Most people think of social-emotional health and social-emotional skills as synonyms. While these are related, they are also different. Traditionally, social-emotional skills are often described as a child’s ability to be calm, listen, express themselves, follow instructions, share, take turns, etc. While these are all part of social-emotional health, the skills, like sharing and taking turns, are symptoms or outcomes of a socially-emotionally healthy child/person but are not ‘health’ itself. It is important we differentiate these two terms so that we can focus on understanding and addressing the most important social-emotional goals for a child.
When I asked several different types of therapists, including mental health professionals, occupational therapists, and speech and language pathologists what their definition of social-emotional health is, their answers were quite eye-opening. While many people include the description of having the potential for meaningful relationships and emotional depth, almost everybody includes the idea that ‘social-emotional health’ is having coping mechanisms. While the ability to develop our own coping mechanisms is important, especially within our social-emotional world, to define that health is ‘coping mechanisms’ is the same as saying that physical health is the use of antibiotics or some other solution/intervention/treatment. Coping mechanisms can be very useful solutions to challenges, just as treatments for physical ailments are useful. However, defining health by a solution to a problem cannot be our standard.
The true definition of health involves the absence of the need for a solution or intervention, meaning that health is when we don’t have the need to develop coping mechanisms because we can understand and handle the emotions we experience without having a disproportionate, rigid, or maladaptive response. This does not mean that people who need these supports or interventions are somehow sick, but it does mean that there are different levels of healthiness. Being able to effectively communicate about those emotions and experiences, and understanding where they come from (their root), are some of the core ingredients to achieving and maintaining this health. This understanding and proportionate consistent responses allow us to adapt our behavior in a social setting and open us for deep intimate relationships. According to Kaiser Permanente,
“Social emotional health is the ability to understand and manage our emotions and to form social connections and relationships with the world around us. Strong social emotional health enables an individual to integrate their thoughts, emotions, and behaviors in a way that supports greater health and well-being in life.” (https://thrivingschools.kaiserpermanente.org/mental-health/social-emotional-health/#:~:text=Social%20emotional%20health%20is%20the,and%20well%2Dbeing%20in%20life.)
Imagine what a truly socially-emotionally healthy person could look like. In reality, very few people, if any (including myself), are this way across the board. We all have weaker and stronger areas of social-emotional development, and this is what makes us each unique. Social-emotional health is an aspiration, and likely not something anyone can fully achieve. We must be comfortable constantly working on ourselves, being reflective, introspective and analytical, while also challenging ourselves to deepen our understanding of and deal with our past experiences that shape our current perceptions, feelings, decisions, and reactions. Behavioral therapists who practice ABA or CBT will tell you the best a person can achieve is being taught new skills, learning new behaviors, or developing coping mechanisms. However, professionals who use psychodynamic interventions, like The Greenspan Floortime Approach® for children or a variety of adult interventions, know that all individuals are capable of developing and strengthening the core elements of social-emotional health. While you can’t teach someone to be empathic, we all have the potential to become empathetic. As Dr. Greenspan once said, “If you want a child to develop empathy, show them empathy!”
Mental health is a big part of social-emotional health, and anyone who’s studied mental health knows that there are two prevailing theories of emotional development and emotional health that also apply to social-emotional health, cognitive behavioral theory and psychodynamic theory. According to the article Comparing the process in psychodynamic and cognitive-behavioral therapies, “Cognitive-behavioral therapy promotes control of negative affect (the outward expression of our negative feelings) through the use of intellect and rationality combined with vigorous encouragement, support, and reassurance from therapists. In psychodynamic psychotherapies, there is an emphasis on the evocation of affect, on bringing troublesome feelings into awareness, and on integrating current difficulties with previous life experience, using the therapist-patient relationship as a change agent. This helps us understand how our current behaviors and strong feelings are rooted in earlier experiences.” (https://pubmed.ncbi.nlm.nih.gov/8473585/)
Cognitive behavior theory focuses on addressing symptoms of mental distress and changing current behaviors, without considering our past. Psychodynamic theory focuses on understanding our past experiences and our subconscious, while helping us connect how we develop, grow, and change throughout our lives based on our relationships and experiences, past and present. While both approaches have shown ‘effectiveness’ in treating various diagnoses, only the psychodynamic model attempts to help us understand how each of our experiences shape who we are, who we become, and how they impact our behavior.
CBT assumes the best we can do is be taught or learn new behaviors and coping mechanisms to deal with life’s stressors, challenges, and things that overwhelm us. Psychodynamics says that we are a byproduct of our environment, and that the environment is constantly causing us to change, starting at birth. Our experiences, especially those social and emotional experiences, tend to drive the way in which we develop and become both emotional and cognitive beings. Our understanding of how these experiences impact us, and our role in them, can help us not just learn coping mechanisms, but actually improve our overall social emotional development and health, reducing the need for coping mechanisms in the long run.
What is more interesting is that our current understanding of neurological development as well as genetic expression, supports psychodynamic theory. We now know that neurologically, every experience we have activates different pathways in our brain. Having new experiences and perceiving experiences differently than we may have perceived them before, can cause new pathways to build (i.e. growing and changing our brain constantly). In addition, each of these new experiences is not simply a sensory experience involving touch, taste, smell, sight, and sound, but also an emotional experience. We categorize and integrate the various sensations into a single picture and define it as emotionally pleasurable, aggravating, exciting, etc. Every new experience has the potential to change our perception of future experiences. CBT looks at how we process our current experiences but chooses not to look at the emotional underpinnings of these experiences or the previous experiences that have led to our current perception.
In genetics, the field of Epigenetics looks at how many of our genes turn on and off throughout our lives based on environmental factors. It establishes that genetic expression is not fixed at birth but instead changes throughout our lives due to emotional and physical stimulus. This understanding of the interplay of nature and nurture shows that we are constantly changing and that most elements of who we become are not predetermined at, or before, birth. We all have genetic and neurological predispositions but those are not fixed predeterminations.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752894/#:~:text=Several%20lifestyle%20factors%20have%20been,and%20working%20on%20night%20shifts.)
Because of our neurological and genetic adaptability, and how our experiences and the environment constantly cause biological change, we can do more than simply learn new behaviors. We are constantly changing, growing, and evolving. We are developing new emotional understandings of the world, shifting our perceptions of the world, and changing the way in which we see and understand the things around us. This constant development in turn changes how we interact with the world and changes our feelings about these experiences and our responses to them. These advances in our understanding of neurological development and genetic expression support a psychodynamic model of social emotional health and how it can be achieved.
When thinking about Social-Emotional Health, especially for children, the most comprehensive and sustainable results will come from focusing on the ‘big picture”. Setting goals and working on the core capacities of health, and not simply teaching skills, will facilitate long term growth and success. For some adults with mild challenges, the best option may be a CBT based approach. However, for children still rapidly socially-emotionally developing, a psychodynamic approach allows them to continue to naturally develop without interference. A psychodynamic approach, like The Greenspan Floortime Approach®, incorporates our current understanding of social-emotional health, neuroplasticity, and genetic expression allowing children to reach their optimal development.
To learn how to apply The Greenspan Floortime Approach®. Register for the Professional or Caregiver/Parent Course at www.stanleygreenspan.com/floortimeu/. Parents and Professionals can also receive Greenspan Floortime® Expert tele-coaching with video analysis and feedback.
For in-person Greenspan Floortime® based OT, SLP, and Social Group programs, and coaching contact The Floortime Center®, www.thefloortimecenter.com.