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

Transgender Identity and Childhood

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

Chico Center for Psychotherapy

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. 

Welcome, Jamie.

To schedule an appointment with Jamie

Call (530) 487-4245

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

How to talk to children about the attacks.

As an American journalist interviews the editor of a French journal for children, she appears clearly shocked that the Frenchman refuses to 'reassure' the children after the attacks. She feels that this would imply robbing the children of their childhood. You can watch the interview here.

What I like is how the adults take as a starting point the actual questions of the children. They do not immediately respond to them, but take the time to reflect, and then give answers. The answers are in the line of the truth, and in language that is straightforward. The tone is not alarmist, but contained. You can see how seriously the French journalists take these kids' questions.  By taking the children's questions seriously, and by responding to them, the children will feel respected, and as safe as they possibly can.
 

Here are some of the questions the children asked with the answers that were published: 

Why are the terrorists against us? Are they doing it out of revenge?

Frabce , like other countries is at war with the terrorists of the Islamic state, which have taken control of parts of two countries: Syrie, and Irak. The US and other countries have been    bombs in Irak and Syria against the terrorists. They try to target camps where people who might get trained to organize attacks in our country. Terrorists have decided to take vengance by terrorists attacks in Paris. Isis has confirmed that they organized the attack.

Why do terrorists attack innocent people?

Terrorists have killed people in Paris who were eating out in a restaurant, at a concert or at a soccer match in Paris. They have attacked places where we celebrate, and have attacked our way of life. They think that those activities are bad according to their believes.

Why does religion make terrorists do horrible things.

Terrorists are ready to use violence to impose their ideas. They say that they fight to defend their religion. They want to impose on everyone the same very strict rules. They get these rules based on their interpretation of the Curan, the sacred book of Muslims. Examples of very strict rules: forbidden to listen to music, women have to be covered in a black veand can only leave the house in the presence of a man, obligation to pray…

Why do terrorists commit suicide? 

My child does not want therapy.

When parents first meet a counselor or therapist to talk about their child, they are often concerned that their child will not want therapy, or would not be willing to come in to talk. I typically do tell them that indeed for therapy to work it is important that the person engaged in it wants to come, is engaged in the process. This is the case for adults as well as for children. My first job as a therapist whether I am working with an adult or a child is to explore whether there is a demand for help. Sometimes the adult is sent by a concerned spouse, but is not suffering himself. Sometimes a child is brought in by concerned parents, but the child is not suffering himself. In those cases it might be better to work with the concerned spouses, or with the concerned parents.  It might take some time to explore whether the child wants to come.  

Just the child saying he or she does not want to come is of course not enough of a reason as the child does not know what he is refusing.  It will be important for the child to say this in the presence of the consulting room, after the experience.  Sometimes a child just tells his parents that he does not want to come, but actually engages in the process and tells the therapist session after session that he wants to come back.  If that is the case, it is something that needs to be explored. It is important that the decision to start or not start the treatment is something that is expressed in the treatment room, by the child himself, and not through a parent. 

Parents might be hesitant of their child wanting to come to treatment because they think of therapy as a way 'talking about feelings.' Although treatment can certainly include talking about feelings it is not only that, and it is much more in the work with children.  The child will typically come to the treatment with the idea that the therapist is a figure like a teacher or a doctor, a parent: an authority figure. It might take several sessions for the child to explore the possibilities and nature of the therapeutic space: a space where you can say whatever comes to your mind without getting in trouble, a space where you do not 'have' to do anything.

As an example of this I can mention a child that came in pouting, feeling he had been forced to come to see me. He did not want to come and talk to me. He had spent the whole session with his head on his arm, pretending he was sleeping, and eventually even falling asleep. He was refusing my presence. Or was he. At one point I peeked under his arm, met his gaze, waved at him, and he waved back and smiled. At the end of the session, in which I had been talking about what his parents told me about him, I told him I would like to see him again (even though he did not do anything!) He responded to my surprise that he wanted to meet me again the next week. A session were apparently little happens can be very important, and actually can mean a lot! 

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

Sweden steps away from CBT monopoly, opening the door to more reflective therapies.

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 effective for treatment of schizophrenia new study finds.

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

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

Balancing Empathy with fostering a sense of Competence

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."

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.

Center for Reflective Communities.

I am often asked as a therapist working with children about parenting resources. I often  recommend as a good parenting resource the website of the Center for Reflective Communities (Formerly Centrum for Reflective Parenting.) You can find their website at www.reflectivecommunities.org. 

The center for reflective parenting develops parenting workshops that are based on cutting edge research in the field of mentalization, and reflective functioning. The relevance of their work is that they help parents approach their child from multiple perspectives. This ability to approach the child from a multitude of different vantage points will lead to a positive relationship, a secure attachment.

Sometimes the relationship between a parent and a child gets stuck when child and parent are stuck in one interpretation. For example, a parent comes in to talk about the child and says that the child is often 'lying,' A reflective approach can help the parent look at this 'lying' from different perspectives. This word 'lying' with its moral judgments ... might lead to interactions where the both parent and child feel misunderstood. Through reflective practice the parent might come to realize that there are many different varieties and reasons for lying, and might come to a hypothesis as to why the child might be doing this. Expressing these reflections might help the child move beyond this. It will typically lead to a different interactive pattern than the child 'lying', and the parent punishing the child for lying, and accomplishing nothing, as the child will typically continue with 'lying,' 

In difficult divorce cases it is often the case that parents lose their reflective capacity, Because they might feel so hurt they can only look at things from their perspective. This perspective seems to completely eclipse the perspective of the child. This is often so strong that although the parent notices this, he or she is not able to step out of it. It is often confounded by the fact that when the child is very young, the parents are unaware of their child's perspective at all. The parent might think that a 1 or 2 year old child might not be affected greatly by this. Unfortunately, this leaves the child in the lurch. 

For a parent to make a habit of not just reacting to the behavior, but of reflecting on what might be behind the behavior of your child is a crucial step in building that secure attachment with their child. Psychotherapeutic work with children and parents can be at least in part be understood as a breaking open of interpretations, 'meanings' that are too rigid and non productive; or only tend to produce quarrels and yelling, and not much fun.

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

Language as traumatic for the child.

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

Child therapy and trauma II

For the child to master those invasive experiences, these excitements of his body which bombard him or her in the first years of  the child's life, he will need to turn to the Other to help him 'make sense' of them, to help him 'manage' this excess.  When this Other person is experienced by the child as absent, then the child is left to his or her own devices which might lead to anxiety - separation anxiety. It is this anxiety which lies at the base of fear of the dark, being alone, or finding a stranger instead of a familiar face. It is a reaction with respect to the absence of the person who helps manage this 'excess.' It is anxiety connected with an absence of a symbolic elaboration of this anxiety.

The child will typically attempt to master this anxiety by entering language, by starting to speak. Language will help the child to master the anxiety, to manage it. There is a double movement of the parents inviting the child into this world of language, while the child at the same time has to be willing to take the step into language. This is not always easy, as we see that a lot of children cannot make the choice to speak so easily. 

This anxiety has to do again with a 'structural' trauma and is not always easily perceived by parents and caregivers. But psychotherapeutic work can help a child that is stuck in anxiety move forward towards a growing ability to 'symbolize' this anxiety.

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

Child therapy and trauma

As I mentioned in the last post, when concerned parents bring their child to me, they often have an idea of what might be the cause of their child’s problems. They think it is often connected to some traumatic event. A trauma is understood as an accident, something that could have been avoided. It is an overwhelming event that the child cannot handle, deal with, does not have the symbolic capacity to process.

The most common reason that parents bring in their children is because of a divorce, or separation. They recognize this as a traumatic event for the child. And often with good reason, as for the young child both father and mother in the house are the scaffolding of their world. Once this framework collapses it is as if their world collapses. The young child does not know about the intricacies of the adult world, and will often interpret this traumatic event with the tools that it has at its disposal. The mis-understanding that follows can be the seed for a lifelong feeling of inadequacy, low self esteem. ‘I was my dad’s princess. Now, he suddenly leaves me. There must be something wrong with me, I am not enough…’

However, trauma is not just accidental, it is ‘structural.’ In the early years of its life a child is bombarded with sensations, emotions that overwhelm, invade his body, and that the child does not know what to do with, what to make of it. For a very sensitive child these experiences can be truly ‘traumatic,’ and overwhelming. However, in those cases he parent who is not aware of an immediate trauma in the common sense of the word, can be at a loss at how to help the child. The parent might start to feel inadequate, guilty as he feels he cannot help the child. It is in those cases that therapy can often help the very young child and his parents. Unfortunately, they are the cases where parents often do not seek help because of the mistaken idea that since there is no clear ‘trauma.’ They think that in those cases therapy cannot help, that it must be ‘biological.’ However, in many cases the symptom of the child is connected to a ‘trauma’ that is not perceived as such by the parent as it does not conform to our common sense understanding of what trauma means.

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

Treating the child

A child cannot addres him or herself to a therapist on his own accord. He has to pass through the parents. Sometimes, it happens that the child asks the parents directly to go see a therapist, to 'talk to someone.'  Typically however it is the parents who worry about the child's nervousness, agitation, or apathie, about the symptoms he is presenting. 

The parents often have an idea of what is not going well for their child.  Often the parents think that the problems are related to events that they think might have been traumatic for the child.  This first dialogue with the parents is very important for me as a therapist and gives me a lot of information that will be helpful in starting to work with the child.  That initial dialogue will also help the child to determine whether it can trust the terapist.  As he feels the parents have trust, he might start feeling comfortable entrusting some of his thoughts and feelings to this person.  

In my work with the child it is important to not encapsulate the child in a pre-established schema. This might be a bit different from an approach which is very widespread where the child is compared to the yard stick of the ‘normal child.’ But where is this normal child? That child is nowhere to be found as the norm is just an average of a big group of individual kids, each with their own specificities and particularities. Instead of letting myself be guided by a norm, I take my starting point in what the child brings to the session, what he says, what bothers him. It is important for me to listen to the child’s own suffering, and to listen to his truth that emerges in there. It is important to see what reality is intolerable for the child, and to help him treat this in the treatment through conversations, play, and art: different means the child can use to ‘treat’ that what is problematic for him or her. 

Contact An Bulkens at (530) 321-2970