Chico Center for Psychotherapy

Psychotherapy and Counseling services for Children & Adults | Support for Parents


Chico therapist An Bulkens, LMFT is psychotherapist and counselor in Chico, California.  An Bulkens specializes in psychotherapy and counseling for young children  (toddlers, preschoolers, adolescents) and support for parents, with a special emphasis on  early childhood psychotherapy, and counseling  for preschoolers and Kindergarten aged child.  She also offers parenting skills support. She offers psychoanalytic psychotherapy for adults.  Her approach is grounded in  Lacanian Psychoanalysis. She was also trained as a clinical psychologist in Europe, Belgium.  Her education emphasized developmental psychology and psychoanalytic therapy. 

Filtering by Category: Chico Parenting Support

Chico Parenting Support: free parenting workshops

I wanted to share some information about upcoming parenting workshops.  I have been planning on starting a reflective parenting group but it is still in the works.  I would like to share the parenting workshops that are coming up, conducted by Lynn Haskell.  Lynn has been active in the community working with parents and young children for many years, and will be offering the free parenting workshops at Butte College.  The workshop 'NO DRAMA DISCIPLINE' is based on the book by Daniel Siegel, MD and Tina Payne Bryson, PhD. It is an interactive workshop that includes exercises and group participation.  The focus will be on parenting pre-school to school age children.

May 24    Week 1/4  Rethinking Discipline, your brain on discipline

May 31    Week 2/4  From tantrums to tranquility: Connection is the key

June 7    Week 3/4  1-2-3 Discipline: Redirecting for today, and for tomorrow

June 14 Week 4/4  Addressing Behavior: As simple as R-E-D-I-R-E-C-T

To sign up call Butte College Foster/Kinship Care Education at 530-897-6235 to sign up.



The Cost of Helicoptering and Snow-Ploughing your Child

Psychologists from the University of Mary Washington looked at how the parenting style of 'helicoptering' correlates with the self-determination and well-being of college students.  297 Undergraduates students (18-23) described their mother's typical parenting behaviors, as well as their autonomy and competence, their anxiety and depression, and how satisfied they were with life in general. 

The students who described their mothers as more helicoptering were  found to suffer more from anxiety and depression, and felt less autonomous.  They were also struggling more to get along with others. 

In two different studies it was found that young adults with helicopter parents have become addicted to affirmation, that they prefer the boost of self esteem over having sex, eating sweets and drinking. 

When children are praised for accomplishments, achievements they tend to read this not as the parents intend to.  They think: 'You love me for what I achieve, accomplish; this means you don't love me for who I am without my accomplishments.' They feel that they can only get love by earning it. 

Another problem is that this kind of parenting, where the parent is so over involved with the child, more than with the people of his own age class is detrimental for a more deeper reason. Why does the parent have to be so focused on the child? Why does the parent have to find satisfaction for her own life vicariously through the child.  The French Psychoanalyst Francoise Dolto pointed this out long time ago. In the introduction to Mannoni's 'The First Encounter with the Analyst' she mentions that the one crucial component in having a healthy development of the child is that the parents find the reason and meaning of their life in their spouse, or people of their own age, and not in their children.  This means that the thinking and worries about this child, that work done for this child and the love for this child never dominate the parents' emotional life. 

It is indeed the very opposite of helicopter parenting.  It is interesting that like Dolto would have predicted it is specifically this kind of parenting, which goes against the one fundamental environmental condition that Dolto mentions for healthy development that is found to be connected with an increase in mental health issues among young adults. 

To schedule an appointment call An at (530) 321-2970

Sensory motor play in early intervention

Robbie Levy, an OTRL who founded Dynamic Kids in New York, a practice that partners with NYU in graduate research came to talk in Chico.  She described how the children that are brought to her are increasingly younger, and also have a shifting presentation.  Where in the '90s there were more motor issue, the current presentation is dysregulation and anxiety. 

There are multiple issues that contribute to this changing presentation.  Children are from a younger age exposed to media.  The average 3 to 5 year old child spends 5 to 7 hours per day with media.  While the guideline is about 1 hour per day. And NO technology for children between 0 and 2 years old.  When a 3 year old spends that many hours on technology, she does not have enough time for physical movement, outdoor time, exposure to develop other than visual and auditory senses, time with manipulatives, quite, contemplative time, or pretend play...Another issue is when the parent tends to be on the phone as well.  This reduces the interaction time between the child and the parent. This interaction is important for the learning of the child, as it is during those interactions that the parent can scaffold the child's knowledge, and this interaction is most important as it helps the child to regulate. And this is were things seem to go wrong currently, as a typical general education kindergarten looks more like a special ed kindergarten looked like a generation ago.  Currently between 30 and 60% of children in a regular kindergarten class qualify for OTR services. 

What is needed is a real change in culture.  A lot of our current practices, not just technology contribute to the dysregulation of the children, leading to the need to introduce meditation and yoga practices in school.  In the following posts I will share some ideas about how to implement some ideas that can make daily life a bit easier if you are living with an easily dysregulated child. 

To schedule an appointment call An at (530) 321-2970



6 challenging times with your young child according to Brazelton

Berry Brazelton is Clinical Professor of Pediatrics Emeritus at Harvard Medical School as well as the founder of The Brazelton Touchpoints Center at Boston Children’s Hopsital.  He was awarded a Citizen’s Medal by President Obama.  He was also named a Living Legend by The Library of Congress.

Brazelton’s work emphasizes that there is no right or wrong way to parent.  Every baby, every child is different.  If one approach does not work, another can work.  ‘Learning to be your child’s parent is about having an experimental, trial-and-error mindset.’

The difficulty moments for parents are when children reach certain touchpoints.  According to Brazelton they are predictable developmental points, but parents typically think that there is something wrong with their child.  They get anxious, it might be in those moments that abuse becomes more likely.  They might think that there is something about their parenting that is not quite right.  They might get upset with their child.  It is here that the parents will need extra support.

According to Brazelton there are 6 touchpoints:

-Unexplained, end-of-day fussing that starts around 3 weeks.  This can be very difficult for parents as it is unexplained, and very hard to sooth.

-At 4 to 5 months, the child can focus the eyes much further from the breast which might make feeding more difficult, possibly leading to conflict between parent and child.

-Between 7 and 9 months the child start to point.  The parent can feel bossed around.  They can put crawl and put little objects in their mouths. 

-At age 9 the child start to read the parent’s nonverbal cues.  At this point the child start to test the limits. This can be a shock for parents.

-At age 2 there are the temper tantrums, the ‘terrible twos.’

-Then there is the toilet training which does not have to be a struggle, but often is, and can end up becoming a battle of control.

-At age 3 there is the ‘I want to do it myself’ issue.

All these touchpoints are moments where the parent can start ‘arguing’ with the child, but possibly also with the other parent, which complicates the situation. However, they are moments of growth for the child, and can also be moments of growth in the relationship with the parent. 

To set up an appointment you can reach An at (530) 321-2970


Your child off to college? Left with an empty nest?

Did your child leave for college, and are you left with an 'empty nest?' Chances are that you do not feel 'empty' at all.  Chances are that you are handling the situation pretty well. In a comprehensive study about parents' well-being when children leave home, Genevieve Bouchard concludes that the consequences of children leaving the parents is relatively positive. Other studies also indicate that 'empty nest syndrome' is largely a myth.

That being said, it is a fact that interaction and activity patterns between parents and child have to be modified for the family to persist.  And that families have to adjust to the new situation. The system is being profoundly modified. 

Becky Scott in 'Life in the Empty Nest' gives the following advice:

1. There is no 'right' way to cope:

Just like with pretty much everything in parenting. Although parents would like to have the one right way to approach a problem, an issue with their children, there is not one right way.  Each family, each parent and child have to find a way that works for them.  There is no formula, but there is room for creativity.

2.  Communicate

With your child to come to an agreement about how often you will be in contact, with your spouse how you will fill your child free schedule.

3. Address and resolve conflicts immediately.

As both children and adults are adjusting into their new roles, it can be stressful for both parties.  The pain and conflict that can emerge during this time is not a new conflict, but typically something old. It might be the time to take a closer look at this.  I think of a mother whose very old feelings of abandonment were triggered.  Although she wanted her child to become independent, she was perceiving his striving for independence as an abandonment, a rejection.  The difficulty this woman was facing was how to find a balance between supporting her children and letting them learn on their own.

4. Finding balance between independence and connection

You want to support your child fostering interdependence.  His or her support system should include his family of origin, but also new friends, college... It might be hard to let go of being the only one or main one protecting and supporting your child.  

How do you think you might feel about your children leaving the house?

To schedule an appointment call An at (530) 321-2970


Your child's creativity and it's GPA.

Counseling centers at universities and colleges have been overflowing with emergency call.s  At one university it was stated that over the past 5 years emergency calls to the Counseling center had doubled.  Students are increasingly seeking help not just regarding issues like depression and anxiety, but regarding on the surface banal problems that seem to occur in everyday life.  An example was a person who felt traumatized because a roommate called her the B-word.  Or a student who called the counseling center because he saw a mouse.  Or even getting a B or a C can activate a student to call a therapist, as it is considered often as 'failure' are a reason to call the counseling center.  This current trend seems to indicate a decline in resilience among young adults. Colleges are struggling.  Traditionally their mission was to busy themselves with higher education, but the lack of resilience to address typical problems seems to demand that the university and professors also take on the role of substitute parents.  They wonder how much hand holding has to be done.

Peter Gray, the author of Free to Learn connects this decline in resilience with the dramatic decline in children's opportunities to play, explore, and pursue their own interests away from adults.  Among the consequences he states are well-documented increases in anxiety and depression, and decreases in the sense of control of their own lives.  This generation of children has not been given the opportunity to get into trouble, make mistakes and solve them.  Gray thinks that 'helicopter parenting' is at the core of the problem, but he makes clear to say that it is not the parents who are to blame.  We are living in a 'helicopter society.' He states that if we want  to counter these social forces, we have to give the children the freedom and practice to take responsibility for themselves. In the current society, children and parents alike are victims of the increased power of the school system and a schooling mentality that says that kids develop best when carefully guided and supervised by adults.  

We could see in everyday life and my practice with children and their parents that this plays out in the attitude towards grades. Often anything under an A is considered inadequate.  The focus on GPA becomes so central, as it is taken as the indication of future success or failure. What controlled research studies are currently discovering is that there is either no correlation, or even an inverse relation between GPA and Innovative orientation or creativity.  A study at NYU found that there was an inverse relation between students' reported GPA and their orientation towards creative or innovative work. One of the possible explanations was that possibly students with propensities toward innovation are less concerned with grading systems that rely on memorization.  Or, college going students with innovation intentions may be more likely to approach their education as a means to discover new ideas, wanting more out of the experience than a series of external valuations. 

So, in today's helicopter society it is harder for students to build upon their natural curiosity and creativity. As parents, it might be our task to not fall in the helicopter trap, and leave the door open for growth towards independence, and leave room for creative exploring of interests, rather than focus too strictly on GPA.

You can contact An at (530) 321-2970/




How parents can help kids through their separation.

One motivation for a parent to bring a child to talk to a counselor or therapist is when the parents are going through a separation or a divorce.  Parents, aware of the conflict between them are often sensitive to the need of the child to have a neutral space to talk, to put things in perspective.  It is this neutral space from which to respond to their child’s implicit or explicit questions which has been lost.  The parents are at odds with each other, feel angry and hurt.  The child picks up on these emotions no matter how good the parents try to hide it, and parents are often at a loss of how to speak about their emotions to the child without attacking the other parent whom they feel so hurt by. 

An initial step would be for the parent to be aware of this underlying emotion, and to be able to name this emotion, acknowledge it.  This will allow the parent to recognize it toward the child in a more neutral tone, without the underlying, for the child confusing affect.  The child picks up on the underlying, diffuse anger that you are trying to hide, but if you can tell him as you are aware of your feelings you can say: ‘You know, I am very angry with your dad. We have a big disagreement, we are trying to work it out. I am sorry that I have been a bit short tempered, but our dad and I are working on it.’

Parents who are caught in a heated separation also tend to forget the good aspects about the ex, and the father of the child. And they might not realize that be painting this negative picture of the child’s other parent, they are at the same time painting a very negative picture of their child. Being able to acknowledge to your child your conflict, but also maintaining a space to talk about the positive aspects of the other parent will be an enormous support to the child.

Also being aware that you and the other parent share the same goal of nurturing secure children can be a common goal that allows you to connect, and transcend a space of hate and resentment.


Contact An to schedule an appointment at (530) 321-297

Learning about the world by creating your own world in art and play.

Before I started working as a psychotherapist, I worked with preschool age children in a small nursery school program that I had created.  I ran this little school l for about five years before opening my private practice.  One of the important things I was able to witness during my work with young children was the importance of play, and the typical high level of creativity, and natural creative exploration in young children.  You don’t have to teach a young child to play. You don’t have to teach them to be creative.  Children are naturally, deeply creative.


In a recent post, T. Goldstein states that 'any time a child does or learns something new they have to be creative in their own, small way. They have to come up with something original, which they’ve never done before, and something useful, which can be used to solve the problem they may be working on. Although this type of creativity may not be what we think of as being behind the great works of Picasso or Bach, the important connection between play and the arts cannot be overstated.'

It is easy for a young child to be creative before formal schooling, but it can be hard for children to keep that same sense of creative freedom once they’ve entered the classroom. Especially because of the current emphasis on curriculum standards.  This tends to lead to a certain rigidness of lessons and it deprives students of the best way of learning: through personal exploration and discovery.

This tendency has unfortunately entered early schooling as well.  Kindergarten is especially noted for moving away from child-directed activities and, 'disturbingly, towards high pressure teacher-led pedagogy.'  Goldstein mentions that 'engagement in the arts—which emphasizes personal ways of knowing, thinking about the self, and discovery—may be key to providing children with creative experiences.' 

In psychological and educational research on creativity, Goldstein states one often talks about different types of “Cs”: “Pro-C,” “Big C,” “Little-c,” and “mini-c.” “Pro-C” and “Big-C” are what we’re usually talking about when we use the word “creativity”—advances in the arts, engineering, or sciences with innovation and usefulness at the forefront. 

It is “Little-c” and “mini-c” that is critical to children’s growth, knowledge, and achievement. These can be thought of as the kinds of creativity children engage in when they’re discovering something new to them.  The process involved in this is foundational in later achievement and abilities.

How can we foster this capacity: One way is through engagement in pretend play and the arts. As children play they are creating a protected space for themselves to make mistakes and try out different emotions and social situations. Creating knowledge on your own is the best way to learn—children and adults alike will remember more, and know more deeply, material that they have taught to themselves over material explained to them. 

Sciences, math, and engineering do also require and engender creativity.  But at the elementary and middle school levels, much of the coursework in these topics is based on recreating knowledge that is already well established in those fields. 

The arts on the other hand demand creativity in the moment, constant trial and error, discovery, and mistakes. Goldstein mentions that 'in a detailed ethnographic analysis of high quality visual arts classes for adolescents, psychologists Lois Hetland, Ellen Winner, Kim Sheridan, and Shirley Veenema found that the key concepts being taught in arts classes—beyond learning how to hold a paintbrush or mold clay—were to stretch and explore thinking about materials and topics and to observe and reflect on how to engage in artistic work.'

It may be (and research is currently investigating this) that by learning these skills in an artistic way children will be better prepared for more traditional academic learning and creating their own knowledge. 

As parents we can make sure that our children can experience these kind of creativity engendering activities outside school life, which seem to be currently not feeding this need of children.

To schedule an appointment call An at Chico Center for Psychotherapy at (530) 321-2970

Respecting your teen's privacy in a technology filled world

As a therapist working with children, teens and their parents the issue of how to deal with a teen's privacy in this technology filled world comes up on a regular basis.  I recently came across an interesting study by Cranor, et al, about parents' and teens' perspectives on privacy. It was interesting that most of the parents interviewed thought it was important for their teens to have privacy, that it was an essential element in their growth towards becoming independent adults.  It was interesting to see that the researchers found that the parents in general transgressed this right when it came to monitoring their children's use of technology.  They did not act in accordance with their believe in the importance of privacy at all.  The reason for this was a lack of understanding by the parents on which role social media played in the role of their children's social life.  The fact that popular media focus on those new technologies from a 'worst-case scenario' point of view also contributed to this effect. The reporting might give parents the impression that Snapchat is use mostly  for sending sexually explicit messages, while it is only a small fraction of teens who use it that way. 

The negative effect of this is that teens feel that their space is being invaded, and they feel they are not trusted by their parents.  All this can lead to a negative spiral of growing misunderstanding between parents and teens.  

The study finds that it is important that parents get better educated about these technologies, on the other hand, they agree that parents have an important role of guidance to play.  They advocate for software that is less restrictive but tends to nudge the teens more in the right direction.  The current digital monitoring software is not in tune with the goals of parents.  Parents want to guide, but not necessarily block certain sites. 

Digital parenting software that would be more in tune with parents' objectives would detect actions that a parent might not approve of and take the opportunity to remind the teenager of the parent’s expectations and the teen’s responsibilities, yet not block the action.  In a field trial of privacy nudges for Facebook, Wang et al. found that visual reminders of a family member being able to view content was effective in encouraging privacy-protective behaviors The nudging approach to digital parenting software might alleviate parent-teen tensions because teens would still be free to make their own decisions, albeit with guidance and reminders.

To schedule an appointment call An at (530) 487-4245.

For the study, see: Cranor, Lorrie Faith, et al. "Parents' and Teens' Perspectives on Privacy In a Technology-Filled World." SOUPS. 2014.

The daydreaming child

Daydreaming: Not a Useless Waste of Time

Parents are often worried about their non-focused, 'daydreaming' child, who does not seem to be paying attention much to what the teacher or the parent is asking. In their book Wired to Create: Unraveling the Mysteries of the Creative Mind, Scott Barry Kaufman and Caroly Gregoire dig into creativity in a new way. They argue that daydreaming is a crucial part of the creative process, and for children to thrive as creative beings. 

According to a study by Harvard psychologists Daniel Gilbert and Matthew A. Killingsworth, we daydream forty-seven percent of our waking hours. Whenever we are the least bit bored, our minds naturally wander. In those hours of daydreaming we explore associations, we make connections, we search for possibilities.


Kaufman and Gregoire devote an entire chapter of their book to the topic of daydreaming. In fact, they present good scientific evidence that both daydreaming and using solitude for reflection are among the attributes of highly creative people.

In an excerpt from their book, Kaufman and Gregoire point out the many benefits of daydreaming:

Creative thinkers know, despite what their parents and teachers might have told them, that daydreaming is hardly a waste of time. But unfortunately, many students learn to suppress their natural instincts to dream and imagine— instead, they’re taught to fit into a standardized mold and to learn by the book, in a way that may not feel natural and that very well may suppress their innate desire to create. But as two prominent psychologists recently noted, “Not all minds who wander are lost”— in fact, the mind’s wandering is vital to imagination and creative thought*.

Nearly fifty years ago, psychologist Jerome L. Singer established that daydreaming is a normal and indeed widespread aspect of human experience. He found that many people are “happy daydreamers” who enjoy their inner imagery and fantasy*. According to Singer, these daydreamers “simply value and enjoy their private experiences, are willing to risk wasting a certain amount of time on them, but also can apparently use them for effective planning and for self-amusement during periods of monotonous task activity or boredom.”

Singer coined the term positive-constructive daydreaming to describe this type of mind wandering, which he distinguished from poor attention and anxious, obsessive fantasies*. By making these important distinctions, Singer was able to highlight the positive, adaptive role that daydreaming can play in our daily lives, under the right circumstances*. From the beginning of his research, he found evidence that daydreaming, imagination, and fantasy are related to creativity, storytelling, and even the ability to delay gratification*.

Of course, mind wandering can be costly when it comes at the wrong time, especially in regard to things like reading comprehension, sustained attention, memory, and academic performance*. The inability to control your attention when the task at hand requires it often leads to frustration, just as the tendency to get wrapped up in distracting negative thoughts can lead to unhappiness. But when we consider the fact that most of our important lifegoals lie far into the future, it’s easier to see how daydreaming might be beneficial. When our inner monologues are directed toward and measured against goals, aspirations, and dreams that are personally meaningful, the benefits of daydreaming become much more clear*.

Over the past decade, scientists have employed newer methodologies to investigate these potential benefits. In a review of the latest science of daydreaming, Scott and colleague Rebecca McMillan noted that mind wandering offers very personal rewards, including creative incubation, self-awareness, future-planning, reflection on the meaning of one’s experiences, and even compassion*.

Many parents worry about children who daydream excessively. And indeed, daydreaming can cause developmental challenges. In 2002, Eli Somer introduced the term maladaptive daydreaming to describe how it can interfere with academic, physical, and interpersonal functioning. When daydreaming inhibits healthy development, affects sleep habits, or increases negative behaviors, parents should seek professional advice.

For the majority of children (and adults) daydreaming is not only a good thing, it’s essential to our flourishing as human beings


Kaufman, S. B. & Gregoire, C. (2015). Wired to create: Unraveling the mysteries of the creative mind.(link is external) New York, NY: Perigee.

Killingsworth, M. A., & Gilbert, D. T. (2010). A wandering mind is an unhappy mind.(link is external)Science, 330 (6006), 932.

Somer, Eli. (2002). Maladaptive daydreaming: A qualitative inquiry.(link is external) Journal of Contemporary Psychotherapy. 32:2-3, 197-212.




How psychotherapy can help children through divorce.

As a therapist working with children I often get phone calls from parents who are concerned about their child as they are moving through a divorce. For young children the experience of the parents splitting up is a radical overturn of their world. They have been born into the world, seeing those two parents as majestic pillars on which they could count. These friendly giants made them feel safe and comfortable. 

As parents go through a divorce, there is so much pain and suffering involved, and each parent goes through this process in their own way. It is rare when the pain does not go along with accusations, resentment... It is especially hard for the child when he feels that the two trusted pillars of his world start attacking each other, disparaging each other. Even, when parents feel like they are not explicitly critiquing the other person, there are often implicit subtle messages that do not go unperceived by the child. These are very puzzling to the child. As he feels that an attack on the other parent, is actually an attack on the child. 

These very subtle messages are often interpreted by the child as the parents telling the child: the other parents is as good as I am, you should love me more than the other parent. I think of a little boy who feels that whenever one of his family members asks about the things that happen at the other house, he feels that this person is asking the boy to say bad things about the other house (as he feels that this is how is communicated about the other house.) To satisfy the demand for bad things, he then tends to tell negative things about the other house in order to satisfy them. In a situation like this the boy cannot be free to speak what he wants, he wants to please the negative appetite of each house. Each house wants to hear: we are the best, you love us more than mom, or dad... The child becomes this way the victim of the childish rivalry between the mother and the father. 

Hence, the importance of being able to differentiate between your being hurt as a partner, and recognizing the enormous importance or role that your ex has for your child. When you are putting down, resenting this other person, your child will feel it as a personal attack on him or her. 

In my experience in work with children who are going through divorce it is important to also meet with the parents, so that they can feel validated in their role as parents. 

To schedule an appointment call An at (530) 321-2970

The 2 key components to handling your child's tantrum.

Parents of young children often consult a therapist or counselor because of acting out behavior, or the throwing of tantrums. A child's tantrum, especially if it occurs on a regular basis can cause a disrupt family life, and exhaust parents, leading to less patience of parents, more irritation, and hence more tantrums. 

There are two key points in addressing this kind of behavior that are often overlooked, and which are crucial in addressing your child's tantrum:

1. Stay calm:

Often when the child escalates, the parents escalates along with the child, not being able to contain the child. In those instances it is initially better to give yourself a 'time out' than immediately giving your child a time out. If you feel you are starting to escalate with your child, step to the side, take a few breaths, calm yourself down. The first important step to containing your child is to stay calm yourself. 

2. Reconnect:

Once the child is calmed down, the parents are mostly relieved that the storm is over,  and not much is said about the whole incident. However, as a parent you might want to reflect on the whole event. You might want to think about what triggered your child, what did he or she think, what did he or she feel. If you have some ideas about that, you can tell your child this in simple words, and you might have some ideas on how your child might be able to go about it in the future. 

So, while the child is escalating, you stay calm, do not try to reason with the child. You might want to use some soothing words, empathize with his strong emotions, without becoming overwhelmed by them. You can tolerate them, you are containing them for the child, who is not able to do this.

After the child is calmed down you can use words: not preaching, not lecturing. But reflecting words about what you think was going on for the child, and how the two of you might be go about it differently the next time. 

To schedule an appointment call An at (530) 321-2970

Early Behavioral Therapy help children with ADHD

A new study, published in the Journal of Clinical Child and Adolescent Psychology, found that typical stimulant medication like Ritalin,  prescribed for children diagnosed with ADHD as a first-line of treatment, was actually most effective as a supplemental, second-line treatment for those who needed it.  Often at doses that are lower than what is typically prescribed. The study showed that children who started with behavioral treatment before being prescribed medication did better.

The study was unique in the fact that it is the first study that evaluates the effects of altering the treatment in midcourse. For example, adding a drug treatment to a behavioral treatment, or the other way around.  The results show that the sequence in which you give treatments makes a big difference in outcomes. It is important to note that this study tracked behavior, and not abilities like academic performance or attention. 

The study enrolled 146 children with ADHD diagnosis between the ages of 5 and 12, and assigned half of them randomly on a low dose of generic Ritalin.  The other half received no medication, but their parents began attending group meetings to learn some techniques that could help them modify and respond to their children's difficult behaviors. 

These techniques were based on a simple system of rewards and consequences. Parents reward positive behavior, ignore irritating but harmless behavior like doing baby talk. 

If a child had not improved after 2 months, the child was randomly assigned to eiter a more intense version of the same treatment, or an added supplement, like adding meds to the behavioral treatment. 

About two-thirds of the kids that started with the behavior therapy needed a 'booster.' About 45% of those who started on medication did. However, the behavior first group had on average four fewer rule violations an hour at school, than the medication first group.

According to the authors it could be that the parents of the children who started on the medication were less motivated to follow up with the behavioral classes. It was a lot of work, and the parents might have thought that it will not make that much of a difference. 

In a different study it was determined that starting with the behavioral treatment before following it with medication, costs on average $700 annually lest per child than treatment as usual. 

To schedule an appointment call An or Jamie at (530) 321-2970.


Adolescents and Psychotherapy

Parents often call me with the request to see their adolescent child who they feel is not doing well, and needs therapy. The parents often have a clear idea of what the psychotherapy needs to fix. Adolescents might have certain ideas about psychotherapy as well which might make them a bit reticent. Not in the least the fact that they might see the therapist as 'on the same side' as their parents. They might feel that the therapist is also there to 'fix' them, as if there is something wrong with them.  This along with a common characteristic of many therapists that they 'want to help,' might be that the therapy with the adolescent gets off to a bad start. 

As a therapist it is important to create initially a space where the adolescent can formulate his or her own demand for therapy. I typically ask adolescents to commit to six sessions so that they can explore whether they want to come in for themselves, not because the therapist or the parents think that they need it. Often parents feel uncomfortable with this, they feel that they have to make the adolescent go to therapy. However, therapy is something that cannot be forced on anyone.

In case the adolescent does not want to come in, it might still be possible to work with the parents to explore how they can help their adolescent. At times I meet regularly with the parents, and the adolescent knows that he or she is welcome to join whenever he or she is ready. Even, if they do not join, often the fact that they know their parents go and talk about them can help them.

To schedule an appointment call us at (530) 321-2970


Hidden messages in the alphabet song: MeN nO Pee

One of the reasons I love working as a psychotherapist with young children is their unique and fascinating relation with language. Their relation to language differs very much from the one that we have as adults. We are often caught up in the meaning of language, and don't have as much of an ear for the equivocation that is inherent to every use of language. As children are entering language with 'fresh ears' they experience language more at a concrete level and might hear messages that we as adults have become 'deaf' to. 

I recently had another nice example of this in my practice. A little boy who had had some difficulty entering language, was proudly writing down the alphabet.  He got stuck at the M. He sang the alphabet song, to help him remind what would come after the M, and although he was singing it correctly he could not figure out that next was N. Unsure, he wrote O, deleting the N - avoiding the word NO I thought. As he was singing it, and he seemed utterly puzzled, and I repeated what he said, I started to notice what he was hearing: Men No Pee. This boy, who had been very puzzled by his mother thinking he would be born as a girl, and who had also felt there was a certain prohibition of expressing aggressive, typical boy like behaviors seemed to hear in this alphabet song, the message that he could not be a boy, that men could not do what distinguishes them from girls (boys can pee standing up, girls sitting down).  

As we caught this message that he was hearing, and which expressed something about how he felt about himself, we were able to talk and laugh about it. I, as a girl, was able to deflate this message from what he heard as a prohibition of his 'boyhood.' 

Sometimes it is in being attentive to these very subtle things that we can get a peek into the mind of a child, and the ability to address it.

To schedule an appointment with An call (530) 321-2970

The pleasures and benefits of having a conversation with your child

The therapeutic effect of having conversations with your child

The center of reflective parenting  mentions that among the many important roles of a parent is to make sure you provide enough time in your child’s life for family conversation, solitude and boredom. 'They are like nutrients for child development and for passing on your reflective capacity to your child. Unfortunately the lure of electronic devices & social media has infected family life and is eroding the confidence of many parents to play this role.'  

Parents often report feeling too helpless to counteract their child’s obsession with all the new technology. 

To boost your confidence that you do have a good answer about what kids can do besides electronics, and you do have the power to change the situation,  here is a list of the benefits you will provide your family through making the time for conversation, solitude and boredom, as mentioned by the Center for Reflective parenting. 

The benefits of family conversation

  • Children practice using their mind, to express themselves and to make sense of what other people have to say.
  • Children feel more enduringly connected to the their family
  • Children gain the habit of talking about feelings, so they are less likely to impulsively act on them
  • Children become less vulnerable to peer pressure and bullying
  • Children gain insight, empathy and acceptance toward other people
  • Children gain a sense of trust in others and themselves.

The benefits of solitude and boredom   

  • Children develop the strength to think for themselves.
  • Children widen the horizon of their own mind through the use of creativity and imagination
  • Out of this creativity and imagination spring the roots of your child’s attempts at innovation and exploration into what is possible.

Conversation is simply that back and forth of taking turns at sharing what is on your mind and listening to and responding to what the other person has to say. . Conversations can be brief or long and can take place anywhere. The topic doesn’t matter and there is no subject too trivial to have a conversation about. What matters is that family members have the time and the opportunity to talk about their idea, their feelings and their perspectives. If your family is out of practice, initially your child may resist. Don’t give up. In fact you can have a conversation about why conversation matters.

Solitude and boredom involve time alone with nothing in particular to do. They require you to stop loading your child up with activities and stop feeling so responsible for entertaining them. Let them discover the joy of entertaining themselves even if they complain.

It requires you to be a good role model and mentor. Turn off your electronics more often. Step up your efforts at engaging in family conversations about anything and everything. Let your child see you engage in activities that do not require a device.

It’s hard to do in this day and age but I have confidence in you! 

For more information on reflective parenting you can visit the website of reflective communities.

To schedule an appointment, contact An Bulkens at (530) 321-2970

Talking to your child about what you want to forget

As a child therapist I often work with children who have only one parent consistently in their lives.  Often when parents separate there are strong negative feelings towards the former partner. This might even be more so in cases where there was physical or verbal abuse between the parents. When the relationship was extremely traumatic for one partner, there might be the tendency afterwards to avoid bringing up the partner, the other parent of the child. It can be very hard to find the words to talk to the child about the person that has caused them so much pain and hurt. And when the other parent happens to not be in the picture anymore it can be easy to completely 'forget' about him or her.

Never talking about a child's absent biological parent however can become quite problematic for the child. Parents often don't see that. They might say: 'He never asks, so we don't say anything.'  However, it could be that the child is aware that it is a very sensitive subject and that he better not brings it up. But the child knows it has another biological father/mother and will try to makes sense of this absence with whatever means he has at his disposal, according to his developmental stage.  

A boy told me that he thought his biological father who he had not seen since he was 2,5 years old was dead, that he had died from a very bad disease. However, his bio dad was still alive. When I met with the child individually he said that he did not know whether his biological dad was dead or alive. He said he had never seen his biological dad at first, but then said he remembered one thing: His dad had told him to stay in his seat, but he had gotten up and he had eaten from his dad's plate. His dad got mad at him, and then left and never came back. He cried, and cried after that. We could say that although he might know at some level his dad is alive, somehow he is dead to him, as he had not become present in conversations he might have had with the other parent, who was too pained by the relationship to address her child about his father.

The child's understanding of why his dad suddenly left out of his life: 'I did something wrong, did not listen to my dad, and I took something that belonged to his dad. This made my dad so angry that he left me forever.'

The radical absence, 'dead' of the father from his life is also illustrated by the fact that he does not realize that his last name came from his father. He thought that both his first and last name were chosen by his mother because she liked them. The idea that both his mother and father could have chosen his first name, but that his father had given him his the last name, that he himself had received from his father before was completely new to him.

The parent might be relieved to be free from the abusing spouse and might be happy to forget about that part of her life, but the young child is at a different stage.  It will be important to become to be able to talk to the child about this other parent, the absent one. This will help the child to open himself up to new perspectives that might help him eventually move away from the interpretation he had of the father's disappearance at a very young age.  

In my work with parents I often think together with them about how to talk about very difficult past experiences that have touched the parent's life and the child's life. The process of creating a narratives that is in line with their the 'truth' but also allow for the child to have a positive sense of themselves as the child of both their father and their mother, can be a very rewarding experience. 

To schedule an appointment call An at (530) 321-2970

Child therapy and trauma III. The boy who thought he was a fish.

When parents consult a therapist for their child, they might at times have an idea of what 'caused' the problem: a divorce, sexual abuse.  In our culture these seem to be 'legitimate' reasons to reach out to a therapist when there are issues with a child.  The problem seems to be able to be related to an understandable 'trauma' for the child. 

However, when there is no clear 'traumatic' cause, and the child is having problems it might sometimes be harder for the parent to bring in especially a young child. The parent might feel that the suffering of the child must be somehow related to him or her not doing something 'right.' The parents are often saddened that they are not able to help the child. In a couple recent posts I have been trying to open this notion of 'trauma.'

Trauma is not accidental, it is structural. There are different components to this: The young child in his very first weeks, months, years is bombarded with experiences that affect him or her. The child has limited tools to make sense of these experiences. But he will make sense of it with whatever tools at its disposal. A very sensitive child can have a harder time and might need extra support.  As mentioned before a child will try to master these experiences by entering into language, trying to make sense of it. His 'interpretations' can be in the eyes of the adult utterly illogical, irrational. But it is a sign of the child's intelligence that it is trying to put a world together that 'makes sense' with whatever elements are at its disposal. 

So, entering language is a way for the child to make sense of 'traumatic experiences,' but language in itself can is traumatic as also addressed in an earlier post. In this context I want to refer to a vignette H. Deltombe. 

A little boy of 4, Dylan, does not talk. In school he is isolated and sad. He does not sleep or eat well. At the first encounter with the therapist, however he seems eager to engage but does not have the means. He does not play, does not draw... However, at one point he started tapping the table in a certain rhythm. The therapist responds.  He is delighted with the effect he has on her. A game starts where the rhythms are differentiated, modified.  

As the treatment progresses he engages in a game of peek-a-boo. A game that would be typically liked by younger children, but in which he delights. Each child asks himself the question: 'Can I be missed, can they do without me?' When the therapist goes looking for him she indicates that she wants to find him. This game develops over a long time. Although he is still not speaking, there is communication using rhythms, and sounds. Eventually he starts making animal sounds from his hiding place. The therapist guesses the different animals. Sometimes he tries to make her afraid, and she guesses: a lion, a tigre. Then, at one point she hears a small sound, that she is not able to name. He appears from under the table and mimicks a fish. 'It's a fish.' He looks at her pensively and quitely, nods, and continues to make the same movement with his mouth. At that moment the therapist remembers what the mother had told her during the initial interview. She had joked with the father as they were going to have a child: 'As we have already Bob, the fish, we can now have Dylan,' in honor of their favorite singer. 

The therapist immediately tells him: 'You are not a fish, that is just a joke, you are a little boy and you can speak.' After what appears as a moment of shock, he suddenly seems 'at ease.' The following weeks he changes, eats, starts speaking. 

This boy was petrified under a 'traumatic word.' The treatment was able to separate him from this place of the 'fish of his parents' to which he had been reduced. By himself, by his parents? It is not that simple. But through the treatment he has been able to free himself of that position of 'object.' He can now truly become a boy. 

This is an example how something what is 'traumatic' can be very subtle and how it differs from the regular understanding of an 'accidental' trauma.

To schedule an appointment call An Bulkens at (530) 321-2970.

Who is a 'real' mother or father?

Both, the children and the adults that I work with in my practice often tend to use the expression of 'my real father,' 'my real mother.' I might have addressed this before but the implicit resonances of this phrase are often quite detrimental for the child. For example, I had a young child become very upset about the fact that his grandma told him that his father was not his 'real father.' However, this father had been there since he was born, had given him his name and was actively involved in the child's life. For the child of a certain age, there is 'real' and there is 'fake' or 'pretend.' His grandma's phrase suddenly diminished the value of his father to the realm of the fake and pretend. This is not something he will easily accept, and this had quite a detrimental effect on the relationship between the child and his grandmother.  I explained to the child that each child has only one biological dad, but can have more than one dad.  The dad that raises the child is as 'real' as the dad who made the child in an act of love, but is not present anymore.  This explanation was quite a relief to the child, and did calm him down. 

It is more precise to speak about birth mother and father, or biological father, than to use terms as 'real,' which then reduces a person that can be extremely important and 'real' in the child's life to someone who is 'fake,' not real.  

To schedule an appointment with An, call (530) 321-2970

An Bulkens    |    Licensed Marriage and Family Therapist    |   MFC 52746

Tel. (530) 321- 2970    |   186 E 12th ST,  Chico, CA 95928