Interview with Sue Gerhardt

I’m talking to Sue Gerhardt, psychotherapist and author of Why Love Matters. Sue, the title of your book focuses on why love matters. What is it that you mean by love, and what is the impact of that on the baby’s developing brain? I think attachment research has given us a whole new kind of sense of what love really is. It’s a much more practical, more operational kind of idea of how love works in practise. So I think love is– most people think of love as a kind of nice feeling, a nice warm feeling towards somebody. But attachment research has broken this down into– it’s more active. It’s actually about how you support another person.

So it’s about how you– it starts with really noticing what they’re feeling, and picking up on their body language and their non-verbal kind of signals, and then using that information, responding to it, and providing what’s needed.

Which can vary from the practical things of changing a nappy and something to eat to more nuanced or sensitive kind of support for feelings. So in babyhood, this is particularly crucial. This emotional responsiveness is particularly crucial, because babies can’t manage their own emotions, and really, a parent, or an adult, has to do it for them. So parents are, in a way, they’re a bit like an emotion coach. They pick up on what states of arousal the baby’s in, whether it’s high or low, and they kind of help to keep it on an even keel. They regulate the baby in various ways, but also I think there’s a concept– another concept in attachment thinking which is ‘scaffolding’.

And so, as well as managing the baby’s ups and downs, the parental role is also about scaffolding, which is supporting the baby, or toddler, or child, even, while they’re learning a new skill, and sort of being there behind them to catch them if they fall while they build up their skills, and that’s also really important. One of the benefits of this kind of very sensitive interaction is it’s a kind of mutual to-and-fro. And those interactions actually do help build up the brain structure. I mean, this is how we work. OK, so can you tell us a little bit about what the impact of that interaction is in terms of the physiology of the baby’s brain?

I think one of the main ways in which a baby responds to the parent is biochemically. The interaction releases or triggers off various biochemicals. So for example, warm, affectionate parenting helps to release a hormone called oxytocin, which makes the baby feel relaxed, and confident, and trusting.

And actually there are a whole range of these biochemicals that get triggered by particular kinds of experience, and they have quite a knock on effect on the development of the structure of the brain further on, down the line. A lot of the biochemicals that are specifically in the brain, which are called neurotransmitters, which are things like dopamine, serotonin.

They are also involved in neurogenesis. So you need to have enough of them for the brain to grow appropriately, and when experience is positive and basically OK, there’s usually enough of these to facilitate the brain growth. And when things don’t go so well, there may be a deficit of those things, which then has a knock on effect– particularly on the prefrontal cortex, which is– you know, some people call it the social brain. Which is kind of really important in our ability to think about emotions, and manage our emotions. OK, so can you tell us a little bit about what the longer term impact is, in terms of the child’s developing sense of themselves as a person?

One part of the prefrontal cortex that’s particularly important in social interaction is called the orbitofrontal cortex. And that is really built up through positive social interaction and feel-good; feel-good kind of biochemicals help it to grow. And during the period, roughly from about six months to 18 months, there’s a massive burst of connection in that particular area, which corresponds to– the timing corresponds to when the baby is actually enjoying the most intense kind of social bonding and connecting up with the parent. And that’s when the attachment style, if you like, of the baby is starting to get established.

So can you tell us a little bit about what the importance of this early environment is in terms of the baby’s developing sense of who they are as a person? What’s becoming really clear is that the brain– it’s not just the brain that develops in an interactive sort of way. But our actual sense of self is a very interactive phenomenon, if you like. People do not become themselves without input from other people. And in babyhood this is particularly acute, because the basic self is starting to emerge through feedback, really, from the people around the baby.

So it’s really important that the parent feeds back accurately. Parental attributions are actually very powerful, and if the parent gets the baby wrong, then that’s going to make it difficult to build a kind of comfortable, you know, accurate sense of self on that basis. Obviously, a baby can’t talk, so a lot of what the baby’s learning about himself or herself is conveyed through body language, again, through faces, primarily. And the parents’ expressions indirectly kind of reflect back to the baby what kind of state he or she is in. So the parent’s face might yawn or something, say, “oh, you’re very sleepy”. And the baby will get an idea of himself being a sleepy baby.

And gradually these things get put into words more and more, and then you can attach a label– a verbal label– to those different states once they’ve been kind of identified. But I think research has shown that one of the really most crucial things is that the parent should think of the baby as a person. As a person with feelings, and not just somebody who needs kind of the practicalities. So actually, to become a round, you know, a fully fledged person, a psychological person, you need a lot of psychological input to help that develop.

Sue, the research on attachment suggests that, as a consequence of early interaction, the baby is building up what has become known as internal working models, and that these internal working models are being developed in the absence, or prior to language. They’re using a part of the brain that is unconscious. And that these internal working models stay with the child throughout their lifetime. Can you tell us a little bit about that? I think internal working models form on the basis of kind of regular experiences.

So there has to be a kind of cumulative load of things happening the same way over and over again, and these sequences– I think the way the memory works is that maybe the very earliest memories are more like sort of flashbulb memories. Gradually, the brain gets better organised and more able to hold a sense of a longer sequence of interaction. And the things that happen over and over again– with a parent or whoever the caregiver is– they’re the things that the baby starts to form, kind of, expectations of what the world is like, how people behave, this is what tends to happen.

And it’s very useful because it’s a kind of predictive tool, and the brain in general is a predictive tool. It helps us to make our way in the world, because we can sort of figure out what’s going to happen next. So what does the research tell us about the stability of these internal working models and whether they can be changed over time? The evidence seems to be that they continue, that they don’t kind of disappear. But that may be because most children live in families where they are having similar experiences with the same people over and over again.

I think if circumstances change more dramatically, and there are a whole load of new experiences that keep happening over and over again, then you can add another internal working model. I don’t think the original one will necessary be replaced. But I think you may get a repertoire of internal working models that might be triggered in different circumstances. So from the point of view of if you haven’t had a good start, and your working models are quite, sort of, insecure and negative, I think you can add better, more secure ones later in life. The more positive, cooperative early experience a child has of those early relationships, the more it helps the orbitofrontal area of the prefrontal cortex to develop.

And one of the things that that enables the baby’s brain to do is to– the orbitofrontal cortex has the ability to inhibit, hold back, the amygdala and more basic emotional reactions. So this is really central. It’s like– somebody described it as a kind of pause button. And if you have that, you can pause and you can reflect on maybe “should I do this or shouldn’t I?” “What’s the other person going to feel?” And it’s really the basis for all sorts of really important social capacities, like empathy, self-control, and things that are the base of a productive society.