This commentary addresses practitioners working on the front lines with parents and infants. It offers a simple model of “listening in,” rooted in contemporary developmental science, which can be applied in a broad variety of complex and challenging circumstances infants, parents, and practitioners face today. It draws on decades of research in attachment, mentalization, and infant observation to provide evidence supporting this approach.

At its core, listening in calls for letting go of the “expert” stance. It reframes a deficit as an asset. By replacing certainty with the humbleness of not knowing—suspending expectation with a willingness to be surprised and to make mistakes—practitioners can find their way into a family’s experience [3,4]. Of course, many circumstances call for a practitioner’s specific knowledge. But in terms of promoting healthy relationships and healing when development has gone awry, the not-knowing stance plays a central role.

Dr. Barnes, 2-week-old Max’s pediatrician, immediately sensed his mother Dayna’s anguish communicated through her cracking voice. She felt overwhelmed with terror that she would never be able to breastfeed. A minor postpartum complication had gotten things off to a rocky start as Max needed two formula feeds while Dayna underwent a procedure. He had then latched well, but at their follow up visit when he was three days old, he had lost more weight than the lactation nurse felt comfortable with. She advised Dayna to pump between feeds and give Max a bottle of breast milk.

Dr. Barnes learned that the current sense of panic resulted from Max now not even seeking out the breast at all, and a pumping session that morning that produced less milk than expected. Dayna experienced the full impact of accumulated feelings of failure from her pre-baby life come bearing down on her with a crushing weight. Max’s father Pedro now observed the pair with a tense and anxious expression.

At a natural pause in Dayna’s story, Dr. Barnes took time to observe the sleeping infant nestled on Dayna’s chest, his left hand curled against his face. She described in detail what she saw; the gentle rise and fall of his breath, the robust cheeks, the relaxed posture of his arms.

This brief period of observation helped to shift Max’s parents out of their agitated state. Dayna said how the skin-to-skin helped to calm her, relieving the pressure to get the baby to nurse. Through her tears she said, “There is more to our relationship than me feeding him.”

After a moment of quiet, they noticed a gentle stirring. The three adults watched Max’s efforts to rouse himself out of deep sleep. First his arms stretched over her head. Then he extended his legs. Next, he opened one eye and then the other. His gaze seemed to land briefly on Dayna’s face before the effort seemed too much: he closed them again as he shifted back into deep sleep. They were rewarded when both eyes opened together. As time slowed, they saw him open his mouth, turn his head, and reach his lips towards Dayna’s breast. “He’s rooting!” she exclaimed joyfully. Max told his parents- not with words but with behavior- what they longed to discover: “I’m not done with nursing!!!”

While Dr. Barnes wanted to reassure them that breastfeeding would now be fine, the truth was that she didn’t know. She simply opened up a space in which they could tolerate the uncertainty. Freed from the pressure to fix the problem and released from debilitating feelings of self-doubt and anxiety, they could be fully open to listen to their son’s subtle communication. Several days later they reported settling into a nice rhythm of breastfeeding, pumping, and bottle feeding.

We see in this vignette a change in Dayna. She shifts from what is termed “non-mentalizing” where her reactions to her infant are clouded by her own worries and fears, to “mentalizing” [1]. She becomes curious about Max’s behavior in terms of his motivations and intentions. Decades of developmental research that grew out of the field of attachment theory reveal that mentalizing—also described as a caregiver’s capacity to “hold their child’s mind in mind”[5]—promotes a child’s ability to regulate emotions, build a positive sense of self, and form healthy relationships with others.

By listening in, observing without giving advice, Dr. Barnes helped to move Max’s parents from a state of agitation to one in which they could reflect upon the situation from their son’s perspective. Dr. Barnes found this stance, where she allowed herself to not know what might happen, more challenging than giving expert guidance. But she knew from experience that such an approach often led to rich rewards, both for herself and for her patients.

Practitioners may feel overwhelmed by the obstacles families face. They hear from parents preoccupied by things that get in the way of mentalizing. Self-doubt, depression, external stresses of poverty and discrimination, in addition to historical trauma and ongoing disruptions in current relationships, all may play a role. In these circumstances placing intentional focus on opening up a space in a caregiver's mind to hold their child in mind can counter feelings of helplessness.

When a child feels held in mind, their capacity for self-regulation improves, giving the caregiver an increased sense of competence and confidence, in turn increasing their reflective capacities. The clinical encounter has the potential to set in place a positive cycle of interaction.

A culture replete with images of the “perfect” parent alongside advice about “10 tips for raising the perfect child” makes caregivers vulnerable to feelings of guilt and its more destructive cousin, shame. A focus on relationships can be heard as an admonition that “it’s my fault.” The concept of the good-enough mother, as described by British pediatrician turned psychoanalyst D.W. Winnicott [8], provides a powerful antidote to this dilemma. The term refers to the way a caregiver is most attuned with their infant in the early weeks when they are most helpless and dependent. As development proceeds and the baby grows into a more complex and more self-sufficient person, a caregiver gradually fails in attunement. Winnicott wisely identified that not only are imperfections inevitable, but they are also essential for a healthy sense of self and ability to relate to others.

Decades of research by developmental psychologist Ed Tronick [6,7] offer evidence for Winnicott’s clinical observations. Healthy infant-caregiver relationships, far from being perfectly attuned, are in fact mismatched a whopping 70% of the time. As long as the majority of mismatches are repaired, development proceeds in a healthy direction [6,7]. Baby’s signals can be difficult to read. As infant and caregiver move through misunderstanding to understanding, their trust in each grows.

By listening in, Dr. Barnes did not cut the repair process short to offer her own solutions. Instead, she let her calm presence lead the family through the messiness to repair. For Max and his family, navigating through a moment of discord provided fuel for growth and change, for parents, infant, and their relationship.

When the caregiving environment holds a child in mind in keeping with that culture’s traditions and values, the child develops a trust in the knowledge acquired though moment-by-moment interaction [2]. In countless episodes of mismatch and repair in activities such as feeding, bathing, and going to sleep, a child learns “this is how we do things.” They develop a primary sense of belonging [7].

Perhaps the most important feature of the model of listening in is to help find our way into the experience of a person different from ourselves. Even in sameness there is difference. When practitioners listen to a caregiver from a not-knowing stance, they create a space to enter into that family’s culture as a starting point, rather than assumed notions of relationships that derive from a purely Western perspective. In many cultures around the world, and in many subcultures in Western nations, multigenerational influences play a major role in development.

Practitioners cannot carry this burden alone: they must be supported by long-term investment of resources. But in the clinical encounter, when those on the front lines listen in to the whole of family’s experience, they support caregivers in doing the same for their child. Each moment of connection brings us all closer to shaping a better world.