Psychotherapists notice Increasing obsessive symptoms in children and young adults.Read More
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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.
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
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.
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
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/
As parents we have been told that positive reinforcement creates more good behavior. Some money for cleaning your room, a movie ticket for getting good grades, extra x-box time for being nice to your brother. However, a study in the journal Child Development shows that our commitment to positive reinforcement can be counterproductive. This study shows that rewarding a child's sharing resulted in the child actually choosing to share less.
The study wanted to find out how many marbles 48 3-year-olds were willing to share with a puppet. During a game, it seemed as if a child happened to get three marbles while the puppet got only one. Half of the children noticed the difference and gave the puppet a marble without further prompting. If not, the puppet said, "I only got one marble" and then "I want to have as many marbles as you" and then, if needed, "Will you give me one?"
After the children had shared a marble, there were three ways of follow up. Some children simply moved on without any feedback, others were praised ("Oh thank you for sharing a marble with me! That was really nice"). And a third group was rewarded with a little toy.
After certain time passed the kids were tested again—over three related but different games. The result was that children continued to equalize an unfair outcome after the experience of praise or a neutral response. However, they shared less often after they had received material rewards!
The study shows that there is a sense of fairness in young children, but that this sense gets corrupted in a way by tying it to a reward. When the reward was absent, so was fairness. "Receiving a reward initially in the collaborative sharing context diminished children's motivation to share in new situations in which they had never been reinforced before," the paper writes.
Rewarding fairness makes children overall less fair on future tests. The message from this study is loud and clear: "Parents and educators should be encouraged to rely on intrinsic motivation and reinforce feelings of autonomy and competence as much as possible rather than to provide superfluous material incentives, which can even have detrimental effects."
To schedule an appointment call An at (530) 321-2970
As a therapist working with children and adolescents I am often confronted with a demand from parents to help their child. It is typically not the child herself that picks up the phone and reaches out. Sometimes, when the parent calls the children themselves have asked their parents to talk to someone, but more often the parents call because they are concerned, and it is not sure whether the child wants to come in for himself or herself. And if they do, they might have quite different concerns. In cases where children do not want to come, or are hesitant I like them to commit to 6 sessions to give it a try, so that they can see whether it would work for them. Because, indeed, it is not because the child says he or she does not want to come, that she really does not want to come. It could just mean that the child does not want to do what the parent thinks is best for the child. There is nothing wrong with that. Indeed, the child will have to see for herself whether she wants the therapy for herself.
Parents often become confused when I put it that way, as they feel their child 'needs' the therapy, and it should not be left to them. My response is that therapy only works when a person can get engaged in it, and not when it is imposed by someone else.
I came across an interesting article by R. Muller about a 17-year old girl 'who refused to undergo chemotherapy after being diagnosed with Hodgkin Lymphoma, a cancer of the lymphatic system. The Connecticut Superior Court ruled that as a minor, Cassandra did not understand the severity of her condition. She was taken to Connecticut Children’s Medical Center in Hartford, where she was forced to undergo chemotherapy.'
In an essay that recently got published the girl states:
“I should have had the right to say no, but I didn’t. I was strapped to a bed by my wrists and ankles and sedated. I woke up in the recovery room with a port surgically placed in my chest. I was outraged and felt completely violated.”
As her mother did not comply with the court ruling, and did not bring C. to her appointments, she was removed from her mother and placed in foster care. C. argued that she cared more about the quality of her life than the duration. Yet she was told that undergoing chemotherapy would increase her chance of survival by 85 percent. Without it, doctors said there would be a near certainty of death within two years. C. acknowledged this risk, but maintained that she had the right to make decisions about her own life and body.
The mother supported her daughter's decision:
“She knows the long-term effects of having chemo, what it does to your organs, what it does to your body. She may not be able to have children after this because it affects everything in your body, it not only kills cancer, it kills everything in your body.”
There is some concern that C's opinion on medical treatment could have been influenced by her parents. This issue is especially important given the far greater chance of survival offered by treatment.
At this age the right to independent decision making at this age is an important factor. In her essay, Cassandra writes:
“I am a human—I should be able to decide if I do or don’t want chemotherapy, whether I live 17 years or 100 years should not be anyone’s choice but mine.”
And it is important that this desire for independence should be heard. Does this mean that any demand has to be immediately satisfied, because it is the demand of the adolescent wanting to be independent? Of course not. It is important to hear and and worked through.
A refusal to see treatment, whether it is chemotherapy or psychotherapy does not necessarily have to be considered an obstacle to the treatment. It is an important message that needs to be heard, and that can be worked on. And it is an essential first step in having a successful psychotherapeutic treatment with an adolescent.
C. was discharged from hospital last April, after completing treatment. Prior to being released, she wrote on Facebook: “I have less than 48 hours left in this hospital and I couldn’t be happier!”
She reported that she was grateful that she responded positively to the drugs and was predicted to survive cancer-free. But she also added:
“I stood up and fought for my rights, and I don’t regret it.'
Counselors and therapists working with children and their parents are often confronted with the difficulties for a child of living in two households. It becomes increasingly difficult for the child when the parents do not, or barely communicate, and when miscommunication between parents build up. As I mentioned in the last post, a common effect of this is that parents perceive that the child is lying. However, this 'lying' is an effect of the parents not communicating, and the child wanting to protect both parents, and wanting to please each parent. This 'lying' can add to the conflict between the parents, who think that the other parent is instigating the child to lie, leading to an increase in alienation between the families, and complicating the position of the child.
The practice of shared parenting has been recognized by the research community and by legal and mental health practitioners as the preferred parenting arrangement after divorce, and being optimal to child development. It is recognized that shared parenting is the most effective means for reducing high parental conflict. Of course this applies to situations where there is no substantiated family violence or child abuse.
However, in my experience there is a lack in services to help families to support in their shared physical custody. It often is just 'shared' with respect to the 'time,' and the 'sharing' at other levels seems to be left to the child (hence the tendency to 'lie'). For this collaborative parenting to be successful, there needs to be an accessible number of family relationship centers that offer family mediation and other relevant support services outside of the court system. In this county it seems that mediation is immediately linked to the 'court.' There is a need for governments to help establish such networks. To help parents create an environment for their child where 'shared' parenting is not just a 'time share.' Because when it is only a time share, without any further communication between the parents, the divide between the parents can get so big, that it is as if a wall is constructed within the child. The child lives in one world when living with one parent, and in another world when living with the other parent. It is as if the child is not allowed to have 'shared parents.' Each parent thinks he is the only parent for the child, and acts as if the other one is not there. The effects for the child can be devastating even when 'on paper' there is 'shared custody.'
To schedule an appointment call An Bulkens at (530) 321-2970
Working as a counselor or therapist with parents and children who are stuck in spiraling, worsening relationships, it is clear that a lot of the conflict traces back to a disconnect related to an inability to take the other's perspective. Child and parent are each stuck into their own perspective, are frozen.
It is my work as a therapist I help to 'defrost' those rigid perspectives and to help people look at things from a different side, a new perspective. Being able to do this is one of the most effective, and often ignored skills to have. Gary Klein in a recent post mentioned a game that he played with his daughters called 'Switch' which implied arguing for one position in a debate, and then at the moment of 'switch' starting to argue for the other side. His grown daughter now feels that she has an edge over others in her profession as she can quickly 'decenter' and take someone else's perspective.
Klein argues that this game of perspective taking can only be done with older kids. He might be right if we are talking about debating certain political issues. However, even with very little kids, when we 'mentalize,' express what we think is going on in their minds, we offer a model of perspective taking. When they have been exposed to this continuous reflective activity, where there minds have been 'mirrored,' where their standpoint has been validated, however imperfectly, by a person who is curious about their perspective, by the time they become teenagers they might have learned a way of flexibility that will allow them to look at their parents' perspective with a more open mind!
To help a parent at times take a different perspective can be very difficult, as the position might have become so hardened, and so intertwined with very personal experiences.
Some of the parents are very strict in the way that they perceive a 'lie' by their child: A lie is something that needs to be punished. This could be the case, but it would also be important to explore the underlying reason for the lie. Often in situations where the child lives in two separate houses, the lie is an effect of the child being stuck between two parents who do not communicate anymore, who undermine each other and who 'need' the child each in their very own way. The lies are the effect of a child that is stuck in between and does not know what to do, where to go. Being able to take on that perspective of the child, can help the parent better respond to the lies. There can be additional interventions, other than punishing the child, to help the child from a position where he does not have to lie anymore.
To schedule an appointment call An at (530) 321-2970
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.
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.
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
In the beginning of this month Debra Soh, published an article in the Wall Street Journal tltled: The Transgender Battle Line: Childhood. She points out that psychologists have figured out how to treat adults with gender dysphoria, but what about a 5-year-old child?
'What should parents do if their little boy professes an intense desire to be a girl? Or if their daughter comes home from kindergarten and says she wants to be a boy? In recent years the dominant thinking has changed dramatically regarding children’s gender dysphoria. Previously, parents might hope that it would be a passing phase, as it usually is. But now they are under pressure from gender-identity politics, which asserts that children as young as 5 should be supported in wanting to live as the opposite sex. Any attempts to challenge this approach are deemed intolerant and oppressive.'
How to best deal with prepubescent children who identify with the opposite sex has become so politicized, that, Soh points out, professionals working with these populations are extremely reluctant to get involved as they have seen what happens when they deviate from the going cultural and political view.
Soh mentions the recent experience of Kenneth Zucker, a psychologist in Toronto. In December 2015 the city’s Centre for Addiction and Mental Health announced that it would close its Gender Identity Clinic, which Dr. Zucker had led for 35 years. The news came after months of public allegations that Dr. Zucker, an international expert on gender variance in children, had been practicing 'conversion therapy', which aims to change patients’ sexual orientation. However, he had not been trying to dissuade anyone from being transgender. Instead his therapy facilitated exploration of gender identity. Gender-atypical males could consider being boys who simply liked female-typical things. One doesn’t necessarily need to be a girl to enjoy nail polish or bedtime stories about fairy princesses! Pointing that out to a gender-dysphoric child isn’t the same as practicing conversion therapy. By the way, Dr. Zucker had been following the most up-to-date standards of care published by the World Professional Association for Transgender Health—a document he had co-written.
The need to give time to 'explore' is crucial here. In the current climate it seems that when a child expresses gender dysphoria, it needs to be immediately 'fixed.' It is important to take time. This need to slow down and explore is also justified by scientific studies.
In a study of 44 gender-dysphoric boys, conducted by Zucker 80% grow up to be not transgender, but bisexual, gay or lesbian adults. Thus, helping prepubescent children feel comfortable in their birth sex makes more sense than starting a lifetime of hormonal treatments and surgeries that will in all likelihood turn out to be unnecessary and unwanted.
Also when children do transition, some regret it. 'In a 2011 study of 25 adolescents who had been gender dysphoric as children, two girls who had undergone social transitioning to boys—by taking on male-typical appearances—regretted it and struggled to detransition. One wanted to begin wearing earrings, but said she couldn’t because she “looked like a boy.” The other, hoping for a fresh start with high school, hid childhood photos at home that depicted her time living as a boy. Both feared teasing from their peers.'
This is why Dr. Zucker put the emphasis on exploring gender with childrenr. Then if a child’s dysphoria persisted into adolescence—gender identity becomes more fixed with age, and the start of puberty often determines whether it will desist—Dr. Zucker would recommend transitioning, including puberty-blocking hormonal therapy.
Soh points out that Dr. Zucker was recently awarded $500,000 from the Canadian Institutes of Health Research to conduct an MRI study on the effects of medical transitioning, on adolescents’ neurodevelopment. A grant of this size speaks to both his credibility as a scientist and the importance of this research. The halting of this study in the wake of the closure of Dr. Zucker’s clinic means the critical answers he sought will remain unknown.
'The most current science has been trumped purely because it is at odds with the dominant political view concerning transgender development.' Soh points out that although we don’t allow children to vote or get tattoos, yet in the name of progressive thinking we are allowing them to choose serious biomedical interventions with permanent and irreversible results.
The silencing of those who oppose this sends the message to parents that early transitioning is the only valid and ethical approach for a gender-dysphoric child. This message—pushing children to transition at increasingly younger ages so that they will fit neatly into one of two gender categories—is false and unscientific. It is more progressive to offer them the time and the space they need to figure out who they are and what is ultimately best for them.
To schedule an appointment call An Bulkens at (530) 321-2970
introducing new therapist!
I am very excited to be able to work together with Jamie Batha, LMFT. Jamie has had a lot of experience working with children in the schools as a school psychologist, and has been licensed as an LMFT for 25 years.
She will be welcoming children, teens and their parents, as well as adults.
She was trained in cognitive-behavioral therapy, EMDR, and short term therapy.
To schedule an appointment with Jamie
Call (530) 487-4245
After years of complaining that cognitive behavioral therapy receives all the public funding, it seems that therapists who work in a more reflective, less educational paradigm are about to get a break – in Sweden at least.
Sweden’s government has put substantial funds into CBT provision and CBT training. Now, it looks like the government’s National Board of Health and Welfare, has accepted that psychodynamic therapies are as effective as CBT at treating depression – might lead to the introduction of government support for psychodynamic therapies.
Also in the US substantial funds have gone into CBT, and there is a similar dispute from psychodynamic therapists who claim that practice-based research shows that all therapies work equally well in the field – therefore they should all get funding, not just CBT.
The shift in Swedish policy is in part due to the work of Rolf Holmqvist, professor of clinical psychology at Linköping University, whose research suggests that just about every form of talking therapy is equally effective when used in the field.
In an interview Rolf Holmquist states the following:
RH: 'In our study we used the CORE-OM system for rating therapy outcomes [as opposed to the Beck Depression Index, designed by Aaron Beck, who’s also the founder of Cognitive Behavioural Therapy]. We started by examining outcomes in primary care centers. In Sweden, there is perhaps one such centre for every 10,000 people. And at every centrer, there is one or two people providing psychological treatment. We asked therapists to ask their patients to rate their state on the CORE-OM outcome measure, so we could follow the progress of their treatment, which was typically rather short – on the average six sessions. We compared a number of things, particularly how different treatment orientations succeeded – particularly CBT and psychodynamic. We found exactly the same results, for both depression and anxiety. They all got good results, with about half of patients recovering. Even supportive therapy, which is the Cinderella of therapies because it seems too simple, got quite good results.'
One could object that the study only looked at very short therapies. It might be said that the positive effect does not have as much to do with the actual therapy, as with the well known fact among clinicians that just the fact of starting therapy leads to an improvement, has a therapeutic effect.
The study also underlines the relevance of not just randomized studies, but practice based studies. I would add that case studies where the particularity of each patient is studied has proven great support for more reflective theories. It is impossible to grasp the particularity of this work in randomized studies, but a growing openness to these kind of studies lends support for reflective therapies. We could say that for treatment to work, the patient needs to have a choice, and the therapist needs to have a choice. There is no one size fits all. Monopolies dry op creativity, also in the world of therapy.
To schedule an appoinment contact An at (530) 231-2970
Psychotherapy or counseling for the treatment of psychosis and schizophrenia has been frowned upon in the mainstream. No point in talking with or listening to schizophrenics! The recommended treatment option consists typically of heavy use of antipsychotic drugs. These drugs can cause severe side effects such as weight gain, or debilitating tremors.
However, the results of a new long term study might finally be a game changer. The study found that schizophrenic patients who received more one-on-one talk therapy, in combination with family support and smaller doses of antipsychotic drugs showed greater recovery over the first two years of treatment than the patients who received the standard drug-centered care.
First episode psychosis happens typically to young people in their late teens, or early 20s. The study found that the sooner people start treatment after their first break, the better the outcome. The study was based in part on successful programs in Australia, Scandinavia and elsewhere that have improved people's lives for decades. It is the first implementation in the real world in the US.
The study involved over 400 patients and more than 30 community clinics in 21 states. All randomly selected. The patients were randomly assigned to the combined treatment or to treatment as usual. Over the two years that the patients were followed both groups showed steady improvement, but by the end those who were in the combined program had more symptom relief. They were functioning better. The progress they had made was more noticeable to friends and family.
To schedule an appointment contact An at (530) 321-2970
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
In reflective parenting it is important to maintain a balance between being sensitive to your child's emotions, while also setting limits or boundaries. It is important to walk the line between the two. Whereas too little empathy can get in the way of a child's sense of wellbeing, too much can interfere with his his sense of competence.
With too much empathy we mean that a parent can feel so empathic that he or she feels the same upset as the child. When a parent feels the child's distress too strongly, there is a tendency to jump in and fix things for the child. This does not give the child the opportunity to figure things out for herself. Competence is built when children are encouraged to take on challenges, to problem solve, and manage disappointments on their own - with the support of the parent.
A true empathic response implies that you have just a taste of what the child feels. The parent senses something in herself of what the child is feeling, but it does not coincide. Although the parent is connected to the child, he is also separate.
Reflective parenting aims for empathy coupled with helping kids to develop grit and resilience!
Resilience: Resilience requires optimism and an ability to reevaluate the situation. It rests on the belief that for the most part situations tend to work out and openness to the possibility that if one way does not work try another way! If at first you don’t succeed, try again.
A child tries out to be on a team but does not make it, and is upset and angry. If they are resilient relatively quickly they come out of it, because they realize not everyone can get everything they want and that it was good for them to at least try.
Grit: Grit involves having goals, a willingness to work hard at pursuing them and not being afraid of failure. Grit involves passion.
A child who plays basketball wants to get better. They practice dribbling or shooting baskets for an hour a day. At their next game the child make lots of mistakes. That week they try even harder and practice for 2 hours every day.
Reflective parenting encourages parents to build confidence by promoting Grit and Resilience in your child.
- Encourage children to be more optimistic and assume things will work out.
- Encourage children to believe in their ability to solve problems and meet challenges.
- Allow children to manage the situation on their own, as much as possible.
- Inspire children to try their best.
“I know you can do it! I know you are capable to handle this!” “I know you want me to help but let me first give you a chance to handle it.” “It is more important to me that you try your best, than whether or not you win.” “Even more important than how I feel, or if I am proud of you, is for you to consider if you tried your best, and if you feel you are proud of yourself."
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.
In the earlier blog I talked about trauma and psychotherapy with the child. When parents bring their child in they often think that their child’s suffering must be connected to a trauma, which is typically understood as ‘accidental.’ If trauma is ‘accidental,’ it would imply that it can be avoided, and that there are some children who can escape it. However, trauma is 'structural.' This means that also children who have not suffered an ‘accidental’ trauma can sometimes get stuck, and might at times benefit from psychotherapeutic work.
Indeed, one can say that entering into language for a child is puzzling, even traumatic. Language is at first completely incomprehensible to the child and full of equivocations. The words of adults are for the child full of impasses and ambiguities that cannot be resolved, and the affectif charge often adds anoteher puzzling dimension. The child's attempt to make sense of this, or to question the adult can be complex, puzzling, and lead to a cascade of mutual misunderstandings between parent and child. Parents often think that communication is straightforward: a word is a word and means a thing, and they might gloss over the fundamental dimension of misunderstanding that is structural to human interaction. Often the implicit question goes unnoticed. In my work with children and parents it is crucial for me to explore what parts of language might be puzzling the child to the extent that it gets in the way of his or her development. And what might be the implicit questions that are connected with this piece of language which are not being heard.
A little girl yells in a bout of frustration, angry at her mom: this is my house, leave my house, leave me alone. These words shock and hurt the mother: They are the exact repetition of the words her father had used when the couple was going through a divorce but still living together in difficult circumstances. The mother’s affective response to these words was one of pain, sadness, feeling rejected by her daughter. She took the words literally as a real desire of the little girl really for her mother to leave her. This lead to a response of the mother moving away from the child, leaving the child feeling abandoned, in despair, clinging to the leg of her mother, who became increasingly frustrated with the apparently illogical behavior of the child.
It is clear that those strong words the girl heard spoken by her father at age 2, 5 had a big impact. The threat of her mother being sent out of the house must have been a scary, but maybe even fascinating thought –leaving her alone with her daddy. In her anger with her mother, she expressed the same movement of rejection, she had seen her dad express to her mom. However, although she spoke those words, she was clinging to her mother’s leg, clearly not wanting her mother to go. One could think that maybe the example of her dad being angry with her mom was the only model she had, and that was how she expressed her anger. But there might be more at stake. We might see that expressing them in a moment of anger to her mother also implies an expression of puzzlement with those words. It might be a question regarding their parents’ relationship ending, and wondering about their fights, and about her place in this story. Are the fights between her and the mother also going to end in her mother leaving her? Would her dad ever say such a thing to her, if he would get mad at her? When she yells this at her mom, could it mean: Dad was right to send you out of the house. I wish I could just be with him, and not have to bother with you. At dad’s house batteries never die…’
In my work with parents I hope that they can start to see that what their child says can have many layers to it, it is not one dimensional. When a relationship is stuck or a child is stuck, and the parent does not understand the child, or might be stuck in a limited understanding of the child, psychotherapeutic work can help start exploring a different approach that might open up the relationship between the parent and the child, or might help the child get unstuck.
In my work with the young child I help the child in the process of making sense of the enigmatic language of the adults that surround him or her, and I offer him a place where he can start to find his own place in the for him possibly confusing world of language.
To schedule an appointment, call An at (530) 321-2970
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