Dr. Blaise (00:00:00):

I think we make a really big mistake to try to be calm all the time because the world is not calm all the time. And children need to learn how to develop a thicker emotional skin to criticism, to big emotions, to unfairness and all of that sort of stuff. So it’s okay. It’s okay for kids to experience their parents getting upset and maybe some conflict, but what is not okay is for that to just persist unaddressed.

Dr. Sarah (00:00:35):

We are diving into a really important and often painful topic how some children, especially those who are highly sensitive, can struggle with deep feelings of shame, self-criticism, and even self-hatred. If you’re parenting a child like this, it could feel heartbreaking and overwhelming. You may be walking on eggshells, unsure how to help your child feel safe in their emotions or in their own skin. You may feel like the strategies that work with other families only seem to make things worse. Joining me is Dr. Blaise Aguirre, a world renowned psychiatrist and one of the leading experts in dialectical behavior therapy or DBT. He’s the founding medical director of the three East Continuum of Care at McLean Hospital in Boston, a program that helps adolescents struggling with suicidality and emotional dysregulation. Dr. Aguirre is also the author of the powerful new book I Hate Myself: Overcome Self-Loathing and Realize Why You’re Wrong about You, and I cannot recommend it highly enough. This book is a lifeline not only for young people who are struggling, but for the parents, therapists and caregivers trying to support them. In our conversation, we talk about where self-hatred really comes from, why traditional approaches to emotion regulation may fall short if we don’t address the underlying beliefs driving a child’s pain and what parents can do starting today to help their child feel understood, safe and worthy of love. Dr. Aguire shares incredibly moving stories, practical tools, rooted in DBT and deep wisdom that will stay with you long after the episode ends.

(00:02:10):

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.

(00:02:40):

In today’s episode, we talk a lot about parenting sensitive, highly emotional children. If you’ve got a child like this, you already know that what works for other kids doesn’t always work for yours, and that can be incredibly frustrating and isolating. That is exactly. I created Parenting by Design, my guided program for increasing emotional and behavioral regulation in sensitive kids. In this program, I’ll walk you through how to map out your child’s unique nervous system so you know what’s happening for them before, during, and after their most dysregulated moments.

(00:03:16):

You’ll learn how to customize your parenting strategies to meet your child’s specific needs based on their brain, body and temperament. This isn’t about scripts or hacks, it’s about building a toolbox that actually works for your child, one that leads to more calm, more connection and more confidence for you both. So if you’re listening to parts of this episode and thinking, this could be my kid, I hope you’ll check out Parenting By Design. You can find the link in the episode description wherever you’re streaming this podcast, or head to drsarahbren.com/parentingbydesign to learn more and get started. Okay, now here’s my interview with Dr. Blaise Aguirre.

(00:03:52):

Hi everyone. Welcome back to the show. We have Dr. Blaise Aguirre here. Thank you so much for coming on.

Dr. Blaise (00:04:07):

It’s absolutely wonderful. It was a little bit hot in Boston today, so you actually did me a tremendous service in a nice air conditioned room right now.

Dr. Sarah (00:04:17):

I’m glad. I’m so glad I could help you with that.

Dr. Blaise (00:04:19):

Thank you. Thank you for your help.

Dr. Sarah (00:04:22):

So let’s jump in first by just orienting our listeners to your work. You’ve done a lot, but you’re also very, you’ve written a very important book called I Hate Myself: Overcome Self-Loathing and Realize Why You’re wrong about it. There’s a lot in that. Can you talk a little bit about how you ended up organizing the work you’ve done so far into that kind of a book?

Dr. Blaise (00:04:45):

Yeah, so I’ve been treating suicidal adolescence for the last, this is going to be my 18th year, and all I’ve done is professionally is just to work with kids who really struggle with wanting to live. And this is not the quote, attention getting type of, oh, I’m going to kill myself. It’s people who suffer deeply with thoughts of suicide and tragically will sometimes act on those thoughts and even more tragically, will complete suicide. And there are lots of new therapeutic techniques that try to help kids who are struggling this way. And there’s treatments like dialectical behavior therapy, cognitive behavioral therapy, mentalizing based therapy, schema therapy. So all these kinds of different types of therapies, and many of them do a reasonable job of helping kids with suicide. And certainly the one that I use mostly dialectical behavior therapy, I think has the largest evidence base for helping suicidal and self-destructive kids.

(00:06:06):

However, there was a group of kids that even if they were under better behavioral control using techniques of treatments like dialectical behavior therapy, still struggled with suicidality. And when I dove deeper into that trying to understand why would somebody who’s in much better control, who probably has lots to live for, they’re often intelligent, artistic, creative, why would they still want to die? And when I started asking the question more, they would tell me that they hated themselves. And I think that in the past I used to say, of course you don’t hate yourself. I mean, look at you. You’re wonderful, you’re creative, you’re smart, you’ve got resources, you’re attractive, you’re healthy, you’re fit. Any of these accolades or attributes that a child would want to have or that a parent would want to have for their child. But despite all of this, they still did not see themselves that way.

(00:07:09):

And they saw themselves as deeply flawed. And that flawed us came with profound emotional pain and a feeling that they were a burden to the world. And they thought that the kindest thing that they could do for themselves and for other people would be to kill themselves. And tragically, even though we lost far fewer kids to suicide than the research would’ve anticipated, we still lost some. And at the core of many of these completed suicides was self-hatred. And I just felt like, okay, then I did what a scientist does or what a researcher does or what a therapist does is go to the library and get all the books on self-hatred out there so that I can help people out. And there were a grand total of zero. So then it’s, well, wait a second, if there’s this vulnerability factor to suicide and there are no treatments for it, what are we going to do about it? So I decided, I mean, it was time for somebody to write a book on it, so I gave it a go. And here we are.

Dr. Sarah (00:08:24):

But it’s interesting, and you talk about this, so there’s these really solid treatments. We know that they do tremendously helpful things in reducing acuity. We talking about DBT, really that’s focusing on building skills. It’s a skill-based treatment. So we could talk a little bit about it, but maybe later. But at its core, it’s breaking down. It’s helping a child work on skills, but which is good, but skills are they’re tools. If the person wielding the tool doesn’t care to wield it, because there’s a much more core base issue, which is that I don’t see the point. I don’t believe you, when you tell me I am lovable, I think you’re really onto something when you say, okay, if we can distill what’s going on down to this core root issue of self-hatred and we want to deconstruct that with a kid, they learned that they aren’t innately. It’s not like, yes, we can talk and I think we should talk about temperament and how there are some kids that are just biologically and very innately more vulnerable and more predisposed to having that sensitivity towards misperceiving these experiences in the world and internalizing them and developing this narrative. But it’s a learned narrative.

(00:10:00):

So how do we help the child one understand that that’s not, it’s like there’s a core distortion happening and it’s really hard to get a kid to realize when they’re living inside of a distorted reality.

Dr. Blaise (00:10:19):

Right? I chatting with a colleague recently who was an ex-military and had lost the lower part of his right arm and he had to learn to do everything with his left arm, and he used to be a right-handed tennis player. He can’t play tennis anymore. And I mean, there’s absolutely nothing that you can do to get him to play tennis with his right hand because he just doesn’t have an arm. And I think for these kids that come in, it’s not as if, Hey, wait a second, you do have a right arm. You just aren’t using it just like I am deeply floored and no amount of telling me that I can do something would be like me telling this guy, well, you can play tennis with you, right? I say, I can’t have a right arm. These kids, you can say, no, you’re lovable and you’re wonderful. They don’t believe it. They don’t believe it, it’s, it’s something that starts to develop from their earliest memories. And because they don’t have a point of reference, they don’t have a point of reference that is non self-hatred. So it’s the only thing that they know.

(00:11:38):

It’s like a fish and water. The fish only knows water and you take it out and they say, what’s going on? But that’s what, no. So it just knows self-hatred and it embeds. And now many of the children who come to my program have had very similar backgrounds, but one of the differences is that why don’t those other children go on to develop self-hatred? And often it’s because there are protective adults in their life who tell them that whatever narrative is being told is just not true or they’re protective or the child experiences love in a nonverbal way. I mean, most love that is experienced non-verbally is the most beautiful kind of love there is. I mean, if you could actually name all the reasons you love someone that probably isn’t love, that’s maybe admiration or something because it’s a feeling state, it’s a feeling that we can’t put words to. And when a person has that experience, they feel settled, their biology settles, their sense of self settles. But when a child doesn’t have those protective factors, either because they are so emotionally sensitive or because the barrage of messaging of critical messaging is so large, they internalize it. They internalize as a self concept and then telling that it’s not true just doesn’t work.

(00:13:11):

So later for me, the breakthrough that occurred was to show them that they learned to hate themselves because they weren’t born hating themselves. They had to learn to hate themselves and they could learn to hate themselves, they could learn to love themselves, but that it was learned. And then I’d say, okay, with any learning, who taught you math? Who taught you to swim? Who taught you how to ride a bicycle? Who taught you to hate yourself? Who were your teachers of self hatred? And now if bicycle teacher taught you how to ride a bicycle, well, you probably want to go to that person to teach you how to ride a bicycle. But if your self-hatred teacher taught you to hate yourself, you don’t want to go back to those people because all they’re going to do is perpetuate that teaching. And by the way, it’s whether it’s intentional or not, I mean there are some people who can be very intentionally harsh, but most criticism doesn’t come from a place of cruelty. It comes from a place of fear, a place of how the parent themselves was taught a place, a place of this work with my other kids and that kind of thing. But it was a learned construct and I just hammered this idea until they begin to see, oh wow. I kept being told that I was not as good as my older sister, that I was the messy one, that I was annoying, that I was very emotional, and that those labels were very judgmental and then they just stuck.

Dr. Sarah (00:14:50):

It makes me think too, because obviously the kids that are coming to work with you are under just the level of acuity is very high. And I’m sure there are parents that are listening who have lived this experience. We actually have a group in my practice, like a therapy group for a parent group, for parents who have adolescents who have been in crisis because it’s more common than we realize. But I also think a lot of parents are listening to this podcast are thinking, okay, I don’t don’t ever want my kid to get there. Or I have a young kid who says little things like, I hate myself, or I’m no good at this, or You hate me, or is highly sensitive to that criticism. But I also imagine a lot of the kids that you’re working with, yes, I’m sure a lot of them have very explicit trauma histories. But I also know that a lot of kids who get to this place of really profound self-hatred, whether or not it is yes, in terms of also leading to suicidal ideation, but even kids who they function fine, but in the inside they really just don’t like themselves and they don’t believe they’re lovable and they do experience depression and anxiety, but they kind of look fine on the outside.

(00:16:11):

They might not be showing up at your clinic. But I also, a lot of those kids, again, some have trauma histories a lot and not in the way that we would classically imagine a parent listening isn’t like, whoa, I wasn’t abusive to my child, or I’m not abusive to my child. I’m super loving. I might have some high standards, but I’m not sitting here just berating them and constantly telling them how lazy or awful they are. Where are they getting this from? And some of it might be coming from peers, some of them might be coming from social media. But then you have sometimes these sensitive kids, and I’ve seen this even in really young kids where they’re so acutely sensitive that there’s such an intense filter that when they hear even the littlest bit of criticism that isn’t coming from a parent intending to really make them feel bad, even sometimes parents who are actively trying to validate, for example, when you’re saying if a kid is saying, I hate myself, and you’re like, no, you’re wonderful. You’re so wonderful and a super sensitive kid hears you, don’t get me. You don’t even believe me, I must be the worst. So it’s like, what do we do when it can make a parent feel very helpless? Because no matter what they do, they can’t control what gets internalized.

Dr. Blaise (00:17:43):

When I lived in Lexington, Massachusetts, there’s a little driving range golf driving range near my house, and I remember my kid once found a golf ball in the back of the driving range, and then all my two other boys wanted to go and get golf balls. And so we went to the back of this driving range and they found 500 golf balls back there. And when they came home, it turned out that there was a lot of poison vy back there, which didn’t make me the favorite person in the house, but one of them had a bit of a rash, the other one more of a rash. And the third one had a massive whole body rash and it took, I dunno, a month for it to heal. And the first one just took a couple of days and some cream. So if you think about they were exposed to the same poison ivy, the reaction that they had was very different.

(00:18:38):

I mean, three kids with probably the same genetics makeup more or less, but three very, very different reactions. And so you can say, Hey, I’ve got three kids and I treat them all the same and I love them all the same. But to your point is that some of them, because of their temperament, because of their emotionality perceive criticism, any form of criticism as a judgment of their character, and even though a parent isn’t necessarily trying to, obviously no parent wants a child to hate themselves, but let’s just say for example, let’s just say that you have an artistic child and you have a child who’s a great soccer player. So what happens is, and the parent is a sporting parent and loves all of their children, but then they go to the soccer field to watch their soccer playing child, and the artistic child sees the parent cheering for their soccer playing other child and like, wow, you’re so great and you’re scoring goals and you’re fantastic, and I’m so proud of you and dah, dah, dah.

(00:19:58):

And the other kid comes home and draws a picture of Barney and it’s like, oh, that’s so cute. Let’s put it on the fridge, or whatever it is. So even though there’s no intention, the child then starts to compare themselves with their more successful older sibling, the one that is that they see in the eye, the parent, and they compare themselves. If only I were as soccer playing as my older sibling, I would be as loved as my older sibling is because these children respond to emotional intensity. And when they’re seeing the parent having a very intense reaction with the soccer playing child and not getting the same kind of reaction for what they do internally as I am not as good as, so again, of course the parents are unaware and they’re not trying to hurt their child, but the emotion sensitive child has emotional sensitivity working against them.

(00:21:03):

I think it’s a super talent, by the way, but I think in that case it’s working against them and there’s a lot of comparisons going on. And to them it feels critical. It feels as if that joy is not being directed at the soccer playing child, that it’s being directed at the child who’s sensitive to it. It’s like, I would praise you as much as that child if you were as good as, and that’s going on in the child’s head. It’s not going on in the parent’s head, but that’s how they perceive it. So it doesn’t have to be the bullying, the trauma, the rejection that goes on. It can be very well intentioned.

Dr. Sarah (00:21:50):

I also can see this kind of perfect storm happening. So it’s like you might have this sensitive kid who is more vulnerable to reading into the absence of euphoric cheering for their art project, like you’d cheered for their brother’s soccer game as this referendum on how good they are. But then they show up bristly because of that and maybe especially they’re really little and they can’t really organize that experience. It’s just coming out in weird, icky places. So they’re more irritable, they’re more difficult, they’re porcupine. And so there creates this sort of relational and environmental feedback loop where the kid perceives things, it makes them feel bad, and then that bad feeling manifests in yucky behaviors that make them kind of create this self-fulfilling prophecy where people do start to avoid them or real from them or have really yucky exchanges with them. And so we create this kind of dance that we cannot get out of and we get entrenched in it.

(00:23:05):

And the parent, I’m thinking of your kids with the poison ivy, like I doubt any parent would say to the kid who had the bigger rash, you’re blowing this out of proportion. Stop having such a big reaction to this poison ivy. Look, your brother has a small reaction to the poison. But we do do that for sure with kids who are having genuinely outsized reactions. We’re trying to help them understand how unrealistic they’re being unreasonable they’re being. The problem is we’re usually doing that in the heat of the moment, which is never a good time for teaching. So I’m curious your thoughts on what I’m talking about here, but I’m also thinking what is a mentalization based treatment or dialectical therapy based treatment do to help get this loop to get interrupted and start to reorganize kids back into reality and build some skills for checking that distortion?

Dr. Blaise (00:24:10):

It reminds me of the old quip. Insanity is hereditary. You get it from your kids. And I think what happens is is that some interaction happens and you have an irritable child, and an irritable child is harder to work with than a non irritable child when you have that. I had a colleague who had a baby, and it was what people would describe as a perfect baby, slept through the night, never cried, just engaging and loving. She’s like, wow, this is so incredible. I had a second child who was the polar opposite, why did I have the second child?

(00:24:55):

So you have to have compassion. One thing, I never hid my emotions from my kids, and actually I’ve got four children and they’re ultra happy, they’ve been successful, but I’ve seen very successful unhappy people. They’re just happy and they’re successful. I don’t care about their success as much as their happiness, but I would yell at them and I would ground them and I would send them to their room and I would do all the things to try to change some of the behavior. Some of those things worked and some of them didn’t. But the one thing that I always did is I always went and hung out with him. I always owned what I did wrong. In those situations, I would say, you know what? Yeah, you only took one extra scoop of ice cream. And I made it seem as if World War III had started, and maybe it was because by you taking an extra scoop, your brother couldn’t have an extra scoop.

(00:25:57):

And then I got really upset because I sided with your brother that it was unfair and all of that sort of stuff. And I had a big reaction. And I think we make a really big mistake to try to be calm all the time because the world is not calm all the time. And children need to learn how to develop a thicker emotional skin to criticism, to big emotions, to unfairness and all of that sort of stuff. So it’s okay. It’s okay for kids to experience their parents getting upset and maybe some conflict, but what is not okay is for that to just persist unaddressed. And again, it’s important to model the mistakes that you make. I was wrong and I was wrong, and I apologize for being wrong. Sometimes their parents will say, well, I don’t want to give my child too much leverage by admitting that I was wrong about something.

(00:26:57):

And it isn’t modeling the kind of behavior you want them to have as adults later on in life. So one thing, DBT, dialectical behavior therapy, it starts off with this idea that polar opposites can coexist at the same time, and that contradictory ideas can both be right at the same time. So this is just as an example. A lot of the kids that I see self-injure, they cut themselves, and most people would agree that it’s a problem that people cut themselves. I do. At the same time, for the children who are cutting themselves, they don’t see it as a problem. They see it as a solution, and the solution is to the problem of how they feel in the moment, their emotions. So here you have a behavior, one person seeing it as a problem, the other person seeing it as a solution, a problem in a solution, or coexisting in the same behavior.

(00:27:56):

And so DBT says that in the moment that a child is really upset, they have a point of view that makes sense from their perspective, and you as a parent have a point of view that makes sense from your perspective. And that finding a way to understand each other in the moment is a much, much healthier approach than either yelling at them or sending a child to their room. And so as I say, whenever there was some level of stress inducing parenting that I would do yelling or whatever it is, then I sit with them and say, Hey, let’s just talk about what happened. And I get it. I get how you would want that extra scoop of ice cream. And then they just learned that it would be okay to have that. And sometimes they were wrong. And then there’s consequences to being wrong. I mean, my oldest boy was so taken by the work that my parenting style, he became a social worker and is now doing behavioral therapy in Boston.

Dr. Sarah (00:29:16):

That’s amazing.

Dr. Blaise (00:29:18):

And again, and as much as I’ve often used examples from childhood in my parenting groups, he says that he now uses examples about me being a parent in his therapy. My dad used to do this, that or the other, and this is how we dealt with it, and this is how I talked to him about it. So VT, it provides skills, but one of the most fundamentally important of all principles, and this hasn’t changed in all of eternity, is that you have to regulate before you can reflect that the dysregulated mind cannot think We make terrible decisions when we’re emotionally dysregulated. We make terrible parenting decisions when we’re emotionally dysregulated. And so what happens is a child is really upset and then because we’re emotional beings and because we mirror their upsetness, we start to get upset and then we make all kinds of promises we’re never going to, you’ll never ever drive again.

(00:30:24):

And you picture this 80-year-old child being driven around by their a hundred year old parent because you swore that they would never drive again. Of course that’s not true. So before you can have any kind of reflective, introspective, productive discussion, you have to regulate. And sometimes earlier on in the day, it’s easier to regulate. But when you’ve had the stress of work, the stress of all the school stuff that’s going on, the stress of, I don’t know, the food not being cooked properly or being delivered late, or all the stresses of life and the dog pooping all over the carpet and you’re like, oh my gosh, I’m ready to pull my hair out. And then your child says that the teacher wants to talk to you because you haven’t handed in your homework and you’re ready to lose it. I mean, that’s when a lot of parenting mistakes get made because they themselves are dysregulated. And this is where you have to have strategies, whether you’re tagging out, whether you say, look, you know what? We have to address this, but I’m going to give myself 20 minutes where I’m going to go and lay in a bubble bath or whatever it is.

Dr. Sarah (00:31:36):

Or I’m just realistically, because when we’re in the thick of it, you can’t take a 20 minute bubble bath, but you can take a beat. You can say, hold on, I’m too hot right now. I’m going to go going to splash some cold water on my face. I’m going to take a breath. But we forget, I think we do think, well, if I can’t take a 20 minute bath, there’s no other alternative. So I’m just coming in hot. And I think you bring up a very good point, which is regulation is a family systems issue. It’s not a child issue if we are all kind of connected. Our nervous systems are all connected as humans. Any humans in a room are going to have interconnected nervous systems, but a family system, we’re hardwired. These are attachment systems. Our kids are paying their unconscious back of their brain is paying such close attention to the subtlest of our facial cues, especially sensitive kids, especially kids whose fight or flight system’s probably always on a little bit in the background, which means that their threat systems are very carefully detecting the smallest sign for threat because they have to, their system is just kind of wiring themselves to be ready to fight or run or shut down. And so when you come in from that long day of work and you’ve got just that sort of flat face and your shoulders are hunched, you don’t have to say a word. You could even say, Hey, love, I’m so glad to see you. I miss do how was your day?

Dr. Blaise (00:33:20):

Yeah.

Dr. Sarah (00:33:20):

But if they see the hunched shoulders and the flat face, their back of their brain is like, oh. And then they start to get more agitated and then they start again with really little kids. They’re not going to say to you, you seem tense, and that’s making me uncomfortable. They’re just going to pick a fight with their sibling because it’s just erupting out of them in weird places.

Dr. Blaise (00:33:50):

But just, okay, let’s flip that around. I mean, you’re a parent. Yeah, you’ve got a couple kids.

Dr. Sarah (00:33:56):

Yeah, I got two.

Dr. Blaise (00:33:59):

And you take clearly your podcast really seriously, and you want to help parents and you want to teach and you want to educate. But if your children started fighting right now and started yelling and you heard crashing in the background and you said, I have to go and find out what the heck is going on because you’d be really upset. And I said, no, no, no. Wait a second. I made this time for you and you promised me that we would be on for a certain period of time, and you’ve got to stay focused. You going to say, not only would you be really upset because your kids are fighting, but then it’s like, who the heck are you to tell me what to do? You yourself would start to get dysregulated. So you think, no, I’m a professional. I can take care of things that you at that now you’re going to take care of your kids. And you’re thinking like, wow, I had this guest on who’s telling me what’s what. And then that might be sitting at the back of your head because then you’re feeling like, oh wow, am I feeling guilty? So there’s so many factors are taking place.

Dr. Sarah (00:35:00):

It’s so much.

Dr. Blaise (00:35:01):

And you see the dysregulation in your child, but then this is where from a DBT perspective, the mindfulness parts of it is so important to me is when you’re coming in hot, you’ve got to know that. And then in DBT, we have this very cool emotional regulation strategy of putting your face in ice cold water, which is not only does it do fabulous things for your skin, let me tell you because I’m with collagen production and all of that sort of stuff, but it lowers the body temperature very, very quickly. But you’ve got to be aware. You’ve got to say like, wow, this is not the best version of who I am. I’m probably not going to deliver the best problem solving skills of who I am because I’m too dysregulated. And the more dysregulated you are, the narrower your thinking becomes. If your house is on fire, all you’re focused on is putting out that fire. You don’t want to have discussions with me about Dostoevsky and crime and punishment.

Dr. Sarah (00:36:06):

No, it’s so true. Incredible. This makes me want to go back to something you said earlier when you were talking about how this example you gave of if you lost it with your kid because of the ice cream, but what really matters is that when you went back, even if what they did was legit not cool, and you go back and say, these two things are true, I lost it. I was scary. I took something small and made it really big.

(00:36:33):

And I’m sorry what you’re doing there. One is modeling to all parents that you don’t have to be constantly regulated all the time to be a good parent. We do lose it. And that repair is really important. But what you did in that moment too that I think is really important for these sensitive kids is you modeled not just repair, but you modeled vulnerability and that we can be vulnerable together and it’s safe. I can say I messed up. And it doesn’t undo your expectations of your child as a parent or the things you have to sort of boundaries you have to hold. And it doesn’t teach your kid that you are soft and don’t have authority in the family. You’re teaching them that we can be vulnerable together. We can name the things that we didn’t do well, that we’re not happy with and we can repair.

(00:37:29):

And you’re also sharing your thought process. You’re teaching them how to organize themselves. These are all skills that you teach in DBT, right? So obviously in the heat of the moment, we’re not going to do teaching. We’re we’re going to try to self-regulate. If we can’t, we’re going to just try to keep everybody safe. And then afterwards, we’re going to repair, we’re going to cool off, we’re going to reconnect. But in the completely later moments in the non hot, non lukewarm, but the truly cold, the way I often describe it is before, during, and after. The during is the explosive. The moment, the after is a good time to debrief, connect the dots, repair set new expectations, do a little teaching. But for super sensitive kids, they can’t tolerate teaching in the after either because it just brings them back to the jury. It’s just too, they’re sensitive to shame, they’re sensitive to self, the feeling of being criticized, even if it’s not your intention, they’re more vulnerable to seeing your feedback as criticism. The after comes the next before right before is where the magic happens. That’s where your DBT skills and your mentalization skills are going to come in, right?

Dr. Blaise (00:38:42):

Yeah. Well, actually one of the things that I don’t actually, I used to be criticized by my colleagues that I went too quickly to teaching. So what happens in the after is in the sort of debriefing I want to get at, things seem to have been settled. First of all, I changed the context. So I remember with my son who was sensitive is I’d say, Hey, let’s just go for a walk. And we would be walking and he loved jogging and something, go with him for a jog or whatever it is. Go out and go and get that extra scoop of ice cream at one of the local stores, just the two of us, and just say, I just want to know what that was like for you. Just tell me what that was like for you. So I’m not going to say, look, do you see how when you wanted that extra scoop and then your brother couldn’t get that extra scoop, how then he would’ve been upset and then you guys start fighting and then there’s a lot of chaos. I just stay with the affect. I stay with an emotion. What was that like for you then? It was like, yeah, I felt embarrassed. And then later on when I was thinking about it, I felt greedy and then I felt jealous and I felt whatever it was that it was feeling and just like what was that like?

(00:40:08):

And then I also ask him, I want him to be part of the solutions that work for him, because I remember my two younger ones when they would play soccer, and if they fell, I’d say, get your A up and go chase that ball or whatever. And they would do that. They were fine. I could yell at them while I wanted. And they were running around and one of them is becoming a lawyer now, so he’s like, things are black and white and it’s fine. But for the other one, if I said, get up, then he’d be like, so hurt. Feel like you think I’m being lazy. You think I’m not wanting hard enough and everything like that. And so no two children are raised by the same two parents. I mean, you may think, Hey, my partner’s the same partner. They said, no, he is not.

(00:40:56):

No, she’s not. They are different partners because you are different as you grow, you’re different as you interact with different children, they change. They’re not models of each other, how they’re going to interact, they’re going to be different. So I just stay with that emotion. What was that like for you? What would be helpful next time? This is likely to come up again. And so let’s do this differently. What are we going to do differently next time? And that it also makes sense that you would feel in that way. And then if I can get there, and as they get older, they can also say, does what I do is what I did? Did that make sense to you as well? And if they’re too young, they might not be able to tolerate it, but later on they’re able to say, yeah, I mean, if I had two kids, I’d probably want them to have the same amount of ice cream. But you can get there because you’ve co-regulate it all. You studied with affect, you haven’t gone to problem solving.

Dr. Sarah (00:41:54):

But what you’re teaching, and this is where I think people can very easily get it wrong, is I think most people here, we have to teach after the heat of the moment. Don’t teach in the heat of the moment. Okay, fine. I wait, we’re cool. I teach. What am I teaching? Most parents teach what the right behavior was going to be.

Dr. Blaise (00:42:14):

Exactly.

Dr. Sarah (00:42:16):

I got to teach my kid, it’s not okay to hit. Your kid knows it’s not okay to hit. They already know that what is missing is not a knowledge of right and wrong and what’s expected. What’s missing is what you’re talking about, that self-awareness, that ability to think about, wait, what was I feeling? Why did that thing that happened lead to that thought? Which led to that feeling, which led to the urge to smack my brother. We want to help kids. What the teaching? I think you’re describing a different lesson. Can you talk more about that? What is the best thing to teach and how do we start to build those building blocks for kids?

Dr. Blaise (00:43:03):

Yeah. Well, I mean, if you were to say, okay, let’s go into the desert, and then you’ve got a book on snakes and you say, okay, these are snakes, and if you see them, they’re probably dangerous and stay away from them. Okay, whatever you get bitten by a snake, never going to forget that. You don’t have to have a book to do that. You’re terrified. One of the most powerful forces in the universe to glue memory and glue learning is strong and powerful emotion. Now, I remember with my son, again, the one who became a social worker. He had this really annoying habit of leaving his cello at home.

(00:43:54):

He ran cross country, but he also liked to play cello of all things. But he would leave it at home and then he’d call me up and say, Hey, can you bring it over? And one day I said, look, this is your responsibility. You’re the one who wants to play cello, and I’ve brought it over 10 times and every time you forget, you call me up and I bring it to you next time. I’m not going to bring it to you. So what happened is, of course, he forgets his cello again, and I stuck to what I committed to, and he was ostracized by the band. It’s like, dude, you forgot the cello. You didn’t bring it. And he said, oh, I tried to get my dad to bring it and everything like that. And he never, ever, ever again forgot the cello because the emotion that it was associated with that event was so powerful that it impacted him.

(00:44:53):

And we talked about it. So first of all, it wasn’t done out of punishment. It was natural consequences are very, very powerful because they’re often associated with very strong emotions. And he was upset with me. He said like, you didn’t do it. And I said, okay. And at the same time, you’ve never forgotten the cello again. And what’s interesting is now he’s just turned 28, and he said he often uses that cello incident from his point of view when he’s working with kiss. So he remembered it very powerfully, but who would’ve remembered it otherwise if I always brought the cello? And so part of my point with this is that we have this finger pointing style of teaching as if was, and you could say, wait a second, what just happened? I said, I was speaking in Spanish, and why aren’t you speaking Spanish? And is it because you’re a bad person? Whatever. It’s like, wait a second, what just happened? And I want to don’t presuppose that your child understands what you’re trying to teach. Understanding is always in the ear of the perceiver, not of the deliver. I always know exactly what I want to tell my kids, how they understand what I’m trying to tell may be completely off. My youngest invited me for show and tell and said, oh, this is my dad, a psychiatrist who writes books and helps people. I said, all right. Everybody answered this question, what state are you in? So half of them said, Massachusetts.

(00:46:44):

Another 40% said their emotional state, happy, sad, or whatever. Two had come from organic chemistry and said, solid. Now I’ve asked a question, I know exactly what I mean, but how the other person’s perceiving it is not necessarily with a clarity and understanding that I have. So when they say Massachusetts, it’s not for me to say, don’t be funny, don’t joke around with me. That’s how they’ve understood the question. Now, yes, there might be some sarcasm or some playfulness around that question, but just accept that maybe how you asked how you delivered a question isn’t the way that the person understood it. And that when you get a reaction that is unexpected is to say, wait, what? I don’t understand how you got to that to Massachusetts to say, I’m in the geographical state of Massachusetts. Okay, I get it. I was thinking about emotional state. And so one of the things in that context is that when the child has a big reaction, we tend to perceive it from our point of view, and then we see it as them doing something wrong or whatever it is. But the child themselves might not be seeing it that way. So before judging and before criticizing, you want to have a degree of not only understanding what’s going on, but also understanding that whatever was going on in their brain at that time allow them to make sense of the behavior.

(00:48:30):

So is this idea that I have a mind and that you have a mind and that I could say, okay, you just nodded your head when I said that and that, so in my mind I can interpret nodding of your head as endorsement understanding of what I’m trying to say. If you shook your head, that would then be confusing to me. Like, wait, why are you shaking your head? But rather than being critical of you and judging you, and they’re saying, oh, wait, I’m confused. Why you judge your head, but you shook your head, but obviously something’s going on in your mind at that time that caused that to happen. And rather than me saying, you’re ignorant and why aren’t you talking to me about this? It’s like saying, what just happened? What is going on for you in the present moment? And that does allow the child to develop a sense of self-awareness, awareness of themselves and awareness of others. And over the long run, it’s the greatest gift that you can give your kid more than a powerful education, more than a brand new car when they turn 17 more than anything else. It’s just that ability to just know their mind and know themselves. It’s a way of setting them free from the traps of delusion that we fall into all the time.

Dr. Sarah (00:49:57):

Yeah, and I agree. I think one of the best ways to teach a child to know their own mind is to take that same stance that you’re describing from the parent’s perspective of, I don’t know your mind. I inherently am going to be curious and wonder what’s in your mind. And in modeling that curiosity about the inner experience of the child as unique to them and not known by everyone automatically you are teaching them, there’s this real meta communication that’s happening. Oh, you have your own mind. I have my own mind. I don’t always know how you think and feel, so I’m going to be curious about it. The judgment or the perception of judgment or the perception of criticism or the genuine judgment or criticism if we don’t realize we’re even doing it, is coming from assuming we know the other person’s mind and assuming it’s the same as ours. In attachment science, we often refer to this as reflective functioning, but mentalization and reflective functioning are basically the same thing. It’s this ability to reflect on our internal experience and be curious about why it is where it is at and do the same for another. And if you can teach that to a kid, that’s what I’d be doing in the debrief, that’s what I’d, I’d be modeling that curiosity of just like you said, something happened that really seemed to really upset you. How did you get there?

Dr. Blaise (00:51:36):

And the one caveat, because I’ve been helping out at our, we have a day school for kids on the spectrum, on the autism spectrum, and for some kids on the spectrum, they do not have that capacity. And in that situation, you may just have to teach it as a rule because they just might not understand and say, okay, the rule is in this situation that you cannot hit somebody else. That’s just a rule. But they’re also definitely, because it is a spectrum, I mean, there’s definitely some kids have more of an ability to recognize the impact on others more than others. So you do want to be, ideally, if you can get them to sort of recognize the importance of developing that reflective capacity mentalizing, then great. But if you cannot, then yeah, you can also set it as a rule. And this is where you have to again, know your child and understand what their limitations are. Because if that child who’s maybe on the spectrum just gets bullied and tormented and be told that they’re worthless and all that because they don’t have a reflective capacity of their disorder, then they can too go on to develop a degree of self-hatred. And then you as a parent are frustrated like, why doesn’t the child get it? And okay, but a colorblind person cannot see colors that they cannot see. It doesn’t matter how much you yell at them.

Dr. Sarah (00:53:15):

And even that’s a very well taken point. And even just regardless, kids who aren’t on the spectrum, you got to kind of be tuned into their developmental stage. If a really young kid, this is a very big complex system that you’re going to be slowly building a skill for. And it’s also totally okay to say it’s not okay to hit. But that wouldn’t start with that. I’d start with the, you got pretty upset when that thing, do you understand why they call A, B, C – antecedent, behavior, consequence? I would really focus more on helping them understand the antecedent that led to the behavior. Yes, you can then help them say, Hey, this behavior is not okay because it hurts people. And that you could do the B to C connection too, but start with that. And also the connecting, the doing it in a different setting when you’re walking with the kid, especially boys, but all kids really movement helps with this.

Dr. Blaise (00:54:19):

Absolutely.

Dr. Sarah (00:54:22):

But yeah, I think that’s so helpful. Thank you so much. If people want to get your book, they want to know more about your work, how can we connect them to you?

Dr. Blaise (00:54:32):

Yeah, so I run a program again, mostly for self-destructive kids who are emotionally sensitive with different kinds of conditions where there’s depression personality disorders, and it’s in Boston at McLean Hospital and website is the number three, the word east.org. And we use dialectical behavior therapy to teach these skills because in the same way that a person who doesn’t know how to ride a bicycle or speak a language or play musical instrument doesn’t have the skillset, we assume that people who are struggling are not misbehaving. It’s just that they don’t have the skillset to be able to manage. So we use dialectical behavior therapy skills to teach them emotion regulation skills, distress tolerance skills, mindfulness skills, interpersonal effectiveness skills. And yeah, I think these days in the online shop bookstore would have any of my books. And actually, I was in LA recently and I bumped into some of my books in a bookstore. So you can certainly order them. And I see a lot of them in libraries, and I think that’s a fantastic use of getting these books. They can be shared with many people without having to everybody buy a new one.

Dr. Sarah (00:56:14):

That’s amazing. And for people who don’t know, the program that you run is the gold standard. People come from all over the world to go to your program. Thank you. It’s not just for people who live in Boston.

Dr. Blaise (00:56:29):

No, I know. We’ve had people come from all over the world. Ironically, I wish that there were enough resources around the world providing what we do so that it wouldn’t be so necessary to disrupt people’s lives and families to use my program. But right now, more and more programs are developing the skillset to be able to deliver good DBT, but for now, I think we are doing as well as we can. And the other thing we’re focusing now a lot on is when people have problems that DBT can help for, but then what happens if they also have something like obsessive compulsive disorder or they’ve got an eating disorder, they’ve got a substance use disorder, or they have learning disability. So how do we develop and continue to improve our own skillset with kids who have more than just emotional dysregulation and suicidality?

Dr. Sarah (00:57:41):

That’s great. Yeah. I also think DBT, obviously it’s a really good treatment for this level of issue, but I mean, I ran DBT at this hospital that I worked at for a number of years, and I remember being like, wow, I’m healthier just because I’m running the group. It’s a skill. And in fact, actually that’s what prompted me when I started parenting, when I became a mom and I was learning about different types of parenting philosophies, and I was like, wow, there’s some aspects of parenting that feel like if you’re doing it, the way I was learning about it was like, oh, this is kind of like DBT for babies. This is prophylactic. And I do think if you’re interested in what we’re talking about, you can get a DBT book, like a workbook. You can learn some of these skills not in this acute treatment setting. Absolutely. Just to build emotion regulation skills and interpersonal effectiveness skills and distress tolerance and mindfulness skills. It’s very useful for anyone to practice.

Dr. Blaise (00:58:45):

Two of my books are DBT for Dummies and the DBT Work for Dummies. And ironically, I mean, during the pandemic when DBT for Dummies came out, and my co-author and I appeared on some TV shows, it went to number one on Amazon, which I think spoke to a certain kind of need that people wanted about what to do. So I mean, both the DVT for Dummies and the workbook do actually teach a lot of these skills. And something else that you said just struck me. So I’ve had patients who I’ve known for 19 years, they’re now moms, they’ve got their own kids and all of that. They stay in touch with me even though I did DBT.

(00:59:38):

And when I said, well, wait a second, I just taught you a bunch of skills. Why do you still stay in touch? They all say, you helped me get to where I needed to be. That is the most powerful love that a person can have for somebody else is like you helping me get to where I needed to be. So the methodology, because sometimes people say, oh, it’s just like skills. You learn a manual and then do this skill. But when that’s delivered with caring, because somebody needs a certain kind of help, if a kid wants to learn how to ride a bicycle and you teach ’em how to ride a bicycle, that is much more powerful than understanding all the reasons why they couldn’t ride a bicycle. And it’s like, wow, thank you. You did this thing that I was asking you for. You didn’t necessarily spend, oh, your mom yelled at you when you were a little kid, so you couldn’t ride a bicycle. And not to say that some people don’t want to know those things, but it’s like helping someone get to where they want to do is a gift for them, and it’s the thing that connects us at the end of the day.

Dr. Sarah (01:00:44):

Yeah. Yeah. I mean, it really speaks to how important relationships are, right? Yes. I do recommend everybody go get these books and learn these skills, and we’ll link them in the show notes, but don’t underestimate the power of a relationship in the context of learning these things.

Dr. Blaise (01:01:00):

Exactly. Exactly.

Dr. Sarah (01:01:01):

Thank you so much.

Dr. Blaise (01:01:02):

Thank you.

Dr. Sarah (01:01:09):

Thank you so much for listening. If you or your child is struggling with feelings of self-hatred, anxiety, or other mental health challenges, please know you don’t have to go through this alone. I hope this podcast can be a good first step for helping you feel seen, guided, and held with psychologically and scientifically backed information you can trust. And if you want additional support, I welcome you to reach out to my group practice Upshur Bren Psychology Group. We offer in-person and virtual therapy appointments to families in New York state and coaching services for non-diagnostic support for those nationwide. To learn more about our services, visit our website at upshurbren.com. That’s U-P-S-H-U-R-B-R-E-N.com, or click the link in the episode description to schedule a free 30 minute consultation call where we can offer you recommendations and guidance of supportive resources that best align with your unique needs. I’ll be back Thursday answering another listener question. And until then, don’t be a stranger.