Sam and Jessica

Being human means communicating with others via touch, eye contact, tone of voice, and words. Through our interactions, we have the power to impact one another at every level. One of my most powerful experiences of the truth of this fact did not take place in a seminar or consulting room, but rather at the home of a friend. I had volunteered to watch his two young children for a few hours while he ran some errands. I had known Jessica, four, and Sam, six, all of their lives. I was someone on an outer ring of their universe, an attractive combination of familiar and new and I was completely unprepared for what was about to happen. The minute their father left, they shifted from low to medium to high gear, and I found myself in the midst of a frenzy of excitement.

Toys began flying out of closets and storage containers; games were begun and tossed aside; videos were started, stopped, and replaced—a succession of Indian princes, mermaids, lion kings, ladies, and tramps. After what felt like hours, I glanced at my watch to find only 15 minutes had passed! Four more hours at this pace? I wasn’t sure that I could survive. I kept trying to refocus Sam and Jessica’s activity but to no avail. At one point, as we dashed from the bedroom to den to the living room, I sank to the floor in the hall and propped myself up against the wall. When they realized that I wasn’t right behind them, they ran back to find me.

They stood panting, one on either side of me, wondering what new game I had concocted. My suggestion that we sit and talk for awhile passed unnoticed. After a few seconds, Sam looked at his sister and yelled, “Show Lou how you burp your dolly!” Both of them let out a scream and Jessica soon returned with an adorable squishy doll. As I reached for the doll to hold and admire it, Jessica threw the doll on the floor face first and drove her fists into its back. As Jessica and Sam took turns crushing the doll into the carpet, I watched in horror, completely identifying with the doll. I had to hold back my urge to save the poor thing from its vicious attackers.

I quickly reminded myself that I was feeling sorry for a ball of cotton and that I should turn my attention back to the children. I also realized that rescuing the doll would be scolding Sam and Jessica for their behavior, which I did not want to do. I struggled to make sense of what was happening and asked myself if there might be some symbolic message in the way they were treating this doll. Jessica and Sam had experienced a great deal of stress in their brief lives in the forms of severe physical illness, surgery, drug addiction in the family, and an understandably overwhelmed support system. The frantic activity I was witnessing may have reflected the accumulated anxiety from all they had gone through, mixed with normal childhood exuberance. But how might knowing this be helpful to these two beautiful children?

As I reflected on these things, I was hit by the notion that perhaps the doll represented both Sam and Jessica. This doll needed to be burped. It needed the help of an adult to alleviate its discomfort and regain a sense of comfort and equilibrium. Perhaps Sam and Jessica were showing me that when they needed to be comforted, they were met with more pain, or, at the very least, insufficient understanding and warmth. Might their behavior be a message? “Please, we need nurturance and healing!” Their world seemed chaotic and unsafe, a whirlwind; these were the same feelings that they had created within me during the last half hour. Was their behavior a form of communication?

They had each taken a number of turns “burping” the doll, and I suspected that their attention would soon turn to me. What to do or say? I didn’t want to burp the baby their way, and my thoughts about what was happening would be meaningless. I could feel my anxiety growing when finally, they both turned to me and cried in unison: “Your turn!” I hesitated. The chant of “Burp the baby, burp the baby” began to rise. I looked at both of them and said, “I know another way to burp a baby. Here’s how my mom burped me.” A cheer went up, and I suspect that they assumed that I was going to set the doll on fire or put it in the microwave.

I gently picked up the doll and brought it to my left shoulder. Rubbing its back in a circular motion using my right hand, looking down at it with tenderness, I quietly said, “This will make you feel better, little one.” A silence fell over the hallway. I looked up to find Jessica and Sam transfixed as if hypnotized. Their eyes followed the slow circles of my hand, heads tilted like puppies. Their bodies relaxed, their hands limp at their sides, calm for the first time.

After following the movement of my hand for about 30 seconds, Jessica looked up at me and softly asked, “Can I have a turn?” “Of course you can,” I told her. At first I thought she meant that she wanted a turn burping the baby. But then carefully, almost respectfully, she took the doll from me and placed it on the floor with its back against the wall. She stepped over to me, climbed over my crossed legs and put her head on my shoulder where the doll’s head had been. She turned to me and almost inaudibly said, “I’m ready now.” As I rubbed Jessica’s back, I felt her growing more and more limp as she melted into my shoulder and chest. I half expected Sam to tear her off, climb on himself, and turn it into a wrestling match. When I looked over to him, I could see that he was in the same posture and state of mind that he had been in watching me burp the doll. He eventually looked up at me and asked, “Can I have a turn?” Before I could answer, Jessica lifted her head slightly and told him, “In a minute.”

After a while, she gave up her spot on my shoulder, and Sam had his turn being “burped.” It felt wonderful to hold them in this way and to give them something they seemed to need so badly. After a few turns for each of them, we went into the den, curled up on the sofa, one of them under each of my arms, and watched a movie. Actually, I watched the movie— they dozed off after only a few minutes. While my eyes followed the frenetic animation on the screen, my breathing paced theirs, and I shared the peace they seemed to be feeling.

I marveled at how they managed to communicate their pain and confusion by creating these same feelings in me. Emotion is truly contagious and a powerful source of human connection. By having them set the initial pace of our play, I told them that I respected their way of coping. Through the use of the doll, they communicated that when they needed soothing, their anxiety was often met with more of the same. When I burped their doll in a caring and loving way, I showed them that I was capable of soothing them if they were feeling bad. By asking me to burp them, they told me I was trusted. In falling asleep, they said, “We feel safe, and we know you will watch over us while we rest.” While none of this was spoken, the communication was clear.

Our interactions with the doll changed Sam and Jessica’s state of mind and body as well as my own. I believe that it not only impacted their attitudes and behaviors that afternoon, but it may have also changed their brains in some small but perhaps permanent way. I could see this reflected in their faces and hear it in the tone of their voices; something fundamental had changed that affected their entire beings. I provided them with a metaphor through which they could reorganize their experience, have their needs met, and regulate their emotions. Together, the three of us co-constructed a new narrative for them to use as a way of soothing themselves and each other.

Were this process to be repeated enough times, their brains could reorganize around this metaphor of nurturance and holding and enhance communication between networks of cognitive and emotional processing. Perhaps Sam and Jessica could internalize a model of self-holding and nurturance that would help them navigate future challenges. This kind of interaction is at the heart of all forms of psychotherapy, regardless of philosophy or technique. All forms of therapy have their own versions of integrative metaphors, serving to reorganize neural networks and alter human experience, hopefully, for the better.

This is an excerpt from Dr. Cozolino’s book The Making of a Therapist.