A letter to new fathers… on connecting with your lovie

“Sir you cannot sit there!  We have to clear this aisle…  Are those all your books?”  

“Hmm… No…”

I looked down, feeling a bit of shame, but it quickly turned to anger… Seriously, this is why people just shop on Amazon!  Because of stupid rules like this!  Here I am, just allowing my one year old child to explore her environment and this lady thinks I pulled off those 30 books from the shelf!  Where is my child?  Oh, my lovie has wandered off!  

Thoughts on fatherhood:

I have a passion for the first years of life.  

Attachment happens in the first months of life.  These little lovies learn how to trust, and if they feel safe, learn to thrive in curiosity and awe.  Books on innovation miss that the key to exploration is a secure base of connection and love.  So, here are my ideas:

1.  Fathers, spend face-to-face time with your infants.  Try to mirror their facial expressions and tones of voice.  Go on morning walks, afternoon swims and nightly baths with your infant in his or her first year of life.  Mom enjoys skin-to-skin time… and so should you!  If your child is experiencing fear of some type, try to absorb it and calm yourself to calm your child.  

2.  Fathers, when your youngster is getting into something dangerous, rather than saying, “No,” pick them up and move to another activity.  If he or she squeals with anger and protest, try to empathize by saying in a similar tone as them, “That must be really hard,” or “huh -oooo…,” then redirect… “Let’s go play over here.” THINK: connect and redirect… connect and redirect…

3.  Fathers, dance with your child.  Make rhythmic movements and laugh (or giggle).  Help your lovie move their entire body in sync with the music.  Let your joy mirror your child’s joy!   

4. Fathers, encourage exploration.  The second part of attachment is rejoicing and being exuberant about exploration.  The beginning of shame is when a child is exploring and you react with fear, anger or sadness.  Of course, sometimes this is appropriate… but not all the time!  Instead, try whenever possible to get excited with discovery, curiosity, and wonder.  

About

Welcome to my blog!

I am Dr. David Puder a psychiatrist based out of Redlands California.

I blog to share my curiosity and passion on how we can improve our connections with others.  I dream that we might embrace the challenge of pursuing more meaningful connections as the primary goal.

Connection was not something that always came naturally to me.  Some trials and set backs led me to the realization I was not connected with my emotions and with others.  But through approaching connection like one might approach becoming an expert musician or world class athlete, I decided to see feedback as a gift, found amazing mentors, enrolled in advanced training, experienced therapy first hand, and took on therapy patients.

It is not some theoretical science, but rather something artistic, beautiful, contagious and deeply meaningful.  Join me.

Why DARE failed… and it keeps going…

16 years ago a paper came out as a 10 year follow up to the DARE (Drug Alcohol Resistance Education) program showing that it had no effect in changing anything. (Lynam, 1999)  The abstract reads:

“The present study examined the impact of Project DARE (Drug Abuse Resistance Education), a widespread drug-prevention program, 10 years after administration. A total of 1,002 individuals who in 6th grade had either received DARE or a standard drug-education curriculum, were reevaluated at age 20.  Few differences were found between the 2 groups in terms of actual drug use, drug attitudes, or self-esteem, and in no case did the DARE group have a more successful outcome than the comparison group. Possible reasons why DARE remains so popular, despite the lack of documented efficacy, are offered.”

Another study that looked at 2000 sixth graders till tenth grade found that there were not actual drug use differences between groups of students in the DARE program. (Clayton, 1996)

This study stated “No significant differences were observed between intervention and comparison schools with respect to cigarette, alcohol, or marijuana use during the 7th grade, approximately 1 year after completion of the program, or over the full 5-year measurement interval.”

What is DARE?  17 weeks of one hour sessions giving informational content on drugs, media use of drugs and peer pressure.  The teachers have 80 hours of training on drug use consequences and teaching skills.  It has no booster sessions after its initial training.

The more I looked into the research, the more I realized that all the studies said the same thing: no long term effect!  

That led me to another study looking at why DARE continues despite the lack of research that was widely known and disseminated in 1997-2000 by CBS, ABC, New York Times, Boston Globe, US News, and the World Report.  This study (Birkeland, 2005) in which they interviewed 128 people involved in implementing and making decisions about the program showed that the researchers were overlooking that school officials did not think such a short term program would change behavior but it established a relationship between the cops and kids.  Also “evaluators generally agree that decision makers do not usually put evaluation findings directly into use.”  Put another way, school districts ignore the evidence.    

  1. Most decision makers knew the negative program evaluations but had not actually read the studies.  
  2. Decision makers continued this 17 hour program because “it was one very small component of a larger community initiative” and did not expect it to win against the kids’ families that used or TV and movies that widely promote drug/alcohol use.  
  3. Schools value the relationships made between the cops and kids.  Cops also value this, one saying “oh, the kids wave with all fingers now instead of just one!”  “Cops are seen as a resource for protection, for answers for some questions, for direction and for care.”
  4. Others thought there personal experience was more convincing then scientific evidence, claiming that their program was unique or special.  

My thoughts:

If schools value relationships with cops why not build a program where the cops are giving more then “content advice”.  Why not train the cops how to build connection with their students and then through the right questions find the student’s own goals for the future.  With a clear vision, purpose and mission kids will be moving towards something.  Connection skills can be taught and is the bedrock to long lasting change.  Building a program around advice and “don’t do this or a bad thing will happen” just has not been shown to work.    

DARE’s content program has not been shown to help likely because what actually helps is asking the right questions.  Motivational interviewing is a well tested and studied technique used by therapists and addiction specialists which helps the client find their own intrinsic motivations to change.  When I first learned this method, got the book (Miller, 2012) on it, I found that people who came in with drug use actually were able to make movement to change.  The book provides research on how content and confrontation approaches actually push people further into addiction (something I have seen time and time again in my practice of medicine).  

Rather then teach students to observe how modern culture promotes drugs, why not get celebrities to promote something different?  Once again this is moving from using a negative model for change into a positive- look at that amazing celebrity role model – as a way to promote change.  Characters who save the world with a sacrificial love grab the heart of youth and adults.  Look no further to the Lord of the Rings, Hunger Games, Star Wars, Braveheart and many other epics that speak to this truth.  

In addition to face to face contact, in a modern age of social media, a new program will connect students online in an ongoing way over years, not just one semester.  Ideally teachers and cops will be able to interact on an online platform with students at various schools.  

I believe using the DARE program as a learning tool for what does not work, and looking at what actually works, we can re-define the ideal program.  

 

  

Mirror Neurons: what they teach us about connection…

When watching your favorite sport do you feel like you are apart of it?

When watching someone cry do you feel their sadness? 

When seeing someone in pain, do you also feel that pain to some extent? 

When you see someone move, does it make you want to move as well?

The basic idea: when you focus on another’s movements, emotions, intentions, your brain lights up automatically in around 10% the same way… 

In 1992 while studying a monkey’s brain with electrodes attached to the motor area (the area that lights up when movements by the body are made), researchers found by accident that not only would the neurons become activated by the monkey reaching out to pick up a piece of food, but also when the researchers made a similar movement.  Later the same team published a paper that showed that there were mirror neurons responding to mouth actions and facial expressions.  Further studies confirmed that around 10% of neurons in certain areas of a monkey’s brain had mirror abilities.  Later these studies were expanded to humans.  

A recent study summarizing the data of 125 fMRI studies of humans (brain imaging that shows what is active), found that there were many areas of the brain with this capacity.  (Molenberghs, 2012)  Beyond seeing actions performed by others and having them represented in our brain, there are 3 other areas of the brain that are activated in a similar fashion: 

  1. Ever wonder why watching people embrace enthusiastically at an airport is fun to watch?  When you observe someone being touched, a similar area in your brain (the secondary somatosensory cortex) activates in a similar way as the person being touched.  (Keysers, 2004) 
  2. When you only hear something, like someone cracking open a peanut, how do you know what is occurring?  Another study showed that there was a similar brain circuit firing in both doing the action and hearing it and just hearing it.   This study also showed that those with higher scores on perspective taking (ability to slip into another’s shoes) had stronger activation of mirror areas! (Gazzola, 2006)   
  3. When we watch someone grieve at a funeral, ever wonder why we feel their sadness?  When you feel emotion, you experience the emotion in your brain, like they are to a lesser extent.  (Gaag, 2007)

Now researchers are saying that the mirror neuron system is involved with: 

  • Understanding another’s actions and intentions

  • Neural basis for the human capacity of empathy

  • Learning new skills by imitation and rehearsing 

Why do I care about this?  Why am I passionate about this?  What is my story here?

Prior to doing training in therapy most of the mirror neuron signals I was picking up were unconscious and out of my awareness.  My first impatient psychiatric month as a medical student I became depressed, likely because I was picking up my patient’s suicidal depression and had no way of processing it or working through it on a conscious level.  Once I realized that I could feel to some extent what other people were feeling, I started to pay attention to how my subjective experience changed, moment to moment, when I was with another person.  Over time this has led me to more accurately understand what another person feels.  To do this best, I have to empty and clear out all the noise of my own thoughts and really focus on the person in front of me.  Time alone in nature, being in therapy, embracing my spiritual life and having good friends to process things with, helps me do this. 

To differentiate if I am experiencing something of my own or picking something up I frequently ask for feedback.  For example, if after sitting with someone who says they have been stressed, I feel tightness in the back of my head, I might ask, “where do you feel the stress in your body?”  The person might say, “I feel it in the back of my head, especially right now” which allows me to know why I feel that tension myself.  

What to do with the information:

Then from there, get in touch with what it might be like to experience such tension.  Then reflect back to them what that feels like to you.  For example, you might really feel like it would be hard to live with such tension.  You could then say, “I feel it must be hard to live with such tension, the stress must be significant.”  

I believe from really paying attention we can better understand a person’s thoughts, needs, feelings, desires and goals.  Connectedness comes from someone feeling that you understand them on these levels.  

 

 

 

 

How to notice and use micromicroexpression to connect

The art of connection begins with deeply listening to people.  I learned from my mentor Dr. Tarr that connection comes from right-brain to right-brain emotional relating to one another.  Some people naturally can tune into another person’s emotions with extreme accuracy and be incredibly empathic.  Others of us need to improve our ability to understand our own emotions and also the emotions of others.  

My Story:

 I learned about micro expressions in psychiatry residency from an older resident who was alexithymic (he was unable to feel other’s emotions).  He told me he studied it so that he could understand people’s emotions.  I watched the TV show “Lie To Me” which depicts Paul Ekman who through the power of observing people’s expressions and body language solves FBI and other crime cases.  I soon after read his book and have since taken some advanced training.  Subsequently I created a video that expresses highly emotional content.   I broke down the video content of this which I will have linked in this post.  

Lets start with Anger

 

When you see anger consider being curious about it. 

As I see you express that I wonder if you are frustrated?  

Perhaps you are frustrated about something?

 

The Video That Changed My Life (The Still Face Experiment)

I have watched this video at least 100 times.   Told my friends about it.  Lectured about it.  It changed my life, by showing me what is connection and disconnection.  Perhaps it is why I am so fascinated by connection.  When you see it, and really soak it in, think about all its implications, it changes everything!

Before I go any further, please watch it and pay close attention to it, and ask yourself these questions:

How does the mother and child connect with each other?   

How does the child try to connect with the mother when the mother has a still face?

Here is what I noticed from the video:  

1st the mother interacts beautifully with the infant.  They are mirroring each other: smiling together, moving their hands together, following each other’s cues, and when the baby points, the mother looks.  Of note, when studying healthy parents who are instructed to play with their infant, this type of attunement (“acting the same way at the same time”) only happens on average 13% at 3 months, 10% at 6 months and 21% at 9 months (Tronick, 2007 p 155).  Acting the same at the same time only happens ~15% of the time in normal infant-mother interactions so don’t worry if you are not doing this all the time!

Various authors call this type of connection different things including: synchrony, reciprocity, matching, coherence, mutual delight, affective attunement, and intersubjectivity…  

Then the mother is told to not move and hold a “still face”. 

 

In this film a normal baby (without attachment issues) is interacting with a normal mother (without depression or drug/alcohol issues).  In contrast we can think of many reasons why a “still face” would happen over and over frequently through a child’s life: 

  • Alcoholic parent: the parent’s intoxication prevents normal mirroring
  • Drug using parent: consider a mom on meth who is frantic, hyper, and not emotionally responsive
  • A parent who is very self-focused 
  • Parents being glued to the TV or phone (something for most of us to think about!)
  • A depressed mother or father whose face shows less emotion.  A Study has show that depressed mothers were only in social play 5% of the time whereas infants of normal mothers were in play about 13% of the time (Tronick, 2007 p 160) 
  • Imagine the baby moves from foster care to foster care where they are neglected

In this video, the baby has different tactics to re-engage the mother.  Think about how we also have these tactics to engage other people!   The child tries to signal the mother to reengage in all the ways he has in the past.  This is done by either signaling with positive affective tones (e.g cooing), neutral affective tone (pick me up gestures), or negative affective tones (making a fuss).  

 

You can see the child pointing, trying to touch the mother, and then scream… all things that normally would elicit some connection.  

Then the child bites himself, goes into what I would consider a fight and flight sympathetic state.  Anger expressions are evident.  He tries to self comfort himself, which in the still face experiment is classified as oral sucking, self-clasping, or rocking.  He will also try to shift his focus, on objects and on his self.  

 

When the child goes into shut-down or dissociation, biologically the child enters a dorsal vagal state and certain higher functioning brain areas are going off line.  He looks away.  Body posture falls apart, and at this state, if you are tuned in, you might feel slightly light-headed even watching it.   You can see the distress in part on this mother’s face, who is trying her best to follow the research proticol.  In the still face experiment they classify these states as withdrawal, escape or avert/scan.  

Research showed that when that child was re-intruduced to the same room months later cortisol levels (a stress hormone) were higher then normal.   

How this changed my life:

1.  I started noticing when I was disconnected or “still faced” with my family and those I interact with professionally.  

2.  I spent time breaking down the components of connection and disconnection which I will further elaborate in future posts.  

3.  I started noticing more and more the world of non-verbals.

4.  I now know consciously why when I receive a “still face” from someone else it is so painful.

So have you ever noticed when someone is mirroring you or not mirroring you well?  What have your experiences been like?  

Tronick,  Ed, “The Neurobehavioral and Social-Emotional Development of Infants and Children” 2007

Connecting In A New World Of Dating.

I am no longer on the market, but I have some friends and patients that I talk to about dating.  There are three mistakes that people make in dating:

1.  Not meeting the right people.  

2.  Not setting up a low intensity first date.

3.  Feeling a deep commitment early on with someone you do not know.   

3 Life Lessons on Connection I learned From My Mentor Dr. John Tarr

I was taught by Dr. John Tarr as a resident physician and now co-teach with Dr. Tarr on Thursdays.  We teach psychotherapy classes and review video with residents on their therapy sessions.  Dr. John Tarr’s passionate portrayal of the inner workings of the mind have inspired me and informed many of my ideas on how to connect with people.  Although I am sure Dr. Tarr could fill volumes with his knowledge, and likely most of my posts are influenced by him, I will try to summarize some of the things I hear most often.  

1.  You are entitled to your emotions.  

Entitled here means that your subjective and unique emotional experiences have value.  You have an experience which is unique and different and often comes with emotions (anger, sadness, fear, happiness, suprise).  Shame and guilt will only send your emotions into your unconscious and cause psychological defenses to pop up.  

Let me explain this deep but profound idea.  If you have anger over someone cutting you off in line, and the anger is intense

Emotions-> Shame/Guilt-> Defenses

Some common defenses:

Intellectualization of anger: “I am NOT ANGRY… I just am following the truth of the situation and have studied legal”

 

  Commonly happens when loosing a loved one, the sadness is so intense, and has no place, that the person dissociates it and feels disconnected.  A defense against the sadness felt might be the person pours themselves into busy activity, binges on food, or drinks alcohol.  What if we were to create a space for such emotion and not need to disconnect from it?

I can imagine if you are a spiritual person, being entitled to your emotions might sound off.  

Therefore to connect with our own experiences, our emotions have value, meaning and we should be allowed to feel them.  

 

Someone shares their frustration to b”she is entitled to feel angry, 

2.  

 

 

 

6 Ways To Move Out Of Disconnection.

I am speaking in this post to people who at times feel disconnected, out of body, dizzy, light headed, and un-grounded.  These times can come around times of stress, trauma triggers, or sometimes people feel this perpetually for a season.  I think if we tune into someone’s story, if they feel this, then we will also in part.  For example, I sometimes will be talking to someone in a session, about something stressful, and I will get a sense that this is happening because I get a bit light headed.  I will ask “do you feel light headed or having a hard time focusing?”  And they usually describe something similar.  Interestingly when my child was crying with colick this was the same experience I had.  Or when in some argument a close friend, I will feel it then as well.  More intense versions of it will happen in life or death situations.  Sometimes people describe panic in this way.  

How to exit disconnection:

1.  Try to resonate (feel with) their disconnection

When you sit with someone who is in a state of disconnection or dissociation, you might feel it in part.  This is your mirror neuron system, which allows you to experience a bit of what the other person is experiencing.  

I first try to put into words why what they are talking about is disorienting, “it makes sense that you feel disoriented here, at this moment, because of what you have been talking about”…  

2.  Find the emotion.

In dissociation or disconnection, the emotional area of the brain is off line, it is important to reintegrate it. Often when we start to feel, the intensity of rage, fear or shame keeps us from coming out of a state of disconnection, and once again we go back into a dissociated state.

Sometimes we need to ask the question in different ways, to get us to feel.  

What do you feel in your body while you tell me this?

What might you wish me to feel by telling me this?

What might you fear I might feel by telling me this?

I sometimes read clients’ micro expressions and then help them find their emotions.

We can journal an angry journal entry.  Put words to all the reasons we are angry!  “I am angry because my plans were interrupted, my rights violated, I was concerned for my wellbeing, expectations were broken, I was totally overloaded!”  Then try to notice the body sensations of anger “my hands and legs tell me I am ready to fight, my neck is tight, my eyes glowing, I notice a tightness in my chest and stomach”…

We can journal our embarrassment and shame.  I wanted to cover my face, cower in the corner, my own son stood up for me and I let him down, he found out that I lied to him for years.  He was my biggest fan and now I lost his respect.  

3.  Become grounded in your body.

In disconnection, the right anterior cingulate (which has to do with interoceptive awareness) and the anterior cingulate cortex (which integrates bodily responses with behavioral demands and with emotional awareness) both have decreased activity.  For centuries humans have felt at times disconnected.  I speculate that every culture and time has tried to find solutions for this.  Yoga, Tai chi, Pilates, and Qigong are examples of this, which essentially is focus on calm breathing in different body postures.  My favorite exercise is to stand up and shift weight from your right to left leg.  Focus only on the bottom of your feet.  Start with shifting 50 lb back and forth.  Then decrease it to 25 lb, then 15lb, then 10b.  At this point if you can still feel the slightest shift of weight from right to left then continue this for several minutes.  Likely you will notice that it grounds you!  Another way I do this is by walking and focusing on the bottom of my feet.  As you walk, return your focus to all the different sensations that occur simply by moving your feet up and down.  For those who need a much more stronger sensation, it might be helpful to hold ice while lifting up your hands.  

4. Doing mirroring exercises.  

More on this later.  But basically sing with others, laugh with others, dance with others.  There is something about movement with others that is important.  Improv seems to have different exercises to help groups move into connection.  If you understand the mirror neuron system they seem less silly!  Often without knowing why, disconnected clients gravitate towards these things, in order to find ways to ground themselves.  

5.  Optimizing your sensorium.   Sensorium is not something most people think about, but I think it is a helpful concept to understand.  Sensorium is our mental capacity at a given moment.  If we are tiered, starved, sleep deprived, with no connection to loved ones, we have a lower sensorium then our baseline.  Someone with dementia will have a lower base sensorium and therefore a small urinary infection will make them delirious with hallucinations and increased confusion.  If you have obstructive sleep apnea (stop breathing thousands of times per night) then you will have lower sensorium then normal.  Doing things that increase our bodies inflammation hurts our sensorium.  Alcohol decreases our sensorium.  To optimize our sensorium, we eat healthy, have moderate exercise, and eliminate certain medications, alcohol and drugs, and increase our sleep quality… I will blog more on this later.

6.  Find your meaning and purpose.  

Meaning and purpose activate your frontal lobe, and bring your brain into more integration.  In disconnection our frontal lobe activity is actually decreased in brain scans.  I find Rembrandt’s picture of the prodigal son and Henri Nouwen’s story “The Return of the Prodigal Son” has been very grounding in my life on a spiritual level.  I have read the book which is Nouwen’s quest into the story behind the picture.  I can visualize it in my mind when feeling disconnected.  In one 2 year longitudinal study of a group of 596 medically ill elderly patients, feeling disconnection from God, designated by those who answered positive to “Questioned God’s love for me” increased their risk of death by 22% compared to those who did not (RR, 1.22 P=.05).  (Pargament, 2001)  I will therefore in my blog try to address connection and disconnection in this context as well.  

Please write any comments on things you might add or have worked for you.  Or if you have any questions or thoughts about what I might write on in more detail, leave a comment and I will try to address it in a further blog.