The Mattering of Little Things

Experience and Narratives

As human, social beings, we live experientially. But not all of our experiences are the same. Some experiences, some moments, matter more than others. As Mattingly (1998), and others have argued, some things are mere experience, while some things constitute significant experience. Something is happening here. As Daniel Stern (1994) has described, these points of significance mark a before and after, have a particular feeling shape, and are represented to ourselves as a “lived moment of a whole experience” (p. 17). For example, if you hear a song that in some way mattered to you, let’s say if it was a breakup song, or a song you sang in your high school talent show, you probably experienced it in a multimodal way, in your body, how you heard it, perhaps emotionally linked to some significant other, but not just in a cognitive kind of recollection, like naming that tune. When we experience something significant, it often becomes part of us, is within us, and is represented within ourselves and to others through our narratives and other expressions.

Narratives are tightly tied to experience; they are the innately human capacity to make sense of our experiences in the world, represent them to ourselves and others, deal with the unexpected, and manage troubles or disruptions in our lives (e.g., Bruner, 2002; Mattingly & Garro, 2000; Mattingly & Lawlor, 2000). Because narratives foreground the particularities of experiences, they often serve to amplify the little things.

Narrative structuring of lived experiences occurs early in development, prior to the ability to verbally produce narratives (Stern, 1994). As Bruner (2002) has told us, “Our lives with stories start early and go on ceaselessly; no wonder we know how to deal with them” (p. 3). He and others have also argued people change (or develop) through narratively organized experiences and narratively driven reflections on who they are, and who they are becoming.

And as Mattingly (1998) and others have said, effective narratively organized clinic action or healing practices are generative-producing emergent, enacted (e.g., Lawlor, 2003b; Mattingly, 2001) significant moments of experience that are intersubjectively constituted. When we do, and coordinate actions with another, we rely heavily on narrative structures to act together.

Narratives also reveal how we shape our understandings of our own experiences and how we reconcile what we see as breaches from the expected. These examples don’t just apply to events, but also our sense of who we are and who we are becoming. Our interactions with the world may reveal a kind of breach between who we think we are and who we are becoming, and how others see us. Narratives also expose what’s at stake and where the mattering lies.

In this talk, I will draw on several research projects that have primarily used forms of narrative phenomenology and ethnography. Narrative phenomenology is a term Cheryl Mattingly, Melissa Park, and I (e.g., Lawlor & Solomon, 2017; Mattingly, 2010; Park et al., 2021 ; Solomon & Lawlor, 2018) have used to describe how we have coupled narrative inquiry and phenomenology, referring to understanding lived experience perspectives. Or, as we sometimes say, how real people live real lives (Mishler, 1996). These two approaches together provide a way to relate individual lives with broader social, cultural, and collective influences; facilitate seeing the individual in relation to time and place; and examine the details, particularities, or nitty-gritty of everyday life. Narrative phenomenology foregrounds the interpretive work of meaning-making as a personal, but also culturally informed process (Mattingly & Garro, 2000) and reflects a hybridity of participant observation, phenomenology, and narrative approaches, across multiple contexts.

Overview of Research Studies

These studies have included the Boundary Crossings series of studies funded by Maternal and Child Health and the National Institutes of Health in which we followed African American children with special health care needs enrolled age birth to age 8, their families, and the practitioners with whom they were engaged over a 15-plus-year period. We were examining how cultural misunderstandings and understandings developed in clinical and community settings, meanings of illness and disability in family life, and how people came to know enough about each other to forge effective partnerships.

I will also draw on “Autism in Urban Context Study: Linking Heterogeneity with Health and Service Disparities.” This study included 25 African American children with autism ages 4 to 10, their families, and practitioners who served them, led by Dr. Olga Solomon. I am also drawing on three smaller projects involving medically fragile children and their families; collective narratives with family members of autistic adolescents and adults; and a current study of the intersectional effects of the multiple pandemics we have experienced, including COVID, racial and social inequities, and health inequities, funded by the Chan Division and co-run with Dr. Erna Blanche. Details of funded grants are provided in the acknowledgments.

Although these research projects have each had their own identifying features, they also have distinct differences. In preparing for this lecture, I have had the opportunity to reflect on the continuity and stickiness of some ideas that have endured over time, as well as the departures and disruptions in thinking that came with each new endeavor. Not surprisingly to some, this talk will also be about stories: how stories help us make sense of our experiences and how stories can be vehicles for engagement and promote deeper understanding.

All of the projects described shared a commitment to gathering and valuing multiple perspectives. We have been particularly interested in how it can be that individuals who share an event, such as a family dinner, or an occupational therapy session, may have very different perspectives on what happened and what they experienced. Sometimes, many of us might even in our own minds have more than one perspective on what is happening and what it might mean. Our goal has not been to decide which perspective is more right or true but rather to appreciate the multiplicity and diversity of interpretations that seem to be generated by one happening and to recognize that events in the moment carry the remnants of past experiences as well as anticipated futures. We also have grounded a lot of our data and analysis in an appreciation for how each perspective, even if it may vary quite a lot from other perspectives, has its own intrinsic validity. Michael Jackson (2005), the anthropologist, further reminds us of the importance of gathering multiple perspectives by noting, “the ways in which storytelling, simply by virtue of its being a shared action of speaking, singing, sitting together, and voicing various viewpoints, makes possible the momentary semblance of a fusion of disparate and often undisclosed private experiences” (p. 359).

The Nachos Story

I want to now share some data points or stories to provide some material to think with. This is, on the surface, a story about nachos as told by a mother of a teenage son in a collective narrative meeting with other parents. These meetings were developed as a data collection method to enable families to tell stories to each other. These evolved in some studies to be more like social learning communities and, as many parents have told us, provided a valued opportunity for them as research participants to be with other families who “get it,” to be heard.

This particular passage is drawn from a recent study of parents who had adolescents, young adults, or adults with autism in their families. And as an aside, one thing we have learned through multiple projects with the autistic community is that language is not a little thing, and there is no consensus about the use of identity-first language. In this talk, I am trying to honor the choices that participants themselves have made in the language choices.

This excerpt is narrated by the mother and her mother, or the child’s grandmother, who is present in the home.

But today my mom just was—I made my son some nachos and he didn’t want to have anything to do with it. And my mom was sitting in the living room and she was just like, “I just really want some nachos.” My mom’s trying to diet it’s—so she’s, you know, she’s talking to herself, but out loud, “You know, I just really wanted some nachos and would you—would you just go get me some?”, and he just got up, went into the refrigerator, put it together, and then brought her a plate. We didn’t know what he was doing. Usually, he’ll walk out of the room and—we, we always give him things to do or say and we—I just always wait for him to respond.

The mother continues with her story:

He—he’s completely nonverbal . . . and when someone comes to him and they talk to him, I kind of just wait to see—maybe he’ll respond one day. . . . Before I kind of chime in and say, “Aw, he has autism; he doesn’t speak.” So he just put it together, and he brought it to her, and my mom, she took it, and then I mean . . . it didn’t even register at first cause he kind of disappeared for a while and then he came back and, you know, he handed it to her. He just sat down and so she’s like, “Oh thank you.” Then she’s like [in a loud, high-pitched voice], “He brought me nachos!” She was just screaming. She said, “Did you see? Do you see these nachos?” and I was like, “Yeah.” “But did you hear me tell him I really want the nachos, but the nachos were here?” I said, “I know.” So that happened literally like 5 minutes before I walked out the door to come here. He surprises us every day.

Ordinariness as an Extraordinary Achievement

I know it is hard to convey the emotion, sense of awe, and excitement that this mother shared, but I hope her words portray that. This is a brief story that is, on one hand, a seemingly ordinary moment in family life, but I will argue it is so much more. Like many impactful stories, there is a breach of what was expected—perhaps hoped for, but not expected. And, more importantly, the ordinariness of the delivery of the requested nachos was perceived as a remarkable achievement: in essence, something extraordinary.

These moments of extraordinariness are not just limited to a particular activity or event. They often, and we’ve heard this in many ways—particularly from families, but also from clinicians—reveal capacity that people hadn’t necessarily identified or perceived in their child or children, and these moments can end up being quite transformative (Solomon & Lawlor, 2013).

Many of you, probably just in terms of experiencing the pandemic, have noticed in both personal and collective discourses how much talk there’s been about getting back to the regular, the routine, sort of an appreciation for the mundane and how, in some circumstances, like maybe going to the movie theater for the first time in 3 years, or eating in an indoor crowded restaurant, what once was ordinary is now experienced as something that has become extraordinary. The mattering of these moments in daily life are often revealed when we recognize the extraordinariness in the ordinary.

Complementarity and “Partnering Up”

I am going to now shift to the second major theme of complementarity. Boundary Crossings and related projects were based on a fundamental question: How can we come to know enough about each other to effectively partner up? (e.g., Lawlor & Mattingly, 2014). I recognize that sounds also like a very simple, straightforward question. But I must say, even after many years it continues to be a question that deserves more scrutiny, more elaboration. This question is particularly salient when therapists and other clinicians come from very different lived experiences from the people who engage with them in their practices. We found that a “good enough” understanding of one another’s cultural worlds for effective collaboration often does occur despite the complexity of what must be learned. Clinic and family cultures are both highly heterogeneous, consisting of numerous subcultures, variations in practices and beliefs, as well as ways of knowing. Understanding another’s culture is not just a need for clinicians but rather also important for clients and families who may have the greatest cultural understanding task and the most at stake. Over time, one of the things we’ve appreciated is all the work that children and families often do to develop their own understanding of the sociocultural dimensions of the clinical worlds that they’re in and to understand them better (Lawlor & Mattingly, 2014). I know I’ve shared this story in the past in publications, but it’s about one young child who was about 3. She was close to the end of therapy with an occupational therapist whom she had worked with for a number of months. They had developed a very close relationship, and she wanted to tell the therapist that her imaginary friend had been attending occupational therapy this whole time. The therapist was very touched by this child sharing this kind of very private secret that she hadn’t shared before. But a few minutes after the child shared the story, she looked a bit upset and put her hands over her mouth like a megaphone and yelled, “Don’t tell Dr. Greene,” her surgeon. Even young children often try to intuit or understand or come to know the ways our clinical worlds work, and she was, I think, accurately perceiving that this was such a unique story that the therapist would share it with the surgeon. And she didn’t want that private secret shared (Lawlor, 2009).

Partnerships demand coming to understand how another is thinking, perceiving, and acting to relate, coordinate actions and interactions, and produce effective and responsive health care. An effective partnering occurs around a constantly evolving story, whether it’s a developmental story, an illness story, or a medical and rehabilitation story. What kind of stories or life stories are possible, and how do experiences within the clinical setting intersect with the child’s or family’s unfolding stories?

One of the ways that we talk about partnering up is to encourage people to figure out how to learn in the moments of engaging with another in a clinical setting. So, it’s not preconceived knowledge about how to have a good collaboration or partnership, but it’s a relational in-the-moment experience of learning how to learn from one another in the context of giving care. We encourage clinicians to think about how to “learn how to learn,” to borrow a phrase from Gregory Bateson (1972), in the moments of meeting another rather than entering an encounter with preconceived notions of how to best engage. Or to say it in another way, as William F. Hanks (1991) has said, “that learning is a way of being in the social world, not a way of coming to know about it” (p. 24).

The intersubjective load on health care encounters is magnified when people perceive one another in ways that foster distrust, heighten vigilance, anticipate conflict, or foreshadow danger. The load is weighted as well with the work that people do to anticipate how they might be perceived or misperceived in ways that may negatively impact care or that could be dangerous, resulting in a judgment about their capacity to be a “good parent” and comply with medical directives and routines. One mother shared:

But then when I go in and start breaking stuff down to them [referring to information from her own reading and research], they turn their back and, “How did she know this?” And then, you know, the doctors have this—little recorder where they go and record stuff. . . . My last appointment—I just mentioned my carpal tunnel and he went off. . . . He went to that little tape recorder, and I was like, “Be quiet!”, telling my kids, “Be quiet! Shh! I wanna hear this!” He was like, “Mom can’t—I don’t think Mom can—” “Uh . . . what did he say?” “I don’t think Mom can handle this situation anymore and Mom needs to get this and that fixed.”

This mother’s reading of the situation is an example of how intersubjectivity can also reveal how someone can intuit what another might be thinking and pay attention, and in this case to alert to potential problems or misunderstandings. As Michael Jackson (1998) has argued, there are complementary poles to intersubjectivity. For him, compassion and conflict are complementary poles of intersubjectivity, both requiring an understanding of another. Or, as another example, one might say that attunement or harmony may be on a complementary pole to bullying. In practical terms, we might say an aggressor really knew “how to push my buttons,” acknowledging how someone must have a clear reading of the other to provoke or bully.

Different ways of engaging come with different social contracts and expectations. There are multiple terms available to describe relational forms of two or more people engaged in joint endeavors (e.g., collaboration, coalition, coordination, coercion, collusion), and in health care encounters such relational terms are often used with both a lack of precision and an assumption that their meanings are self-evident. Although the term collaboration peppers the literature and is commonly heard in clinical discourse, its depiction belies the range of forms of engagements in clinical encounters and the multiple perspectives of individuals on how they actually experienced the encounter.

I’m sure I’m not the only one here who’s heard a phrase such as “That was such a great collaboration with you,” and my thought bubble explodes a little bit, because I think collaboration might be one of the last words I’d use to describe that exchange or that partnership. We encourage people to really think about their social contracts with the people that they’re engaging with in their practice worlds and their clinical worlds, and not to presume that the word collaboration means that people are truly experiencing the kinds of reciprocity and engagement that would rise to that level.

Of all of the relational words, and the shadings of meanings, I am particularly drawn to the term complementarity. Complementarity has been defined as “the quality or state of being complementary,” with a secondary definition of “completing or making whole” (https://www.dictionary.com). The parallels with the term reciprocity add to our selection of this term described as how “one thing supplements or depends on the other” (https://www.thefreedictionary.com), or as “combining in such a way as to enhance or emphasize the qualities of each other or another; a relationship or situation in which two or more different things improve or emphasize each other’s qualities” (https://www.oxfordlearnersdictionaries.com/us/).

We argue that the narrative underpinnings of effective partnerships are constituted through a set of processes and related practices we term narrative complementarities. Narrative as a qualifier to complementarities is intended to emphasize the narrative structuring of key elements, including narrative mind reading and intersubjectivity, construction of joint actions in health care encounters, temporal and spatial characteristics of care, and moral and ethical concerns.

Complementarities among people in health care encounters afford the construction and brokering of knowledge, perspectives, and expertise central to partnering up in the delivery of effective health care. We identify forms of complementarity that emerge in situations of conflict, contested identities, or dissonance and analyze how a certain degree of difference affords effective partnerships. Many of us could reflect on our own relationships and would probably also conclude that partnerships in which we are very similar, or just like another, probably were less successful than partnerships in which we appreciated and learned from our differences, a phenomenon captured by the phrase “Opposites attract.”

One of the reasons why I think it’s a term that is worth thinking about—and thinking about how to potentially enact it—is that it makes it possible to leverage differences and to make sure that differences enhance the ultimate outcome of health care and developmental services. This approach is not about bridging or diminishing difference, but it’s about really thinking about how people coming from different perspectives and different expertise can create something better, more complete, or more whole. One important aspect of leveraging differences is to maximize the available expertise of all the parties involved in a health care encounter. We draw on the term distributed expertise in that it is not the clinician that has all the expertise needed to create the best outcome, but rather all parties have forms of expertise that can contribute. Sometimes, decisions or plans or actions aren’t in just one mind but rather distributed across minds or maybe even between minds. When these kinds of collective approaches occur, one might hear “I don’t know whose idea it was or who said it,” acknowledging the distributed nature of learning from each other.

There are a number of terms that have arisen to try and capture ways of engaging that promote responsive and effective care, including cultural safety (Kirmayer, 2012) or cultural humility (e.g., Agner, 2020; Greene-Moton & Minkler, 2020). These approaches offer tools to promote reflection on one’s stance or way of being in the moments of our engagements with others. I see some affinities between these terms and complementarity. These ways of reframing our encounters can be catalytic and hold potential to alter relationships and social contracts; power dynamics; and how care is coproduced, offered, and received.

Interconnectedness and Belonging

I would now like to turn to the third major theme in this talk: Interconnectedness and Belonging.

The stories shared in this talk highlight the centrality of connectedness in family life and clinical worlds. As Tronick et al. (1998) has asked, “What is it about connectedness that makes it so critical to human experience and to development?” (p. 296). Or, as Carrithers (1992) has pronounced, there is an “innate human propensity for mutual engagement and mutual responsiveness” (p. 55).

Although intersubjective processes are by nature not directly accessible, their import is evident and quite transparent and arguably observable both in the moments of health care encounters as well as daily life and in the narrative representations of these experiences through interviews and other texts. Evidence is also available through moments of contestation, conflict, and disruption. As Cole (1996) and others have argued, our deep reliance on intersubjective processes is often most apparent when breaches occur and misunderstandings are revealed. I have previously shared an example of a therapy session in which a child completed a puzzle and the therapist moved to engaging the child in cleaning up the puzzle so that they could go on to the next activity (Lawlor & Mattingly, 2014). This child often liked a pretty fast-paced therapy session. The therapist immediately sensed a breach in understanding and pivoted to leaving the puzzle out so that everyone could enjoy what he had done. The child visibly relaxed and transitioned smoothly to the next activity. This is, of course, just a small act and a brief moment, but arguably a pivotal moment. This could be dismissed as a little thing. I would hope that it illustrates how central these little things are to the creation of therapeutic experiences that matter.

Occupational therapists often link interconnectedness with engagement. I have described engagement as the coupling of the quality of the interrelatedness among the participants and the investment in the action or the doing—or, in other words, the importance of “doing something with someone else that matters” (Lawlor, 2003b, p. 432). In therapy, these characteristics often contribute to the enactment of significant experiences, that something is happening here.

In this example I will share, I am quoting a mother who is referring to a dance recital. It is not a therapy session. But I think it is very relatable. The mother describes her exploration of dance classes for her son with autism in her ongoing efforts to find community-based activities to enhance her child’s experiences and engagement.

Here she’s talking about a dance teacher who organized an event and who supported her son’s participation:

And I was shocked because, you know, the loving—you know, people in the audience—’cause they could see right away he’s a kid with special needs, you know, he’d do some little thing and they’d all start cheering. I thought, “Oh, he’s gonna die,” because, you know, the noise. And he just kept going with a big smile on his face. It was amazing. But I was thinking, “That’s the power of doing something you really love with people you really love.” And I thought, “There is no program better than that.” You know, it was just really neat.

Practitioners also have moments of engagement with families and children that become part of their lives and interwoven with their narrative construction of their practitioner selves:

’Cause, Sal is like my heart, I don’t know what it is about him. He is just so loving. I mean, when I have bad days or something happened that night and I go see him, and that smile is just. . . . “Oh—,” like, “Oh, Sal.” And he comes and gives me a hug, gives me another hug. It’s just perfect. I’ll be sad to stop seeing him, but I’d be happy to know that I was a part—I played a part in him being able to develop.

Intersubjectivity extends beyond just the people to encompass the cultivation of understanding of spaces, places, and institutional cultures (Crapanzano, 2003; Jackson, 1998). One of the things that’s intrigued me most, and it’s been one of those aspects of spending so much time hanging out in occupational therapy clinics that I’ve enjoyed, is looking at the wonderful work that clinicians do to transcend the physical space. Sometimes, when I have been in a clinic, and maybe there’s a game of basketball going on, you almost think you’re on a playground with people playing basketball. Therapists and children often work and use narrative strategies to transcend the constraints of the physical environments. Therapy contexts are constituted through actions, interactions, improvisations, and use of an “as-if” kind of mode (e.g., Lawlor, 2003b).

Concluding Remarks

I encourage you to think of these forms of engagement as little things, with an awareness that little things can be gateways to healing, connectedness, and making whole, and maybe the thing or the big thing. As you gaze anew at your practices, I hope you discover many little things that warrant investment, uncover the extraordinariness in the ordinary, and engage in partnerships that are, perhaps, transformative.