← Talkaboutable with Dr. Susan Swick
Talkaboutable with Dr. Susan Swick
Dr. Matt Biel and Dr. Vilma Reyes on Raising Resilient Kids
00:36:09
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Lemonada
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Talk about Able is produced by Lemonada Media in partnership with Montage Health and their Ohana center for Child and Family Mental Health, and it's made possible through funding from the Montage Health Foundation. I'm Dr. Susan Swick, and this is Talk about Able. There is no health without mental health, and supporting families is the most powerful way we can support the mental health of growing children. That's why I am so excited to share my live conversation with Dr. Matt Beale, Director of Georgetown University's Thrive center for Children and families, and Dr. Vilma Reyes, director of Training and Community Programs at the Child Trauma Research Program at the University of California, San Francisco. On May 20, we met up in Washington, D.C. at the Thrive Center's Innovation Hub Solutions Fair. It's a whole day dedicated to gathering innovators from Thrive's Innovation Hub Fellowship program with change makers, researchers, policymakers, and system leaders to talk all about mental health for children and their families. So in our conversation, Dr. Beal and Dr. Reyes shared stories of difficulty and frustration and stories of accomplishment and hope. From working with kids right in middle school to working with immigrant families, we'll hear about some real challenges and opportunities for impact. This is a conversation about what's possible for children and families when they have the support they need. Matt there's been a lot of public conversation about children's mental health, much more so now than when you were in medical school or than when I was in medical school. But it's so powerful to zoom out and not just think, how are we? What resources do we need to treat our way out of this crisis, but to think also about the relationships the child has, their family, the system they're embedded in, the community that they're in, and what resources may be naturally there to help sort of develop their psychological immune system, if you will, the way they develop a physiologic immune system. So I'm hoping you could maybe share with all of us in the room how you think about relational health and what is relational health.
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C
Simply put, the idea of relational health, or early relational health in the early childhood world in particular, is that we can only understand children and their development, their healthy development, and also where development may run into challenges. We can only understand that in the context of the relationship with the primary caregivers and people in their lives, and that if we take that more interpersonal relationship rather than intrapersonal perspective, we'll learn so much about how children grow up healthy, how resilience forms. Because resilience is not something that you are either lucky enough to be born with or not. It is something that develops through experiences. And those experiences are largely interpersonal experiences. So it's a much richer way for us to think about how to support health and well being and how to help people recover when they're struggling.
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I love that answer. Vilma, I want to ask you to build on that a little bit. If we are thinking about how I like to think a lot about how could we make mental health as concrete as dental health for parents? Parents know what it is for their child to be adequately nourished. They know what it is when pediatrician says, oh, here's where your child is on the growth curve at this checkup. How can we operationalize mental health so that they also could think in concrete ways about how they're teaching their child to brush and floss and when they need a checkup and what's the equivalent of a toothache? How do we make it simple, memorable, but still useful and authentic to invite parents into thinking either that their two year old is observing what's happening even if they're not able to understand it well, and that adversity is not something we should actually try to protect our children from because we can't. How do we equip them? How do we bear it alongside them? How do you think about this work clinically and beyond when you think about how to help parents actively engage with building mental health,
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all wounding, all healing, all learning emerges in relationship. And so I think parenting, because it's such an enormous, humbling task, we want to make things concrete. But I think the real story is much more complex and layered and bigger than that and harder to make concrete. While early childhood experiences paint and color how we create relationships with our children. And so it's sometimes even though you can make it super concrete and a parent can say, if I just do all these things, if I just take them to the dentist, if I just do all of these things, I'm going to be doing it right enough and they will be good enough. And I think what sneaks up sometimes is the shadows of how you were parented becomes who you are and how you are as a parent. And sometimes you have to look at things that have been unhealed in the past because what doesn't get healed from your past gets passed on inadvertently. I mean, nobody wants that. And so yes, there's a part of it that is concrete. And we can work to make our kids more resilient, be able to adapt, to manage stress, all of those things. And I think because trauma emerges in relationship. Even if you know all these things here in your frontal lobe, the moment that you feel activated by your kid rejecting you or whatever they're doing, that is bringing out something from your past, it will call upon us to have to look deeper, you know, beyond the concrete and look at things that maybe you thought I was doing fine up until now, but now that I'm a parent, it's really sneaking up on me, you know, so there's two layers to your question, to your question. I hope that was close enough to as concrete as I could make it.
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B
Well, and I. It seems to me that even without an experience that we might objectively describe as traumatic, that parents are humans. And I used to say having children was like getting a PhD in anxiety, where you feel like your vital organs are walking around the world without you. And even if the adversity that you have faced is milder, it still animates maybe the fears and your inclination to be protective or self blaming or to lean in and bear difficulty alongside your child. It's part of the challenge. So, Matt, you talk about how stress moves both ways within families, in relationships, from children to parents, I mean, duh. And also from parents to children. What are you seeing at this moment, either clinically or at home, or more broadly with the Thrive center and sort of thinking it from a public health perspective, the sort of state of parenting, the state of families, I think it's
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C
not a news flash to suggest that we're living in an anxious time. And the sources of the anxiety, I think, have been well described, but it's worth enumerating them quickly. Our brains are kind of prediction machines. That's sort of how they work. And when the future feels particularly uncertain, our anxiety is activated. And when we're parents, our anxiety is activated around our children. When parents or caregivers or just adults with kids in your life who you care about. And so adults who care about kids right now are worried about the climate and the planet, our ability to live alongside our neighbors peaceably. Will there be jobs? And is education going to be providing my kids what they need to be successful in the future for these jobs that may or may not exist. And all of those worries are entirely legitimate. And for many, many parents, there are also much more proximal worries about is my child going to be safe walking home from school? Are we going to have enough money to cover groceries this month? And so those worries compound. From the perspective of a parent, there are a few reactions you can have. You can either sort of freeze and feel powerless and hopeless. That gets translated to your kids. You can over cope and overcompensate by trying to anticipate the dangers around every corner and be hyper vigilant and hyper prepared and thinking about everything that just might happen. That gets translated to kids. You can, in a more mundane way just not be your best. You can be irritable and short tempered and impatient. And we've all been that, you know, probably already today. But when you're in that mode all the time, that gets translated to your kids. And so I say all those things not to say there's no way to do it right, only to say that the way that parents are perceiving the future and perceiving it as an issue threatening, particularly right now, that is having an effect on our kids. And similarly, when kids struggle at 2 or at 22 or at 42, parents suffer and struggle with that as well. And so it's highly bi directional. And I think particularly in the enormous amount of discourse around the youth mental health crisis over the last, it really started late 2000 teens and of course accelerated during and after the pandemic. The overwhelming amount of that overwhelming discourse has been focused on what's wrong with our kids. And very little has been focused on what's going on with parents and caregivers. How is that influencing kids? And how might we have better success at tackling this very real and persistent crisis if we take a more ecological family, focus on the fact that these things are relational and our kids will do better when parents are able to cope with and manage all of these very real anxieties about the future, work on metabolizing them so they don't get translated so heavily to our kids. And this is something that is easy to talk about and super hard to do at home. Just ask my kids.
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No, simple but not easy. I'm struck with the fact that when there's so much uncertainty and anxiety, it's harder to experience joy as a parent or as a family system. And joy is not mental health. But it's easier to come by when you have a little bit of resilience and you have modest mental health. And thinking about how we facilitate communities, parents, families, more extended communities, being able to hold a volume of uncertainty anxiety so that they can still be of support to one another and have a little room for joy seems like the simple but not so easy thing you're talking about.
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I think that's such an important insight. And on a sociological or cultural level, if you look at communities and cultural groups, that have experienced like the, the greatest exposures to sustained adversities across time. They also have Genius for Joy.
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Yeah.
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And so like it, it can't be downplayed how important it is on an individual and family level and also on a community and cultural level to, to prioritize that. And it does get lost in the shuffle far too often. So I think you're right on it.
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I love Genius for Joy. I'm going to keep that. Putting that one in my pocket. We're going to take a quick break. When we come back, we're talking about how being a part of a strong community is essential for the mental health of our children. Stay with us. So, Vilma, then, speaking of Joy, thinking about how our children outside of our homes, they spend most of their time in school. So I'm wondering if you might be able to talk a little bit about how you've brought work into schools to facilitate both making it easier to access treatment or making it easier to build health.
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I've been living in the early childhood world, and so I will extend your question beyond school to community. Some of those might be pre K within the school setting, but maybe more like community centers, early childhood centers. I think the point is still taken that we need to think of all the eccentric circles that a family is embedded in and reach out more to community. The U.S. attorney General, I'm sure you've seen all this report. The folks that say smoking is bad for you have said that parenting is a health hazard. It's almost funny that something that we've done since we've been human is now a health hazard. We've been parenting since we've been human. What's different now? This is mapping out with other research showing more of a loneliness pandemic in the last 50 years of people feeling more and more isolated and hearing more about sense of belonging, important. So all of these things come together in that erosion, the erosion of this village, this sense of community. And I primarily work with immigrant families who are being terrorized and are afraid to leave their home, are afraid to go to school or church or send their kids to any childcare center because of exposure and risk. And so I'm just thinking of back to the very first comment of going beyond the home into the community. What does that look like? And I think there's not enough of people like me to go around. But what we've always had since we've been people is have a village and have each other. And I think that's what's been eroded and that's where we really need to invest in, is to take what we know might help to repair trust and bring in and lift up and center community, whatever that is. So maybe schools, maybe whatever other. What I'm seeing more in like, is grassroot organizations that the community still trust. The joy that you're speaking of when I talk to families, that has always been with community. Being together has been with us kind of here. And that's the very thing that in the past couple of years is now. Is now a threat. Like people coming together in big groups of people is a threat. And so taking your question to kind of broaden it to community, what's being eroded pretty intentionally? And what can we do as all folks here that are trying to think about solutions and repair, to bring and to center again community and to make it safe for people to be together. And I think part of it is this bigger context of not just interpersonal trauma, but collective traumas. How can one experience all mental health when you're attacked and that's safe and not given justice? So it's. I'll let the folks here that are experts in school talk about school, talk a little bit, but I think it's still so relevant to think beyond the home.
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B
Well, I love that you brought up community because schools are an exquisitely important place where kids are building mental health and they're experimenting. And it's incredible for them to also get mentors and caring adults in their orbit who aren't related to them. But it's not a community that includes parents. Elementary does maybe, but less and less so as kids age. So by middle school and by high school, parents are a little more marginal. And thinking about those communities that fortify the bonds between parents and other parents and between parents and children, where there really is a richer sense of kinship, it's not home or school. It has to have that sort of third domain.
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And that's developmentally. Yeah, vital. Right?
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Is that right?
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By middle school, kids need to be building relationships with other adults, coaches and teachers and religious leaders and. And what have you. And one of the, you know, the. One of the most robust indicators of how kids will function at school, particularly in high school, is whether there's an adult at that school that they feel knows them and that they trust. It doesn't have to be 10, it just has to be one. But if there's one adult that a kid feels really connected to, that sort of changes the entire experience of walking into the school building. Even if you go to, I mean, my kids go to high school with 3,000 kids, but they would each tell you who's the one adult at school that they know is looking out for them. And if they're having a bad day, that person's gonna notice. And that. That really does. It totally transforms the experience of being in that crazy building every day.
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B
Right, right. Right.
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So extend that to parenting. Like, even just knowing. I mean, that's beautiful.
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Right?
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Like that you're not the only parent that's feeling this.
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That's right.
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You know, just bringing parents together.
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Right. For parents to be aware, because they do lose some of the kinship that or the community of parents that they have in kindergarten or first or second grade. As their kids get older, their kids need their parents to feel grounded and connected and to be able to bear uncertainty. But it's hard to bear uncertainty when you're in the dark. And they don't need to get it from their kids. But what are the strategies we might be able to devise? So it's community. Usually when parents can talk with other parents of the same age or those who've been there already and be grounded and like, this is how it's supposed to be in middle school.
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Find the right podcast. Hello.
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Hello, Thelma. I'm going to rearrange a couple of questions here because I want to actually talk about what you raised, which is the fact that immigrant communities already managing an incredibly steep climb of building a new life in a new country with a new language and a different culture, probably a lot of economic adversity, all of that. And now for families that have immigrated here, they are additionally navigating the extraordinary burdens of family separations, of being targeted by appearance or language, of hearing about ICE raids, of not being able to gather with a community that may have been fortifying or helpful to them, and by being maybe publicly vilified in ways that I think were sort of unthinkable a decade ago or a little more than a decade ago. I'm wondering if you might say a little bit about the effects that these multiple stresses can have on children and families. And if that's not hard enough, then you could. You can share with us, if you'd like, how your own story, your own experiences maybe have affected how you show up for these families.
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My family came seeking asylum in 91, and things were very different. And I. While we struggled in some way be undocumented for a long time through middle school and high school, nothing compares to the depth of fear that I see families having today. So while that inspired me to keep doing what I'm doing, I continue being just more fathom of, like, how is this going on for this long, Right? What you're seeing all over the news, I'm seeing story by story of story of horrific things happening with no justice, no due process, overcrowded detention centers where people are literally dying. Young children being kept there much longer than the law allows, families being forcefully separated. So you're talking about anxiety, which we all are feeling on some level. I can't even fathom the wear and tear on your nervous system as a parent to be constantly worried that in any day you might not be able to pick up your kid from school or that you could be detained by doing normal things like going to a grocery store. Is it the right thing to do to go to an immigration appointment or not? Because people are getting detained there. What is the right thing to do? And just being constantly terrified and this being pretty intentionally done to this criminalization of immigration. So all of this is obvious to anyone here, and I know you know this, the part that sometimes is not as obvious when you're thinking about 0 to 5 is that young children need to believe this myth that their parents are superheroes, that they are stronger and wiser and kinder and can keep them safe in this otherwise big and frightening world. And that's a myth. Developmentally, need, right, to have a secure base that you can explore from and come back to. And there's things that inevitably happen in life that parents can't control, you know, to anybody, that kind of ruptures that myth. But for immigrant families, this myth is getting popped every day when they get messages that their people, their parents, don't have dignity, don't have respect, are not welcome. And that takes a toll on your sense of safety in the world and in your sense of security in your caretaker, your caregiver, your parent. To be that superhero, you need to feel safe in the world. So this is causing a rupture in the parent child relationship on two levels. On the child not feeling secure in the world and who they are, who their people are. But also it has an impact on the parent's sense of confidence, of being a parent, because this is forcefully done to them and they can't control it, they can't protect them from it. That protective shield is eroded from outside forces. That part, I think, is important for us to understand because it shapes what kinds of interventions we need to repair those ruptures across all of these levels. Ruptures in trust.
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Do you have a thought about what People can do. We don't want to offer psychological solutions for structural problems, problems of structural injustice, because that's dismissive and it puts the burden on the people that are facing the greatest adversity. But are there things that we might think about doing at a community level that can be supportive in the face of sustained structural difficulty?
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A
Yes. The fact that all of you are even here means that a trillion dollar industry that is designed to keep you numb and distracted has not worked on you. And that's what you can do, is to stay alert, to be informed, to use your privilege in whatever area of privilege you have to speak up. To say this is not right. I mean, that's something we all can do as humans, is to stay engaged, stay in it. We cannot have you numb and distracted. We need you in this fight in whatever way you can.
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B
I love how that rhymes with what I often am saying to parents, which is, you're not supposed to have solutions all the time. You're not supposed to be able to fix things. But you do need to keep showing up and maybe there's something that we can hold on to in that. We're going to take one more break and then we'll be right back with Vilma and Matt. Okay, we're going to wrap things up, so I'm going to invite both of you. As we're talking about maybe enormous challenges that often feel overwhelming and disempowering and slightly like cause for despair. I'm going to ask you two questions because you're still doing extraordinary work despite overwhelming needs and sometimes meager resources. My first question we'll start with you, Matt, is what one policy would you change if you were the king?
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C
Can I have two?
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You can have two.
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He's the king. He gets to do that.
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King, Matt.
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So I'll do it developmentally. I think for families with young children, like reasonable paid parental leave would be the thing. And I would love to see us develop a real service experience for emerging adults that every 18 year old spent at least a year in their community contributing in some way. And there are lots of ways to do that. But I think that, that I think we have a massive gap in connection to one another and capacity to have conversations across difference. And forgive me, I've heard this on another talk somewhere. A psychologist from Berkeley who does this experiment around awe and he has people draw a stick figure of themselves and then they go out and have an experience in nature and then they come back and draw the stick figure again. And invariably the second stick figure is Drawn much smaller than the first. And the way that he understands that is that experiences of awe make us feel appropriately small in the universe. And it takes us out of the sort of starring role in the universe. Put us in a much better position to be humble, to be patient, and to be collaborative with other people. And I think a service experience, it may not be awe inspiring, but it is. It does make us feel smaller. Doesn't put ourselves at the center of the story. So I'd love to see that for every young person.
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Nice job. All right, Queen Vilma, how are you going to top that? What one or two policy changes or magic wishes would you have?
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I would say pay. I would say the wealth gap is the biggest act of violence in this country and world. They're keeping us divided. That is right and left. It's not. It's up and down. I think if I were to change one thing, it would be fair pay. Because that mediates almost every other stressor. Fair pay for parents.
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Okay. Amen. You two are.
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But I'll take the other two, too. Those are great. Those are great. But give them money. You know, Got money. Money is no money, no mission.
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B
All right. Second question is, what makes you hopeful, Matt?
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That one's easier, people. My patients are extraordinarily strong. And my colleagues are ingenious. And my family is the best. And so I get to be around people every day to make me hopeful.
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Velma, what about you?
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Is this the same one?
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Yeah. What makes you happy? How come you go to him first
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and he takes all the good answers? And then I have to say, me, too.
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I'm gonna ask, what makes you hopeful about Matt?
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He's the best. It's the people. I agree. I think I'm so grateful to have accompanied so many people for now, a couple of decades in their stories. I've learned so much from them. My mentor, Alicia Lieberman, talks a lot about hope. And she says, you know, going too fast from hope to something like positive without really being in it. Butchering her quote. But to avoid feeling pain is brittle hope. And I think wise hope, like the hopeless here in this room, are from people that have seen. That are not looking away. They have seen the pain and suffering and yet find themselves in positions of. I have an idea of something I can do to help with that. That's incredibly hopeful.
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It's wonderful.
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So,
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Matt Biel, I appreciate both of you. Thank you so much for agreeing to have this conversation. I hope it's a cause for hope, for people to recognize that actually, we don't wait for magical solutions to big, complex problems. We start by showing up listening, maybe the genius of joy, but also learning from our colleagues and from our children, who often have extraordinary things to ask us or to tell us. So thank you so much for joining us today. Thank you everyone for being here. We're so excited. If you haven't subscribed to Lemonada Premium yet, now is the perfect time. You can listen to Talk about Able completely ad free. Plus you'll unlock exclusive content like even more helpful advice and tips on the challenges parents are facing. Just tap that subscribe subscribe button on Apple Podcasts or go to lemonadapremium.com to subscribe on any other app. You can also listen ad free on Amazon Music with your prime membership. Talk About Able is produced by Lemonada Media in partnership with Montage Health and their Ohana center for Child and Family Mental Health, and it's made possible through funding from the Montage Health Foundation. Together, we're committed to helping families talk about the issues that children, teens and young adults are facing today. We believe that when these conversations happen at home, even about the most challenging subjects, children build the skills they need to flourish. Because when families are connected, the hard moments become more bearable, the good moments become even better, and it all becomes Talk About Able. The show is produced by Hannah Boomershine and James. Our senior producer is Muna Danish, mixing and sound design by James Barber. Kristen Lepore is our VP of Content Development and Jackie Danziger is Head of Content. Maggie Croucher is our Senior Director of Partnerships. Executive producers include myself, Stephanie Whittles Wax and Jessica Cordova Kramer. Special thanks to Kelsey Talley and Maya Smith. You can help others find our show by leaving us a rating and writing a review. Thanks so much for listening and we'll see you next week.