internally regulated by values he has not personally chosen.


          To a greater or lesser extent, this happens even to those infants we label Secure. Even the B-3 babies usually grow up to be hassled adults with a mortgage and a car payment, a spouse and a child. True, they tend to have bigger houses and newer cars, and their rates of divorce and child neglect are lower. But if we who have so-called “successful” lives are honest with ourselves, we will admit that we often feel vaguely but deeply unfulfilled and empty. We have everything we need; we are the richest people on earth. But we still want more. We have interesting careers, but we still wait eagerly for Friday afternoon, and go home trying not to think of Monday morning. We don’t have diagnosable mental or emotional conditions, but we are often irritable with one another, we often feel unappreciated and undervalued, and we know in our hearts that we have passed on to our children many of the same wounds we received from our parents. We try not to dwell on such dreary thoughts. We name it the human condition, and agree that it is normal.


          On this point I have grown somewhat dissatisfied with Attachment theory over the years, or at least with the way it is often taught. There seems to be a belief that a secure infant will grow up feeling that she is worthy and lovable and that others are dependable and benevolent, while the insecure infant will grow up feeling unlovable and will see others as unpredictable or disinterested. In my experience, this is grossly overstated. Most middle class samples of infants observed in Ainsworth’s Strange Situation yield roughly one half secure infants. By that criterion we might expect that roughly half of today’s audience feels worthy and lovable and expects the rest of the world to be dependable and benevolent. I doubt that is true. I further suspect that those of us in this room who do know we are worthy and lovable have had to work hard during our adult years to arrive at that realization.


          In my personal experience, the two really important and lasting characteristics of secure infants are 1) a desire to communicate with other human beings, and 2) the ability to tolerate moderate degrees of anxiety when that communication gets uncomfortable. Selma Fraiberg used to say something similar. When I was a young therapist I had this curious habit of lamenting the lack of perfect parenting in even my healthier client families. (Need I tell you I was a young parent myself then?) Selma was fond of reminding me “Bill, a secure attachment doesn’t inoculate a baby against neurosis; it just give the child the skills she will need later on to work it out.”


          So far, I have been trying to emphasize the point that infancy is not just a way station en route to something better; it is a fully human state of being which we need to understand so that we can reclaim it in our own adult lives. Infants are not merely helpless and undeveloped beings needing adults to keep them going until that can run on their own. Adults are not merely technicians and trainers, tooling up the infants until they are replaced by them. Our mutual relationship is more complex than that. Infants have something to teach us. They possess something that we have lost sight of. I am proposing that Presence and Joy and Awareness of Others’ Awareness are important ingredients of that lost something, and that a major task of adulthood is their recovery. I would now like to spend the last section of this talk outlining how I think this endeavor could affect our theory and practice and very lives.


Effects upon theory and Practice


          Earlier I proposed that Presence was lost as the infant learned to objectify experience, to transform the constant flow of experience into stable, enduring “things”. Most western theories of development assume this fully objectified view of oneself and the world is the self-evident goal of mental development.  I am suggesting that this may only be the early adult view of reality—the way life seems to the average hassled worker bee. I am further wondering if babies interrupt young adulthood in part to challenge this notion of reality. It is as though they are whispering: “You think that reality is the apparently stable, enduring universe of objects (including your own mind) you have conveniently labeled and categorized for manipulation, but we have come to show you that there is far more happening than that.” This ‘something-far-more-happening’ is what you sense when you hold an infant to your face and just feel its breath on your cheek. But if you are like most people, it is not what you believe, because it is not what you have been taught. And, as my wife is fond of telling me whenever I grumpily grope the kitchen drawer for that never visible special knife or spoon, “Bill, you will never find it if you don’t first believe it’s there.”


          The unquestioned acceptance of the brain’s habit of organizing and labeling the world of physical objects until they become our only reality haunts us at all levels. It is responsible for the notion that the only things that count are those that can be counted. That’s the same notion that surrounds you with checklists and tools and demands for measurable goals. You arrive at your first appointment with so many pieces of paper to fill out you hardly have time to ask the client “What is going on in your life? How can I be of help to you?” It is a perverse irony that you have to complete all this paperwork just to prove to some third party that you were really there, while in point of fact filling out all that paperwork prevents you from being truly present. If you’re not careful this obsession with measurable fact will lead you to fill out the social history form with meticulous care, yet you will not understand much about what this history signifies to its owner. Or you will worry so much about choosing the correct diagnosis that you may miss the opportunity to understand something crucial about this family’s experience of living with this baby. Or you will be so focused on what service, or advice, or coping skill to provide, that you will not be simply, utterly, and without distraction present to the family.


          If you are not present in the sense in which I am using the word, you cannot experience Joy in your work. Joy is veiled by the constant stream of thought going on in your head about all these “objects” your brain has organized and labeled and wants to control. Most of it is concerned with making judgments and predictions. Some of these are about yourself: “you’re not sitting right; you don’t understand the hidden meaning of this baby game; you’ve got to make the parents stop behaving like this.” Some of them are more positive: “oh, you said that so nicely; that was a perfect intervention; you can just see your relationship growing stronger.” Yet even these positive judgments cannot bring Joy because you worry you cannot live up to them in the future. The stream of talk that is not about you is about everybody and everything else: “Nobody should treat a baby like that; this child would be fine if her father would only let up on her; the lady should just dump the guy.” Even when the commentary is not obviously judgmental it prevents you from being fully in the moment: “This chair is really getting uncomfortable…it’s probably because of that extra ten pounds I put on this summer…I can’t wait for this talk to end…I wonder what kind of lunch they’ll serve?”


          However, if you are truly present, you will automatically experience Joy. I mean that seriously. The absence of all those voices will provide a peaceful, quiet place from which the world seems full of wonder and interest. When you stop judging yourself, you will stop noticing what’s wrong with your clients and fellow workers. Oh, you will continue to see how they suffer. In fact, you will see more clearly than ever how they create their own misery. But since you will not be blaming them for it, you will find you can say things to them that you couldn’t say before. It will seem natural to exclaim to the mother who is yelling at her child “wow, she really can make you mad, can’t she?” Before, the words got stuck in your throat because you were so mad at her you were afraid to let them out. Now they flow easily, and the mother will be more likely to actually hear what you have to say. You will more easily step into the experience of the mother who is so distraught she has just dropped off her five-month-old daughter to spend two weeks with a father the infant has never seen before. You will communicate to her that you truly understand how overwhelmed she is. Yet without effort you will find the right moment to say to her “You must be feeling so depleted right now that you don’t even have the energy to imagine what that must feel like to your daughter.” You can do this because you are not angry with her, nor do you feel anxiously hopeless about the infant.


          If you are truly present, you will find your interaction with people automatically moves to a deeper level. You will talk less about yesterday and tomorrow and about people who are not in the room. You will listen more, understand more, and what little you say will open up spaces for your listener. You will feel less need to do, and more freedom to be. In the end, you will find yourself joyful simply to be there with this other human being, sharing your experience of this moment.


          If you decide to try this seriously, you may find yourself fearful at first. Your fear will be that if you practice just being present, you may not act when necessary. “If I were simply present, I wouldn’t make sure the failure-to-thrive infant got fed; I wouldn’t call the authorities when I saw abuse; I wouldn’t make sure the developmentally delayed infant was brought to the proper services.” Such fear is not justified. If you are truly present, you will automatically and spontaneously know what to do, and you will do it in ways the family can actually benefit from. Your fear is just the voice in your head, repeating the common view that what makes people grow is new information, new behavior, new techniques, new insight—all of which are outside the person, needing to be imported by someone else. This is the common view of most hassled adults, whether they be teachers or therapists, supervisors or administrators. This was also the common view of your parents when you were very small. They too were hassled, overwhelmed by the belief they were responsible for teaching you how to correctly organize, label, and handle a world they themselves had been taught to mistrust. They couldn’t see that what you mostly needed was someone who was utterly, simply, and without distraction present, holding you joyfully in their awareness.


          What I am suggesting today is that really important growth does not come from the importation of goods and services from the outside. It comes from the recognition that everything necessary already exists within. There is enough power and love and truth within each human being to solve any problem. It has only to be recognized. It is a question of removing the veils that cover what is already present. This is what a mother does when she repeatedly communicates “I see you reaching, running, crying, laughing, hurting, growing…” It is what Winnicott meant by holding the baby in one’s mind. It is what a therapist or a good friend does when they say “I see you carrying this anger or fear or emptiness inside you; I see how it damages you; yet I also see that it is not all that you really are.” It is the process Lou Sander and the Boston Change Process Study Group described as “moments of meeting” in that wonderful special issue of the Infant Mental Health Journal in the fall of 1998. It is the inevitable result of experiencing the Awareness of another’s Joyful Awareness of me that makes me Present to myself.


          Almost by way of postscript, I would also like to suggest that this view of infancy offers a better understanding of the biological purpose of grandparenthood. Mary Main once observed that it was obvious why attachments occur during infancy—it was to insure that the infants would survive. But she wanted to know why attachments last beyond infancy, once physical survival is more or less assured. She answered, quite wisely, that attachments endure because adults must insure not just that their babies survive, but that they survive to become the kind of parents whose own infants will survive. In the same manner I have wondered what might be the biological purpose of grandparenthood. How do we contribute to life after our reproductive years have ended, and what is the role of attachment in that process? We need to rethink the adult tasks of development during the fifth, sixth, and seventh decades of life. These are typically covered quite rapidly in most human development courses—a few paragraphs about emotional consolidation and growing wisdom. Rarely is anything said about how any of this might relate to infancy. However, if attachments remain important in later life—and they do—there must be a relationship to infancy.


          The older adult, the grandparent, is looking at infancy for the second (or should I say the third) time. When you are older the sight of an infant strikes a different chord within you. You don’t feel so much a sense of responsibility for what she will become as you do a sense of awe for the miracle she already is. Perhaps this is because your own parents are not so vividly present among the voices in your head, exhorting you to be this or that kind of caregiver. Perhaps it is because you no longer look at life from the point of view of the hassled young worker bee trying to survive physically, mentally, and emotionally. You know there is more to life than coping, getting ahead, planning for the future. In fact, the future is growing less important to you. The present has become what matters. You begin to suspect the infant shares with you a deep truth that everyone else is forgetting.


          If you give it room to grow, this awareness can change everything. It will deepen the joy you feel when you see a child, whether it be your biological offspring or not. It will help you parent your own grown children once more, this time in a more enlightened manner. It will change the way you are with people—clients, co-workers, friends, and spouses. To the extent you are fully present, you will become in the words of the ancient Purépecha poem about the curandero or healer “a mirror so clear that those who look into it see all the way through to the other side.”


          So this is your ultimate developmental task, begun in infancy. You are to become an instance of life grown conscious of its own joyful presence. You are no less miraculous than a newborn. You need only to stop all the noise in your head, all the talk about how things ought to be. You need only be present to who and what you are right now. If you do, you will transform the way you see everything else. This in turn will offer others an opportunity to experience themselves in a new way. And thus you will have fulfilled your original newborn promise to re-freshen the human spirit.












William M. Schafer Ph.D.

9th Institute on Infant Toddler Mental Health

Phoenix, AZ

September 2, 2004


I cannot help but think of the last time I spoke to this conference. It was September 21st of 2001, ten days after the attack on New York. I remember walking through almost deserted airports and flying to Phoenix on a nearly empty plane. I could sense people’s preoccupation. It made them seem to shrivel, back away and keep their distance. In my bag was a copy of a talk I had written on what infants can teach us about being present and joyfully aware of each other’s presence. It seemed an odd combination. The talk was well received, perhaps in part because of how people were feeling in those days immediately after the attack. Today, however I feel a certain ironic gratitude that I didn’t show up in 2001 with the talk I have this morning, entitled “Can We Risk Being Vulnerable”?


          The inspiration to talk about being vulnerable grew out of the quick inner reaction I experienced upon first seeing your conference title—From Risk to Resiliency. It was, I must confess, a negative reaction. It went something like this: “Your goal is resiliency? Can’t you aim any higher than that?” I have since checked out this reaction with many people, and none of them shared it, so those of you who chose the conference title can relax. My reaction was due to nothing more than my own peculiar way of thinking. Nonetheless, I have observed over the years that peculiar thoughts are often useful, so with your forbearance, I will pursue them. They have to do with the unwarranted emphasis we place on strength, prediction, and control to the exclusion of vulnerability, uncertainty, and trust, and with how this lack of balance affects our work, our field, and our lives.


          When I was a graduate student in the early 1970’s in Ann Arbor, I spent eight years (I was a very slow graduate student) at the Child Development Project in the Department of Psychiatry of the University of Michigan. It was a place unlike any I had ever known. Selma Fraiberg and Edna Adelson were my supervisors. Peter Blos, Jr. was our psychiatric consultant, Jeree Pawl our staff psychologist, and Vivian Shapiro our lead social worker. Alicia Lieberman was a doctoral fellow. Judy Pekarsky and I were graduate interns. Even we young ones were assigned ex-tern students to supervise. I was given the only male in the group. His name was Michael Trout. For two years he suffered the indignity of being Bill Schafer’s first supervisory guinea pig. We both survived the experience and would both today agree that our years there were absolutely magical.


          I came away from the Child Development Project with a strong faith in Prevention and Infant Mental Health. I thought that if we could only foster strong, secure attachments in all children we could do away with juvenile delinquency, drug addiction, teen pregnancy, antisocial behavior, harmful parenting, poor citizenship, corporate greed, road rage, bad breath and war. I was convinced that the key to human development had at long last been found: secure attachments lead to strong egos, good health, and lifelong happiness. No matter that at times Selma was fond of saying “a secure attachment won’t prevent neurosis; it will just give the child strength to work it out with a therapist later on.” I wanted to put an end to human misery. Infant mental health offered a way to do that. We could identify those who were at risk; we were learning how to treat them effectively. We only needed to teach our new method to the next generation of social workers, psychologists and educators, to demonstrate its effectiveness to doctors and nurses, administrators and legislators, and the world would be transformed. I now look back on those years with warm fondness for my youthful idealism and rueful amusement for my foolishness. I was a victim of what Saniel Bonder, the founder of the Waking Down movement, has called the western hyper-masculine bias. The western hyper-masculine bias is about domination and control. It is right-brained and conceptual. It believes that the most effective pathway to change is through categorization, analysis, prediction, manipulation, and control. It is sad that the promotion of human attachments so easily falls under the spell of this bias. Human attachment is a lived relational experience. But the people and institutions who promote it often forget to live what they promote. In our hyper-masculine modern world we, too, easily assume that one develops infants, families, and their associated programs the same way one develops a space mission. A successful space mission determines its goals, breaks them down into component objectives, builds a decision tree that prescribes “if this happens, do that”, manages the process from a position of central authority, makes sure everyone follows the script with scrupulous precision—and  bingo! it puts a man on the moon. For fifty years this has been the model for every major American enterprise.


          Unfortunately, this hyper-masculine model of change works well only with certain aspects of reality. The aspect to which it is best suited is the one Ken Wilber calls the world of Its. The world of Its refers to the aspect of things you talk about. Its can be described in their absence. Its can be measured, manipulated or remanufactured. If you consider clients as Its (and you can, for they are physical bodies) you will find yourself trying to diagnose, treat, or cure them.


          The hyper-masculine model does not work well when you turn to the world of I and You, however. The world of I and You refers to beings one must have a conversation with. We beings of the I and You world cannot be described in absentia; we have to speak our experience each in our own unique tongue. We cannot be measured; we can only be understood. We cannot be manipulated; we can only be engaged. We cannot be cured; we can only be witnessed as we attempt to heal ourselves. In the world of I and You, change demands that we be present to and consciously vulnerable with one another.


          Let me illustrate what I mean by conscious vulnerability with a case example. The case is taken from a group supervision I facilitate for an in-home program for young children. A young social worker in her second year of professional work told us about one of her families. A four year old boy whom I will call Jessie and his twenty-three year old mom were living together in a public housing complex. The worker, I will call her Ann, described the boy as wild, uncontrollable, and demanding. If his mother did not immediately do what he wanted he would tell her loudly “Get me the f---ing toy!” Or he might threaten her “Do what I tell you, woman, or I will f---ing kill you.” He had already been kicked out of two day-care situations. He had greeted Ann’s visits with stony silence.


          There was a man in the picture, though he lived elsewhere. Ann did not know if he was Jessie’s father or not. Given Jessie’s behavior, Ann suspected this man was abusive to Jessie’s mom. Jessie’s mom, I will call her Belle, was reluctant to talk about him. Belle had lost her own mother to a drug overdose when Belle was twelve. She had been raised by her grandmother, attending public school as a Special Ed student. She had not finished high school. Until six months ago the grandmother had been Belle’s legal guardian, receiving Belle’s food stamps and SSI check and controlling her spending. Suspicious that her grandmother was pocketing some of the money for herself, Belle had successfully fought to get control over her own money and was now living on her own with Jessie.


          Ann described Belle as “slow”. She didn’t seem to understand much of what Ann tried to tell her. She never followed through on any suggestions Ann had made. She let Jessie run the house. As Ann continued to describe Belle her own voice grew more strident. “She’s got to get her act together soon. I tell her, ‘Belle, you need to get Jessie to the doctor for an evaluation!’ but she never does it. I tell her ‘Belle, you need to call these people about the rent you owe’ but I know she won’t do it.” While Ann was speaking I could feel myself becoming slightly irritated with her. Her words “Belle, you need to…” had an edge to them that I found increasingly unpleasant and I began wondering what it was like for Belle to have Ann come to her home. I didn’t like feeling this way about Ann. It made me reluctant to ask her more questions about her case. I was afraid some of my own anger might show. So I just let her go on for a bit while I looked for something in her manner that I could attach to in a more friendly way.


          Ann kept oscillating between her fear for what Jessie would grow up to be and her frustrations with Belle. It seemed to reach a kind of emotional climax as Ann concluded her litany of complaints about how Belle only wanted her to take her places and do things for her. “She needs to learn how to do these things for herself if she wants to be a mother. It will do her absolutely no good at all if I do everything for her. I am there to teach her how to be independent.” Then she paused, looking at me sort of helplessly. I felt she was inviting me to say something. So I sent out a little probe. “So Ann, when the idea comes up in your mind to make the phone call for her, or to drive her to an appointment, you find something in you really resisting that idea?” Ann shot back an immediate reply. “I’m a therapist, not a case manager. I’m there to make her independent, but she won’t let me do my job!”


          At this point one of the other therapists in the group spoke up. She was in her fifties and had been doing outreach work for a long time. She was also African American. It had not been explicitly stated, but from the clients’ actual names it was pretty clear that Jessie and Belle were African American.  Ann was white. The older worker gave Ann a heart-felt pep talk about how sometimes you just have to do for people who are not capable of doing for themselves. She went on at some length. What she said was kindly said, but there was a sermon-like quality to it that was having absolutely no success with Ann. So I stepped in and invited the entire group to sit quietly for a moment while contemplating their own feelings so far. After several minutes of silence I asked: what was similar about the pattern of feelings we could observe between Jessie and Belle, between Belle and Ann, and between Ann and ourselves?


          All of the parallels that emerge among those patterns of emotions illuminate some aspect of conscious vulnerability. If we consider Jessie, we find a little boy who is absolutely terrified. Not just because he may regularly witness some man beating up his mom, but more fundamentally because he senses that his mom is not strong or wise enough to contain Jessie’s own fear, frustration and anger. It is as though Jessie were telling us, “I have all of these feelings, and I know I cannot contain them, but she can’t either.” The vulnerability of that experience is so intolerable to Jessie that his only escape seems to be rage and threats of more rage. The rage is his way of proclaiming “I will not be vulnerable; I will be strong and I will be in charge.” The ego’s hyper-masculine need to be in control always begins as a reaction to the experience of vulnerability.


          If we turn to Belle we see a young woman who feels too overwhelmed to function. Her mother was an addict who killed herself. She may well be a victim of multiple other traumas. She spent her school days in special education. She is sick and tired of people telling her she can’t do anything well on her own. She wants nothing more than to be left alone. Yet she also knows that alone she is too confused, overwhelmed and vulnerable to survive well. She now has to raise a child. And she knows she cannot do the job. But to say that out loud to someone, and to trust that they will not use it against her—that would simply make her too vulnerable. The ego’s hyper-masculine need to defend itself always begins as a reaction to vulnerability.


          If we consider Ann, we see a parallel image. Ann graduated from a master’s level program at a prestigious university. She is intelligent and a perfectionist. I doubt that this first job of hers is the one she really wanted, but it was all she could get. Even though a part of her thinks the job is beneath her, it is making her feel confused, overwhelmed and vulnerable. She wants to protect her client child, and she feels she is failing. More painful to her even than that, Ann herself lives in a relationship that often erupts into physical violence. She does not speak of it, except to one or two close intimates. Belle’s inability to extricate herself from abusive relationships is pushing Ann hard to take an unwanted closer look at her own situation. She is reacting with exasperation and impatience, trying to make Belle independent. The ego’s hyper-masculine need to manipulate the external world rather than allow the internal world to reach consciousness always begins as a reaction to vulnerability.


          Finally, if we look at my part in this chain of vulnerability, the parallel continues. I have worked with this supervision group for many years. Some of the older members were once my students. Many of them look up to me, fondly and reverently, if unrealistically. I don’t want to blow my guru status. I like Ann, but I am also felling angry. I can’t mention her personal situation or bring it to this public forum. I feel hampered by that lack of freedom. I am worrying about her suitability for this kind of work. She is so tightly defended. Under that tightness she is so angry. In many ways she is just like I was at her age, hiding all her secret wounds under a façade of expertness and independence. Watching her I am forced to recall my own fears of exposure, past and present. If she would just grow up and become a mature clinician right now, I would not have to experience any of this discomfort. The ego’s hyper-masculine need to cloak itself behind a mask of perfection and competence always begins as a reaction to vulnerability.


          To be strong, to defend, to manipulate the external world, to present a favorable image—these are the ego’s basic preoccupations. They begin at birth. Being catapulted down that birth canal cannot have been easy for any of us. And it did not become easier as we learned how to breathe, to regulate body temperature, hunger, bright lights, loud noises, and the gurgles and gasses of internal energies. Just going on in being was an immense task for that little spark of awareness that inhabited each of our infant bodies. It wanted only one thing—to be aware, to be present, without any restrictions regarding to what. That is its nature—to simply be aware of and present to whatever happens. And alas, that is the root of our vulnerability. Our fundamental nature as human beings includes one aspect that is pure awareness, unlimited in its eagerness to experience everything, and another aspect that is a physical body, one fragile speck in an immense universe. Most of the time, particularly when we are very small, this pure but very impressionable awareness is terrified that it cannot survive either the joy or the pain of being here in this physical world.


          Fortunately, we are given helpers. If we are very lucky, they are attentive and devoted and they help support us through the ordeal. If we are less fortunate, they project on to us a lot of their own anger, grief, and worry about their own ordeal. But it is very rare, perhaps unheard of, that they either kill off the impressionable spark of awareness entirely or protect it so perfectly that it escapes altogether the terror of being here on this earth. And that is why we humans need to develop an ego. The ego’s task is to protect the wide open, impressionable pure awareness at the center of our being. The ego wants to keep the window of joy and of pain from opening too widely. It learns to remember, to predict, to control, to defend, to project an image. If we are lucky, it is a strong ego. That is, it remembers, predicts, controls and projects images in ways that help us more or less get long with all the other egos out there doing the same thing. If we are not so lucky it is a damaged ego, remembering, predicting, controlling and projecting images in ways that lead to constant trouble. Either way, the ego’s job is to send out danger signals whenever experience threatens to become too joyful or too painful. Either way, its job is to automatically classify and label each experience rather than allowing us to just feel it. It this way it manages to sustain the illusion of a stable world whose past can be recalled and whose future can be predicted. In the end, it transforms the great mansion of our mind into a tiny house with only two livable rooms One is called the past; the other the future. In them we hide from the present, with its wide open window of joy and of grief.


          This way of living in just two rooms works pretty well most of the time. Your memory of how to get to work is so good you can do the drive each morning half asleep. Your assessment of what each day’s tasks will demand from you is usually accurate enough to keep you from being too startled and overwhelmed to function. You know which colleagues to get close to and which ones to avoid. You know how to hide the parts of yourself which truly shame you. You know how to project the image of the person you want to be. What matter that much of your joy is sacrificed to keeping your pain manageable? Your ego is protecting you. You are resilient.


          Resilient enough, that is, until you desire an intimate relationship. With your lover, your child, your parents, your friends, or with that especially difficult client you have to take some risks. Intimacy demands more than a thick protective shield. Intimacy demands you reveal that inner spark of awareness that is your real self and that you be present to the other person in a manner that invites them to do likewise. When we talk about attachment theory we often place far too much emphasis on only one half of a central truth. We are too fond of saying that a healthy attachment is one in which a person feels safe in the other’s presence. Defining healthy attachments this way neglects the second half of Bowlby and Ainsworth’s definition—that a healthy attachment is one in which a person feels safe enough to risk exploring something new. In any intimate relationship there is risk as well as safety. For a child the risk may be trying out some new behavior. For an adult, the risk is dropping the armor shield of the ego and showing up naked, ready to tell the whole truth not just the easy part, ready to experience the full gamut of one’s feelings. Intimacy requires conscious vulnerability.


          Conscious vulnerability is therefore one aspect of resiliency. But it is a quite different aspect from the one that is usually implied. In most cases, resilience refers to some quality by which the ego protects itself from the full impact of trauma. This quality is invariably defensive in nature. One has an abusive family—one learns to be tough. One has a neglectful family—one learns to be self-reliant. The defensive maneuver serves a useful purpose, for it gets you through a difficult childhood. Every person here in this room today grew up with some variation of this story. But every person in this room has also experienced the cost of continuing to live out the story. It is the cost of what I call the Two Sufferings. The first Suffering is the original trauma, say the hurtful or neglectful family. The second Suffering is the constriction of one’s own being caused by the presence of the shield built to keep out the pain of the first Suffering. It is carried in the body like a ghostly armor—a tightening, a shrinking, a fainting, a lack of full presence. It adds its own pain to the original one. You experience this second pain as chronic resistance, low energy, persistent edginess, recurrent anger or sadness, and lack of joy. It is so constant that you become accustomed to it. You hardly notice it.


          If you are lucky, some problem will come into your adult life to make you more sharply aware of your second Suffering. You fall in love, and then you struggle to find a way to live happily together. Perhaps you can’t, and you lose one another. You have a baby, and it grows up imperfect just like you. You get a client or a colleague who pushes all your buttons. All of these crises are actually tremendous opportunities! The first Suffering you cannot do anything about. It is past and done. Somebody hurt you, and you cannot change that. The second Suffering you can do something about. It is alive and present within you, waiting to be healed through life’s ongoing setbacks. What can you do? You consciously welcome the first Suffering back into your awareness. You deliberately allow each new crisis to bring the memory of that Suffering and all the feelings associated with it to enter you. You continue to do this until you have fully metabolized them. You make a conscious decision to live your entire life in this manner.


          Now this never seems like a very good idea to anyone. It makes us so vulnerable. It seems such a risk. That is why we usually need someone else to be present with us while we try. All real growth occurs in the context of a relationship. Jessie cannot be freed from his need to use rage as the tool with which to control his mother until Belle can be helped to more fully experience her own childhood feelings of being abandoned and unloved. Belle cannot be expected to allow such painful feelings until Ann can examine her need to manage her own pain by manipulating external events. And Ann cannot be expected to welcome that painful self-examination if her supervisor is angry with her because she threatens to tarnish his reputed charisma. The ladder of life is constructed in such a way that no one can move to the next higher step until the person just above reaches down to grasp his hand. We are all in this together.


          In clinical work, the willingness to enter into conscious vulnerability defines our potential for professional growth. If we allow ourselves to be consciously vulnerable when visiting a family we will be sure to get a full dose of the feelings of a small child. These will then be blended with the feelings of the child’s parent, aged in the bottle of our own past history, and finally poured out into the glass of our supervisor’s reactions. What a complex wine this is that we drink in our daily rituals!


          Ann struggled as she listened to her colleagues parsing out the parallels they saw between Jessie, Belle, and herself. Knowing that one supervision hour was not going to permanently change how Ann saw herself and her world, I finally said to her “Ann, you have the right to choose how much you can put yourself out for any client. No one can tell you what you have to do. But if it becomes clear to you that you cannot help Jessie unless you let Belle really depend on you, what will that be like for you?” Attempting some humor, but in obvious pain Ann replied, “This is not feeling very good to me.” It was the most honest thing she had said the entire session. For that one instant she was letting herself feel vulnerable.


          From that moment on there was a change in the entire room. The older social worker gave no more lectures. Instead she shared the story of a client years ago who had made her feel like quitting her career as a social worker. Others followed, with stories of their own pain and eventual growth. In the end, I felt I could honestly thank Ann for opening up an emotional space in which the entire group was able to reach a level of sharing that is rare indeed among the agencies that I visit.


          I am well aware that this hour of supervision will produce only a tiny visible change in Ann’s behavior with Belle. I would rather have found a way to re-shape her entire attitude toward herself and her clients. But I am powerless to do that. I am left to admit that Jessie continues to live with an overwhelmed and in many ways inadequate mother; that Bell continues to work with a young and inexperienced home visitor; that Ann will have to go on with an imperfect and infrequent supervisor in a struggling agency. That is our common cup of vulnerability.


          At the same time I am aware that Ann’s honesty brought all of us to a point of self-examination that our supervision groups constantly seeks but cannot always achieve. Every time we risk this level of conscious vulnerability we reach a new level of conscious awareness. That slowly but continuously deepening level of conscious awareness I have come to know as the true product of all clinical work. Over the years it has produced the wonderful, dedicated and increasingly professional staff of this particular program. Like a fine wine, it is difficult to describe in words, but you can instantly recognize it once it is on your palate.


          I want to summarize what I introduced to you nearly an hour ago as a peculiar reaction to the title of this conference. Upon reflection, it is clear that there is absolutely nothing wrong with seeking to promote resiliency. We simply need to distinguish several levels of it. The first level is the resiliency that allows one to survive the active hurts and passive omissions of childhood. This level creates a defensive shield that simultaneously protects and limits one’s development. It survives into adulthood as that set of automatic reactions we call “personality”. It is largely unconscious, operating like a machine that is so well oiled we cannot even hear it run. Its purpose is the continuing survival of “me”. Its price is the veiling of that inner center of awareness that is the silent “I” hiding just behind and under everything I can tell myself about “me”.


The next level of resiliency is the one that allows us to inquire whether living like this is truly satisfying. It is the inner strength required to ask “Who am I, really? What do I think is most important? What actually works in my personal and professional life? Am I living my life as fully as I can? What does my heart tell me?” This level of resiliency has to be consciously exercised. It originates from the inner and central self, the continuing presence of that spark of awareness that entered the world with my physical birth. When it shows up, it is anything but silent. At its first utterance I may feel my whole world shake because I sense that its ultimate purpose is the deconstruction of my own hard-won ego!


          There is an inner paradox that governs the relationship between these two levels of resiliency. The ego must be resilient enough to consent to its own demise. A weak ego cannot tolerate conscious vulnerability. Nor can an ego that is so buffed up that it is inflexible.


          Resiliency therefore is finally revealed as the particular type of strength that can spring back to its original form. It comes from two Latin words re and salire, and means literally “to jump back”. To be resilient means to be able to revert to something you once were, but are no longer. The truly resilient adult is willing to take the risk of becoming like a small child once more.


          This is the possibility I want to leave with you for your consideration today. You and I were once wide open, impressionable, vulnerable infants who wanted nothing more than to be fully present to the world and to each other. We feared nothing and no one; we hated nothing and no one; we welcomed everything and everyone. It was our nature to be that way. But very early in life we became afraid to remain that wide open. Life was sometimes just too overwhelming. The people to whom we became attached sometimes failed us. We tightened up. We protected ourselves. We literally got bent out of shape. Now that we are adults we have to decide whether we will risk springing back to our original natural form.


          We do not have to do this alone. It is our very nature to live and to grow in relationship to one another. “Relationship based practice” is not just a phrase for professional life. It is not something you “practice” on clients. If you think you can dedicate yourself to a life of work in prevention simply because you know it makes sense to treat small children before they get in trouble, think again. You are falling into the hyper-masculine trance. You are assuming you have the power to chart the course of someone else’s life. You are setting yourself up for tremendous frustration and disappointment each time you fail. You are setting yourself up for endless confusion as you try to classify, analyze and manipulate data to prove your overall effectiveness. You are living exclusively in the world of Its, where every positive outcome is balanced by a negative one.


          The underlying truth is that relationship based practice is a way of life. It is a practice in the same sense that a yoga or form of meditation or type of prayer is a practice. We do not remain dedicated to prevention because we can demonstrate its effects upon others. We remain dedicated because of what we have experienced it doing in our own lives. We do it because if we did not do it, we ourselves would be diminished. You are here today because in your heart you know that if you were not here, you would be less whole, less present, and less alive. And to that extent society would be damaged, for you by your failure to show up would have contributed to making it a society that has no concern for the less fortunate.


          We are all in this together. That baby and his mother cannot risk a forward step unless someone ahead of them risks leaning back to offer a helping hand. That person in turn cannot risk such a step unless someone else is willing to support her. And so on and so on. From Risk to Resiliency does not describe an isolated line of development; it actually describes a spiral—from risk to resiliency to yet further risk and even greater resiliency. Nor does From Risk to Resiliency describe a process intended for the sole use of clients. It is meant for everybody, in every relationship, every day.


          A little over three years ago everyone in this room was deeply sobered by the tragedies that had just occurred in New York, Washington and Pennsylvania. Today many of us remain saddened by the chain of events those tragedies unleashed upon the world. But I think it is important to remember that these are only the most recent links in a chain of heavy metal that has gripped the world for at least five hundred years. It is a chain of growing impersonality and of deepening forgetfulness of our relatedness to one another and to our earth. It seeks to dominate nature rather than to belong to it; but it only succeeds in gradually destroying nature. It seeks to predict and to control the future; but in truth it mindlessly repeats a past it has long forgotten. It fears death so deeply that it exhausts its own resources trying to prolong life; yet it holds on to life so fearfully that every day of living is infused with little deaths. The ego’s hyper-masculine need to dominate, to predict, and to turn fear into violent rage always begins as a reaction to the experience of vulnerability. That vulnerability in turn stems from the belief that only the physical and measurable aspects of reality are real and important. This belief has today become the dominant conviction of our culture. Yet when people become convinced that they are only highly complicated pieces of machinery, they grow alienated, fearful, and angry. They can no longer perceive their relatedness to a Wholeness that is living, moving, conscious, and alive. But if they can recover the experience of living Wholeness in their daily live, no event will ever seem too terrifying to endure nor too trivial to celebrate. Our life work with infant, toddlers, and their families is just a small part of a badly needed whole-scale revolution in how humans live on this earth. It offers each one of us the opportunity to spring back to our original form, to consciously choose to be eager rather than fearful, engaged rather than aloof, welcoming rather than rejecting. It is our birthright to live that way. We need only sincerely desire it and steadfastly believe it possible in order to claim it.


Thank you for your attention.

























The case for epistemological diversity in infant-toddler mental health


William M. Schafer Ph.D.

13th Annual Infant Toddler Mental Health Coalition

Phoenix, AZ

September 19, 2008






Introduction: a question to the audience

Before I begin, take a moment to ask yourself: What do I consider the most important aspect of my work with infants and toddlers?  Then ask: What does the institution I work for consider the most important?


          I am betting that most of you experience a tension between what you believe is most important about your work with infants, toddlers and their families and what the official culture of the workplace tells you is most important. Depending on who you are and where you work that tension can be experienced as nagging annoyance with bureaucratic process or pervasive despair about ever being understood by the powers that govern your life. I want to suggest that this tension is has nothing to do with any failure on your part to communicate your vision to others. If you feel misunderstood it is because you don’t share your culture’s basic assumptions about science, human nature and development. That makes you a counter-culture agent. Your choice therefore is either to resist, or to celebrate your role as an outsider.


The basic assumption you don’t share is called empiricism. Empiricism is the belief that the only reality is that which can be observed and measured. The first thing to note about it is that it is an “ism”. An “ism” is simply a way to shove a whole big complicated patch of life into a simple black-and-white container that is easier to lug around on a daily basis. Precisely because they are so black-and-white, “isms” cannot afford to raise serious questions about their own basic assumptions.  No “ism” can see itself. This is where epistemology comes in.  Epistemology’s job is to make visible the underlying assumptions of any point of view.  Technically, epistemology is one of the most subtle and difficult areas of philosophy. Fortunately, it can be mastered in a matter of minutes. You only need to understand baseball.


          At the end of every baseball season all the umpires hold a banquet. At the dinner they celebrate the season and their accomplishments, hand out awards and generally have a roaring good time. At the conclusion of the dinner it is customary to toast their profession. At one such banquet the youngest umpire rose to give the first toast: “Gentlemen, raise your glasses. To the balls and to the strikes; we call them as they are.” Everyone stood and solemnly drank a sip of fine wine. A few minutes later one of the older umpires offered a second toast: “Gentlemen, raise your glasses. To the balls and to the strikes; we call them as we see them.” There was a murmur of some approval as everyone took another sip. Finally the oldest umpire of them all rose with glass in hand:  “Gentlemen, raise you glasses. To the balls and to the strikes; until we call them, they ain’t.”


          It’s a slightly odd joke, but once you get it you have mastered the central elements of epistemology. The first ump was articulating the philosophy of empirical realism. It goes way back to Aristotle. Empiricism assumes that everything, even the mind, is material. Since matter is extended in space, the more accurately you measure it, the more accurately you will know it. The guarantee of truth in the empiricist worldview is the accuracy of measurement. Empirical realism has been the dominant epistemology of Europe for at least five hundred years. It is the driving force behind the American health care industry, among other things. If you don’t buy into it, you cannot be considered mainstream, dependable or an insider.


The second ump was toasting what epistemology calls idealism. It goes back to Socrates and to the Buddha. Idealism holds that the mind projects the material world onto its own subjective screen. In other words, spirit generates matter. The guarantee of truth in this system is the purity of spirit. If you want to see the world accurately, clean up your soul. Idealism has always been the underdog philosophy of Europe, never fully acceptable yet never fully vanquished. It appears most prevalently today in a lot of New Age thinking.


The old-timer’s toast was based on an epistemology that Merleau-Ponty called the middle way. Its origins go way back to classical China and Laozi. The middle way says yes, there are objective forces out there, and they constrain and shape our knowing, yet in turn they are organized and changed by our knowing them. I’ll give you an example, this time not from baseball but from the birds and the bees. The honeybee and the orchid are mutually interdependent species. Bees need the orchid’s nectar in order to make honey. In turn, the orchids need the bees to spread themselves around. Their interdependent dance is largely orchestrated by vision and color. The eye of the ordinary honey bee is exquisitely adapted to pick up ultraviolet light. Orchid petals are exquisitely adapted to reflecting ultraviolet light. Which adaptation came first, the bee’s eyesight or the orchid’s color? As it turns out, they developed together over a period of 60,000 years. Orchids and bees co-created both the colors of the orchids’ petals and the visual acuity of the bee. They were in a partnership, each transforming the other. The middle way, the last umpire’s view of reality, makes this partnership the key element of knowing. There is an independently existing world out there, but it has no real organization, no “cognitive shape”, until you and I give it one. The pitcher winds up and throws, but there is no game of balls and strikes until the ump calls it into being. The middle way is compelling and subtle. It is the guiding philosophy of modern theoretical physics and I would argue that it should be the guiding philosophy of any discipline that focuses on relationships, such as infant-toddler mental health. But the middle way is not simple to apply, and it is decidedly not mainstream or “in”.


Now does the workplace tension you feel about how you see infants and toddlers have anything to do with conflicting epistemologies? I hope to tell you that it does! The epistemology that all of us inherited from our culture is the empirical realism toasted by the youngest umpire. It taught you that to be scientific you had to be objective. To be objective, you had to be emotionally uninvolved. Your payoff was that objective evidence is stable and unchanging. Subjective impressions are notoriously personal and vary from person to person. Objective evidence can be trusted; subjective reactions can be swayed by emotion. Empiricism wants a world based on fact, not fancy. It is hard to argue with that. Who would not want knowledge based on fact?


Yet the fact is that everyone in this room knows from his or her own experience that empirical knowledge, as wonderful and necessary as it is for mastering the world of things, misses something tremendously important when applied to the world of persons. What it misses is precisely the concrete uniqueness of lived experience. Objective knowledge, like a butterfly pinned to a board, is abstract and inert. Lived experience, like a fluttering butterfly, is specific and animate. One hundred years ago the great American psychologist William James articulated the difference between them. Today his language may sound a bit archaic in places, but it remains as true today as when it flowed from his pen:


“Every Jack sees in his own particular Jill charms and perfections to the enchantment of which we stolid onlookers are stone-cold. And which has the superior view of the absolute truth, he or we? Which has the more vital insight into the nature of Jill’s existence, as a fact? Is he in excess, being in this matter a maniac? Or are we in defect, being victims of a pathological anesthesia as regards Jill’s magical importance? Surely the latter; surely to Jack are the profounder truths revealed; surely poor Jill’s palpitating little life-throbs are among the wonders of creation, are worthy of this sympathetic interest; and it is to our shame that the rest of us cannot feel like Jack. For Jack realizes Jill concretely, and we do not. He struggles toward a union with her inner life, divining her feelings, anticipating her desires, understanding her limits as manfully as he can, and yet inadequately, too; for he is also afflicted with some blindness, even here. Whilst we, dead clods that we are, do not even seek after these things, but are contented that that portion of eternal fact named Jill should be for us as if it were not…

If you say that this is absurd, and that we cannot be in love with everyone at once, I merely point out to you that, as a matter of fact, certain persons do exist with all enormous capacity for friendship and for taking delight in other people’s lives; and that such persons know more of truth than if their hearts were not so big.”[1]


Measurement Madness

           I want to show how this epistemological quarrel affects our work by listing three widely accepted truisms that dominate our prevention scene. They flow directly from empirical realism’s belief that the “really real” has to be totally physical. The first is Measurement Madness, which I think can be summarized in the phrase: 




          There is a well-engrained belief in the western world that if you cannot measure something, it is not worth worrying about. According to the empiricist view of classical western science, the measurable is observable, repeatable and therefore real; the not measurable is subtle, likely to surprise you because it is constantly changing, and therefore fantasy. The most obvious way Measurement Madness influences our field is in the way it affects reporting. Take a look at the following directive instructing clinicians how to write a clinical goal. It was issued by a company that specializes in mental health and chemical dependency and serves more than 23 million Americans in over 70,000 practitioner locations. Its directives have enormous influence on the entire field of mental health. Please read these instructions carefully and take note of your reaction.


Characteristics of a Clinical Goal

Observable:  Can be detected and described.  Can be seen, heard, or perceived by the senses, and is related to the specific problems/symptoms presented by the patient.  Is well defined and concrete.


For example, if we are treating a patient who has left work and withdrawn to home because of depression and anxiety, the potential observable goals are:

1.       Reduce days missed from work

2.       Leave the house for other activities

3.       Decrease depression score


Measurable: Is quantified by counting observable events or by a scientifically validated measurement scale.  Where and when the targeted behavior should occur for the goal to be achieved.


The measurements for these goals are:

1.       Reduce days missed from work as shown by pay stub

2.       Leave the house for other activities as shown by an activity log for 4 weeks

3.       Decrease depression score on the Beck Depression Inventory





Specified Time frame for Accomplishment: Includes an estimate in days, weeks or months for accomplishment of the goal.  This estimate is based upon norms for treatment response, modified by history of patient’s prior response and patient’s unique characteristics or circumstances.


Adding time frames for accomplishment completes these goals:

1.       Reduce days missed from work as shown by pay stub within 3 months of initial appointment.

2.       Leave the house for other activities as shown by an activity log for 4 weeks within 14 weeks of initial appointment.

3.       Decrease depression score on the Beck Depression Inventory within 90 days of beginning treatment.




            So let’s say that Mr. Jones, who has always been somewhat anxious and withdrawn, was recently in an auto accident. A young woman in the other car was killed, the mother of a two-year-old child. Ever since the accident he has had difficulty sleeping and recently he began staying home and missing work. The therapist to whom he is assigned may or may not yet know that Mr. Jones’ mother died suddenly when he was two years old. But never mind that, according to the definition of clinical goal given the therapist, the purpose of treatment should be “to reduce days missed from work as shown by pay stub within 3 months of initial appointment; to leave the house for other activities as shown by an activity log for 4 weeks; and to decrease the patient’s Beck Depression Inventory within 90 days.” 


What on earth have we come to? More importantly, how did we get there?


          Now we all understand that directives like the above are driven by profit. That will never change. Having said that, however, let’s take a look at some of the less obvious, more hidden factors that drive this madness. I particularly want to address these because their very invisibility makes them all the more dangerous. First of all, did you notice how the recommended clinical goals betray a decided lack of trust in the client? If Mr. Jones were to tell us he is back at work and out and about socializing, that is not good enough. He is required to produce pay stubs and an activity log. Underneath this lack of faith in the client is a lack of trust in the therapist. The therapist’s judgment of his patient’s emotional state has no value; only a paper and pencil test will do. What produces such a breakdown of trust? The company would probably answer that bad or unscrupulous therapists do. Because their auditors have encountered cases of shoddy treatment or deliberate fraud, the company requires irrefutable proof that they are getting what they are paying for. They have a point. Unskilled and unscrupulous therapists do exist. But is the most efficient way to reduce their number to turn the paperwork of all therapists into legal documents? Sometimes I just wish I could pass on to such a company the advice of my father, who labored for fifty years as an accountant for the railroad : “Bill,” he would tell me, “never spend a dollar trying to save a dime.” 


          Actually, the question of trust goes deeper than the practicality of my father’s simple wisdom. The root of the problem with trust is that the empiricist worldview contains an internal contradiction. It begins by saying that all of reality is material, therefore observable. Then it does something extraordinary. It goes on to say that the most important part of this observable material world is invisible! Yep, the steak and salad you had last night tasted great, but the really important parts of it—the proteins, the saturated fats, the fibers, beta-carotenes, anti-oxidants and so forth—were imperceptible to your palate. And that guilty feeling nagging you about your eating may seem quite obvious to you, but the true essence of it is a lack of serotonin produced in your brain.


It’s a neat trick. First you convince everyone that only the observable is important; then you tell them they need an expert with a really expensive instrument to see it. And voila! empiricism, which is supposed to have rescued us from medieval religious superstition, reinstates its very own priesthood of scientific experts. Of course, like all priesthoods the experts split into factions and begin to wrangle. Fifty years ago, only shrinks could judge someone’s mental health. Today, not even they can, for only the high priests of laboratory research have sufficiently refined tools to do the job. “The only things that count are those that can be counted.” One of the unavoidable results of this unanalyzed assumption is that we no longer have faith in lived experience. Instead we have to put our trust in paper artifacts. It is a good example of how the belief that the universe is fundamentally mechanical ultimately makes automatons of us all.


Did you also notice how Mr. Jones and his current lived experience of life have been reduced to a list of symptoms? The western way to describe Mr. Jones’ lived experience is to objectify it. That’s because empiricism believes that the further away you stand from something the better you understand it. Mr. Jones is “understood” by assigning him a diagnosis—he “has” depression and anxiety. Did you know that diagnosis comes from two Greek words meaning “to see through”? The metaphor is that of an x-ray. It peers though the felt flow of experience in order to see the objective truth inside it. For the empiricist, the permanent reality is always concealed by the lived experience. Poor Jones’ experience is just the packaging. The real goal of treatment is to get rid of that invisible thing that he has. The therapist’s job in turn it to “do” this to Mr. Jones. In the end Measurement Madness has thoroughly, I would say hopelessly, objectified not only Mr. Jones, but his therapist and his treatment as well—a “technician” is removing a “thing” from an “object”.


Black and White Notions of Causality

          The second myth of linearity has to do with causality. I call it the black and white notion of causality. In order to describe how it works let me ask you to shift your attention from baseball to football.


It is well documented that the Oakland Raiders incur more penalties when they wear their traveling black uniforms than when they are at home wearing white. Now if you have a scientifically inclined western mind you might ask: is this because black uniforms make them look rougher to the referees, who then penalize them more frequently; or is it because when they wear black uniforms they actually feel meaner and play dirtier football? This is how the empiricist mind works—it identifies alternative explanations and then asks which one is true. It would never have occurred to Laozi to put the question in this way. If asked “do the Raiders receive more penalties because they look rougher or because they act rougher” he would have answered: “Yes”. Empiricists think that opposites exclude one another. The middle way thinks that opposites imply one another. Empiricist notions of causality are black-white, linear and exclusionary; middle way notions are grey, mutually entailing and associative.


          I believe that empiricist assumptions about causality affect the field of infant toddler mental health at all levels. The area I want to focus on today is evidence-based practice. The federal Government Performance and Results Act of 1993 mandated evidence of effectiveness for publicly funded programs and services. That put pressure on program administrators to muster evidence that their programs work.  It has also kept a lot of academic psychologists well employed designing treatment outcome research. Unfortunately, however, the empiricist bias that dominates American psychology has limited evidence-based practice research to what Chambless & Ollendick[2], writing in the Annual Review of Psychology, call the empirically supported therapies movement. The empirically supported therapies movement (ESTM for short) is an attempt to draw up a list of empirically supported treatments for specific disorders. This list will then tend to become the short list of acceptable (and reimbursable) treatments. The very attempt is to my way of thinking quite problematic.


          The first problem is that empiricist science can only see what it has tools to measure. So the ESTM limits its attention to symptom clusters: “Mr. Jones has a panic disorder; his wife has PTSD. Let’s see if our treatment strategy gets rid of these symptoms.” As a result the ESTM has remained locked in to a focus on DSM IV Axis I disorders.[3]  Making matters even worse, in order to keep the research “clean” the disorders are reduced to minimal complexity—one single symptom at which a single intervention is targeted. The intervention is typically brief, 8 to 10 weeks, again in the interest of rescuing the research from the complexities of longer treatments. Finally, since the researchers feel obliged to ape the standards of experimental design for physical sciences, treatment subjects are randomly assigned to two groups, one of which receives the specific treatment targeted for their specific symptom and the other of which receives no treatment at all. The model is familiar. It is the pharmaceutical model, copied from standard drug trials. The medical model once again trumps the psychological model. Bodies are machines; they operate according to mechanical laws. Lived experience should be studied from the same point of view.


          To date, the empirically supported therapies movement has generated a lot of data that in my view has little importance or relevance to human healing. In the real world people don’t present with just one symptom and work for 8 – 10 weeks to see if they can disqualify themselves from their diagnostic label. Even more important, in the interest of good basic science, evidence-based practice should include all the evidence and not remain restricted to comparing one brief therapy to no treatment at all. As Drew Westen and Rebekah Bradley[4] observe in Current Directions in Psychological Science: “The burden of proof for a new treatment should be that its outcomes compare favorably to the outcomes obtained by experienced clinicians, not…that it works better than nothing”.


          The truly useful psychological research in recent years has produced a wealth of information about attachment patterns, personality traits, temperament, and maladaptive ways of trying to regulate emotion and impulse. These general patterns and traits underlie many different DSM diagnoses and may well account for far more variance in treatment outcomes than any specific treatment strategy designed for one specific symptom. What we most importantly know from more than 25 years of psychotherapy research is that there is a large “generic” positive effect of all kinds of treatment. Most psychotherapies “work”, provided that they are conducted by skilled and experienced clinicians. The common denominators of good outcomes are more fundamental and broad than the theoretical niceties of individual therapies. In fact, they may be so fundamental and broad that they extend beyond the boundaries of psychotherapy itself. Dan Stern, writing in the Infant Mental Health Journal earlier this year, observes:


“I think that there is a quiet theoretical revolution taking place…In most of these programs the home visitors do not necessarily have formal training as psychotherapists. Of course, they receive a short special training to do the home visiting and are closely supervised. Some are nurses or social workers, fewer are psychologists, others are simply experienced women. Does it matter? One gets the impression that it may not. There is something else ‘nonspecific’ going on…The overwhelming nonspecific, positive factors lie in the relationship between the visitor and the family.”[5] 


If Stern is right, emotional healing is not the special province of the mental health profession alone.


          Our field of infant toddler mental health is an extremely fertile seed-bed for insights into what helps people to develop, to grow and to heal. I suggest that rather than simply importing models from other fields of evidenced-based practice research we should be developing our own. The unique qualities of our subject matter—the non-verbal felt world of infancy, new beginnings and developing relationships—may help us escape the worst of the mechanical biases in the myths of linearity that pervade American psychology. We need to develop a language that accounts for process. That way we can focus on what we know is truly important. 


One area of focus should be the process of building a working relationship. What is important about a first visit is not the generation of a treatment plan, but the communication that the visitor understands the gravity of the family’s concern and yet feels hopeful about the future. The expected outcome of an initial visit is quite simple: the invitation to return for a second visit. We should be developing a language of observation for all the subsequent steps in the development of the treatment relationship: the first time a client risks asking a really open-ended question, the first time a mother says to her home visitor “I was thinking about something you said last week”, the first time she allows herself a moment of pleasure with her baby, the first time she allows herself that one feeling she never wants to feel, the first time she shows curiosity rather than resentment about a problem, the first time she acknowledges how important the home visits have become to her—or equally important, the first time she acknowledges how hard they are for her. 


A second area of focus should be states of mind—for both the family and for the home visitor. We need a better language to describe the different states of closed consciousness: rigidity, fear, hopelessness, rage, resentment, need for approval—all those states that close the heart to growth. We need a better language to describe the different states of open consciousness: soft, accepting, self-forgiving, expecting benefit, grateful. We need to pay attention to how we can create and hold tiny islands of these higher states of mind during each home visit, for it is on their fragile shores that lasting change is always born.


All of these signposts are simple, ordinary events. You already are already familiar with them; you know how important they are and you know how important their absence can be. What you need is the courage to talk about them with your fellow workers and to explore them for yourselves. This is not easy. Our culture does not readily support language about process and experience.  It much prefers a world of objects and things. If we want to develop a language of process rather than of things we will have to make some radical changes. The language will have to grow out of our daily experience. It must become a shared language, i.e. one understood by front line workers and up-line supervisors as well as administrative personnel. This means that front line clinicians, supervisors, researchers and administrators must all work together to create meaningful treatment goals, meaningful process notes and meaningful treatment summaries. That means that the time spent making meaning of our clinical work must be valued sufficiently to be compensated a fair rates for all concerned. That means that program directors have to unite together in a reasoned but implacable resistance to the inexorable pressure to raise case loads to the point where one can no longer do the work thoughtfully, much less make meaning of it afterwards.


          Now that is a large agenda. In one paragraph I have just suggested that we change not only the way we do paperwork, but the way we organize group supervisions, the way we get paid and the way directors negotiate contracts with the government. I don’t think that’s going to happen within the next fiscal year. But I do think we should begin. Otherwise we will be forced to use the empirically supported therapies movement’s language of objects, with its measurement madness and black and white notions of causality.



The Software View of Training

          Actually, what I just laid out is a broad agenda of training, which is the last issue I want to discuss. And just as empiricism has a powerful negative effect on how we administer programs and upon how we understand the process of healing, empiricism also affects how we go about training the next generation of workers in our field. I call the empiricist notion of training the software view. 


The metaphor works something like this: people are hardware; training is software. Human beings all have the same type of brain; they are pretty much interchangeable. Training is just content that you download into the hardware of people’s brains. One corollary of this view is that any two people with the same training will do the same job interchangeably. A second corollary is that any promising new program developed by leader A with group X can be programmed into trainers B and C and downloaded with equal effect to twenty other groups nationwide. The model works fairly well in the domain of known tasks,[6] whose nature is orderly, logical and capable of being written down in a procedure manual. It does not work quite so well, however, for the development of skillful teachers, child-care workers, home visitors and clinicians.


For the moment let’s make a simple verbal distinction between training and development. Training is more mechanical than development. Training has to do with procedures. We train people to fill out Form A, to apply for insurance B or to complete Report C. The software model works fairly well here. You can codify the procedures, package them, and give them to people. The training can be brief, perhaps even done on line, for it requires minimum familiarity between trainer and trainees.


We must be careful to not confuse training with development. We have a tendency to call everything training. We say we train people to teach young children, to become competent home visitors or to do a certain kind of therapy with families. We do this because our black and white notions of causality make us view teaching, development and even healing as a set of procedures that one person does to or upon another. And since rote procedures can be taught using the software model, we think this is how we should train people to be sensitive listeners, perceptive observers and reliable attachment figures.  


Yet everyone in this room today knows that this is not how it works. If you look to your own experience you know that the most major and important transformations you have experienced in your own life did not happen because someone gave you a new piece of information or a new technique. They occurred because something shifted within your way of seeing, feeling and understanding your relationship to whatever you were struggling with. You didn’t download some new content into your hardware.  You changed the hardware itself—that is, you experienced your struggle from a new state of consciousness. And that happened because someone else shared with you their more open and receptive state of consciousness about you and your struggle. This is what happens in what Dan Stern calls a “moment of meeting”.


Clinical practice with clients tells us that people do not change how they live in the world solely because they have new information. They change how they live because they have adopted a new relationship, a new mental and emotional stance toward themselves and toward the people and events in their life. In a similar manner we do not train young professionals to be skillful child care workers, teachers and therapists by downloading new information into their heads but by leading them to adopt new attitudes and habits in their interaction with children and their families. As a result the kind of training that fosters their professional development is process-oriented, ongoing, experiential, interpersonal and multi-leveled.


          Process-oriented training begins by assuming that change is the true constant, that people are already in developmental motion and that the purpose of training is to detect the trainee’s growing edge and support the next developmental steps to be taken. It does not try to make every worker fit some preordained mold. It does more than set up arbitrary skill sets and make each worker conform to them; it attempts to harness the unique capacity of each worker and move it forward.


Because it is process-oriented, such training needs to be ongoing. Teacher and student meet over time and develop a mentoring relationship with one another. They get to know far more about each other than the standard seminar invitation to “tell us your name, where you work and why you chose this workshop”. The purpose of the relationship is the development of the whole person of the student, mind and body, heart and soul. And if the outcome of a long process of training is that a given worker decides to move to a different city or change to a different field, that is accepted by both teacher and student as a positive outcome. (As Henry Ford once said, the only thing worse than training people and having them move on is not training them and having them stay.)


Such training is also experiential. The student is not asked simply to study or to memorize something, but to have an actual experience of it. This means that the teacher must be personally familiar with the experience, and skillful in helping others to achieve it. There is an old saying in personal development work: the map is not the territory. Real clinical training does not just provide the student with a map; it invites him or her to walk the territory. And this of course strongly implies that the training will be interpersonal, for the teachers must know that territory from their own lived experience and not just from books.


Finally, training whose goal is development will be multi-leveled. That is, the development of process-oriented programs and agencies can occur only if all levels of personnel become process oriented. It cannot be, as it often is, mandated from on high by a bureaucracy that remains entrenched in Measurement Madness, Black and White Notions of Causality and Software Notions of Training.




          You have probably already noted how many times in the course of this talk I have used the phrase “lived experience”. Lived experience is our subjective felt sense of what happens, the inner stream of first person consciousness. Empiricist psychology is terrified of lived experience. It worries that lived experience is not sufficiently objective, that it changes from person to person, is therefore not trustworthy, and if given too much influence will bring chaos. There is a grain of truth to the empiricist fear. Whenever lived experience is the central focus of attention we should expect more variation, more surprises, more creativity…more change. 


          And that is the point. Our field is about change. Babies are the heralds of the possibility that life can be new and different. Each birth is a physical proclamation of life’s endless creativity. Empiricism is terrified of change. It wants timeless principles that offer the possibility of prediction and control. And that is why empiricism is so insidious. Even those of us who understand that its offer is an illusion have to admit that the illusion is a comforting one. It feels good to think that we can predict and control life. It takes fierce courage to admit that we cannot—because life does not belong to us, we belong instead to it.


          And thus courage is what we need if we are to escape the stale air of empiricism.  It is not easy to be a counter-culture agent.   We much prefer to belong to the majority. The majority runs the institutions, and institutions reward those who obey their rules and punish those who do not. The counter-culture agent, however, is one who has discovered that the institution’s punishments are small potatoes compared to the pain of being false to one’s lived experience. Once you realize this you naturally begin to look for others who share your conviction.  In such company you find the rewards of living honestly with your fellows. At some point you may even go public with you convictions, speaking your mind respectfully but frankly in public meetings. If you do that, you will experience the exhilaration of being a public change agent as well the terror of being a public target. It may not matter how far you go—to whatever extent you participate in the counter movement, you are an agent seeking modest but real change in the institutional culture.


          I say modest change, because we should be careful of what we ask for. We would all like to make relationships and process mainstream ideas in American health care. But from what you know of human history, what do you suppose would become of infant toddler mental health if it were to become the dominant player in the American health care industry? My guess is that it would become immediately subject to what I call the Produce Section rule. That’s the rule that says “it’s always the ripe vegetables that spoil first”. In the final analysis we may all be healthier and happier if we simply celebrate our role as change agents, part of Dan Stern’s quiet revolution.


Our field is a natural partner in that revolution, for infants are by nature human subjects that have not yet turned experience into things. They have not yet fallen under the empiricist spell of mistaking the institution for the mission the institution is supposed to serve. They are the first to sense that just because we have child care centers, we do not necessarily have child care; that just because we have human service programs we do not necessarily have service. The work that we do with infants, whether in hospitals, in preschools, in clinics or in homes, tells us that professional technique and lived experienced are equally important, co-creating each other, somewhat like the orchids and the bees. Therefore if we want to really understand our profession we must view it through multiple philosophic lenses. Some of it is best analyzed empirically as an object, and some of it can only be encountered as process in the world of lived experience. My plea to you today as that you don’t confuse the one with the other, that you do not allow the methodologies or the priorities of the one to trump those of the other, and most importantly that you do not feel bad because you do not belong to the majority empiricist crowd that sees the world through one lens only.


Myths of linearity have in common the belief that nature is writ with straight lines, that it is a one-directional, mechanical chain of cause and effect. They propose themselves as objective science, “hard knowledge”, the view from no individual point of view. In fact they may be the most anthropomorphic myths of all, for the straight line appears nowhere in nature except in the human ego, convinced that it sails its fragile boat on a one-way river from birth toward death. Myths of linearity take this human experience and project it onto the universe, proclaiming that this is how all things are. In truth however we live our seemingly linear lives in the midst of myriad cycles. That fact should give us pause, at least moving us to honor the mystery of what we do not and probably cannot ever understand—the incredible, astonishing, ever surprising nature of this sacred Process into which we have so improbably been born.



Chambless, D., & Ollendick, T. (2000). Empirically supported psychological interventions: Controversies and evidence.  Annual review of Psychology, 52, 685-716.


Palmer, P.J. (1998). The Courage to Teach: Exploring the Inner World of a Teacher.  San Francisco: Wiley.


Schafer, W. (2008). Models and Domains of Supervision and their Relationship to Professional Development, Zero to Three, 28, No. 2, pp.10-16.


Stern, D. (2008). Introduction to the special Issue on Early Preventive Intervention and Home Visiting, Infant Mental Health Journal, 27,  No. 1, pp. 1-4.


Westen, D. & Bradley, R. (2005). Empirically Supported Complexity: Rethinking Evidence-Based Practice in Psychotherapy. Current Directions in Psychological Science, 14, 266-271.





[1] James, 2000 Pragmatism and other Writings, G. Gunn (Ed.) New York: Penguin, 2000, pp. 286-87.

[2] Chambless, & Ollendick, 2000.

[3] DSM IV is itself a result of the Measurement Madness.  It is a compilation of external behaviors that are assumed to indicate an underlying illness.  But since there is no willingness on the part of modern psychiatry or psychology to value subjective experience, the external indicators are simply listed without any attempt to explain how they are linked together in the person’s subjective world.


[4] Westen & Bradley, 2005.

[5] Stern, 2008, pp.1-2.


[6] Schafer, 2008.