Embrace the Messiness! An Interview with Pediatrician Claudia Gold

This episode of the “Mad in the Family” podcast discusses the role of human interaction in child development. Specifically, how conflict and miscommunication between parent and child is not only O.K., but crucial to a young person’s social and emotional development. According to our guest, Dr. Claudia Gold, the “messiness” of our relationships is exactly what helps us build trust, resilience, and a solid sense of self in the world. That is the subject of her latest book, which she discusses with us.

Claudia Gold, M.D., is a pediatrician, infant-parent mental health specialist, author, teacher, and speaker based in western Massachusetts.

Dr. Gold practiced general and behavioral pediatrics for more than 25 years, focusing on a preventative model, and now specializes in early childhood mental health. She’s also the director of The Hello It’s Me Project, a rural community-based program designed to promote healthy relationships between infants and their caregivers.

In addition, she works as a clinician with FIRST Steps Together, a federally funded program for pregnant and parenting women with opioid-use disorders, and as an infant-parent mental health consultant at Volunteers in Medicine, Berkshires.

Dr. Gold serves on the faculty of the Infant-Parent Mental Health Fellowship Program at the University of Massachusetts—Boston, the Brazelton Institute at Boston Children’s Hospital, and the Berkshire Psychoanalytic Institute.

She is the author of four books on child psychology and development: Keeping Your Child in Mind, The Silenced Child, The Developmental Science of Early Childhood, and most recently, The Power of Discord, written with Dr. Ed Tronick and published in June 2020.

Dr. Gold is the author of numerous articles, including Mad in America blogs, and presents regularly for audiences of both parents and professionals around the world.

We discuss:

• Her training in the sub-specialty of developmental and behavioral pediatrics, which provides a standard “toolbox” for physicians to diagnose, manage, and treat children’s behavior problems but which she has often found ineffective in practice.
• How this led her to study with D.W. Winnicott, the “British Dr. Spock,” at the Berkshire Psychoanalytic Institute, where she trained in infant mental health. After integrating psychoanalytic principles, genetics, developmental science, and neuroscience into her practice, she quickly began to see “massive, dramatic shifts and meaningful changes” in the families she treated.
• Her individual and personalized approach to helping struggling kids, which focuses less on stopping a troublesome behavior and more on listening to what that child’s behavior is communicating.
• The basics of this approach, which asks, “How is this child stressed in some way?” and digs into the many “layers” of the child’s and family’s “story” to make sense of what is bothering them. This allows the pediatrician to develop a multi-pronged plan for what the entire family can do to change the situation.
• The importance of Dr. Ed Tronick’s groundbreaking child-development research, known as the Still-Face Experiment. Here, researchers observed what happens when a mother deliberately stopped interacting with her infant and presents a blank facial expression instead. Contrary to the belief that babies were passive recipients of their parents’ behavior, the study showed that infants have “a huge repertoire of communication skills,” using their body language to attempt to re-engage their parent’s attention and set the relationship back on course.
• How this discovery led to the ideas embodied in the Still Face Paradigm, the observation that rather than being smooth and perfectly in synch, typical healthy relationships are a “very messy” process of “mismatch” and “repair.” A child’s repeated experiences of their parent’s temporary absence and their own ability to regain connection through behavior builds their sense of confidence and security.
• Her new book with Dr. Tronick, The Power of Discord, which uses the Still Face Paradigm as a jumping-off point to talk about “mismatch” and “repair” as a process for building not only a healthy parent-child relationship but also strengthening one’s sense of self and relationships throughout the life course.
• The concept of the Good Enough Mother. This doesn’t mean it’s OK to make mistakes, but that you have to make them, so parents should “embrace the messiness” of negotiating tantrums and tussles. As she says, “You need to have the mismatch in order to have the pleasure of reconnecting.”
• How intense and chronic mismatch—“with the parent always saying no and kid always resisting” —is a sign that repair isn’t taking place. Why conventional interventions to eliminate problematic behaviors, such as behavior management and psychiatric drugs, lead to those problems popping up in other ways until they are identified and addressed.
• The parent as “neuroarchitect.” How a caregiver literally builds their child’s brain connections through negative and positive interactions with that child as their relationship grows.
• How, in situations where mismatches aren’t repaired or there is too much of a lag between mismatch and repair, it is often a sign that the parent’s issues haven’t been addressed. Commonly they may be overwhelmed and need support and self-care, or face something more serious such as substance misuse.
• That since the brain and its connections change throughout one’s life, there is always a chance to repair problems developed in childhood over time. Dr. Gold explains how “the Still Face Paradigm shows us that if we want to change, [we still can]…The way we are created is through hundreds of thousands of different interactions,” so we need thousands of new and better interactions with partners, friends, colleagues, and others to repair it.
• Why she believes the medical model of mental health is problematic: “The whole premise that you say that [a disorder] exists within a person doesn’t really make sense, because our whole emotional well-being and sense of ourselves is a developmental process over time with other people.” All behavior must be seen in context, and single, one-size-fits-all labels and solutions don’t address the unique family situation in which each child exists.
• How mental health professionals and therapists can better deal with troubled children by taking the time to uncover the story and meaning behind children’s behavior rather than rushing to diagnose and treat them. She believes this approach can be applied at a wider level to help us wrestle with and mend the social injustices we are confronting today.

Relevant Links

Claudia Gold’s website