Exploring Emerson’s Trauma Crying Theory in the Treatment of Babies- Seeking Accurate Empathy – By Karlton Terry
Many baby therapists agree that crying ranks near or at the top of parental motivations for seeking psychological and somatic assistance. Unfortunately some therapies are simply aimed at “stopping the crying,” including repressive behavior modification techniques which only serve to bury psychological content. Temporarily relieved or elated parents may celebrate such short-term fixes, but with these “solutions” comes the likelihood of impacting the infantile psyche in an adverse way, with possible somatic consequences. “Accurate empathy”1 and listening to infantile communication (crying), on the other hand, allows for unwanted psychological and somatic content to be released. When trauma crying is shared, a great shift of deepened empathy occurs in the family. Ultimately trauma memories are depleted and drained from the psychological and somatic systems. The crying stops because the story is told.
Parents, especially new parents, can easily feel anxious, stressed, or inadequate when their babies cry. They are getting acclimated to their new roles, a new pace of life, and new priorities. Additionally, crying babies tend to activate feelings in parents and other adults, particularly people who themselves have unresolved babyhood traumas. Often, babies cry when no apparent immediate needs are present. Attentive parents normally check the physical condition of their baby to make sure it is not “needs crying”2 as defined by Dr. William Emerson. Needs crying expresses need: hunger, fatigue, pain, discomfort, having a dirty diaper, and so on. Often, parents have done everything they can think of to address a baby’s crying, but still for some inner, unknown, sometimes relentless reason, the baby continues to cry. Usually this situation constitutes what Dr. Emerson refers to as “trauma crying.”2
Trauma crying must be addressed in a completely different way than needs crying. With needs crying the parents should meet the need being expressed. It’s not about “stopping the crying” so much as it is about meeting needs which then naturally results in cessation of crying. Trauma crying, however, is how the baby communicates its story and how it resolves and relieves somatic and psychological stress it is carrying. Babies carry more stress and have had a much more complex history than most people realize.
One should never leave a trauma crying baby alone. To properly attend to the baby, parents, loved ones, and therapists ought to listen to trauma crying. It is only through empathic hearing of trauma crying by a loved one or a conscientious and present therapist that a baby can experience the relief from telling its story, and from being understood. Just as adult patients experience somatic and psychological relief from empathic listening, so too can babies. All too often babies who are trauma crying have well-intended breasts or bottles placed into their mouths, and sometimes trauma crying babies are even rocked or bounced gently (or even wildly) in an attempt to “get the baby to stop crying.” In my opinion, this is equivalent to feeding a patient who has come to a session instead of listening. Suppressing trauma crying is equivalent to addressing psychological or somatic issues by repressing them rather than acknowledging, sharing, releasing and resolving them.
So, what can be done about trauma crying? A competent therapist can help the parents by modeling empathic listening. A first exercise is to listen, with the parents, to determine the expressive quality of trauma crying. This empathic listening is easy to teach parents in a few practical steps.
Step one is to obtain the parents’ permission to allow the baby to cry (so long as all of its immediate needs are apparently met). Most parents readily agree to this contract, but it is important for the therapist to keep a sharp eye on the parents as well as the baby. Parental response to trauma crying is revealing of the reaction and negotiation style of the parent, and often indicates where the parents have unresolved embedded trauma themselves. When babies are trauma crying in a session, I always model a grounded, calm, empathic presence with absolutely no pressure on the baby to stop crying. Babies often open up and become profoundly expressive when they are met in this way and sometimes the parents become “activated” (visibly anxious, with tension growing in their bodies, faces turning red or white). If the parental anxiety level surpasses their ability to participate in the session I tell them to pick up or soothe their baby at any time they feel a strong need to do so. Most often though, parents can trust the process enough to continue to try to identify the content being communicated by the baby. It is important for us to remember, and to remind parents, that crying, eye contact, and body language are the only communication capabilities available to babies.
Step two involves the process of working together to understand what is being expressed by the baby. I often ask the parents simple questions such as, “Have you heard this type of crying before?” Inevitably the answer is yes. “What is your baby saying right now? Is he/she angry, scared, sad?” Most parents can identify one of these basic emotions, but in the case where they cannot, it is essential to arrive at a consensus.
Some parents, because of their own unresolved trauma or for other reasons, cannot tell which emotion is being communicated. Until such parents can transcend the re-activation of their own unresolved trauma triggered by the baby’s trauma crying, recognition of the infant’s trauma can not occur. This situation results in a diminishment of relational possibilities, and each participant becomes isolated in his or her own world of pain, coping, adaptation, and all of the other dead ends that truncate human potential. Now is the time to help the parents understand the magic of babyhood. Parents may be irritated, tired, activated or frustrated because of the crying. In this case it is important to spend some time with the parent, even while the baby is crying, helping the parent understand the emotion, the human connection, in the crying. Asking open-ended questions, or describing the crying using non- provocative adjectives, can facilitate different pathways to persuade parental perceptivity. Assume a realized therapist, free from transferences and projections, is confident in the assessment of parental disconnection. If a baby is expressing rage, for example, and the parents cannot understand the content of the baby’s language, then the therapist might ask the parents a series of questions inviting articulations: “Could it be that your baby’s crying is angry? Could it be that your baby’s crying is anxious or mad? Could it be that your baby’s crying is furious-sounding? Could it be that your baby is irritated and fuming?” Sometimes, by approaching the “unseen” quality in trauma crying from an oblique angle, or by adding adjectives, the parents can then see and hear more clearly what was blocked to their perception.
When a parental confusion or denial persists, a healing opportunity is waiting. An effective technique is to ask the parent if the baby is expressing an emotion which it clearly is not. For example, with a rage-crying baby one might ask, “Well, does that sound sad to you?” Then, by process of elimination you can arrive at the correct emotion. Another device I sometimes use is to ask the parents to close their eyes and imagine someone else’s baby is crying. What then could be the quality of the crying? An even better method is to hand the parents a set of ear plugs (for often it is the auditory stimulation that sends parents into a state which blocks their perceptive ability). Once the ears are plugged I ask the parent to look into the baby’s eyes or look at the baby’s facial expression to guess which emotion, what story, and what aspect of the human condition the baby is expressing. Often, by reducing the auditory or visual stimulation in such ways, the baby’s trauma and its affiliated cathartic and releasing expression can be more accurately understood (and therefore permitted) by an over-stimulated parent. The important mission here is to establish consensus among parents and the therapist. Sometimes parents who seem to be “blocked” are actually focused on a particular or obscure aspect perceived only by them, and the therapist can be enlightened by such observation. Then a refining of the witnessing of the baby can be undertaken, and the baby is not only being seen and heard clearly, but more deeply. The empathic human connection that arises from such a moment enriches relationships and can last a lifetime.
Once the main emotion is identified, complexities and subtleties can be explored with a view to deepen the empathy to a state I refer to as “accurate empathy.” Accurate empathy is achieved when the parents and therapist together can agree on the fundamental emotion being expressed as well as the nature of other subtleties and details: “Yes, this is really very angry crying, also with a look of longing and sorrow in the eyes, and a sound of exhaustion trailing off in the voice as the baby goes for the next breath.” When such a consensus is achieved, babies almost always deepen their communication with cathartic and trauma-releasing crying.
Step three involves mirroring and responding. Mirroring in this case means that the parents, in continued eye contact and heart contact, are present to hear what the baby has to say. When parents are in a state of accurate empathy, they are usually no longer activated (or “blinded”). Since such activation can take up emotional space that needs to be utilized by the baby, this is a great moment in potential for family growth, and the baby usually responds by crying even deeper and louder. My experience is that most babies are truly relieved by being heard at this level (instead of shushed, “comforted,” or fed when they need to “speak”). Once the mirroring process has stabilized and is flowing between baby and parent, I ask the parents to say something if they have not done so already. Sometimes parents need help, but usually they come up with excellent language such as “Oh my God, I hear you, baby.” Or, “I really see you are so, so sad.” Babies will cry so hard that their faces turn red, their little bodies freeze up or jerk around, their eyes shut tightly, and they go for quite some time between breaths. I encourage the parents to stay present, especially with waiting eye contact. The baby will eventually catch its next breath, and will inevitably open its eyes right where the eye contact left off. I believe this is some kind of innate program belonging to primal mammalian connection and reassurance, and if parental eye contact is waiting and available to the baby when it does open its eyes after a sequence of profound crying, the baby learns it is being held in “accurate empathy.” This moment is very important and reassuring to the baby. Meanwhile, the parent is developing a deeper permanent empathic connection with the baby.
Responding to the baby can be achieved next and is often a natural step intuitively or automatically taken by the parent. Parents often cry as a natural response to the baby’s communication. In cases where one or both parents are responding to trauma crying by crying themselves, there is much shared emotional energy in the system, and a great transformation can occur in the fundamental family dynamic. A notable side effect of such a session is that the baby usually sleeps quite well in the days following such a session. When trauma crying babies are responded to vocally as well, they tend to be relieved, because they know they have been seen and heard more thoroughly. Typically babies not only sleep better, but eating problems tend to vanish and power struggles tend to diminish. Other forms of response include language, and often parents will say things like, “I am so sorry my dear. I haven’t heard this before.” or “I’m so glad to finally meet you at this level.”
My job at this stage of the session is to closely observe the baby. Usually, and quite often in astonishing ways, the baby’s body language tells an even deeper story suggesting content for future sessions. I do not typically convey such information to parents until subsequent meetings after more rapport is developed, when the parents have become experts at accurate empathy. Often the baby’s face and cranium will exhibit bright red stress marks that reveal where the cranium was most stuck and traumatized during birth. There is always cranial trauma during vaginal births because, as Peter Ellison explains, “In relative scale the feat of passing a full-term fetal head through a woman’s pelvis is comparable to swallowing a baseball.”3 I appreciate Ellison’s statement, and it is maternally oriented for it is the large, fragile fetal cranium that must pass through the narrow thick-boned pelvis, so surely both the mother and the baby must be considered if pain and trauma are to be measured. The average perinatal cranium is one inch larger in diameter than the average maternal pelvic outlet. Ellison goes on to explain that, “unlike other mammals, including monkeys, humans have to rotate their heads to pass through the pelvis.” It is often the “conjunct pathway”2 along which the fetal head is compressed against the maternal pelvic bone which “lights up” during trauma crying. I have seen babies pulling on an ear or pointing with a finger or a fist at an eye or spot on the forehead, compelled by an unconscious or somatic urge to identify the specific sites of their traumas. Each birth and each baby is different. In my experience it is the baby, once empathically observed, who governs where the next steps of therapy shall be directed.
To experienced parents I explain what my observations might mean in connection to birth trauma when I see a baby pointing out its own trauma sites: “Look, that may be a place where your baby’s head got stuck against the bones of your pelvis.” In most cases, when the empathic resonance is strong, mothers have a very clear “felt sense” of what happened and are able to bond with the baby at a level that was inaccessible perinataly.
Besides tracking and making notes of cranial birth (perinatal) trauma, I am also attentive to prenatal trauma that may be expressed by the baby. Prenates are extremely vulnerable, much more so than newborns, and even relatively healthy and happy pregnancies can still have moments which are experienced as traumatic by the fetus. Of the many prenatal traumas mapped out by Emerson “umbilical affect”2 is often the most frequent condition expressed by babies. This term of Emerson’s is utilized to describe the somatic and psychological results of the long, complex, and sometimes perilous relationship the fetus has with its umbilical cord. Infants will exhibit trauma crying with this, and other, prenatal dynamics in similar ways to those described above. Numerous substances, including neuropeptides, are delivered to the fetal system during pregnancy.
Candace Pert believes that ” . . . the receptors on our cells even vibrate in response to extracorporeal peptide reaching, a phenomenon that is analogous to the strings of a resting violin responding when another violin’s string’s are played. We call this emotional resonance, and it is a scientific fact that we can feel what other’s feel.”4 I would imagine that direct transmission of peptides, umbilically as well as through the amniotic fluid, has a profound effect upon the fetus. Jeno Raffai explains that, “Sallenbach (1993) described as an outcome of an investigation into intrauterine bonding that within the sensations of the child are the experiences of the child’s mother. That is important to the Achilles’ heel of child development; Is the intrauterine child able to differentiate his experiences from those of his mother? If he cannot succeed, his mother’s experiences are dominant and he cannot dissolve himself from a self which represents the mother’s body . . . “5 Suggesting the cellular mechanics that inhibit personal growth and proliferation Pert has discovered that, ” . . . cortical releasing factor (CRF) levels increase in highly stressed infants and children, the receptors for CRF become desensitized, shrinking in size and decreasing in number. These changes happen when receptors are flooded with a drug, whether it’s a drug your body produces naturally or a drug you buy at the pharmacy. The memory of the trauma is stored by these and other changes at the level of the neuropeptide receptor, some occurring deep in the interior of the cell at the very roots of the receptor. This is taking place body wide.” In my opinion it is precisely these trauma memories which are released and resolved during empathically witnessed trauma crying, when the baby’s cells become energized, body-wide, in the structured crucible of accurate empathy.
As Peter Nathanielsz states, “The environment in which we grow in the womb has a greater effect on whether we reach our full growth potential than our genes.”6 Nathanielsz also explains that, “When the delivery of oxygen to the fetal brain falls below the required level, fetuses shut down the blood supply to less important organs. Redistributing blood to the brain and heart at the expense of the liver, gut, and other fetal organs is a clever choice in the short term. However, when the compensation continues for a lengthy period, growth of the deprived organs slows as a consequence of cutting down their blood supply.” Nathanielsz specifically addresses only inadequate oxygen supply as it relates to organs and physical development. One can easily imagine that other umbilical stresses, such as inadequate diet or periods of emotional maternal anxiety must have an impact that is stressing upon the “pre-psychology” * as well as the body of the baby.
In hundreds of sessions with babies, Emerson and I have found that umbilical affect is a common malady for fetuses and that it is clearly expressed by certain somatic statements in the baby’s body language. Specifically, body movements which appear to be organized umbilically are a call for somaticized fetal trauma to be addressed. The systems affected include the umbilical area of the baby, along with the falciform ligament, the diaphragm, and the pericardium (all of which are connected). The psoas muscles are frequently incorporated in movements attendant to umbilical affect. Jerky movements, contractions, and stiffness in the legs and arms are also often involved and show clear somatic patterns which are umbilically organized. The symptoms of umbilical affect manifest as tonic patterns in the nervous and musculature systems. Hypertonic and hypotonic relationships express as involuntary or unconscious startle response and back arching. Prenatal trauma and umbilical affect are indicated with these movements.
Treatment of somaticized pre and perinatal traumatized babies is quite successful, affecting positively the relevant psychological impacts, behavior patterns, somatic patterns, and personality formations. Emerson has developed many treatment techniques for working with pre and perinatal trauma in babies, and I am also continuing in my own practice to research and explore techniques which I will perhaps discuss in future papers.
Finally, with regard to crying, I explain to parents that empathic listening can not always be undertaken. If the parents themselves are stressed or tired they should not attempt it. Releasing, cathartic-type crying tends to take on a rhythm and timing of its own, and may not end when a tired parent wants to retire. When a baby is truly trauma crying it is best not to truncate its natural expressiveness. The baby will stop and rest, or return to normal states when it is finished “explaining.” If a baby reaches a state of crying in which it cannot stop and rest after a few minutes, or if it no longer seems to be releasing or expressing then it should be comforted and encouraged to rest. A good practitioner, together with the parents, can usually easily assess when trauma crying (expressive and releasing) turns into needs crying (need to be comforted).
* Human experience resulting from impacts affecting fetal cells, including stem cells, which result in predispositional templates over which individual psychological tendencies are formed.