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All posts for the month March, 2015

This Thursday on ABC Sunshine Coast mornings the topic will be narcissism or extreme self absorption. When is self absorption “normal” and when is it an issue that needs intervention or treatment?  Do “kids these days” still care?  How do you promote caring in kids?
Please tune in at around 9:40 EST or call in for a chat on 1300 903 222.

We all know the scenario, you have finally wrangled the children through their early morning routines (perhaps with the help of my previous blog). They are out the door and headed for the car. You are about to step out of the door on the way to work and school when you hear the shrill, high-pitched whines that indicate that one child has missed out on getting the front seat of the car, again. It’s exhausting…and the day has hardly begun. So, do you leave it, and them, and take yourself off to work by bus – allowing the battle over perceived crime and unfairness to prevail? Or, do you step in with an over-riding command that instils terror and has all of the kids trembling quietly while they buckle themselves silently into the back seat?

Sadly, like all conflict, there is a continuum of extremity when it comes to sibling rivalry and aggression. Sibling conflict can be very violent and, concerningly, research now tells us that it is much less likely to be reported to authorities than other forms of violence or bullying amongst children.

Obviously, if the conflict between your children is violent, then you should always step in. If violence persists or begins to frequently recur, it’s very important that you seek help.

For lesser scale conflicts, though, there are more options on how you respond.  A response is important and warranted. Sanctioning or letting the children sort conflict out completely by themselves can lead to problems because children can learn that bitter conflict is the norm and size, power and resources can be used in unhealthy ways to have a “win”. Researchers know that parents are more likely to leave it to the kids to sort it through when they are closer in age. This is a concern because we do know that exposure to sibling conflict and aggression is linked to poor mental health outcomes for kids.

Also keep in mind that, conversely, parents who step in to manage or settle all disputes between sibs are less likely to assist the children to learn how to do it for themselves. The children are more likely to always look to the adult to do it for them.

Siblings provide a great opportunity for learning about relationships and managing conflict – especially if they are helped to manage the situation with parents or carers who take these opportunities to coach or help in a child-centred kind of way. Coaching children when they are managing sibling conflicts has been found to be associated with better child well being.

I have often told the children that come to see me that their little brother or little sister has the special job of being annoying (and some are very good at their job) so that we can learn to cope with people problems in good ways.

According to university researchers, the sorts of rivalry and conflict that occurs can be different for the different gender of siblings.

When the conflict is brother to brother, the research is suggesting that we need to more often coach with an emphasis on increasing the warmth in the relationship. Sisters (including Charlie’s potential Angels) may more often require assistance with non-competitive strategies and brothers may tend to need additional help to learn non-aggressive problem solving.

When conflict between brothers and sisters, sisiters and sisters, or brothers and brothers arises, these are golden teaching or parenting moments. Take the opportunity when jealously arises to promote non-competitive views of the world and when there is a squabble over resources, encourage the children to problem solve to see if they can come up with a win-win scenario.

There’s also a need to play it fair when parenting. Make sure the measurable support you give your children isn’t piled higher on the scales for one child over the other. We now understand that any unfairness will hang with the child for life and can lead to problematic sibling relationships well into adulthood .

So, sibling “survival” skills are important, but in most lucky first world countries, social skills are more important than fight skills.

Charlie’s Angels learned their awesome self-defence skills from army and police training, not from beating each other up. Their coach and mentor, Charlie, did not step in all the time for his Angels – he phoned in from time to time, usually to congratulate them for behaviour that has reflected some moral high ground. Also, while we might have all had our favourites, Charlie got it fair and never favoured one Angel over the others and he always distributed their resources evenly. Charlie’s Angels could well have been siblings, but only if they were provided with the appropriate coaching and support to learn to manage interpersonal conflict early.  Nice one, Charlie!

This Thursday, around 9.40am EST, on ABC Sunshine Coast Mornings I will be chatting about child discipline.

How do you respond when your child does something they are not supposed to do?
Is it ever appropriate to smack?  What do you remember about they way you were disciplined as a child?
How stressed do you get when your child misbehaves?

The way we discipline children has a big impact on their social and moral development as well as their mental health.

Tune in to hear which discipline methods are the ones associated with the best outcomes for kids, and grown ups. Better still, join us for a chat on 1300 903 222.

Psychologists and researchers refer to troubles with a person’s “get up and go” as issues with “motivation” or a lack of “behavioural activation”. Behavioural activation is important and it is wise to keep an eye out for the child who is straggling in the morning.

Not getting up and getting a move on at the start of each day means that there is less of a chance that we will do, meet, taste, touch, hear, see and feel things that feel good or are rewarding.

We all have things that we want in life and things that reward us. When we are activated, we move towards our rewards. We can start to feel good just by anticipating the good stuff we are working towards.

We feel not-so-good when our goals are thwarted and we sense our satisfaction will be less, or the good stuff feels like it may totally disappear from our reach. If our goals are blocked, we start to be less excited about chasing them. Our drive can start to diminish and we can begin to withdraw.

It is normal to feel like withdrawing when goals are shifted further away. However, when we withdraw, we lessen the chances of achieving things and being satisfied. We also reduce the chance that we will get exposed to lovely, natural, sometimes-completely-accidental rewards and pleasantries – someone being kind, watching people do something silly or funny (because, let’s face it, human behaviour can be hilarious) or seeing, smelling, or hearing something beautiful in nature.

Lack of the accidental rewards, as well not being able to get the things we hoped for, can make a person even less likely to want to get up and go. A lonely, reward-less, unsatisfying cycle can begin.

Sometimes it gets to the point where people become quite slow and have real difficulties gaining pleasure from things that usually motivate them. They can even be clinically depressed. So, is your child’s early morning struggle normal, noteworthy or naughty?

If your child is struggling in the morning, it is wise to reflect on a few things….

  1. What’s your child’s normal pattern and temperament? Are they, and have they always, been a little slow to get going in the morning? If the early morning dawdling or straggling is new or different for them, then something may be going on.
  2. Is your child approaching adolescence? Adolescents and the onset of puberty bring many changes to the body and brain. It is quite normal for a teen to switch their preferred waking hours with a tendency to go to sleep later and rise much later in the day.
  3. Has your child not quite been themselves? Has their appetite or mood changed substantially? Are they having problems achieving the things they want to achieve or is their “flatness” causing big and repeated problems with their routines, friendships and school?

If you feel that the slowness is not usual and not a sign of puberty and you think there are other issues with mood and appetite that are causing big dramas, then it is noteworthy. You should strongly consider a trip to the family doctor. The doctor will likely do some tests to rule out anything biological and may think it is appropriate to get some psychological help for your child.

If the early morning dawdling is more of a nuisance, then consider some changes that will make getting up more exciting and more rewarding. Different things are going to excite different people. Different things will also excite children of different ages.

If your child is in their pre-school or early school years, consider a game of “beat the buzzer”. Discuss and maybe draw with your child the jobs your child needs to do in the morning. Typically, these might include – get dressed, eat breakfast, clean your teeth and pack your lunch.   In the morning when the child wakes, set the kitchen timer or the timer on your phone for a time that you think the jobs could be completed. As the child finishes each job, they can tick it off your list of drawings. If they finish all of the jobs before the timer goes off….then there is a prize. The prize might be time on the computer, TV time, getting to sit in the front seat of the car (if it is safe to do so) or a ticket or sticker that can be saved towards a bigger treat – a movie, special lunch order, or a friend over.

Sometimes we need some artificial rewards to get things up and going for awhile until routine and natural rewards kick in.

Be sure to keep mornings pleasant and fun and always tell people how wrapped you are that they are getting things done easily. Try to avoid an angry, punishing, reward-less morning. It would be perfectly normal and healthy that no one wants to get out of bed for that!

It is wise to prepare yourself for threats to your chosen profession.  Last year, I was asked to address my colleagues at the Annual General Meeting of our regional Australian Psychological Society (APS) group about my experiences as a psychologist in regional practice.  I’ve had some requests from those who could not attend to share some aspects of the presentation.  So, below, I’ve posted the bits I mentioned in relation to the things that I believe threaten psychology as a profession.  Let me know what you think!

 

If I had to sum it up in one word, the biggest threat to psychology in our region is “ourselves”. If I’m allowed a few more words, the biggest threats to our profession are threefold: anxiety that stops us from taking action, laziness, and charisma.

Psychologists, as a breed, tend to be kind natured, intelligent, but easily frightened. I think it’s some sort of anxiety, but psychologists tend to prefer to be very solo in their work. They get in a comfy place and hide there. If a client needs some advocacy or the system isn’t working, it’s easy to shrug your shoulders and say “oh well – not my concern” – but as a psychologist, this is your concern. I have written many a strongly worded letter – like the time I noticed a liquor store application next to the skate park. I have ongoing dialogue with Victims of crime providers and politicians.

These are conversations we psychologists need to be a part of. As I have repeatedly said to many clients “it’s okay to ask for something, but it is also okay for the other person to say no”. If we don’t ask, or tell, or share an opinion, we decrease the chance of change. Get out from your comfy corners and speak up about what bothers you on behalf of your clients and your colleagues

The danger about being an anxious profession is that we avoid things that make us grow. I’ve very often heard people say, “but I don’t have the experience”. I think it’s naïve to think that all clients come with nice neat cases of depression and anxiety. I say, go and get more skills about more complex clients – ask your supervisor, do some reading, sign up for a webinar – It’s these things that could differentiate us from other mental health practitioners – that we confidently apply our knowledge to client’s problems and if we don’t have the knowledge, we should not freeze and refuse a service – we should go and get some knowledge and support for new work with more complex people.

Whilst we value a high standard of ethics, I think some people use the as anxious avoidance. I’ll give you an example.

Our office was trying to help a very suicidal man who called our office but refused to give his details. He said he was calling from a car and was contemplating driving himself and his son (who was in the car) into a wall. While I chatted, others in the team called emergency services who could do nothing without a name or location and he was not giving us those details. He did, however, say he had been seeing a psychologist, so a member of our team phoned this psychologist to see if we could get some identifying information. We got in touch with his treating psychologist who could identify the man from the description of the situation, but said he could not share information because he did not have a signed consent form. Luckily his GP was more helpful and the man and his son were soon safe and the GP followed up.

I was furious! Ethics are there to promote safe and moral practice, not to evade a difficult client. Use ethics to promote safe practice, not to hide behind in times of discomfort – these seemingly small moments threaten the usefulness and professionalism of psychology.

The other threat to our profession is charisma. I like to think about charisma as a special kind of mullet. You know how a mullet is “all business up the front and party out the back” – charisma for me is business up the front, very shiny business, but nothing at the back. Charisma is the false promise that you and your fancy words and your fancy memberships and fancy bits of paper on the wall are helpful. When clients come to a psychologist the expectation is that they will get psychology – not just a chat. Speaking of mullets and all things hair, a chat can be had at the hairdresser or local pub – and you also get a new hair do and a beer from those places. You want more than just a chat from your psychologist. Charisma is a threat to our profession – people soon notice that there’s nothing behind the façade and will refer to someone who will actually do a job, not just give the impression of doing it.

Sadly, for whatever reason, there is a tendency to some laziness in our profession – Scott Miller’s latest research is now telling us that a lot of what make a good change agent is the amount of time spent thinking about/formulating and processing your clients work. So, those of you who see a client, chat and then put the file away ….maybe you should learn to cut hair as well.

When an agency or employer is looking for someone to work with clients, they are looking for someone who will work effectively with clients, not hide from discomfort, and not pass clients around like hot potatoes. The biggest threat to psychology locally is anxiety, charisma and laziness.

It only takes one or two rotten bananas to ruin the bunch. So, let’s prepare ourselves against these threats – seek out new learning and support, express appropriate professional opinions to bring about change (real ones, not just shiny ones) and don’t rest on any laurels and avoid complacency when doing out professional work.

 

There was much more in my rant (changes to to registration over the years, what I think psychologists need to focus on and CPD).  Let me know if you’d like me to pop those bits up, too.

 

Emotional regulation is the ability to be able to monitor and change aspects of our emotions. You hear a lot about it these days and many people do have times when they find it difficult to regulate their emotions.

When it comes to children, it seems that everyone wants to offer something that will get a child to regulate their feelings.  All of a sudden everyone is doing it, offering it, tutoring it, providing vitamins that assist it, offering bodily manipulations that enhance it, selling special aids and machines to assist and all sorts of experts (dodgy and non-dodgy) begin to jump on the band wagon. So much so that, like other concepts that get bandied around too often, I do get a little concerned that the well-researched ideas behind emotional regulation may start to lose “street cred” and people will begin to tune out to all of the emotion regulation information and consider it to be waffle.

If we peel back the layers of people eager to jump on board a buzz topic, we can begin to see what might be truly offered by learning to regulate emotions.

When people come across troubled times, they normally try various adaptive (problem solving, sharing, accepting) and maladaptive things (alcohol, withdrawal, violence) to manage strong feelings. Research tells us that it’s the use of maladaptive strategies to regulate emotions that is most detrimental. Being able to regulate emotion can affect whether or not people with certain personality traits go on to develop problematic mental health such as depression.

I first heard about teaching emotional regulation when I was learning how to implement Dialectical Behaviour Therapy for adults with Borderline Personality Disorder. Most often, those with Borderline Personality disorders have a raft of problematic coping and interpersonal skills and repeated self-harm. They are indeed a complex group to treat. I was not, however, surprised to see the ides of teaching others to manage their emotions starting to crop up in interventions for other mental health issues over the years – eating disorders, chronic depression and autism spectrum disorder. It makes sense to teach those who are having trouble with their feelings to understand and not be overwhelmed by their own feelings or feelings expressed by others.

To truly learn to regulate emotions is a very complex task. People need to be tuned in to the need to regulate themselves and decide whether they want to regulate their emotions or just let fly. If they do want to regulate, then they have to decide which strategy they might use and then they have to correctly execute that strategy.

The idea that poor regulation of emotions can be fixed quickly does seem a little like snake oil.

Learning to regulate our emotions takes time and a willing learner.  When you understand that learning to regulate our emotions is so multi-layered, a day-to-day or school approach would seem to have merit. Many schools are beginning to incorporate emotional regulation into their class curriculum. You may have heard of the Ruler Program or aspects of Seligman’s Positive Psychology  being incorporated into school curriculums. Some schools also use the resources provided by Kids Matter  to introduce emotional skills to students.

It is great to know that there is documented evidence that these emotional learning programs can produce better outcomes for youngsters. However, while social and emotional programs provide useful knowledge about emotional learning, the programs need trained teachers who value the implementation of the program enough to regularly attend the training and implement the programs properly, not jaded teachers who are too busy doing all the other things required of them to value delivering an emotional learning program.

So, tread warily when you are thinking that a child, or indeed an adult that you care about, needs to learn to regulate their emotions. There is no quick fix. A psychologist may be able to assist if you wish to increase the dosage rate of acquiring these skills. A psychologist can help hone in on the particular areas that need work. Also, get on board if your school offers an emotion regulation program (hopefully one that has been adequately researched and provides teacher training and support).

While you are at it, consider the processes that allowed you to understand your emotions as you were growing up.

Guide your children to attend to, and label, their feelings and the feelings of others when you can – watching television together, observing others at the supermarket, sharing your day’s events around the dinner table. Reflect with them on what works for you and for them, and the “pros and cons” of the things they tried to manage strong feelings.

Learning about emotions in ourselves and others is an ongoing process. Getting children attuned to their emotions early may help prevent significant mental health problems down the track, but beware of the quick fix. Look to day to day opportunities with parents, carers and teachers who understand and believe in the programs that rigorous research tells us really work.

why big hugs1Today, I was asked how I came up with the concepts in the Big Hug books……

Talking about tricky stuff with kids

For more than 25 years now, I have had been in the privileged position of listening to the very private worries and concerns of many children. It is indeed a pretty special and sacred position to be in and I am always grateful for the opportunity. From that special spot with young people, I have been privy to their inner most thoughts, how they perceive themselves and others, and the things that they truly value.

When you take some time to understand how each child views the World, there’s a moment where you can start to see the patterns of their feelings and their emotional “logic”. Once you have found that moment or place, you can help a child to unwind the tangled experiences and interpretations so that they can deal with, accept or begin to change their emotional situation. To unwind it, means you have to have a shared explanation. You need something that the child can “get” and understand.

When your client is a child, there is also a need to advocate for them within the various systems that they belong. To do this you need to be able to help their support team, (their families, their carers, their teachers, their welfare workers, their treating psychologists, their doctors, and their special people) to share that same special understanding. After each session with a young person, I usually write them a letter. By writing and sharing the concepts discussed during the sessions, I hope to reinforce what the child and I have learned together and do so in a way that they can share with their support team.

Young children cannot always understand a metaphor the first time around so it requires repeated simple links via words and pictures. I look for metaphors that all ages can understand so that the child can communicate about complex situations in simple ways with the people who know them best. In talking about life (and death), I wanted to base it on something that you know is there, but can’t really touch…the wind. For dealing with the internet, I wanted something that could be fun if played with carefully, but could also have some slippery spots that need supervision and help…. a puddle. For the others in the playground, I wanted a whole heap of metaphors to describe all the different types of personalities that mingle there….jungle creatures. The ups and downs of friendship were always going to be a seesaw. The next two in the Big Hug series are much more intimate and have been written for children when their might be trouble in their families or in the family of someone they know.

The human brain is very complex. There are lots of pathways that a thought or experience can take in a young brain. If a thought or experience has been laid down in childhood, then it needs a child friendly way of mapping it so it can be traversed. Finding a shared pathway can take the “ickiness” or “nagging” out of some tricky concepts and allow a child and their special people a way to work and talk together.

In the 1960-70s, researchers at Stanford University embarked upon the, now famous, Marshmallow Study. They went to the university child care centre to study children’s’ ability to hold back. They devised a task where a child was left in a room with a marshmallow (or biscuit or pretzel if they preferred). The child was told if they wait and don’t eat the marshmallow, the adult would give them two marshmallows when the adult returned. The adult then left the room. There are lots of very funny YouTube clips about the sorts of things that might have ensued whilst the adult researcher was out of the room. Years later, the researchers returned to the study and found out that those who waited for the return of the researcher/adult and received the extra marshmallow, had better life outcomes, fewer issues with being overweight and scored better in high school exams. The researchers are still following this group of, now adult, children and are doing further research mapping their brain activity.

Of course, the Marshmallow study does not mean that your child’s future will be determined by a marshmallow. There are a multitude of other confounding variables that were not accounted for over all of those years form kinder to adulthood. However, people seem to like the idea that those who are patient and hold back will be rewarded on their life journey.

Sometimes, though, not holding back is an adaptive thing.

If you have been starved, why would you hold back? In fact, it would be maladaptive, or just silly, to let that opportunity go by. If you have a huge family and hoards of brothers and sisters and cousins sharing your space, wouldn’t you be more tempted to take that marshmallow? Some children have trouble with being a little too inhibited and holding back too often. Getting it the right mix of “stop” and “go” is a tricky thing to learn.

However, when it comes to mental health, there seems to be a lot of issues that arise for people who have trouble learning to delay their gratification and managing urges. Impulse control or impulsivity is implicated as a risk factor in many concerning mental health presentations. Those who self harm, who have conduct disorder, ADHD issues or anti-social or offending behaviour are very likely to have issues with impulsivity.

Being able to hold back an urge is a complex thing for a growing brain to be able to do. It’s part of what neuropsychologists call an “executive function”. Imagine that the brain is full of worker parts and that there is the top brass, or executive, running the show. Now, imagine that instead of one executive, there is a board and each board member is responsible for different jobs…one for getting things started, one for holding back, one for paying attention, one for managing change, one for organising and planning and one for impulse control and self-monitoring. The board members all need to communicate with other parts of the brain and report back to the board.

Clearly, managing your body’s thoughts and urges is an incredible task for a growing brain to begin to master.

For children who have trouble with executive functions there are a range of things that can assist. Some of these include making sure that the environment helps them – if they can’t do it on the inside of their brain yet, then they will need some help of others on the outside of their brains. If your child has trouble with controlling impulses, it’s important that you try to minimise distractions and temptations that might prompt an urge.

While the environment is being managed, you can also work on helping the child to develop skills such as waiting and holding back. It can help to use visual clues and teachers might want to use traffic lights to prompt children to “stop” and “think” before they “do”. It can also help to re-focus a child and encourage them to self-monitor. If a child has serious problems with these tasks, especially when compared to their friends and class mates of the same age, it is worth getting things checked out. A GP may refer to a paediatrician who could ask for some neuropsychological testing to determine the child’s strengths and weaknesses in executive functioning so that a proper plan of assistance can be purpose-built and put into place by the child’s team.

If you don’t think the child has clinically concerning troubles with delaying their gratification, but you wish to help them work more on “stopping”/holding back from time to time more getting them to “go” when it would help , it is worth trying a few other day to day things.

Once a brain is set on a certain pathway and the “go” button has been presses, the brain is sometimes reluctant to change tack or “stop”. We have known for some time now that if you give a child a series of commands that they are usually likely to comply with (perhaps, “stir this cake mix, crack in the egg, pour it into the pan”), then, when they are on a roll, you throw in one that they are less thrilled about doing (“wipe down the benches”), there’s an increased chance that the less desirable job will get done. The chore is swept along in the brains “go” pattern. This is called establishing a “behavioural momentum”.

Of course, it will help to maintain compliance, waiting, and stopping and going appropriately, if you reward and praise the child and if you model and demonstrate the sorts of behaviours that you would like to see them do. Like all good managers, a child’s brain executive board loves positive feedback and a well-earned treat. My brain quite fancies a marshmallow!