Dr. Dan (00:00):

Nothing is perfect. There’s no such thing as perfect parenting. It’s just showing up and being present. So my deepest hope is that in this podcast and also in all these books I write, people will realize there is no such thing as perfection, but you can learn techniques to monitor more effectively and then modify toward integration. So when you do flip your lid and become reactive, it just means you’re human, but it is your responsibility to readily and reliably make a repair after such a disconnection. That’s what real secure attachment is all about.

Dr. Sarah (00:46):

I am thrilled to have had the honor of sitting down for a second time with someone whose work I deeply admire, Dr. Dan Siegel, a prolific author, Dan co-wrote one of my all time favorite parenting books, The Whole-Brain Child with Tina Payne Bryson. His work has had a profound impact on how we think about parenting mental health in the mind. Dan has an incredible gift for making complicated neurological concepts really understandable and accessible to anyone. In this episode, we’re diving into some really transformative ideas that can change the way you understand yourself and your relationships. In this conversation, Dan breaks down two fundamental states. Our brain can be in calm versus triggered, and he explains how recognizing these states is the first step to identifying our window of tolerance, which is a concept he coined to describe the space where we can remain clear and calm, even in the face of challenges. Understanding this window both for ourselves and our children, can be a very real game changer. So whether you’re a parent, a mental health professional, or simply someone interested in understanding the mind better, this episode is packed with insights and practical strategies that can help you navigate the complexities of the human brain and make life feel a little bit more manageable.

(02:14):

Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

(02:44):

Hi. Today we have Dr. Dan Siegel. I am an incredibly huge fan of yours and I’m so grateful for you to be back on the podcast. Welcome.

Dr. Dan (02:58):

Thanks for having me, Sarah. It’s great to be here with you.

Dr. Sarah (03:01):

Thank you. So we recorded an episode about two years ago, and we talked a lot in that episode about integration of the brain and why it’s so valuable. You had some really amazing strategies that you suggested on what very tangible takeaways that parents could try to use with their kids in day-to-day life to help them build that sense of connection and relationship with another and that sense of self in relationship to another. We talked about the idea of “mwe”, and there was such a fantastic conversation. So if anyone is listening and they haven’t listened to that, definitely go back because that is a really good sort of intro to what we’re talking about. But Dr. Siegel, I mean, you’re prolific in your writing, and one of the things that I think you are incredibly talented at is synthesizing really complicated neurological ideas and making it super accessible. And I think you wrote a series of books with Tina Payne, Bryson starting with the Whole Brain Child, and there’s a bunch of, there’s four of them I believe, in that sort of series of books, but it’s so accessible. It’s got visuals, it’s got the simplest way of taking this complicated idea and breaking it down and giving parents some really useful things that they can take away with it. So I’m really excited to talk to you about some of these ideas today.

Dr. Dan (04:29):

Wonderful. Well, thanks for those beautiful reflections. And it’s really meaningful to know that the writing, which I love doing, but it also takes a lot of effort and a lot of time, and it’s helpful to people. So thank you for the feedback and please call me Dan also.

Dr. Sarah (04:50):

Okay, I’ll Jan. So Dan, can you share if people who are listening aren’t familiar with the whole brain child, you have a very beautiful way of talking about what’s going on in a child or parents brain and nervous system when there is a threat response. And you talk about the upstairs brain and the downstairs brain and the right side and the left side. And I’m wondering if you could give us a little primer on how this works and why it’s so important from a parenting perspective to understand what is happening in a child’s brain or in your own brain when to use your words. We flipped our lid.

Dr. Dan (05:35):

Yeah, well thanks for that question, Sarah. The background just to start with is we have our subjective experience. Like when you’re flipping your lid, you have the feeling of getting distressed and you can have a sense in your body of your muscles tightening, your heart pounding, you’re breathing more rapidly, your gut feels like it’s churning, you’re choking up in your throat. So we want to start with the fact that you have the sensations of your body, and we live in a body, and so you can tell when something is changing in what you can simply call your state of mind. What I noticed, I’m a therapist who started as actually in pediatrics. I’m a physician. I started in pediatrics first, and I noticed that sometimes with the medical challenges that my patients would have, their parents would flip out. And I had seen that as a kid with my own, especially father.

(06:42):

So I knew there was the calm state and then there was this agitated reactive state. So when I was in pediatrics, I noticed that bringing medical knowledge, a medical diagnosis to a family was such a big deal that some parents could take it in and in that state they could work with me as their doctor to get things going for the child. But if parents flipped out, then we couldn’t take it to the next step. So I switched over to psychiatry because that was more fitting for who I am to be a psychiatrist and a pediatrician. But I always learned from those patients in pediatrics that this stuff happens to everybody even if they’re not a psychotherapy patient. But when I became a therapist, I really wanted to understand exactly what you’re asking about. What are these two fundamental states we’re in a calm, clear, receptive state in which you can be a parent effectively, you can be a friend, effectively a spouse, effectively a physician effectively.

(07:49):

But if you flip out of that state, it seemed as I was going through my therapy training, people would either enter a state of chaos, like things are out of control, flooding you or a state of rigidity where you just shut down and cut off from your inner life or cut off from other people. So I didn’t know what to make of that, that there was chaos on the one edge of flipping out, and there was rigidity on the other edge. So I made up this term window of tolerance for when you can stay receptive. So as a parent, for example, if your kid, let’s say, falls down and hurts her knee because she got in an accident on her tricycle, if you as her dad or her mom, if you had some accidents that were not handled well when you were a kid, you might see the injury and start to get all sorts of what we call implicit memories, activating you, and you leave your receptive calm state and you’d go from receptivity to reactivity.

(08:54):

So the first thing to say about flipping your lid, and Sarah, I don’t, did you want this much detail? Yes, always. Okay. Anything you have to give, I will happily. Okay. That’s the problem with thinking about this stuff all the time is you have so much to say about these things. So this reactive state, it turns out in the nervous system, is mediated that it is happening through neural processes. That’s what mediated means. It’s happening through neural processes that are very different. The receptive state is an open, calm place of being available to other people, being available to your internal world, staying calm in the face of the storm basically. So if you’re a sailor, you have a deep keel so that no matter what the winds are, the boat stays in the direction it needs to go. But when you’re in reactivity, the keel has been raised up and whatever the winds are, they just blow you around.

(09:52):

And so you’ve lost your compass, if you will. You’ve lost your direction, sort of an inner compass. And what was strange is things became either rigid or chaotic. So those states of reactivity in the brain are basically activating a threat response that gets you to fight, to flee, to not know whether you’re going to fight or flee. And so you temporarily freeze. And another thing that’s often called freeze erroneously, but it’s not a freeze, it’s a flop. It’s a fainting out of a collapse of helplessness. So that’s mediated in a very different way than the freeze state. And then even as we get older, those are all areas mediated beneath the higher part of the brain, the cortex. But as we get older and we learned and have more social skills, there’s a fifth f, if you will, of reactivity, which is called fawning, where you try to take care of your aggressor.

(10:57):

So we have fight, flight, freeze, flop, and fawn. So there’s all Fs of reactivity, but none of them are a great way to be a parent or a friend or a spouse or a teacher or a therapist or a physician or whatever you’re doing. So the first stage of any kind of regulation is to monitor something and then modify something. So Sarah, I don’t remember if when we were together last time, if we did this yes. No thing where I say no, really. We can try it if you want for your community members, but just if you’re in a car listening to this, you might want to put this on pause and pull over for two minutes. I wouldn’t do this while you’re driving. It wouldn’t be safe. So that’s a heads up. Give me a warning. Yeah. Not only a for your information, but it’s a warning. Do not do this while you’re driving. So just sit back and just take in what I say and just let yourself be aware of whatever your body and your inner life respond with. Here we go. I’m going to say one word. I’ll pause after saying it several times, then I’ll say another word and then I’ll pause and then we’ll do a couple of other things and then we’ll chat. You ready?

Dr. Sarah (12:20):

Yeah.

Dr. Dan (12:21):

Okay. Ready?

(12:24):

No, no, no, no, no, no, no.

(12:38):

Yes, yes, yes, yes, yes, yes, yes.

Dr. Sarah (13:09):

Wow.

Dr. Dan (13:10):

Now take a nice deep breath. Let it go. And now try putting a hand on your chest and a hand on your abdomen and take some nice deep breaths in and out. Gentle pressure on your chest and abdomen. And now switch it out. So the hand on your chest goes, your abdomen and the hand on the abdomen goes your chest. Nice deep breaths, gentle pressure, and the hands to the chest and abdomen. Now place your hands in whichever configuration was most calming for you. Left on top or right on top. Nice deep breaths. And now one nice deeper breath and let it go. And let’s talk about what that was like for you.

Dr. Sarah (14:16):

Yeah. Well, first of all, I was surprised that when you, I mean intellectually I knew what was going to happen. And when you said that, no, I literally felt like everything in my body rise. My heart rate started going faster, my chest got tight, my stomach kind of clenched up, and I could feel my pulse in my, I could feel it. And when you started to say yes, I immediately felt relief and I watched my nervous system really reset back down to baseline.

Dr. Dan (15:04):

Great. Excellent. And thank you for sharing. And how was it for the hands on the chest and abdomen? What did that feel like?

Dr. Sarah (15:10):

That was helpful too, just to kind of reset everything back and kind of reconnect to myself afterwards. And I think it was interesting. I felt actually probably because I was really nervous starting this interview because I’m anxious about interviewing with you. And so it was interesting when you did the nose, I went way up when you did. Yes. I went way down and then when I was breathing, I noticed coming back up again to where I had started, which was a little nervous.

Dr. Dan (15:45):

Yeah. Okay, great. Great. Were you a left hand on top or right hand on top was better or were they the same?

Dr. Sarah (15:51):

For me, it was left hand on my heart. I think it was just easier to reach and it just felt more natural.

Dr. Dan (15:58):

Great. Well, terrific. Thank you for sharing that. And for anyone going through this, just know that everyone’s different. Everyone has a unique experience. You didn’t have to have the same one that Sarah just described, but what you’re describing is very common. And for some people, they don’t trust the yes. So if you’re still feeling reactive, then try putting your hand on your chest and your hand on your abdomen, whichever way is most comforting for you. And you can listen to the rest of this. If you’re not driving in that configuration, go out and stretch, get a drink of water, it can be very upsetting. Now, I do this in my clinical practice with everybody, kids, adolescents, adults, because everyone should know basically how to learn to become a more effective regulator of their inner life. And so regulation, like when you ride a bike, always has two components to it, is monitoring something and being able to modify that thing.

(16:57):

So in this exercise, you get to do both. You’re literally being aware of what’s happening as it’s happening. So this monitoring capacity is also basically you’re sensing something or tracking something, but in addition to just being aware of what’s going on, you want to also modify that thing. So it’s monitor, modify, or sense and shape or track and transform, whether you like T’s or S’s or m’s, you can compare them up however you remember it best. But this monitoring ability is the first step. So a lot of parents, a lot of people don’t have the background to have learned how to monitor well. So I think everyone who’s a parent, this is what I try to do in all my parenting books, well probably all my books actually, is teach people to monitor with more stability, right? So you see with more depth, detail and focus.

(17:58):

So imagine having a camera where it’s all shaky, you haven’t stabilized it, you can’t really edit the video, but if it’s stabilized, you can see with more depth and detail and focus. So that’s the first step for any parent is to learn to do that. And Tina Payne Bryon, my former student now my wonderful colleague and co-writer for these books, we wanted to offer to parents a very accessible way of learning to monitor with more stability and then modify towards integration. That’s the modification. So I have this term called window of tolerance for different situations. Like if a kid does hurt herself and you’ve had your own injuries that you didn’t really work through, well then your window of tolerance for a child being hurt could be very narrow. And what that means is when you go through one edge of the window, you’re into chaos, you go through the other edge, you’re into rigidity, and the space for an injury experience in which you’re calm and clear is very narrow.

(19:01):

You can easily go into rigidity, chaos, so you can get a window of tolerance. Little card I just put out with my publisher, Norton, I have a series of books. I’ve published over a hundred textbooks written by other people, mostly with the Norton publishers, but it’s for professionals. But this would be a cool card to get and keep around your house. We wanted to make it really accessible. So it’s just literally a two-sided laminated guard. But the window of tolerance is a way of seeing when you’re integrated, when things are differentiated and linked, you’re inside the window. And when you don’t do this balance of differentiated and linkage, you bust into chaos or rigidity, which is basically the longest answer, Sarah, you’ll ever get to a simple question. That’s what it means to flip your lid, is you bust it through the window of tolerance.

(19:50):

You’re either in a state of chaos or rigidity in the threat mode, and you want to take a deep breath. And in mind the book Mind site, I have this chapter called Crepes of Wrath, a crepe store. I flip my lid so you can see from the inside out. I do this in most of my books anyway, I talk about my foibles as a human being. But this one was a parenting moment between two kids in a crepe store and how their dad me flipped out. And I had to get my kids to review how I wrote it up in the book. So they made some interesting changes, and ultimately they said to me, yeah, it’s said accurate, what you’ve said, but why in the world would you let the world know what a jerk you can be? I say, good, but that’s exactly what I want the world to know because anyone can flip their lid. The issue is repair.

(20:48):

Repair, repair, repair. TRO has a beautiful set of studies and a book out on the power of discourse discord where nothing is perfect. There’s no such thing as perfect parenting. It’s just showing up and being present. So my deepest hope is that in this podcast and also in all these books I write, people will realize there is no such thing as perfection, but you can learn techniques to monitor more effectively and then modify toward integration. So when you do flip your lid and become reactive, it just means you’re human, but it is your responsibility to readily and reliably make a repair after such a disconnection, repair, repair, repair. That’s what real secure attachment is all about.

Dr. Sarah (21:35):

Yeah, I’m so glad you brought that up because I talked to a lot of parents who they come to work with me often because their kid is flipping their lid a lot, and that’s making them flip their lid a lot. And there’s all these clashes happening in their day-to-Day life. And one of the questions that almost invariably comes up early on in our work together is like, am I messing up my kid if I’m losing it like this with them all the time? And usually when we do some digging, there’s backstory of people flipping their lid on them when they were kids, and just a lot of dysregulation trouble with keeping that sort of receptive in the window of tolerance, kind of integrated state going. And so they’re seeing a pattern emerge. But usually if they’re working with me, and this is what point I often make to them, I’m like by looking at it, by coming in here to talk about it, by reflecting on it and trying to do something different, you’re already shifting course from just blindly repeating the same patterns and that you won’t always be able to avoid flipping your lid or going back into that state of rigidity or chaos because it might be really hardwired for you right now.

(23:05):

And that’s part of the work is to increase that window of tolerance, that space where they can be integrated, but also if you lose it, you can repair. And almost every time we talk about that, they are able to acknowledge that’s actually what was missing when I was a kid. It wasn’t that I needed people not to yell at me. It was that I needed someone to say I’m sorry.

Dr. Dan (23:30):

Exactly. Exactly. Yeah, I couldn’t agree more. Sarah. I think even in your community, it’s great you’re doing this with your clients in your community. You could almost do like a book club series. The first parenting book I wrote is called Parenting From the Inside Out, and I wrote it with Mary Hartzel. And even though it was written many years ago, every word in that still applies. I did an updated thing on the science, but even now, the science is basically saying exactly what it said back then. So you have a very current way of diving in. And Tina, who is my student, as I mentioned, when we came up with the idea of writing further parenting books, we knew I never would’ve written another parenting book had I not written Inside Out first because the research is really clear. We need to go inward to really see these processes of flipping our lid, which I talk about in parenting from the inside out, the importance of repair and really being kind to our inner life with an inner compassion and then being able to be kind to our children.

(24:38):

And it’s a way of modeling that we’re all just human. So parenting from the inside out. And then the four that I did write with Tina are a great series of whole brain child and no drama discipline. Yes, brain, which really explores this no, yes stuff. And then the power of showing up. And then as the kids get older, I wrote with another student of mine, Dina Margolin, we wrote a book for kids themselves to write, so to read, and this would be for preteen kids, and that’s called now Maps. And now maps is basically all about taking this mine site thing, the idea of seeing the mind, and we build on the wheel of awareness in certain ways. We call it a compass that you have, but you learn about as a kid, how to actually monitor and modify toward integration. So that’s a great book to read with your preteens, your tweens. And even I wrote a version of it for preschool kids called Now Maps Junior. But then as the kids get older, then I wrote Brainstorm. So that’s another book. So this whole series of books, they’re not redundant. I mean they don’t repeat themselves.

Dr. Sarah (25:52):

They build on one another.

Dr. Dan (25:53):

Yeah, they build on one another. Exactly. And brainstorm also is written for adolescents themselves to read, but you as an adult can peek into it. And I even take some of my adult patients who didn’t get the benefit of a secure attachment, I have them read the attachment section of brainstorm because I wanted to be really very efficient in my words. And it’s very short section on here’s what happens in attachment. This is what happened to your brain. Your brain is changeable based on what you do intentionally. Here are the things you need to do to grow out of insecure attachment. It’s like, I dunno, it’s like 12 pages or something.

Dr. Sarah (26:30):

But sometimes that’s what we need as grownups. Sometimes we just need someone to say, let me explain it to you. You’re a child, and not in a condescending way, but in that simple way. And in that, I’m just holding it for you and I’m going to digest it for you.

Dr. Dan (26:47):

Well, it’s funny because when brainstorm, when I was just about to send it to the printer, someone called me and said, oh, you should not talk to an adolescent about their attachment. I said, why not? And they said, because they’re still living with their parents. They’ll be so angry with them for not giving them what they need. I said, better that they be angry with them when they’re living at home with them, and then they can all make a repair. And guess what? Their parents could read the book and then they could all actually move towards security. You can earn or learn security. It’s not a fixed thing. This attachment strategy you develop these states of mind are very changeable. So whether it’s in therapy or reading a book or having a book club and you do work as a community, that’s the beautiful thing.

(27:34):

My neuroscience teacher, when I was in medical school, David Huble, he taught me that how energy is streaming through the nervous system changes its structure. And then in 1981 when I was in medical school with him, he won the Nobel Prize. And the same year Roger Sperry at Caltech won the Nobel Prize in the same division, physiology and medicine for showing something very different, that the brain has evolved with an innate difference in a structure. In his case, he was studying left hemisphere processes and right hemisphere processes that are not learned. So between Huble and Sperry, I really was able to absorb this idea that you have both things going on. You have innate proclivities like this next book that I’m publishing soon is for therapists, and I’ll have a version that’s for the general public too later. But this version is for therapists about kids’ temperament, moving their way in this beautiful kind of dance with attachment so that the different attachment experiences we have of avoidance or ambivalence or even disorganization, which we can get into if you want, but they will be filtered through the child’s temperament in these really interesting ways that for me as a therapist, have become really empowering to apply, we call it PDP, the patterns of developmental pathways or these personality patterns that are built on top of your temperament and then intensified by your attachment basically.

(29:11):

So I’m always trying to learn new things, but what I learned in medical school was that you need to hold two things. Like temperament is an inborn proclivity, just like Roger Sperry was able to demonstrate left and right hemisphere are quite different. You have innate differences in your sensitivity to things in your intensity and how you respond to novelty. Just look at those three aspects of temperament. And when you look at the networks in the brain that are involved in different motivations, you can suddenly see these temperaments moving forward into adolescent and then adult personality, which personality just means repeating, enduring patterns of emotion and its regulation thought and what matters to you and behavior and how you interact with other people. So it’s a really incredible moment to actually bring this kind of developmental neuroscience view into the parenting world, into the therapy world, into all these different things. And I hope it’s going to be helpful.

Dr. Sarah (30:15):

Yeah. Oh my God, I’m like, my mind is just turning right now. I have so many questions for you about this is one of the things that I sort of specialize in is I work with a lot of families who have kids who are of the, whether it’s solely temperament or a combination of temperament and the dance that’s already happening with their attachment systems, probably because of two temperaments clashing in a particular way. Exactly. But I work with kids who really can be very explosive, can be very nervous system sensitive, like the dandelion orchid, like the orchid kind of kids. And one of the things I hear so often, because I believe very much in the strategies that you teach, especially in the whole brain child name it to tame it, you have all these ways of simplifying these ways of being with a child and helping them co-regulate or down-regulate when they’re in that state of chaos or rigidity.

(31:17):

But one of the things I hear so much from parents of these very sort of sensitive, explosive, challenging kids is if I name it to tame it, they go more dysregulated. If I try to get close, they kick, if I acknowledge their feelings, it’s like I’m shining a light on this volcano of shame that they just go wild and dysregulate more. It’s not working for my kid. And I do a lot of work in helping families kind of individualize these strategies specifically to that child and recognize, okay, that might be too much noise coming at them, or we have to figure out a way to process this with more distance from the moment. But I’m very curious what your thoughts are on how, what I think are really science backed and universal parenting strategies that you talk about in the whole brain child in a lot of your other books. How do you look at that through the lens of temperament, the dance of the attachment systems for these kind of really explosive kids?

Dr. Dan (32:28):

Yeah. Well, no, it’s a great question. And you, I’m a therapist and so I’m just thinking about all the different families I’ve worked with over these years. And I can’t believe I’m going to say this, but I had to put this in a book recently. Someone asked for the intro, well, how long have you been a therapist? And it turns out it’s 40 years, which is so weird because I feel like I’m 17 years old. So I don’t know how that math could possibly be accurate, but it is. So I’ve been seeing patients for 40 years. So I’m thinking now about all the different situations that come up, Sarah. And I think it’s really true that while we can have cross-cultural ways of looking at things, and certainly culture can shape stuff, we need to realize that there are kids who come with certain challenges to regulation.

(33:26):

I think the word dysregulation is a great word to use. How do you stay in that integrated flow versus how are you busting through the window of tolerance, out of that integrated flow of harmony and now you’re in chaos or rigidity? So I still think in thinking about this 40 year experience of the individuals who’ve had the privilege to work with that, it always comes down to chaos or rigidity is how dysregulation is expressing itself. And no one needs to read this book, but I wrote a graduate school textbook now in its third edition called The Developing Mind, which I’ll be right back there. Okay, there you go. Which is a deep, deep, deep dive for graduate students reviewing thousands of scientific studies. That’s the basis of all these parenting books. So in developing mind, you’ll see what regulation is based on from a neurological mechanism.

(34:22):

But the field I work in, I named interpersonal neurobiology because we don’t want to just look in the brain, we want to look at the relational side in addition to the inner side. So it’s personal and it’s interpersonal. That’s why I use that word instead of social. So the interpersonal means a kid is going to have an inner, the personal, what’s going on in that person as a person, an individual, then they’re going to have the inter. And so in parenting, we want to be very sensitive to both those things, the inner and the inner. So with dysregulation, I think what can happen at times is that you have this way where a child is busting through and becoming, let’s say, chaotic or rigid. And while your most children might respond to your effort to connect, sometimes you need to give space. And Tina and I always write about getting down on the child’s level and really tuning into them.

(35:26):

Well, sometimes certain kids, and in this model, this PDP model, you can kind of find of the nine different patterns that we describe, these are all just tendencies. They’re not like types, but they’re more patterns that have proclivities to them. You can see why one kid would be really needing space, not you tuning in. So it’s not that you leave the house and just go for a walk. No, you can stay near them, but maybe not communicating with them until for their particular temperament. They’re going to need to be just coming to a calm state on their own. Now if you give them space and they don’t become calm, obviously the first step of parenting is make sure no harm is done. So if kid is self-harming, you have to intervene to make sure they’re safe and not going to harm themselves or other people.

(36:21):

So it can be tricky when a child has dysregulation because as a child therapist, we know that there are kids who do have serious dysregulation that’s more on the order of a disorder. And sometimes there are significant psychotherapeutic interventions that need to happen or sometimes medications. So because a psychiatric disorder is a real thing, and as a child psychiatrist, I’m very aware of the research on this that sometimes you need interventions to help regulation. When I even think about some of the friends I have, and they come to me because their friend, and I’m also a child psychiatrist and they resist it, but sometimes their children need to be on medications to help them regulate them once they’re regulated with the help of a medication because there’s a family history of one disorder or other, whether it’s bipolar disorder or serious anxiety disorders or depression, then once they’re on the medication, the kid feels empowered and better about themselves because now they’re regulated, not that the medication is controlling them, but the medication is allowing them to control themselves.

(37:38):

And attention deficit would be another one. So I know for some people this is a controversial issue. I mean, medications have been misused, especially marginalized groups. They’ve been used as experimental subjects without their volunteering to do that. There’s a complicated history about medications. I am one of the least likely child psychiatrists to prescribe a medication. And at the same time I’ve worked with kids where the medications have saved their lives literally. And I’ve had dear friends who are adults whose lives were absolutely saved by being on the proper medications for certain disorders like bipolar disorder. So these disorders are real. So sometimes a person finds themselves in a therapist’s office not because there’s a problem in the relationships, but because there actually is a neurological propensity for a disorder. And I’ve had debates with colleagues of mine. They said, disorders don’t exist. I said, the research doesn’t support what you’re saying and also clinically doesn’t support. When you say that to a parent, then all it’s doing is falsely making a parent feel guilty that they’ve created things. A good example is autism. When autism was first described, people thought it was caused by what parents did, and autism is not caused by parenting behavior. There are neurological things that we’re just trying to understand about that. And other people yell at me and they go, no, autism is an attachment problem. I go, show me one bit of research that supports that.

Dr. Sarah (39:16):

And that’s so terrifying for parents because then it puts them in this perpetual cycle of blaming themselves and then not trusting themselves and what any child needs, no matter why they might be getting dysregulated, whether it’s from a neurological condition or temperament or some learned experience, some dynamic, whatever. It doesn’t matter if a kid is dysregulated and tell me if I’m getting this right, because pulling from your work, but what they need in that moment as a parent to be regulated enough, trust themselves, trust their ability to tune into their kid, see their kid, and be able to allow their child to feel seen and safe and soothed. Absolutely. And you can’t do that if your kid is having a meltdown. And all you can think is something, I did cause this and I’m a terrible parent, and now I’ve gone, I’ve crashed through my zone of tolerance and I’m in the banks of chaos and rigidity because I’m panicking from all this noise that I’ve internalized from people telling me that I caused this, which is so unhelpful.

Dr. Dan (40:22):

It’s so unhelpful. It is both unhelpful and it’s harmful. So ironically, because people know I’m an attachment researcher and I study parent-child relationships, I write about that. So people would think, oh, you must think all conditions are caused by attachment problems. I go, absolutely not, or all conditions are caused by trauma. I said, absolutely not. And at the same time, we want to be aware that there are things you can do. I mean, let’s use autism as an example. There’s a powerful book called, and I want to get the name of it, The Curious Incident of the Dog in the Nighttime. And it is a very powerful book about an individual with autism. And I saw the play in London and the play came to Los Angeles where I am, and they asked me to do a talk with some actors who were not in the particular performance there, but they had done this play and one of the actors has autism. And so we were up on the stage together doing this talk. I can never find the podcast for it, but apparently they turned him on. But this was the issue was what was this person’s understanding of his own condition? He had a diagnosis of autism, and there was an offering that it should be called an example of just the spectrum of normal, that you have a wide distribution of how we are. It’s just a temperament variation.

(42:02):

It’s not a disorder, which you got to take a deep breath and say, beautiful. If you have a thing you want to understand as temperament, that makes sense. And then the mother who was there said, yeah, but if we call this just a variation of normal, I don’t get any funding for the intervention that my son needs. So she said, I don’t want to call this a variation of normal, and then the state isn’t required to give money for years and years and years of therapeutic intervention that I absolutely need. I can’t afford that, so I want to name it a disorder. And so the other people on the panel were saying, no, we don’t have a disorder. It is just, there’s neurotypical, neuro atypical. It’s just a variation on normal. So it was a really interesting emotional discussion. So here’s what I said. I said, we can see the two sides.

(42:59):

You want to feel like you don’t have a disorder. But I said to this young man who is so sweet, and I said, so what is life like for you? He goes, it’s really hard. It’s really hard. Things upset me that don’t upset my siblings and that don’t upset other people, and I’m learning to be an actor, but acting is hard and all this kind of stuff. So I said, okay, well let me offer you one view that whether you call this temperament or call it dysregulation that might be called a disorder. Let’s just remove those issues for a moment and just tell me if this relates to your actual lived experience. He goes, okay, so I said, so one perspective is this, is that when energy flow, which is the universe is made of energy flow, when energy flow is happening, we call that experience and we live in a body that we’re born into.

(43:51):

And some bodies, nervous systems can take the differentiated elements like what you hear, what you see, what you smell, what you taste, and your touch, the five senses, and they’re able to take those streams of energy, they’re all energy and sort of juggle them like balls in the air and you can juggle those things and it’s fine. And the juggling goes well, I said, but for some people that juggling skill because of the nervous systems, innate features is just a little challenged. So now one ball drops and then another one ball drops and you just feel flooded. So let’s talk about the first step of understanding autism as sensory integration. Integration is differentiation, linkage. And do you ever feel flooded by either sound or sight or smell or taste or touch? And he’s just nodding his head like crazy. He goes, he goes, that’s everything I’m experiencing.

(44:46):

I said, okay, so let’s just start there. So don’t call it a disorder, don’t call it whatever, but it is a regulation challenge because regulation depends on integration and it sounds like you have a sensory integration challenge. He goes, okay, I said, so the next thing that happens is it can be very upsetting to feel the chaos that emerges. And so the emotional response, your own emotional response to your sensory integration challenge is to become dysregulated emotionally, either withdrawing into rigidity or you’re flooded in chaos, because that’s my whole life. I said, okay, so then you have an emotion regulation challenge because of the sensory integration challenge. He goes, okay, great. I said, well, one of the most significant things for anybody is relational connection. And so what can happen with someone who has sensory integration challenges that lead to emotion regulation challenges, one of the most emotionally engaging things is relationships.

(45:44):

So what research shows, even in early home videos in the first year of life of kids who ultimately get diagnosed with a condition called, in quotes, autism is they avoid eye contact and they avoid direct, let me name it to frame it, they don’t like that kind of stuff. It is too much in their face literally. And so because it’s flooding them, this third aspect, social relationships, they don’t engage in them. So by the time they’re one and two and now three years old, they’ve been to try to survive. They’ve been avoiding social contact, and so they don’t develop the neural circuitry that allows ’em to have sophisticated relational connections. He goes, that’s my whole life. So I said, okay, so I don’t care whether you call this a disorder or not, but if your mom can get funding for you by naming a disorder, would you be okay with that?

(46:37):

He goes, I’d be fine with that. I said, okay, because with a sensory integration primary issue, we need to help you learn how to develop the neural circuitry to sort through these sensory inputs to allow your emotions to be more regulated, and then you’ll be able to create integration in your brain that will help you have the relationships that you want have. So all that being said, if someone just said to this parent when the kid was three, oh, this is just fine. You’re just not doing it right here. Read more of Dan’s books or something, that’d be super sad because sometimes you need particular clinical interventions with a family to help a child, let’s say, with sensory integration problems and challenges that have led to these emotion regulation problems and then relational connection problems that are basically of dysregulation. I mean, that was a big download, Sarah, but how does that sit with you as a clinician?

Dr. Sarah (47:35):

Well, what I’m thinking, the word that keeps running through my brain right now is like, this is such a hopeful message because a lot of times when parents are grappling with a diagnosis, whether they’ve just gotten one or they are trying to figure out what’s going on and they don’t yet know what’s going on, whether it meets clinical criteria for diagnosis or not, is that there’s so much fear and hopelessness. And what I think I’m hearing a lot from what you’re saying is, and I’ve heard you say this before in other places, that if we look at any diagnosis, whether it’s a DHD, bipolar disorder, depression, anxiety, you can really look at any current DSM five diagnosis and look at it from a view of integration, right? How the etiology might be different, but the way it expresses itself often really can be distilled into symptoms that relate to disintegration and going into rigidity or chaos, and that one of the best ways that you treat it is to help in whatever way it’s showing up.

(48:46):

So in this particular example that you gave with autism, it’s helping them integrate that sensory input and integrate their emotional responses to the flooding of the sensory input and maybe integrate relational cues in a way. But however else it shows up in different disorders, there’s a way to work with it. We can reduce how much someone suffers and we can help improve quality of life. I think we could even make the argument, you can improve the entire family system and the entire attachment system by working on helping people integrate on an individual level and in a family systems way.

Dr. Dan (49:28):

Exactly. Yeah, that’s so beautifully said, and I agree with everything. And the thing that’s so exciting about it for a parent is to be able to say, okay, the main goal is integration, and that’s what all these books, whole brainchild and all the other books are about. Parenting from the inside out is about that. And I need to sense when there’s chaos or rigidity, and sometimes for some kids, whether they have sensory integration challenges that are the foundation for people on the autism spectrum or just they’re flooded for, they’re sensitive. If you talk about temperament in terms of those three things, at least you’ve got the sensitivity of a kid is their temperament, the intensity with which they respond to something that gets triggered because they’re sensitive and then their response to novelty. So when they’re familiar with something, they can be within a wide window of tolerance, but novelty make that window super narrow.

(50:30):

So if you just stick with those three aspects, when we talk about temperament, just sensitivity, intensity of the reaction, once something is triggered and novelty being one of those conditions, then you can start to say, okay, I need to tune into my child’s particular temperament. And it is good to look at it that way. And there’s a case, I’m trying to remember where I wrote about this case. Maybe it was the mindful therapist or maybe mine site. I can’t remember which book I put it in. I’m pretty sure I wrote this up, but there was a kid who was diagnosed, I used to be at UCLA on the faculty there, and we were kind of in competition with Yale because we both were the centers for autism and the big ones in the United States. So somebody came to me, actually someone related to one of my patients.

(51:20):

Anyway, they became my patient, a kid who was diagnosed with autism at Yale. So I had a little bit of a, okay, well, let’s see. And I never like to take the diagnosis that anyone else says, that’s part of my personality pattern and assume it’s correct. But in this case, I really thought they overstepped themselves, but whatever we figured out, he was only two when he came, but we figured out he had this sensory integration challenge, and at that very young age, certainly could have been a setup for autism, but we did this intense work that maybe Stanley Greenspan would’ve been happy about. Kind of like floor model work. Stanley was a great child psychiatrist who worked in this area, and by three and a half, four, he was really fine. So maybe he didn’t have autism and Yale was wrong or whatever, but whatever it was, he was fine.

(52:12):

Whatever labels you put on, I saw him when he was in high school. He was a cool, certainly quirky but totally cool kid in a regular school ready to go off to college, and they just came back to say hi. And it was so sweet to see him, and he remembered this game. We used to play of Domino’s. But the key thing was I could respect his temperament that when he would come in, I would just give him the space in the room. He found the dominoes in a little cabinet, so we said, you want to do something? He goes, yes. And it was all, we’d line up the dominoes during a session and then we’d dance around the room a little bit, and I would let him feel an intensity of us dancing together, but I wouldn’t be looking him in the eye. That was too intense.

(53:02):

We’d just be kind of dancing around with the dominoes in one part of the room we’re dancing and dancing, and then it’d be near the end of the session. I would say, we’re going to have to stop in 10 minutes. So he’d get a sense of time. We’d do some other fun stuff and I’d go, are you ready? We were going to knock the dominoes down, and we’d then slowly dance over to the table with the dominoes lined up, and then we say, okay, just imagine it. So now I wanted him to develop his memory system. Imagine soon you are going to hit that one domino, not the other ones, and it’s going to go. And then we dance around the room some more just thinking about how the dominoes were going to go down. So there would be, it’s basically called this shared social experience of planning the dominoes, thinking about the excitement of the dominoes, sharing the emotional experience of the dominoes, walking over now to the dominoes and boom, and then he knocks ’em down. And then once they go and they all knocked down, then we would dance around the room some more, and that was the session. And we would do that basically every time. Whitter got more and more elaborate when he went from two to three and a half. So here he is. He remembered the dominoes.

Dr. Sarah (54:20):

I bet. Yeah. Oh my God, I bet that’s such a core memory. My little play therapy brain is blinking. I’m like, what? I love just to translate. Because a lot of times parents are like, are you just playing with my kid for like 45 minutes and I’m just paying you to play with my kid? And I’m like, I promise. There is some very therapeutic stuff and it’s hard to, but if a parent were listening to that, the things, and tell me if you think I’m getting this right, the things to me that feel so therapeutic about that, I’m sure there were many just that shared joy and following his lead and helping construct something that then you deconstruct together, but to help him deconstructing something can have a profound sense of grief and to share that and have you be the softly ending for the grief of the dominoes falling, then the holding him in this readiness. I think kids who have a lot of impulsivity like autism or ADHD or they’re really hard to hit the brakes, they move fast into the doing. And when you are, okay, you ready? We’re we’re going to hit the dominoes. What do you think? Wait, hold on. Before you do it, what do you imagine? Pull it into your mind first. You’re building this circuitry of thinking about planning, holding that tension, tolerating that tension without acting, without you’re building his brakes system.

Dr. Dan (55:51):

Totally. Exactly. The building is breaks exactly what the idea of it was. And also from a neuroplasticity point of view, neuroplasticity is how the brain changes in response to experience. When you hold something in awareness, there’s something called a meta stability. There’s a temporary stability. That awareness makes a neural firing pattern held there. So it isn’t just, oh, we’re going to do this. Let’s do it. That’d be too fast. But where we could say, okay, we’re going to do the domino soon, let’s dance around. So he puts his energy into the dancing through his body. We’re holding it in a shared awareness together, but in his brain for his individual awareness, what that awareness does is it allows neuroplastic changes to happen that allow him to make an image of what’s about to happen, an image of the excitement that’s going to be there, the sadness after they fall. The whole plan, the relationship with me and all of it gets literally differentiated networks linking to each other. It’s literally how we’re integrating his brain with awareness. And so I like to say this phrase I made up a long time ago, but where attention goes neural firing flows and neural connection grows. So in play therapy, you are putting attention on a relational shared journey that when it’s held in awareness, then with the proper kind of reflection can become profoundly changing of the child’s brain.

Dr. Sarah (57:30):

And parents can do this with their kids too, right? Play. I am such a big fan of parents pulling emotion regulation skills and integration skills and awareness skills into their play with their kids, because it’s when the kids are most receptive to learning. They feel safe, they feel connected, their thinking brain’s on, and they can practice things in so many different ways. And so I feel like that is such a great game to play with a kid.

Dr. Dan (57:58):

Oh, totally, totally. My wonderful colleague, Tina. Tina Payne Bryson, her next book that she’s writing on her own, actually with a colleague, not with me, is about the power of play for parents. I can’t remember the name of it right now, but anyway, look up Tina Payne. Bryson, her next book is on play.

Dr. Sarah (58:15):

Okay. Oh my God. Maybe she’ll come and talk about it. Put us in touch.

Dr. Dan (58:20):

Great. Will do. Well, this is great, Sarah. I hope all this stuff is helpful for your community, and it’s great to talk to you.

Dr. Sarah (58:28):

So great. Thank you so much. If parents or anybody listening want to find your books, follow your work, you’ve done tremendous work with the UCLA Center for Mindfulness Studies. Tell us where we can find you and connect with you.

Dr. Dan (58:44):

Yeah, the best way is through the website, Dr. Dan Siegel, D-R-D-A-N-S-I-E-G-E-L.com.

Dr. Sarah (58:52):

All right.

Dr. Dan (58:52):

See you there.

Dr. Sarah (58:53):

Thank you so much.

Dr. Dan (58:54):

Thank you. Thank you.

Dr. Sarah (59:02):

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