Secure Attachment, Resilience & the Power of Good-Enough Parenting with Dr. Debbie Raphael

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Learn how to better navigate the mental and physical health of your tween teen or young adult through proven expert advice. Here's your host, Lianne Castelino.

Welcome to Where Parents talk. My name is Lianne Castelino. Our guest today is a child and adult psychiatrist.

Dr. Debbie Raphael has been in practice for more than 20 years, specializing in child, adolescent and adult mental health. She is a former child advice columnist and an author. Dr. Raphael is also the mother of two teen boys.

She joins us today from Walnut Creek, California. Thank you so much for being here.

Oh, of course. Thank you so much for having me on.

So what was that like to learn the theory by day while you were tending to the needs of a newborn, probably sleep deprived at night?

Yeah, I'll tell you, I think it was very motivating and it kept me going.

So I actually think for me, I would even use the word protective, like what I was learning on the job and from my supervisors in the didactics as well. It was obviously food for thought and gave me so much information that I then had and was able to go home and think about when I was with my baby.

So it was almost like an intervention type of process that I was just really fortunate to have at the same time as becoming a brand new parent. And I felt like it really was so helpful that I did start to keep a journal to reconcile the learning with the lived experience.

And during the leave, it was challenging to the point that, you know, I felt confusion, like, what am I doing in my new role? Is this even valuable? Because I was someone who was used to being very productive and kind of achievement oriented. Right.

And then all of a sudden I had this baby, but things really slowed down and it's hard to see in the moment if you're making any kind of difference. And it felt really confusing.

And I remember and I put this in my Book that one day I was just walking along the streets of San Francisco where we were living with my baby in the stroller, my newborn in the stroller, just kind of walking in a daze, probably going to a coffee shop or something, and I ran into one of colleagues from my general psychiatry residency, which is the program that precedes child psychiatry. And. And she stopped and said hello and said hi to my baby. But then she said, wow, you know, what you're doing is so important.

And her saying that to me really just sort of seeped into me and. And then stayed with me because it is so hard to see when you have a newborn and you don't get a lot of feedback, you know.

And so time before I started my child psychiatry actual training, because I wasn't back from leave yet, it was hard, you know, to sort of put that together.

So then when I started the training and got this input kind of every day on how important and valuable everything is, that was very, very helpful to me as a new parent.

That's really interesting context because that was at least 18 or 19 years ago now, if we go back to your firstborn. But it stayed with you, clearly. And so at what point then did you think, you know what, I've got my notes.

This is important, I need to put this into a book?

Yes. I'll tell you. As I was keeping the journal, I realized kind of how valuable all of it was to me, and therefore how valuable it could be to others.

And so as I was keeping the journal, I had that thought and intention. And so I did keep adding to it over time and over the years, I went back to it and added in some things along the way.

But then, really, in these last few years, as that same older son was preparing to then leave the nest and looking into colleges and talking about launching, then I really went back to it and started writing it all in the format of a book, and then combined it with recent research, which was very relevant as well, like research on relational health, which we could go into, and particularly research on the impact of positive childhood experiences and kind of what those are and how much protection they can give if they're able to be kind of achieved in these years.

We know a lot about adverse childhood experiences, or ACEs, and the potential impact on health outcomes in terms of risk, of negative health outcomes associated with that. We've known about that for a couple decades now, but.

So it was nice to go back to what I'd written, the stories that I'd written, the kind of pearls of wisdom and Pillars that I'd come up with and then put that together with the research that's all also more recent and also kind of more strength based, which is really nice. So that was kind of the process.

It must have been such an interesting undertaking for you because we are talking about almost two decades. So much has changed. There's so much of science around. So much of what you're talking about in this book, take us through.

First of all, why did you call it Carry My Strength? Like what? Whose strength is being carried?

Yeah, that's a really good question. Carry my strength is actually a phrase that my mom used to say.

Just on a personal level that my mom used to say to my sister and me when we were getting ready to do something challenging on a given day, she would say carry my strength so that we would know that she was with us even if she wasn't physically with us and giving us her love and unconditional positive regard and support and strength. And so then we would like carry that with us.

And then I came to learn in my training, like the actual meaning of that, which is so similar in terms of what parents do for their children, particularly in those early years. At least they establish it ideally in those early years, which is, you know, when the babies are really young, we.

We kind of respond to their cues, which is necessary for survival, right? For responding if they're hungry, if they need to be kept clean, whatever they need.

Turns out relational health, which is that very exchange and responding to them with our expression or to their sounds is very important and required for survival as well, and is actually considered a new vital sign, which is very interesting, like really, really necessary. But in that process, we're reinforcing what they're commun. And so we're reinforcing and helping them establish their sense of self and who they are.

Right? And their sense of trust that they know that they can count on someone to meet their needs during a stage when they can't do that for themselves.

Right. And so, and so they come to internalize that.

And then the idea is they can carry essentially that strength of their parents with them as they move forward and as they develop their own independ, they now can do that for themselves, but they have the strength of their care provider from those early years. So it turns out my mom knew what she was talking about when she said that to us, so that was really interesting. But that's where that comes from.

But we also have to know that as time goes on and as babies get older, the need for that support and strength, although we're independent and can do basic things for ourselves, that need for connection always does remain. You know, people need support from others, from a community. They need to feel connected.

And so part of the meaning of the title also is as parents are embarking on this journey of parenthood where really everything changes and there are so many transitions, the need for connection and support is greater than ever before, you know, when you're making a big transition like that.

And so I'm applying that also to new parents so that they can feel like they're almost literally carrying my strength, having been through the journey personally and then also having accumulated this knowledge and experience professionally and working with so many families as well, so that they can kind of carry that strength of these stories and kind of this collective wisdom from all these researchers in the field and again, personal stories that are in the book as well. So it's almost like a security object, like a transitional object that a child might have, like a security blanket or something.

Parents really do need a sense of connection and security as well, especially as they go through all the transitions that are part of parenthood and the whole journey.

We can go into it more, but there's something that Dr. Maria Muzik, who's a wonderful psychiatrist and OBGYN provider in Michigan medicine, that she calls the circle of holding for parents.

This is the idea of a village or a community or a support system for a parent and how critical that really can be for parents well being during these years. So I'd like this book to kind of represent this circle of holding as well in the parents journey.

It's such an interesting point because certainly that circle of support is fractured for many people, certainly as a result of the pandemic even before that. But the pandemic I think really put that under a different kind of microscope where not everybody had access to that village that you refer to.

So let's talk about secure attachment. What does that look like day to day?

Yeah, secure attachment day to day. It's. So I really think about two things and I.

And I think about these also just like as goals on the parent journey, what we'd like to see for ourselves and for our child.

And those two things are for a child to come to again, be able to feel a pretty strong sense of self and be able to trust themselves because that really does come from that early attachment. And so then when we see a toddler able to walk and able to kind of wander off like at the park sometimes, so say you're at the park with a toddler.

Sometimes we'll see them walk off because they're so interested and curious about what's around them. But then they'll turn back and, and they'll look at their caregiver. Maybe they'll come check in and come in for a hug and then go off again.

And what they're doing when we sort of see that happening is they're checking in with what we call like their secure base. They know that we're kind of the safe place in this big new surrounding that's really interesting, but also new.

And so they check in with us and then they get to go off again. So they can feel that sense of security even though they're developing their independence.

So that's kind of a sign of a secure attachment, you know, that they can do that. And so that's one thing is this kind of growing sense of self that they can then have.

And then another is the ability to connect and kind of move forward with reciprocal, healthy relationships.

So when we're developing this again, relational health, which is like this, learning how to do this back and forth exchange with our baby when they're little, it's really kind of making or forming a blueprint for them for their future relationships, particularly intimate ones. But, but just in general how they relate to others. It's. It's really showing them how and giving them that experience.

And so, and so that's kind of the second part of attachment is really forming that kind of blueprint for future relationships so they can benefit from the needed ongoing connection. And then others, you know, they can engage others where it's going to be like a positive relationship for both of them and so on.

So those are kind of the two pieces of secure attachment as I, as I describe them.

So on that note, we've talked about toddlers, but what are, if any, correlations or similar alignment between what's going on with secure attachment when you've got a toddler versus a and that whole period of emerging independence?

Yeah, it's interesting because it's really pretty similar. There are some similarities between toddlerhood and then burgeoning adolescence. Right.

Because at each of those stages, the child is developing kind of a new level of independence and kind of separating from their caregiver. You know, in toddlerhood, that's a big deal because they're mobile and they can do it.

But in adolescence, it's a really big deal because they're starting to form more peer relationships outside of the home and kind of coming sometimes to prioritize those above spending time with their caregivers. And so that attachment is and becomes continually very important because they still need the parents.

It's such a transition to, to go off with this new independence with the peers.

And so that link to the caregivers is kind of more important than ever before because again, they know that hopefully that's a safe place for them because things can happen out there with the peers and in the world, just like in toddlerhood. And so that attachment is really important.

And so in adolescence and sometimes it's less clear to the parents in terms of the importance of like being there, being available, you know, for the kids, but that it really is just as. If not sometimes even more important because it's not as obvious yet. It is still so important. And again, that second piece about.

So that's the attachment and that link and going off and coming back and knowing that the secure base is there, but then also that second piece of the connection and the ability to have like, healthy relationships with others and things, that's the second piece which also is important in adolescence.

So curious as to what that looked like in your household, understanding all of the knowledge and expertise you have in your professional life. You also have teen boys 19 and 14. You know, what, what did the. How did that manifest in the Raphael household?

Yeah, that's a good question. Yeah, it's interesting seeing my 14 year old because it's just happening before my eyes, you know, right now.

You know, all children have different temperaments, right? And this is of course in my book as well. So they just have different personalities, different temperaments, and that's what they bring.

And then we contribute the environment and the relational piece. And so with my Younger1, who's 14, he's always been kind of more sort of cuddly and you know, that, that type of kid and.

And I'm definitely seeing that burgeoning independence starting to play out in these early teen years. And so I think just my sort of knowledge of development and knowing that this is really what is supposed to happen, just like they're supp.

Learn how to walk and go away from us, you know, when they're toddlers, physically. I do know that this is a natural thing that happens during these years. And so I know not to take it personally, even though it's really a change.

Like sometimes he just like doesn't even really want to talk to me, you know, and.

And that's fine because he knows that I'm here, you know, if he needs or wants to talk And I remind him, even if he gets annoyed by my reminding him, and that happens, that's fine. I don't care if he gets annoyed. But I kind of know not to take it personally.

And with some of the things that he says, like, I could imagine taking it personally if I didn't really know that, you know, and so. So I do see that playing out. Like, he'll even, you know, kids say rude things. Right. And. But that's part of the natural separation and development.

Like. Like I can be authentic and say, I really don't appreciate. You know, you're saying that to me. Like, that's my. That's my personal experience of it.

But I do understand. So it's not like I, you know, would give necessarily, like, a consequence for that or. Or a big reaction.

So I think perspective on what's happening developmentally is really important. And. And it's. I guess it's lucky for me that I'm able to know that, you know. Yeah, yeah.

Take us through, if you could, in terms of.

When you're talking about distress tolerance, which is something that you talk about in your book, it's usually framed as something kids need to learn. Why does it start with the parent, in your view?

Yeah, well, we are, as the parents and caregivers, the model for everything, and that includes emotional life. And that does start from the beginning. You know, there's. I think there's a scene in my book that I talk about where my older son is a baby.

I don't know exactly what age of babyhood, but we're out, I think, with my sister's family, and he's, like, gonna miss his usual nap time. You know, this is a common scenario. And.

And I worry that, you know, maybe that that won't be good because then he's going to be super tired and upset. And.

And then my sister said something like, because she had a baby two years before I did, so she was a little more experienced, you know, and she said, well, no, that's okay. That's. That's good for them.

They need to be able to tolerate different kinds of situations at different times as long as their general needs are met, you know, relatively, relatively consistently. It's okay, you know, to. To have changes and have them feel not so good every once in a while, because that's like life, you know, and.

And even from that, you know, very early stage, like, she. She was right. So to be able to tolerate distress will contribute to what we call resilience, you know, later on.

And I know that's kind of a, a buzzword sometimes nowadays, but, but it is so true. And when we talk about tolerating distress, we're talking about like tolerable levels of stress, right?

So you know, there are exceptions to everything where there's like a toxic kind of stress as opposed to like what we call a tolerable level of stress.

But day to day distress really does put kids of any age in the position where they can use and call upon and develop coping skills and strategies and tools to tolerate it in the moment.

And sometimes think about, you know, seeking out support, which is a healthy and important thing to practice as well, because through life again, connection is really important and that's, that's a very positive thing to practice.

And then also of course, problem solving skills when there's something more cognitive that can be done as well or to figure out how to handle a situation. So as parents it is really important and it's hard because sometimes it goes against our inclination.

But it's important not to try to fix everything for our kids, to try to make it just right all the time.

And if we know that that's not even in our kids interest to do that, it's really not, then it makes our lives easier too and we, it can bring our tasks down a notch, right. And what's on us. And then it can actually ultimately just be better for everybody because we can only do so much. So it all kind of goes in a loop.

But it's important, important to know that tolerating distress is really important for kids to be able to develop for themselves so that when they go off in the world or even before then, you know, they're able to do that as things come up. And so it does start with us. And you're right, that means we have to try to do it ourselves, right? To tolerate distress for ourselves.

And I will say, and this, this is kind of through my book as well, that as we're remembering these things for our kids and how important these things are for them, it reminds us how important it is for ourselves as well and that that is good for us. You know, like, like in my book I talk about some times where I'm like soothing my baby because our first one was very colicky.

And so it was a big challenge, you know, triggering for people, you know, sometimes.

And so I would be soothing him in whatever way I could and then sometimes just saying the soothing words or singing him a song like it was soothing to me too, you know.

And so to remember the value of some of These, of some of these tools, whether it's deep breathing or, or just taking a moment, you know, it, it reminds us how important this is. And that's, that's for them and for us. So we're, we're modeling for them in our interactions with them.

But, but I will say, I just want to say one more thing about that, that it's also so important to remember through all of this that the concept of the good enough parent, like, runs throughout, through, through everything in that, yeah, we know some of these things and it does not have to and shouldn't be perfect, you know, and, and that, that goes along with distress tolerance, right? Like, yeah, things are not going to be perfect. They're not going to be just right. That's, that's not what we, what we deal with day to day.

And that really is okay.

And it can again, be kind of a relief for the parent to know that and to know that not only is that okay in terms of like, doing good enough parenting, but that's, that's the goal. Good enough parenting is the goal. And that's so different from like a lot of our work jobs where we, you know, want to do it just right.

And that is the goal, right? And not to make any mistakes and to do everything just exactly the way that we should in other kinds of jobs.

But in the parent job, which is a job, you know, and actually can really be helpful to view it that way because it separates it a little bit from our own personhood. But, but yeah, it's, it's a different thing because for the parent job, our goal is to be good enough.

And so we do need to keep just reminding ourselves of that and not perfection. It's just being there is the most important thing, not perfection by any means.

So building on that point in terms of the parent and their role, you do spend time in your book talking about a parent's own childhood and their lived experience as children. Why is that important to consider when people, when a parent is raising their own child.

Yeah, thank you for asking that. It is so important. So parents are people, right?

And so we have our own childhoods and everything that we bring and that has contributed to who we are, to our sense of self, to our ability to connect to our stress response. Right.

And so if we have a history of some early adversity, which can happen to different degrees in childhood adversity and trauma, and what we call ACEs, Adverse Childhood Experiences, they can contribute and contribute to and trigger an elevated stress response. Right? Because when we get scared in childhood or something really jarring happens, then we could go into fight or flight mode.

And sometimes if we get kind of wired that way as a kid because of unpredictability or things like that, then we. We just come to have an elevated stress response. And that means we can be. We can come to be a little bit more reactive. Right?

Especially when there's stress. And the thing is, parenthood we know is very, very stressful, and we know this.

But so given the stresses inherent to the parent role and the parent job, when we have an elevated stress response from our childhood, then we could become more reactive.

And when we're more reactive, we might do things or say things or be in situations that we wish we weren't, you know, with our kid, if we were able to take a step back and respond, you know, maybe the way we like, if we could think about it for a moment. But with the elevated stress response, sometimes it can be difficult to regulate our emotions.

And then some of the things from our childhood could get repeated, you know, and so then that's the sort of cycle that we talk about. But there is so much room for that to change and to stop, so much room for that. And so that's a very positive thing to know.

And the key, the very, very first step, is awareness, because some of these things are just in our nervous systems, and sometimes we. We don't even realize it.

And so if we're able to kind of construct a narrative and think about some of the things that might have happened that were really hard in our childhood, if we can construct a narrative and even come, even try to remember the way that we felt when it was happening, as hard as that can be, and you can seek support, you know, to do that if needed, but that can provide a lot of protection. If you're able to remember the way that you felt, bring it into your awareness, not just the unconscious, but into your awareness.

Because then if we're able to remember that and Think about what that felt like, then we really probably would not want that for our kid. And so that is known to be very helpful.

And there's different kinds of therapies people can engage in to help with that, which is very nice that those are out there, but it's just good to know that that awareness, you know, is. Is so important.

And really the first step, something that I talk about in my book that's a little bit different is this concept of viewing parenting as a job. Because I think, especially based on my experience of doing something like this as my job, right. As a.

As a psychiatrist and child psychiatrist, I understand that the concept of. Of a boundary can be very helpful in helping us take a step back and reflect on what the other person might be experiencing before we respond.

And so that very step back to try to organize and interpret what they're communicating, even if it's really wild and dysregulated, to be able to reflect it back in an organized way can be so helpful.

And so if we have a history of early adversity and developing that increased stress response, where we tend to be pretty reactive, if we can view parenting as a job, then it helps with that blurring between the personal and the, you know, and the role. And it. And then it.

It creates an additional boundary that helps us to respond more the way that we would like, the way we know would be best and most effective for our kid and ultimately for us, because if we're able to validate their experience and then they feel understood, then everything's easier for them. It's in the service of mental health, you know, for them. And then if things are easier for them, then everything gets easier for us.

So there is definitely a way to break these cycles.

And again, developing that security, that feeling of safety and security in the home, that's known to be a positive childhood experience, which is protective for health later on. And it fosters connection and a feeling of belonging for the kid later on.

If they can feel connected in, like, their teen years to peers and have that feeling of belonging, that's another positive childhood experience. So we can break these cycles with. With connection and reflection. I would say those are two, like, huge pieces in breaking the cycle.

We only have a couple of minutes left, but I did want to ask you, you wrote Carry My Strength for pediatricians, therapists, doulas, etc. For parents who choose to read your book, what do you hope that they leave with?

That's a great question, I would say, especially because we haven't touched on it yet, but it's so important and it gets neglected too often is, is to remember joy, to try to get joy when you interact with your child because it's so good for the connection and it's so good for the mental health of both parent and child. So to keep coming back to joy and remembering to incorporate that and actually that that's very valuable and useful and it's not just an extra.

You know that shared joy is, is a recommended thing. Right. It's a protective thing for connection. So I would say to remember the joy as well. Yeah, that's what I'd like parents to remember.

That is a wonderfully hopeful and optimistic note to end on. Dr. Debbie Raphael, psychiatrist, author of Carry My Strength thank you so much for sharing your time and your perspective with us today.

Oh, you're welcome. And you can pre order my book if you'd like, wherever it's sold. Carry My Strength. Thank you so much for having me on. This was a great conversation.

Thank you.

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