Sunday, August 16, 2009
We humans develop in stages from pre-birth to death. There is a series of steps we take both literally and figuratively that lay the foundation for future growth and learning. These are neuro-bio-psycho-social steps that lead us to cognitive, emotional, physical, and social functioning. Erik Erikson and Jean Piaget are among the theorists who named the essential conflicts we must resolve before moving on to the next challenge of life. Our experiences with parents and others help us achieve these developmental milestones. However, conditions and events like illness and trauma can interfere with this process resulting in uneven developmental progress. In reality none of us is cognitively, emotional, physically, and socially the same age or stage. A child of 15, for example, may look his or her age or older, but have the brain functioning of a 12 year old, the social skills of a five year old, and the emotionally reactivity of a two year old. This child needs different and extra experiences to catch up, and parenting her or him like a typical 15 year old will not be successful. In my work, then, I teach "investigative parents" to target the developmental stage and not the chronological age of their child, easier said than done, until the puzzle pieces begin to fit together.
Saturday, August 8, 2009
Sex is the one topic that parents generation after generation have the most difficulty teaching their children. Sexual development is part of human development but the subject is infused with so much cultural meaning including fear and shame that we often avoid the issue. Most people pass on the job of sex education because they are not sure of the facts and don't know what to say. Think about how you learned about sex from your own parents, or rather from peers on the playground. This is particularly difficult and dangerous when we are trying to protect our children from sexual abuse. One in four women and one in five men is the victim of child sexual abuse. Children as early as three or four need to know about "indoor" and "outdoor" plumbing, vaginas and penises and what they do and what they are for, how babies are made and how they are born, and how it feels and how to manage sexual development through adulthood. What is normal is same age sexual exploration like "playing doctor" and "show and tell", and yes, masturbation. What is not normal is sexual knowledge and language beyond age level and coercion, compulsion, and secrecy. These are red flags for sexual abuse. Perpetrator may have been victim and both need intervention. The Child Welfare League of America has some great resources including articles and books for children and parents and links to local treatment options. Sexually abused children can grow up to be healthy, happy adults. Start today.
Thursday, August 6, 2009
The relationship with the parent is the template for all future relationships. This attachment is essential for survival. Without it an infant dies. The attachment is directional, from child to parent. It is driven by the parent's commitment to meet the basic needs of the child. And, because it is a one-to-one relationship, it develops differently with each parent and primary caregiver. We have a different relationship with our mother than our father. Each one is unique, and there is no competition. A person can and does have many attachments over a lifetime. The child's role in attachment is to make his or her needs known. When a parent meets those basic needs; for food, comfort, touch, or soothes the distressed child, the attachment grows stronger. The prime time for attachment is pre-birth to the first three to four years of life. The attachment relationship is brain based. When a parent meets a child's needs, he or she is building brain cells. Baby cries, mother holds, and a brain connection forms. In the same way, if an infant cries but a parent does not respond, a different brain connection is made. The child either feels powerful or powerless. So, attachment contributes to self esteem, identify, and behavior. A child who is securely attached to a parent can make friends, get along with employers, maintain an adult relationship, and facilitate secure attachment of their own child.
Saturday, July 25, 2009
Whether we are therapists, psychiatrists, pediatricians, family therapists, or parents we should all be concerned about childhood depression and the accompanying risk of suicide, especially given the spate of recent suicides by pre-adolescents. As I told San Diego News Network, among a therapist’s first actions is to screen for mental illness including depression and suicide risk. In addition, I make a referral to or consult with the child’s doctor to rule out medical conditions that may cause, contribute, or appear as mental health issues. If depression is the issue, I refer the parent to a child psychiatrist for a medication evaluation. The combination of therapy and medication is the accepted treatment for depression. Screening children means we can start earlier to address hereditary depression as well as depression caused by environmental factors. The key for parents and providers is that depression looks different in children and is easy to miss or attribute to behavior and developmental issues. In addition to changes in eating and sleeping and mood, children with depression often appear agitated, irritable, or angry. Parents and teachers can miss it or minimize it. So, short simple screenings with the Beck Depression Inventory or the Child Depression Inventory are tools for doctors and therapists to use. At the least we will educate about depression. If it means saving a child’s life, then we are using safety contracts with parents and children and accessing psychiatric services up to and including hospitalization. However, the earlier we can treat depression the more success we can have in helping children not only enjoy their childhoods but also grow up to be well adjusted adults.
Saturday, May 16, 2009
In the days of "children should be seen and not heard", parents used to preach that "silence is golden". Sometimes, they would even give the misbehaving child "the silent treatment". These days we understand that silence can be golden as a treatment for children who seem "out of control". Children traumatized by abuse, neglect, chaos, or loss often have difficulty soothing themselves. The normal primitive fight/flight response that protects us from danger goes into overdrive. Everyday events, like homework, chores, or being told no drive the child into something close to a post traumatic stress response. They live with so much stress that even small annoyances send them over the edge. Bruce Perry, M.D. and Daniel Siegel, M.D. describe this neurological disregulation. That is, when faced with perceived threat, we "lose our minds". The parts of our brain that logically process information, the cerebral cortex and neocortex, turn off. Some children become disregulated faster and stay disregulated longer. You are right! They are not listening. They cannot hear us trying to explain, reason, or lecture them. They hear Charlie Brown's teacher, "Wah, wah, wah." Like a child with a temperature we cannot talk them down. They need comfort, care, and calm. The powerful parent using this "silent treatment" stays present, lending his or her self control by silently soothing to help the child regulate. The less said, the better. There will be time to teach a lesson to a brain that's on.
Monday, January 19, 2009
Clinical supervisors call it parallel process. It's the process by which the supervisor models with the supervisee how the supervisee may interact with the client. And, in return the supervisee often re-enacts with the supervisor how the client has acted with the supervisee. This process can be used consciously for learning and teaching purposes if both parties can be aware of it. This kind of interaction is also present for clinicians working with parents and their children. The therapist attempts to model with the parent how the parent might interact with the child. In return, the parent often re-enacts with the therapist how the child is behaving with the parent. If the main tool of attachment parenting is empathy, it is incumbent upon the therapist to use empathy with the parent. If the therapist misses the mark, the parent is likely to have difficulty hitting the mark with the child. Central to these interactions are also the concepts of transference and countertransference. The client transfers to the therapist feelings he or she has about children like joy or frustration. The therapist counters with feelings that can help him or her understand the client if the interaction is managed. It's the therapist's job to know how.