Nourishing Attention, the Self, and Self-Esteem

A beautiful sunrise

When a parent fails to perceive a child truly …

The brilliant British pediatrician and child psychiatrist, D. W. Winnicott, observed that the developing infant/child gets to know him/herself by being seen truly and being responded to on the basis of that true perception by the caring person. For example, when a baby is fretful and tired, and when a parent perceives this and responds (with or without words), the meaning of this response for the baby is something like: “I see that you are sleepy. What you are feeling is that you are sleepy. It is you who are feeling sleepy. I want to help you to be comfortable and to sleep.”

This is a simplified example of a myriad of complex experiences of feeling, of being perceived truly, and of being helped to know him/herself that in aggregate contributes substantially to the child’s eventual sense of individual, unique, and valuable self.

However, some parents are neurotically or characterologically self-absorbed or distracted to the point of NOT seeing their child’s feeling and needs, or more confusingly, of projecting something of their own onto the child … importantly misperceiving the child’s experiences—with resulting pain and confusion for the child.

Lack of necessary early nurturing attention generates frustration, pain, and anger. The anger may fuel a painful enduring consequence—the child’s conviction that he/she is unlovable and not of fundamental worth. This distorted belief does not yield readily and can persist into adulthood—in spite of apparent successes in school, work, and relationships.

I have been impressed by how little compassion these patients are able to have for themselves. It may be that the longstanding, deeply held anger is a toxic fuel that chronically feeds the conviction that “I am not lovable. There is something wrong with me.” This deeply rooted anger can emerge in adulthood as extreme reactions to circumstances experienced as neglect and inattentiveness — being poorly served in a restaurant, for example.

In therapy, exploring in as much specific detail as possible what the patient remembers of childhood is essential. Sometimes, on the basis of what I am able to learn from the patient, it is clearer to me than it is to my patient just how little the patient received in the way of accurate perception and acknowledgment. These patients often don’t make the connection between their own low self-esteem and the failure of nourishing attention in early childhood.

I have observed that many patients whose parents failed them in these ways are themselves notably attentive parents. Instinctively they provide for their own children the quality of nurturing attention that they themselves had not received. It is sometimes helpful for me to draw attention to the difference between what they do/did for their own children and what their parents had done for them—in order to encourage compassion for themselves and to help to nourish their self-esteem.

A competent therapist naturally pays attention to the patient’s feelings and thoughts, and regularly reflects them back to the patient as accurately as possible. This is a fundamental process no matter what brings a patient for help. For patients whose early development was deficient in nourishing attention, this process is, in itself, an essential reparative experience.