Teaching Empathy

I was flying last week. The rows are close together, but the flight was just an hour. There wasn't any room for my legs, however, because of a large suitcase jammed under the seat in front of mine. Very politely, I asked the person sitting in that seat to take the bag and put it under the seat in front of her seat. “I can't do that, she explained helpfully. Then there would be no room for my feet.”

Empathy is the currency of human relationships. Being able to walk in another person's shoes gives us the ability to understand where they're coming from and what they might be feeling. When you think about it, this is the skill behind all kinds of human interactions, including everyday courtesy, safe driving, and successful romantic relationships.

How do we learn this? Are we born with it?

Just like most other behavior, our parents model it for us. But my work with kids who have really difficult behaviors makes me suspect that there's more to it than that. How come some kids are so sensitive to the needs of others, while a sibling not so much—even though they grew up with the same parents? I believe there's a component of brain chemistry involved also.

But whatever the kids are born with, can we make a difference? As it turns out, we can. There are many different aspects to good parenting, but this just hasn't made it into parenting books. As regular readers, and my patients know, I think it's essential.

In one study, children were given a task to do with their mom and a friend. The interaction was observed at 3 and 4 years old. The scientists scored the interaction for conflict vs. cooperation. They found that the most influential factor was the actual words the mother used when talking to the child. Mothers who explained to their 3-year-olds how others might be feeling had, on average, more cooperative 4-year-olds a year later. This is supported by research in which mothers were observed with their children, and what they said was recorded. Children whose mothers often reminded them about what others might be feeling didn't remember the words but did remember the concepts. They showed more understanding of what others were feeling. Maybe these research results aren't surprising. I am impressed, however, by how much these young children can absorb from the little things said my their mothers. Lots of other studies support these findings.

Let's take a step back. Children can, in fact, learn how to appreciate the feelings of others, and this skill could improve their social understanding and relationships. They seem to gain this understanding by listening to the remarks and explanations of their parents. In my mind, this brings up some interesting questions. I didn't find any research on this, but I wonder if they also pick up the negative things we say. That SUV cutting us off on the freeway might deserve an out-loud expression of our analysis of the driver's motives and intelligence, but if our kid is in the back seat, even at a very young age, won't they remember that, too? What about the opinions we voice about our bosses or ex-spouses (or current spouses)? The research is so strong about positive influences that I suspect we may inadvertently provide some examples of insensitivity as well.

If there is a sunny side of the street that we're all supposed to walk on, I haven't found it. Parenting isn't just about only sharing your positive experiences with your children, and hiding the negative ones. How will they learn how to handle interactions that don't go as well as you hope? So a perceptive parent, an empathic parent, will find and use the teachable moments of everyday life, even with the youngest children.

When you see a child crying in the park, ask your child why. If they don't know, help them make up a reasonable explanation. This is an exercise in imaginative story-telling that can be as long or as short as your child likes. But it exercises their empathy muscles, both in trying to imagine why that child is crying, and by the fact that you are interested in why and are interested in why your child thinks the child is crying. As with any behavior, if your children think it's important to you, it will be important to them. It almost doesn't matter what, exactly, your child's scenario is. Maybe the kid fell down. Maybe they had to wait their turn on the slide. Or maybe they couldn't have the pink cookie shaped like a strawberry that probably tasted really really good that their mommy didn't buy for them when they were shopping in the supermarket to buy macaroni and cheese and milk and then get home right away because daddy would be home soon.

Parents translate the world for their children. When we talk to them about the feelings and motivations that make others act as they do, we equip them to manage successfully their lives with others.

Talk to Me

The Allens came to my office looking for a different approach. Alice, their first baby, had been born 6 months earlier, and, they admitted, things weren't going well. They had a hard time articulating the problem, however. Somehow, they just weren't enjoying the experience of parenthood. Why weren't having a good time with their baby the way other people usually do? Was there something wrong with the baby? Was there something wrong with them?

They liked their last pediatrician. When they brought up their vague reservations, she tried to be reassuring, but it just didn't take. The doctor visits were generally brief, and this hazy discomfort was never really focused on.

Baby Allen was a sweet girl with big eyes who smiled at me during her exam. She was growing and developing normally, and had never been sick. She was making some sounds in the stroller, but the parents didn't respond.

“Ack?” she asked when I picked her up. Professional that I am, I knew the answer.

“Ack,” I said.

“Ack,” she repeated, continuing the conversation.

“Ack,” I said, since I wanted to continue too. She paused for a moment.

“Ack?” she asked again, obviously giving further consideration to her earlier question.

“Ack,” I responded, with a big smile. She gave me a big smile in return, which turned into a laugh. The conversation continued for at least 4 or 5 minutes.

Her parents watched the exchange in amazement. It was clearly, obviously, a conversation. She changed her tone of voice as if to convey meaning, so sometimes the same limited sound was a question and sometimes a statement or a surprise. “Haven't you guys ever done that?” I asked them. They said they didn't know she could do that. “How much do you talk to her?” They looked at each other quizzically. I saw where this was going.

What I was doing, fundamentally, was letting the baby steer the conversation. More importantly, it was listening to the baby and allowing her to be in charge. I think of this as an empathic approach, which is applicable to children of all ages. Listen to your children, take wht they say seriously, and, whenever you can, let them lead you.

It turns out that talking to your baby is incredibly important. Though research has barely started on the real impact of these kind of interactions, babies consistently surprise us with the things they can do.

So it didn't surprise me when I read a study, just published, about the conversations of 5-month-olds. They videotaped 37 babies interacting with adults the babies didn't know. The scientists watched what happened to the vocalizations of the babies when the adult made a blank face. Sure enough, the babies stopped their sounds when they got the blank face but continued when they got smiles. Think about this. By the time babies are 5-months old, they have learned how to control at least this aspect of the behavior of their caregivers. From this experiment (and others) we know that babies actively learn what to do by experimenting on us. And what you might not expect is that when these scientists followed up with the babies they studied, they found that the strength of their skills at 5 months predicted their language skills at 13 months. I wonder if there are babies born with great language skills, or if the constant practice of having a caregiver talk to them and with them gives them extra practice and maybe even stimulates the language center of their brains and helps it develop.

Would it help to have a translator for a baby's grunts or cries? This will be the topic of an upcoming post.

I sent this family home with an exercise prescription. I told them not to miss an opportunity to talk to their baby, even read to the baby. It was OK if they read her the newspaper or a magazine.

There was a secret agenda. Empathy, the ability to understand what another person is feeling, is absolutely crucial to successful relationships with others. That includes conversations with babies and complex social skills. The baby will benefit from more interactions with her parents. She will learn to listen and respond, maybe how to initiate and manage a social interaction. She will learn that her parents are interested in what she has to say. But I believed the parents will get a lot out of it too. They'll experience the great things their baby can do and the many ways she will reach out to them.

Epilogue--The prescription really worked! A few weeks later they reported that things have never been better with the baby and between themselves. They each try to outdo the other in how long and complex they can make their infant conversations. They told me that the baby has never laughed so much. Them, too.

The photograph above is from my collection and is by Lewis Carroll.