Shift toward insightfulness among mothers of children in a therapeutic preschool: Keeping the inner world of the child in mind

The capacity of parents of young children in therapy to see things from the child’s point of view and empathically understand the motives underlying children’s problematic behavior is considered by many as a crucial step for therapeutic progress (e.g., Fonagy, Steele, Steele, Moran, & Higgit, 1991; Lieberman, 1997; Zeanah & Benoit, 1995). In our research we have referred to this capacity as insightfulness , and using a clinical sample we showed that improving mothers’ insightfulness toward their children’s inner world was associated with a decrease in children’s behavior problems, while lack of change in mothers’ representations of their children were associated with an increase in children’s behavior problems (Oppenheim, Goldsmith, & Koren-Karie, 2004). In addition, we have found in studies of nonclinical samples that insightfulness provides the conditions for sensitive, appropriate and emotionally regulated caregiving and supports the development of secure child– parent attachment (Koren-Karie, Oppenheim, Dolev, Sher, & Etzion-Carasso, 2002; Oppenheim, Koren-Karie, & Sagi, 2001). Lack of insightfulness, on the other hand, is considered as a risk factor that lowers children’s sense of security and self-esteem, as well as their sense of competence and efficacy (Oppenheim & Koren-Karie, 2002). In sum, maternal insightfulness is significant for children’s emotional development in normative circumstances, and its enhancement is an important goal for parent– child treatment (e.g., Fonagy et al., 1995; Silverman & Lieberman, 1999; Slade, 1999). In this chapter we describe how insightfulness or lack thereof is expressed in the ways mothers talk about their children’s thoughts and feelings, and about their relationships with them. We focus on two mothers who participated in the Oppenheim and colleagues (2004) study involving preschoolers in treatment. Both mothers were classified as noninsightful prior to treatment, and we show how changes in their speech about their children demonstrate their movement toward an insightful stance after a period of treatment. In addition, within the context of the noninsightful pretreatment interviews, we point to specific markers and ways of talking about the child that forecasted both mothers’ potential for making positive use of therapy. Identifying such pretreatment markers may help clinicians anticipate the different pathways parents will take during treatment, and may help offer treatment approaches that build on the specific potential for insightfulness of each parent. Enhancing insightfulness in parents is important because of its implications for parenting and for children’s well-being. Insightful parents help their children feel that their inner world is meaningful and that their thoughts and feelings are appreciated, understood, and accepted. Such feelings are at the core of children’s images of their parents as a secure base from which they can explore the physical as well as the emotional world. Parents who interact with their children while taking their children’s point of view into consideration are perceived by their children as a resource to which they can turn when comfort and help are needed. Children with noninsightful parents, on the other hand, may feel that their motives and wishes are not understood and not accepted; therefore they cannot rely on their parents to contain and regulate their negative emotions, leading to feelings of frustration, loneliness, guilt, and shame. Shifts toward insightfulness do not only represent internal changes in the parent; rather, they are also expected to be expressed in the parent’s communication with the child. Therefore, in this chapter we examine parental behavior in the context of dialogues about emotional experiences between the mothers and their children. We ask whether positive changes in the mothers’ representations about their children are also expressed in the way they talk with them. We close with a discussion of the ways in which the insightfulness assessment can help clinicians in their work. We move now to a review of the notion of insightfulness and its assessment, followed by segments from the mothers’ pre and posttreatment insightfulness interviews.