Alexander Ch. 6- Motivation phase

Hey Guys, Sorry I feel really dumb. I wrote this before my client yesterday and then I came home and totally forgot to post it until this morning. 

Motivation represents the gateway for lasting change…therefore it = IMPORTANT!

From the first contact, therapist begin working towards specific goals:

• Establishing balanced therapeutic alliances with indivual family members
• Reducing negativity and blame
• Instilling a sense of hope (e.g., “I have something to gain by being a part of this process”); and
• Creating a family focus, rather than an indiviaul focus, for both problems and strengths

-Family members have developed rigid or defensive cognitive schemata through which all information is filtered. This is what fuels and sustains the negative interactions. Over time they become automatic.

•  Think about areas or rituals where you have automatic processing (driving, mundane tasks), you begin to do and respond to things automatically with very little conscious thought.

-Disrupting these automatic responses and interactions is a critical first step in the FFT treatment process.

The goal: intervene in the moment to create a different experience that disrupts the family’s automatic responses

• This can be difficult as the family strives towards being more controlled and deliberate, so its important for the therapist to have a lot of relational capital (therapeutic alliance).
• In the early stages, the intent may not be to change attitudes and attributions, or other cognition, but rather to disrupt rigid, negative patterns and create an opportunity for family members to experience that something new and more hopeful is possible.

THERAPIST CHARACTERISTICS: ADOPTING A STRENGTH-BASED AND RELATIONAL FOCUS

The emphasis early on in FFT is on creating a context in which family members begin to experience one another in new and more positive ways.

• Fundamentally, therapists must believe in and be committed to a relational and strength-based approach, even when positive strengths and goodwill in the family are not at all apparent.
• The intensity of the problems and behaviors can be a challenge for therapists and can push therapist’s personal buttons.

Traps that the therapist can fall into:

• taking sides
• Challenging a manipulative behavior to protect vulnerable family member
• using interventions that validate one family member but blame/distance another
• engage in a disproportional of supportive interventions towards family members whom they see as being the victim

-To stick to the relentless relational focus in a way that is sensitive to the diversity of individuals and issues presented in the context of treatment, Therapists must have courage and resilience.

“Fearless empathy”

The beginnings of empathy:

• send the message that the therapist is totally committed to understanding their inner world. Individuals need to feel acceptance from the therapist.
• therapist needs to be aware of potential biasing influence from his/her background
• Send the message that the therapist is not personally overwhelmed, shocked, or frightened, disgusted, or intimidated by the intensity or nature of the family members’ emotions and attributions. It is important that the therapist has non-avoidant ways of dealing with the conflict

To successfully play your role as a therapist, there must be creativity, a willingness to introduce new perspectives and frames, and the flexibility to approach conflict in the man different ways until the therapist gets something that sticks (e.g. creates hope).

SPECIFIC INTERVENTION STRATEGIES IN THE MOTIVATION PHASE

Change-Focus Techniques- Intended to disrupt unproductive family interactions

                Divert-Interrupt

• divert and interrupt escalating negativing and blaming behavior during session. This helps families de-escalate the family’s toxic negativity.

Pointing Process Technique

• Commenting on interactions or events that occur during therapy sessions.  Therapists can describe interactions from a strength-based approach. This serves to defuse or at least lessen the negativity by shifting the focus from the specific content being discussed to relational aspects that underlie it but are hidden from the family members at the current moment.

Systematically Attending to Positive Elements

• It is easy for the therapist to become trapped in focusing on problems and blame. Keep an intent to look for positive elements that exist midst the rapid processing of information. These interventions have 

There are more techniques but I, without thinking, went home after my session, spaced posting this blog entry, and also spaced that I had been using Austin's book at the clinic and don't have my own copy to add onto it. They were all pretty simple techniques, however, and should be easy to scan over in your book.

Functional Family Therapy ch. 7- Relational Assessment Phase

It addresses 2 family domains:

1. the degree of connection between family members
2. the hierarchical pattern involved in those connections

This treatment doesn't de-emphasize genetics, or trauma, or anything like that that affects families, but by the time you use this treatment it's hard to know cause from effect- these behaviors don't emerge overnight.

Goals and tasks of the relational assessment phase

• How do the two things above relate to the problems in the family?
• This assessment helps you to know specific interventions to target specific behaviors. 

FFT helps dysfunctional families become functional and better versions of themselves. This is done by working on relationship configurations to provide them with alternative, more adaptive ways to express these configurations.

Relational Functions as the Linchpin for Behavior Change 

• FFT therapists focus on the relational function of the problem behavior- like someone who is looking for comfort and stress reduction through drugs and unprotected sex. The FFT therapist doesn't try to take away the relational function (comfort and stress reduction) of the behavior but they try to change the cognitive, physiological, emotional, and behavioral strategies they use to meet the relational function. 

Assessment of Relational Functions

Relational Connection

• "midpointing" is optimal for teenager/parent functioning. Same level of closeness as autonomy. Teens can do things on their own but then feel close with the parents when together. 
• Each 3 of these states can be adaptive and they can all be maladaptive. "The problem is not what the relational function is, but how it is expressed and met."
• The important part of this is that FFT doesn't say what every family should look like. They respect individual and family wishes and accept diversity of families and what they want to do/what works for them. If they want an autonomous family, that's fine. If they want to be close, no worries. We just help them get there. 
• It is important to look at the strength of the interaction patterns, not necessarily the strength of emotion. (i.e. the difference between an abused woman fleeing with her child trying to create distance vs. indifference between family members creating just as much distance)

Relational Hierarchy

• Sorry, I don't know how to rotate the picture. 
• The balance of control and power is an important factor to consider in FFT
• IT's important for parents to exercise control through relational connection and relational quality. 
• FFT therapists work hard to create a situation where youth are influenced by parents because they love their parents instead of to avoid consequences. 
• We also want parents to provide guidance through caring, not just in order to control youth.

FFF Ch 4 - Matching and General Parameters of FFT

Matching

• "Matching in FFT means attempting to create an interpersonal relationship in which family members are in sync with the therapist and are consequently able to move through subsequent steps in the process with the fewest impediments.  Matching is related to but not the same as the construct of mirroring.
• Examples
• If a parent reaches out warmly to the therapist, a matching therapist response would be reflected in the same warm manner.  If a family member comes across as cold and distant, the therapist would respond with more interpersonally distant behaviors:  less smiling, more formal speech, fewer emotionally charged words.
• "To use more colloquial language, good FFT therapists are not simply ubiquitous "warm fuzzes."  Instead, they know when and how to behave with emotional distance, embracing warmth, overt control, and unassertive acceptance, depending, of course, on what the circumstances and family member presentations call for."
• "We start therapy very actively, rather than simply by asking lots of questions or allowing blame and sullenness to linger.  We also work very hard, at the outset, to give families the idea that we are looking for understand and solutions rather than adopting the stance of telling them what is wrong with them or proposing solutions without first getting to know them and developing trust and mutual respect."

Structured Parameters

• "By parameters, we mean how FFT is linked to other systems, who participates in treatment, where sessions are located, what the average number of sessions is in the typical course of treatment, anyhow booster sessions are used."  These are not rigid parameters!!!
• Who attends sessions?
• The decisions on who participates in FFT sessions is based on the understanding of which family members will be important in the therapy process to begin change or hinder the process of change from occurring with the referred youth.  It's a functional decision rather than simply grabbing everyone that lives in the home.
• Location
• Be flexible.  Go to their home, come to your office, a community center, wherever
• Number of Sessions by Phase
• Average length of treatment is 12 - 14 sessions over 3 - 4 months
• 5-9 sessions have the primary focus of behavior change.  3-4 sessions in which the primary focus is generalization
• Timing of sessions
• With high-risk families you probably need to have more than 1 session per week for the first 2 weeks.  The spacing of those sessions depends on the severity of the case.
• Booster Sessions
• These can happen over the phone or in person
• Flow of Treatment
• Just look at pages 74 - 76 to see their outline.  I just don't want to retype the entire thing. It's a very quick read.

11/1/14: FFT Ch 5 Engagement Phase

Engagement Phase

Engaging External Systems

• FFT therapists try to establish positive links with every referral source and respond immediately to each referral.  
• They provide as much info about themselves as possible to referral sources to foster a relationship of openness, collaboration, and willingness to help.
• As appropriate, they provide the referral systems with info about tx attendance, progress, need for ancillary care, or other info the systems might need for their own accountability.  
• Most FFT clients come after working with lots of different systems (medical, mental health, private groups, juvy, etc.) and those relationships have to be based on respectfulness, matching, and perspective taking.

Assessment: Pretreatment and During Engagement

• Referral info ("James--runaway", "James--Drug Dealer", etc.) can help to gain as much understanding as possible about the context therapy is about to occur in.
• Formal assessment is only used when specific questions can't be answered in direct clinical contact.  
• FFT emphasizes the identification of the interpersonal impact of the behavior on each family member

Engaging the Family System

• The goal of Engagement is to maximize family members' initial expectations of positive change.  This is accomplished through
• High availability
• Effective management of the intake process
• presentation of tx enhancing the therapist's credibility.
• Engage people who are the major players in the youth's referral and problem behaviors.  This might include people the referral source has left out (live-in boyfriends of mom, etc.)
• It helps to frame it like, "Would you be willing to attend one session so I can get a broader picture of what is going on?  I think your perspective will be very valuable."
• Whatever we can do to get parents and kids in their together from the outset is worth the effort for the increased retention rates and ability to move through the FFT stages more quickly. 
• See them anywhere--Jail, RTC, community shelter, school, etc.
• The first call requires some skills:
• matching
• nonjudgmental attitude
• strength-based focus
• respect
• persistence
• Schedule 1st session ASAP and offer to go to the home if necessary

"Engagement is not therapy--the only goal is to get them into the session so therapy can begin. " 

10/6/14-LLL Session 10

Chapter 10-Latitude through understanding self

A. What is latitude?--"Wiggle room" for children to have their own unique personalities.  Not the opposite of limits, the child needs both latitude and limits.  But within the limits, the parent can validate and encourage children's own unique preferences to encourage latitude.  

         - Story about a father who once forced his son to eat his vegetables and watched while his son held the vegetables in his mouth with tears streaming down his eyes for a few minutes.  The father was ashamed at forcing him to do this.   

        - Another story about the same son sort of deciding to rebel against the family norms.  He started listening to hard punk rock and the dad just put up with it because he didn't appreciate the music, but didn't want to lose a relationship with his son over it.  His son also got an earring and he just laughed it off the same way.  But at the same time, his son was cutting classes and failing school.  When the dad went to have the conversation about not cutting classes, he was hoping he'd have enough money in the emotional bank account for his son to listen to him.  He did.  His son started salvaging his grades and doing better.  

^^Children need the experience of listening to their own voices and hearing what they want and learning how to get it.  Otherwise they'll grow up and not know how to do this.^^

1.  Simpler Skills of Latitude

a.  Emotion coaching helps children feel validated in their own opinions.  

b. Letting children lead.  a.k.a. Don't do for kids what they can do themselves.  Only step in when they are about to give up or are frustrated.  

2. More Challenging skills of Latitude: Understanding yourself

a. The part of you're self you're born with.  (Generic hand-me-down)--Examples: a child who is soothed by physical touch will be soothed by it later, and vice versa.  or Less active children grow into less active adults.  Etc.

b. The part of "you" you learned (social hand-me-downs)--Just like clay, everyone who touches us in some way leaves an impression.  The most influential sculptor of a child is the family--how they interact informs how the child will interact in the world with others.  Then, you invite the parents to reflect on how their FOO has affected them and how that might affect their parenting.

c. How you make sense of the world (internal working model).  What our family teaches us eventually moves inside of us so that even when we are far far away from our family, their unspoken rules guide how we live our life.  What are your internal dialogues and beliefs about yourself?  How does this impact how you parent your children?

d. Keep the good; change the bad. There are no perfect parents, you have the power to become a transitional character.  

B.  Skills at Home

Homework to think a lot about themselves and see how it impacts their parenting, etc. etc. etc.  

LLL Session 11

1. Children have difficult moments

-everyone has difficult moments (due to mood, fatigue, hunger), kids are no exception. In fact, they can be even more susceptible to these things.

-When this happens, it’s important to help children to feel that you are registering their opinions because they tend to be more sensitive than normal.

-Some children have difficulties that make them chronically inflexible (i.e. learning disabilities, ADHD, autism).

-Some kids have difficult temperaments, sensitivity to tastes, sounds, and touch, and difficulty adjusting to transitions. These are often difficult for adults to understand but they are very real inabilities.

2. Difference between unwillingness and inability

-As a parent it’s hard to differentiate between being unable and unwilling. What we think is the reason behind it can greatly influence our ability to patient.

Cues to help know if it’s genuinely difficult for the child:

-Be carefully in tune with how your child thinks and feels and their emotional signals. If you understand your child well, it will be easier to tell when they are overwhelmed.

-Watch for situations where your child’s emotions overwhelm them and learn what more vulnerable situations (hunger, sleep, change) are where they have a higher likelihood of “losing it”.

-Are there situations that almost always seem to be hard for your kid? What patterns do you see in parenting? There may be things that simple seem to come harder for your child or situations that are especially upsetting.

3. Explosive Episodes

-In difficult moments, children become more inflexible and unable to meet further demands. They become more and more frustrated and then their ability to control themselves decreases until they are out of control.

-This is not because they are manipulative or because their parents can’t handle them. It’s because they are delayed in their development of problem-solving skills and frustration tolerance.

In these situations, parents have to make a strategic choice: a. insist on the demands they have made or b. look for another way to settle the child down in order to help them work through their frustration. This choice leads to calming and resolution or toward explosive behavior.

*Remember--They are not trying to be manipulative. Punishing at this point only makes it work.

Inflexible Children + Inflexible Parents = Explosive Behavior

-if your child is truly overwhelmed, you may need to adapt as the parent.

4. Why latitude is better than traditional limit setting in difficult settings

-In difficult moments, traditional limit setting will not work because children are not capable of remembering, following through, or staying on task. When overwhelmed, they are truly “out of control”.

-To get your child back in control, parents need to find ways to sooth and quiet them so they can regain the ability to think.

-Sometimes parents take it personally when the child gets upset.

5. Responding with Flexibility

      a. Avoiding situations in the first place

      -hard situations can damage bonds with your child. Here are some skills to help avoid these       situations:

     -Lead-time warning. Warn your child ten minutes because they need to do something (come for dinner, bedtime) and then again at 5 minutes, and again at one minute.

    -Change your schedule, when possible, to fit better with the child’s capabilities. Making sure they are home to get a nap.

     -Be positive with your child as possible. Keep the “emotional bank account” filled.

     -Try to understand how you may be contributing to the problem.

    -Work on your own frame of mind. Parents need to avoid meltdowns too.

        b. Catching problems in early stages

-Once you see the warning signs you need to act quickly.

      c. Parenting strategies: Plan A, Plan B, and Plan C.

      -Your decision making progress should maybe involve three alternative plans:

      -Plan B is where learning occurs. Plan A is where you have to hold the line, and Plan C is where you graciously let it go to preserve or rebuild the relationship.

       -Plan A.  Using plan A means moving ahead with a
“parent-in-control” attitude. There are some issues that parents must insist on like issues of safety. An explosion may be unavoidable and may have to be tolerated. Plan A should be used be kept to as few behaviors as possible.

      -Plan B. There are some issues that, with patience and skill, parents may be able to help the child work though and understand. These are good opportunities to teach your child. You can help with emotion coaching, validating, and problem solving.

     -Plan C. Some issues aren’t worth insisting on and need to be forgotten or put on the backburner because there are more important things to be resolved. You might do this to 1. Preserve the relationship, 2. Work on other behaviors, or 3. The behaviors in question aren’t ones you can keep track of or enforce.

Questions to ask yourself:

1. How important is it that she be able to master this frustrating situation right now? Is it a high priority?

2. is she able or capable of learning  the skills needed now? Is she mature enough?

3. With my help and support, can she make it through this situation successfully?

*If the answer to all three of these questions is yes, the situation falls into Plan B.

6. Skills to help children learn to deal with frustration

-Help Children learn to recognize and express their frustration appropriately

-Get the child’s permission to help

-Teach children how to compromise

-Help your child with social skills

-Help the child see the situation from another perspective

-Practice good communication skills in your house

7. Children who need even more flexible parents

-Activity. More active, restless, constantly on the go

-Concentration. Easily distracted, or difficulty paying attention

-Intensity. Loud, loud laughing, loud crying, loud everything.

-Regularity. Not predictable in patterns of sleep, appetite, and bowl habits.

-Persistence. Negative persistence: relentless and stubborn when they want something. Difficulty changing activities.

-Sensory Activity. Gets over stimulated from noise, bright lights, colors, smells, pain, warm weather, tastes, the texture and feel of clothes.

-Adaptability. Difficulty with transition and change.

-Mood. Serious, unhappy, cranky.

-Initial Withdrawal. Initial response to newness—new places, people, food, clothes—is to withdraw. 

LLL ch. 12

This chapter was all about putting all of the skills together. It just had a lot of practice and role plays to discuss and know which skills to do when. 

There really wasn't any new information.

LLL-Session 9

LLL-Session 9: Limits through Time-out

1. Introduction to time-ou

-Many people us time-out without realizing its full potential

-Some ways of using time-out are really effective, some aren’t.

-Time out works best because 1) children feel bad about the disruption in the closenss or wond they want to have with their parents, 2) because they find that every time they misbehave they miss out on opportunities, and 3) because sometimes children need “alone” time to settle themselves down from an agitated state.

-Children who know they are loved want to restore their sense of connection.

-time-out motivates children to learn to control themselves.

-they learn what their parents value

The model for applying time-out:

Situation à Child’s behavior is unacceptable èParent hs child go to time-out and the child is temporarily separated from family relationships à Childs unacceptable behavior decreases.

-time-outs are most effective with kids under the age of 10, when done properly.

-Parents who use time-out need to decide when time-out will be used, where it will occur, and how long.

2. Identifying when Time-out will be Useful.

-too many time-outs are confusing for children

-Once a child knows the rule, few or no warnings should be used

3. Identifying where Time—out will be

-should be a place where the child is not getting attention and the surrounding environment is sterile.

-For older children, it’s best one done in a

4. Identifying how long time-out will last

-One minute for every year of the child’s life—up to five minutes.

-start the timer when the child has stopped crying or having a tantrum.

Helpful Guidelines:

-For children four years and older add one minute to time-out for each minute they refuse to go to time-out, up to ten minutes total time-out

-For each minute the child misbehaves in time-out, one minute is added, up to ten minutes

-if an older child (four years and older) leaves time-out, two minutes are automatically added for each time they leave, up to 10 minutes total time-out.

-Before being allowed out of time-out, the child needs to be quiet and behave appropriately for the last two minutes of time-out.

-If time-out reaches 11 minutes or more, consequences are given or privileges are taken away, Parents need to be judicious when doing this and avoid negative family loops.

5. Implementing Time-out

Demeanor of parents:

-Should be calm, matter-of-fact, and assertive. They should know you mean business.

-Don’t express excess emotions

-Don’t use time-out as a time to lecture or scold them.

Parental togetherness:

-parents need to work together

Explain time-out to child:

-explain what time-out is and how it will be implemented before you actually implement it.

Installing time-out

-the hard part is installing it as a procedure that the children accept

-when starting, pick one or two behaviors that will qualify for time-out

Be prepared for a rough start:

-Plan on having to make multiple attempts

-Allow plenty of time

-Be patient and calm

Let it be over:

-when punishment is over, welcome them back and let them know that you appreciate being with them. 

LLL-Session 8 9/29/2014

LLL- Session 8: Limits through Consequences

1. Skills Refining

-Review how the home activity on rewards went. This is important to review because different parents probably had different experiences.

-Review validation skills

Introduction to Consequences

When children misbehave there are three different kids of consequences parents can choose to address the behavior—ignoring them, taking away privileges, punishing.

2.Ignoring

By ignoring, you send the message that the behavior will not be reinforced or rewarded in any way

-parent can expect a certain amount of whining and complaining and this is normal

-judicious use of ignoring will teach the child that it doesn't do any good to whine or complain.

-the most difficult part is knowing when to ignore and when not to ignore.

-parents can effectively use ignoring when 1.) what children want is parental attention and 2.) when the negative behavior is not dangerous or hurtful.

“noise out the mouth” is a term they use to describe when kids are aware of the rule and the reason for the rule but they continue to whine and complain to get attention or delay things…or in the hopes that the parents will reverse a decision.

“Hurtful and/or harmful words or behavior” are times when children actions or words are putting people at risk for emotional and physical damage. Parents have a responsibility to intervene at these times.

*To effectively ignore misbehavior, keep your cool and simply act suddenly absorbed in something else. Don’t make eye contact and turn your back so your child cannot get even a frown. If children can see that you are angry or upset they can tell that they have an effect on you. Stop ignoring when the child stops whining and complaining and start giving positive attention when they are behaving positively.

2. Taking Away Privileges

Situation à Child’s Behavior à Consequence (review the model from Session 7)

-In taking away privileges, the parent takes away something that the child enjoys after misbehaving. :In punishment, the parent gives something to the child that is unpleasant, such as an extra chore.

The model for taking away privileges would be:

Situation à Child’s behavior is unacceptable à Parents take away privileges àChilds unacceptable behavior is decreased, if parent is consistent in letting the child know that such behavior will cost them opportunity.

*For children under 12, the loss of privileges should be short

*Make sure the child knows that opportunities are available to them if their behavior is appropriate.


3. Punishment

Model for giving punishments:

Situation à Child’s behavior is unacceptable à Parent gives a punishment à Child’s unacceptable behavior is decreased if parent is consistent in punishing the negative behavior.

-Punishment should only be used when parents believe that emotion coaching and ignoring their child’s misbehavior is inappropriate.

5. The “do’s” of consequences :

-5:1 Ratio—for every time privileges are taken away or punishment is given, there should be five positive parent-child interactions through attention and praise.

 -Think through or even make a list of consequence options, such as “ignoring”, “taking away consequences”, or “punishments”.

-If at all possible, give consequences immediately

-When possible, decide ahead of time what consequences will be administered when household rule are broken.

-When possible, make sure consequences are understood by children.

-Be consistent across time and parents

-Stay calm

-Separate consequence from love

-use natural or logical consequences when possible

-consequences may also provide teaching moments

-Grounding is usually ineffective. If used, it should be for a short amount of time

-If one technique hasn't worked, consider something different.

6. The “don’ts” of Consequences:

-Don’t punish when, in your emotions, you want to hurt the child

-Don’t withdraw love

-Don’t take away privileges or routines that connect

-Don’t take away privileges that the child has earned

-Don’t make the other parent the enforcer of the rules

-Don’t reward negative behavior

-Don’t fall into negative family loops

LLL Session 5: Values Help Connect and Set Limits

To start out you review everything from the previous week.  That should be pretty straight forward.  You can understand the course of the session simply by reading the questions that they ask.  It isn't super complex.

1. The three anchors and family values
1. Values anchor our lives when things get tough.  The 3 anchors (love, limits, and latitude) will all be affected by the values of your family. 
2. How parents can teach values to their children
1. Verbal Teaching
1. "In your experience, how well does telling = teaching = behavior change work for you and your children?"
1. Telling them doesn't really work, or does so in only a weak way.
2. "Why do you think simply telling or preaching our values to children is not very effective?"
1. There are better ways to teach values rather than simply just saying them.
3. "What ways of talking about values do you think are more effective than simply telling children or lecturing them?"
2. Teaching Through Example
1. This is definitely a stronger way.
2. "As parents, why do you think it is so important for our actions to demonstrate the values we talk about and expect our children to live by?"
1. This is an obvious question.  Practice what you preach.  I keep thinking of the quote "Sorry I can't hear what you're saying because of how loud your actions are." or something to that effect.
3. "If parents want children to love and respect them, the parents will..."
4. "What are your children really learning from you?  Is this different from what you intend for them to learn?"
5. "Did any of you have experiences as teenagers where the way your parents lived and behaved either led you to embrace or reject the things they were trying to teach you?"
6. "What lessons can you learn from your reactions to your parents' teaching methods to help you with your own children?"
3. Teaching Through Experiences
1. With this method you are creating experiences to help your children to learn a value by having a chance to practice it.  They engage and practice the value alongside their parents
2. "Why do you think experiences are such a powerful method of teaching values?"
3. "What are some things you have personally learned from experience that you doubt you could have learned another way?"
1. Generosity
2. Hard Work
3. Honesty
4. "What kinds of experiences for teaching have worked well for you and your children?"
5. "What mistakes have you made with trying to teach through experience?"
3. using values to help determine where to set limits
1. The values and limits of your family should be principally based.

9/30/2014 Love, Limits, and Latitudes Session 7

9/30/2014 Love, Limits, and Latitudes Session 7

Session 7: Limits Through Rewards

Summary Introduction

• The Purpose
• Review the home activity on effective commands
• Understand how rewards affect both anchors of love and limits
• Understand major concepts, so parents can build more structure and positive family interactions.
• Apply rewards through home activity.  As parents are deliberate in their application of rewards, it will increase appropriate structure and positive family interactions.
• Enjoy attending group and interacting with one another.  Group interaction and disclosure are the glue that holds the program together.
• The Major points are:
• Rewards can be used to change behavior
• Parents can use social, tangible, or experience rewards
• Rewards can enhance limits and love
• Rewards can create positive patterns in families
• How to use rewards appropriately
• Prior to beginning this session:
• Bring an example of a simple tangible rewards system
• Review the checklist of supplies and preparation. 

Session Script

• Getting Started
• Starting Session, welcome parents
• Today's agenda, Introduce the agenda to parents
• Skills Refining
• Review home activity on effective commands
• what went well, what didn't go well, what were the most effective commands, review what they remember about praise and attention, and past skills that they have learned.
• Skills Learning and Practice
• Rewards can be used to foster both limit setting and love
• how rewards are part of limit setting
• where there is appropriate structure the home is more calm.
• rewards encourage children to follow the limits
• how rewards create love
• rewards are better than punishments
• rewards provide structure and love
• social rewards are the best, they are free and given often, smiling, praising.
• rewards can create positive patterns in families
• positive reaction from parents usually get positive reaction from children.  Everyone is happy:)
• What are rewards/kinds of rewards?
• Tangible rewards
• can be touched and physically felt: treats, stickers, cards, toys, or money
• Experience rewards
• more commonly called privileges, these can be experiences or opportunities to do something pleasurable, alone or with others, including the parent.
• Social rewards
• attention and praise
• Giving the child something they want (positive reinforcement)
• Taking away something the child doesn't want (negative reinforcement or "relief")
• How to use rewards
• Be clear and explicit about what the child is being rewarded for.
• what is a reward for one child is not a reward for others
• The difference between rewards vs a bribe is that rewards work best when they are explained in advance of the situation.  A bribe is when you give a reward once a child is misbehaving. 
• Skills at home
• Home activity on using rewards
• In session have parents decide on a behavior they want to reward this week and how they will reward it.  Lead a discussion about what these rewards will be, and help group members to apply the principles learned in this session.  Have them write these down.  You can use handout 7.2 "home activity on using rewards"
• Encourage parents to review the skills of praise and attention this week, which fit in nicely with the idea of social rewards.
• Points to remember
• Remember rewards affect both anchors of love and limits
• proper use of rewards can build more structure and positive family interactions
• There is a big difference between rewards and bribes.  Bribes "pay off" a child before he or she complies with the request or command.  Rewards are given after the child responds appropriately.
• Rewards can create positive patterns in families
• Session Evaluation

Session Handouts

• Session Outline
• Home Activity on Using rewards
• Points to remember
• Session Evaluation

9/30/14 LLL chapter 6

 Intro to Limits

Setting limits means providing discipline
As parents provide discipline it creates structure and boundaries in children's lives.
Before children can feel secure they need to know what the rules are and that the rules hold.
It is difficult to be comfortable in an unpredictable environment. When parents provide structure it helps children feel like their world is safe and predictable. They know what to expect when they behave in certain ways. This gives them a feeling of control over themselves and their world.

               rigid__________________balanced________________chaotic

Today's session will focus on how parents can use effective commands when setting limits

DONT FORGET THE LOVE-- don't forget all that great stuff we learned in the previous sessions. They still need to be implemented.

Commands That Work

• Clear commands: explain the rule and be direct and specific in the expectation and a firm/assertive tone of voice that is also polite. 
• "Settle down," "stop it," and "act your age," are all unclear and vague (not good) but things like "sit down" or "keep your hands in your lap" are good because they are specific.
• Use language your child will understand. It would be stupid to tell a 3 year old to "be responsible"

Positive Commands

This is telling your child what to do instead of what not to do. Instead of "don't put the toys there" say something like "Please put the balls on the bottom shelf and the blocks on the top shelf". "Stop yelling" vs "please talk more quietly" or "don't hit your brother" vs "keep your hands to yourself".

Provide Explanations and Give alternatives

Instead of just telling your children "no" explain what your no is about. It's frustrating to just get a "no" and they don't know why they are being refused. Then give an alternative!

When/Then Commands

In the "when" part the parents give the command, in the "then" the parent tells what opportunity will follow. "When you eat your vegetables, then you can have some ice cream"

In doing this parents are giving children a choice. If the "when" doesn't happen, the parents don't give the "then".

Follow Through

When parents make a command they need to follow through which demonstrates to the children that they mean what they say.

Lead Time Warnings

This is letting your children know ahead of time that a command is coming. This allows children to mentally shift gears and prepare for the change that is coming.
Make sure the child understands the command!!

Commands that don't work

Is the command necessary??
pick your battles and only pick the ones that are important to win. "unessential commands are often directed towards small changes that do not really matter and tend to rob children of initiative and may not be important for you to follow up with.
if you don't care enough to enforce the command, don't give it!

Unforceable Commands

Demanding that a child do something that the parents can't enforce becomes a battleground if the relationship is tense. Example: don't eat candy your friends give you at school! A child may comply if the relationship is good, but if not they will start to learn deceit.

Let's Commands

This implies you will do it with the child. Be clearer if you don't plan on doing it with the child! "let's go to bed"

Question Commands

If the child doesn't have an option, it's probably not a good idea to use a question command. Example: "Do you want to put your toys away now?"

Chain Commands

Two or more commands given together. This is doomed for failure, kids can't remember more than 1 or 2 things at a time. Match your commands to the child's developmental level.

What to do when Commands don't work!

Model Obedience

Example:

-Parent: "Simon, please come and take out the garbage"

(Simon keeps playing as if he didn't hear)

-Parent: "Yes, mama"

-Simon (reluctantly but compliantly): "Yes, mama"

Ignore (noise out the mouth)

Sometimes children whine, argue, or attempt to negotiate. If the child's feelings are sincere, do some brief emotion coaching. But if the tantrum is just to distract the parents, ignoring is your best option.

Avoid Arguments

 Children argue to distract parents, just ignore it. You can justify commands, but justifications are short and to the point and not repeated a million times. 

Here are some good methods:

• The broken record method
• Once you state the command and the reason, simply repeat what you say verbatim if your kid tries to argue. 
• Divert and distract:
• This works especially well with young children. If they ask to go play and you say no, and you know an argument is coming you can quickly ask how show and tell went or something else to get their mind off the argument.

9/22/14- Barber & Xia

So, this article was really long and hard to follow/summarize. It mostly talks about parenting styles/types. But this was the gist of it—there are different kinds of psychological control that parents can use on their kids. Psychological control has a lot of bad outcomes. Here are some main points/parts that I took from the article.

-Nurturance (e.g. support, acceptance, responsiveness) is an adequate and reasonable regulation of behavior, and an absence of intrusive behaviors that manipulate to demean the child’s individuality.

-The element of control is an important factor in parenting and child development. Optimal functioning is undergirded by a basic tension between individual freedom (autonomy) and control (regulation, conformity).

There are two major forms of control exerted by parents--Parental Psychological Control & Parental Behavioral Control.

 “The two forms of control [psychological and behavioral] appear to have opposite effects on the adolescent…Adolescents appear to be adversely affected by psychological control—the absence of “psychological autonomy”—but positively influenced by behavioral control—the presence of “demandingness”

Developing children require:

1. an adequate degree of psychological autonomy, that is, that they learn through their social interactions that are effective, competent individuals with a clear sense of person identity
2. sufficient regulation of behavioral to enable them to learn the social interaction is governed by rules and structures that must be recognized and adhered to in order to be competent member of society

-Research has continued in depth and there has been found to be a significant association between psychological control and problematic child functioning.

-Psychological control is the control of the personal domain, strategic manipulation and pressure, conditional regard, coercion and disrespect

-According to research sighted in this article, psychological control—particularly manipulative forms such as love withdrawal, guilt induction, and conditional regard—is by definition controlling because its purpose is to coerce the child into feeling pressured to control or change him-or herself (i.e. his or her thoughts, feelings and behaviors).  This pressure to conform prevents the volitional functioning of the child, a cardinal principle of self-determined autonomous functioning.

-When these control attempts keep happening over time, the child internalizes the pressure to change themselves according to perceived parental demands and does so out of a desire to avoid anxiety, guilt, and shame.

-Children experiencing such control will learn not to value their independence worth but to consider themselves acceptable individuals only to the degree that they do/become what their parents demand.

-Parental conditional regard is effective in getting behaviors from kids in certain areas but has a lot of negative emotional and relational impacts.

-both conditional regard and psychological control predicted the mediator of shame after failure

-dependency-oriented psychological control : attempts to make the child psychologically and emotionally dependant on the parent.

-achievement-oriented psychological control: demands excessively high degrees of achievement by the children

Psychological Control as Coercion

-Coercive parenting has been studied and been associated with internalizing and externalizing adverse outcomes in children

Authoritative vs. Authoritarian:   Both are confrontive discipline which is firm, direct, forceful, and consistent. Authoritarian adds on coercive discipline which is preemptory, domineering, arbitrary, and concerned with retaining hierarchal family relationships.

-Parents can also exert psychological control by excessive domineering and interactions with their children.

Collection of data determined eight main types of psychological control:

-ridiculing

-invalidating

-violation of privacy

-guilting

-excessive expectations

-comparing to others

-ignoring

-Psychological control can impede the child’s ability to develop as an individual apart from the parent.

9/21/14-LLL Session 1

Essentially, begin with an intro much like we had with Andy and Lanae.  Ask parents what they want out of the group, ground rules, intro yourselves, etc.  Overview of the program and then talk about how love is the most important anchor in the program.  Then move on to the skills portion of the day...

1.  Children feel loved through play

     a.  Play is the language of children.  Parents who don't know how to play likely grew up in a home without it, but today they are going to relearn it.  It's accepting, nurturing, and loving for their kids to be played with.

2.  Special Playtime

     Step #1-The first activity and homework is to find time to play with your child.  This is 15-20 min of uninterrupted time a day playing with your child and letting him set the activity and pace of the the play.  Adjust to your situation.  (Leaders need to validate parents' concerns for how this will take too much time and they'll be overwhelmed, etc.  Problem solve to come up with solutions.)

    Step #2-This is a time where the child is the leader.  Don't criticize, ask questions, correct, or take control.  You can gently correct if they start to be destructive, but mostly just listen.  This is the first step to learning their language.
                  a.  Leaders prepare a few skits which show all the wrong ways to play with a child and ask the class to identify them.  1) parent correcting play, 2) parent criticizes play, 3) parent always wins race with toy cars because of competition, 4) parent is constantly quizzing "What does a frog say?", "what color is this block?", etc.

    Step #3-Join in your child's play as a supporter and enthusiast.  Try not to ask questions, just describe what they're doing or seem to be feeling (like reflective listening).  For example, "So you're rolling out the play dough into snakes, cool!", or "you're feeding your dolly just like a real baby, nice and gentle, look what a great mommy you are already!", etc.  Just let your child revel in your rapt attention and enthusiasm.  Think of yourself as a narrator or sports announcer, haha.  Appreciate what your child CAN do.
                 a.  Have someone volunteer to be the child and have the class come up with 5 ways to describe what they're doing and 3 ways to describe how they might be feeling.  Keep practicing for a while, them break into smaller groups and try this.

9/21/14-LLL Intro

OVERVIEW
LLL is a 12-session psychoed parent-training program for parents of kids ages 3-11.  Each session is 2 hours.  Based on attachment theory.

HISTORY OF THE PROGRAM
The program started with the MFT and SFL faculty at BYU in 1998 and is based in three main concepts, Love, Limits, and Latitude.

CONCEPTUAL MODEL
Love: the connection, attachment, and bond between parents and children.  Love is the most important anchor and they think it resolves most of the issues.
Limits: providing structure and discipline.  Children who experience structure experience a sense of control over their lives because they know what the rules are and what the consequences will be so they can be confident that they will "get it right".  Eventually this parent-control shifts to self-control.
Latitude:  Parents respect their children's individuality. Parents prize their children's unique ideas and encourage their differences from them so kids feel confident in their sense of self.

WHO BENEFITS FROM THIS PROGRAM?
Everyone.  Mostly kids who are younger and less conduct disturbed.  So take care to really really help those who aren't younger and who need it most.

CLINICAL ISSUES
FACILITATOR REQUIREMENTS
2 Facilitators per parenting group.  At least one facilitator needs to be licensed or training for licensure in a field like MFT.

GROUP SIZE
Min: 8, Max: 16 group members.  Recruit slightly larger knowing that some won't actually participate.

CLINICAL SKILLS OF LEADERSHIP
They work hard to help the parents in the group experience the interactions they should be having with their kids.  Leader-Parent interactions mirror Parent-Child interactions.  Practice what you preach.

Love: The foundations are play and responsiveness, attention and praise, validation, and routines.  Use humor, make sure the atmosphere is supportive and validating, etc.
Limits: Consistent and predictable.  No time-outs or punishments here, but social rewards exist.
Latitude:  Flexibility, valuing people's input, and adapting to group member's needs.  Being collaborative.

6 Different hats a group leader wears in parent-training:
   1.  Building supportive relationships
   2.  Empowering parents
   3.  Teaching
   4.  Interpreting-research jargon into helpful parenting techniques
   5.  Leading and challenging
   6.  Prophesizing-predict challenges parents will face and predict their success.

PREGROUP PREPARATION
Have a pregroup meeting before session 1 with everyone together for a more casual introduction to each other and the target age group of the kids for the group, etc.  Otherwise there's too much to do in session 1 for the parents to get to know each other at all.

**Page 6 and 7 have a great little box of ideas for how to have this pregroup session: put signs up, call the members, etc.**

LEVEL OF INTERVENTION
Doherty (1995) describes 5 levels of interaction with families:
   1.  Only practical or legal work with parents.
   2.  Information and advice
   3.  Feelings and support
   4.  Brief focused interventions
   5.  Family therapy.

The group is probably most often in levels 3 and 4.  Definitely shouldn't be level 5.

Then they go on to talk a bit about Yalom and the therapeutic alliance and how that's a model for the parents with their kids, yada yada yada...

PROCESS ISSUES
It's important to pay attention to group process, duh.  Sometimes some of the parents literally just need emotional support so they don't care about content, and sometimes vice versa.  It's crucial to acknowledge the balance and make sure everyone's needs are getting met.  The group is more beneficial when it is flexible and includes time to talk, engage, build each other up, brainstorm, etc.  "Exercises" are most useful when prepared well in advance, then processed, generalized, and applied to specific members' situations afterward.

GROUP STAGES
Beginning: Members are nervous and anxious, cautious.  Later on they become more confident and can talk about differing opinions.  Leaders should keep risk-taking activities to a minimum until the group feels safer and more cohesive.

SUGGESTIONS FOR HANDLING COMMON PROBLEMS (I'm just going to do the interesting ones, the others were no-brainers for any therapist)
Parents share examples that do not illustrate good parenting...
It's important to validate parents on their progress, even if they haven't fully grasped something yet.  Try something like, "I like (this part) of what you said because it helps your child...Let me see if I can turn it just a few degrees to see if that would make it even more effective..."  If someone shares something abusive, then the leader needs to disagree more explicitly, but maybe use a little bit of humor to lighten the blow. (stroke kick principle?)
My group has a troubled monopolizer...
Sometimes one person will monopolize group time by sharing deeply personal issues that require psychotherapy (not parent training).  You can avoid this partly by explaining really clearly in the beginning the difference between therapy and the group experience.  It's appropriate sometimes for a leader to pull that person aside after group and let them know that they're concerned for them and their family and not sure the group will meet their needs right now since they are simply a parent-training group, and provide a referral for therapy.
This won't work with my child...
Sometimes parents haven't actually tried the principle, but sometimes children are actually difficult and it won't work with things as they are right now.  Encourage the parents to do all the love and relationship building they can to see if they can set a good foundation for trying different disciplinary practices.
The exception finder...
No parenting technique will work in all situations, the goal is to give you a set of tools so that when you have a hard situation, you'll find at least one that will work.

ROLE PLAYING
Introduce it in the first session and establish it as a norm for the group.  Keep it relaxed and fun.  Use humor (maybe by exaggerating the bad parenting behavior) to lighten the mood.

ORGANIZATION
MANUAL ORGANIZATION
1st four sessions=Love, 2nd 4 sessions=Limits, last 4 sessions=latitude.
3 levels of each session in the manual: 1) Presentation outline, 2) session script, 3) conceptual overview.  Basically study all of these and put them in your own words so you're ready to do the program.

INDIVIDUAL SESSION ORGANIZATION
1) 30 min HW and past skills review.
2) 30-45 min discussing and presenting the topics for the day.
3) last 45-60 minutes for practicing the skills and allowing time for reflections, reactions, discussion, etc.

CLASS FOLDERS
Hand out folders so everyone has a place for class handouts and store home activities.

Then a bunch of research on how great the program is....

9/20/14-LLL Session 3 - Love Through Conversation

1. Conversation is important
1. As Neitzche said "Love is a long conversation"
2. Questions
1. What is it about conversations that make a child, or any of us, feel loved?
2. The cycle of emotional closeness
1. See graphic on pg 57
2. Essentially Emotional Closeness leads to Self-Disclosure, which leads to Vulnerability, which leads to Validation, which takes us back to Emotional Closeness.
1. The first building block of conversation is self-disclosure
3. Questions
1. When people talk about "self-disclosure," what do they mean?
1. It's when people talk about what is going on for them - not just the events that took place, but the feelings as well.
2. Why does sharing feelings with others (self-disclosing) make people feel vulnerable?
1. Sharing your inner thoughts and feelings with someone is risky because the other person might not share your feelings, might laugh at you, ignore you, criticize you, or become angry with you.  When someone self-discloses to you you need to realize that vulnerability that comes with that.
3. When people talk about validation, what do they mean?
1. Validation is the skill of helping your child feel understood and valued for who they are.  When parents validate a child, they create a safe place for self-disclosure.
2. Emotional closeness comes when you have created a place where the child feels close to you and wants to continue talking to you.  By being understanding, you are creating a safe place in their lives here they can come to you and share feelings and ideas and be loved for who they are.  This is emotional closeness.
4. Can you think of times you tried to tell something important to someone who was not understand and afterward you distanced yourself from him or her?
5. How about times you told something important to someone, felt understood, and then felt closer to that person?
6. Have you seen any evidence of the cycle described above in your relationships with your children?
3. How to converse with your child: The art of validation (Adapted from Gottman's 1997 book, Raising an Emotionally Intelligent Child:  The Heart of Parenting)
1. Step #1:  Be aware of your child's emotions
1. How does your child act when they are upset?  When something is on their mind?
2. Can any of you think of an example of when you were able to tell your children were upset from what they did rather than what they said?
3. Have you ever been able to tell what was bothering your children through their play?
4. Have you ever been able to tell what was bothering your child through appetite or sleeping changes, or through other physical symptoms, like stomachaches?
2. Step #2:  Recognizing the emotion as an opportunity for intimacy
1. Can someone share an example of a time that helping your child through a crisis brought you closer to him or her?  It simply is "the stuff" of building close relationships
3. Step #3:  Listening empathetically and validating your child's feelings
1. Pretty self-explanatory
4. Step #4:  Help your child verbally label emotions
1. Also pretty self-explanatory
4. Putting it all Together:  Practicing validation and labeling feelings
1. This is where you role-play with the parents in the group and have them work through a conversation with their "child" where they go through each of those steps.
5. What validation is not
1. It isn't logic.  
1. You aren't trying to gather up all of the facts so you can fix the problem.  You're being present and helping them feel understood.
2. It isn't an argument or criticism
1. You might not agree with the child's assessment of the situation.  Don't argue about feelings.  You don't have to agree with your child to be able to validate him or her.
3. It isn't problem-solving
1. Pretty self-explanatory
4. It isn't an inquisition
1. Gottman says that sharing simple observations usually works better than probing questions to get a conversation rolling.  Children may not know why they feel sad or upset and too many questions often make them (or anyone) feel defensive.

9/20/14-LLL Session 2 - Love Through Attention and Praise

I'm with Lauren on these ones.  These chapters are really weird to write summaries for because there are summaries of the previous chapters and then they are outlines for leading a parenting group.  One example of what I will be skipping are things like "Welcome parents to group and let them know that you appreciate them being there."  I'll give all the detail that you need, but it's pretty straightforward.

1.  Children Need Attention and Praise

Key questions from this section:

• What did attention and praise mean to you as a child?
• How did you feel when your parents were critical of you?
• What gets in the way of you giving your child attention and praise?
• Most parents spend far too little time praising their children
• Did any of you or your friends do similar things out of a desire to get your parents to pay attention to you?
• How much does it mean to children to have you see them perform - in dance, plays, sports, or even learning how to skip, whistle, or ride a bike?
• Sometimes when they don't get that attention they will go inward and tell themselves that they aren't important.
• In what ways do your children seek attention from you?
• How do your children respond when they don't get attention from you?
• How do you children respond when they do get attention from you?

2.  Using Attention and Praise to Build Love

This is important for a couple of reasons.  First, attention and praise help children develop a healthy sense of love and appreciate for themselves.  Second, a lack of praise and attention is unfortunate in that it damages the loving relationship between parents and children.  Think about Gottman's emotional bank account.  Giving praise and attention solidifies a child's feelings of love between the parent and the child.

3.  Using attention and praise to change behavior

Paying attention to good behaviors reinforces those good behaviors.  When we only pay attention to the negative behaviors we tend to reinforce those behaviors.  Think about it in terms of social rewards.  Social rewards, such as attention and praise, may be even more powerful than other reward systems like candy or money because they are related to the fundamental need for connection and love.

Important Questions:  How does it make sense that mom telling the children to stop fighting may actually invite more fighting in the future?   Can you think of any examples where you have used praise and attention to change your children's behavior?  Think for a moment about a behavior you would like to see increased in your child.  How could you use attention and praise to try and increase this particular behavior?

4.  The difference between attention and praise

Both praise and attention require parents to focus on their children.  One difference is that attention tends to be non-verbal, while praise uses words.  Examples of attention are watching a child while they are playing, smiling, or looking up and listening when a child talks to you.  Praises are easier to point out.

5.  Practicing effective attention and praise

• Be specific
• Instead of saying "Good boy!" say "Good coloring on that paper.  I really appreciate it!"
• Use Enthusiasm
• Be appropriately enthusiastic with you praise, but be enthusiastic.  This comes across in tone of voice.  It should be proportionate with what they did.
• Use Physical touch
• E.g. playing blocks with your children and you touch their knee, putting your hand on their shoulder, etc.
• Adjust praise to the age and abilities of the child

Questions to ask the group - they do a role play to get things started

• Why do you think specific praise is more effective than general praise?
• What is wrong with general praise?  (Not saying that all of it is bad)
• How do your children react to praise when it is clear from your tone of voice that you don't care much about what they did?  How is it different when you show enthusiasm?
• Can you think of examples of times you touched your child while praising him or her and you felt like your message really got through.
• Why do you think touching your children while talking to them makes such a big impact?

When to Praise

1. Parents have an endless supply of praise and its free, so use it liberally, anytime, just to let your child know you love him or her.
1. Don't wait for your child to be perfect
2. Catch your child being good and praise good behavior to help them learn how to be socially competent
3. Praise Immediately and Consistently
1. Praise looses its impact with time and sounds more artificial when given long after the event.  However, late praise is better than no praise.
4. Children like to hear you praise them in front of other people
5. Try to use more praise for difficult children, even just for the initiation of good behavior.

Remember, the authors believe that people only truly change for people they trust.

9/20/14 Love, Limits, & Latitude Session 4

So, this is really weird to try to do a summary for, so it'll probably be really short and I won't go through the review skills stuff, I'll just stick on what the new material is for the chapter.

1. Using Conversations to Solve Problems

Problem solving is the last step to Gottman's emotion coaching.

Validation needs to happen before problem solving can happen. Once the child feels understood, then you're ready for problem solving (step 5)-- if you need it.


Step #5: Setting limits while helping the child problem solve.

Problem solving is where the parents help the child by guiding thinking into appropriate ways to handle uncomfortable feelings. i.e. You can understand that your child was angry with his brother, but hitting isn't allowed. So you can problem solve together about what else he can do since he's angry.

FIRST: parents should help children decide what they want to accomplish related to the problem.
SECOND: Help the child think of as many solutions as possible. (Parents, respond non judgmentally to all suggestions)
THIRD: Help the child evaluate the solutions based on family values and consequences and then choose one that seems appropriate.

2. Family routines help children feel loved and safe

Routines build structure in a child's life so they can come to expect to do certain things and to feel that they can be competent in participating in daily life.

3. Developing routines using play, attention and praise

The key is for parents to be deliberate and consistent in their use of routines. The routines that occur frequently are going to impact the parent-child relationship the most.

9/16/14 Kaslow, Smith, and Croft

9/16/14 Kaslow, Smith, and Croft

Families with Young Children: A Developmental-Family Systems Perspective

Intro: 

• Children are intuitive guides to the shared unconscious of the family.  They are honest, direct and their presence enhances the process of family therapy.
• Many therapist don't include the children in family therapy, especially the younger ones.  And when they are included, developmentally appropriate adjustments aren't made so the children's voices aren't heard.
• Family therapy with children requires that therapist know about child and family development, developmental psychopathology, systems theory.

Demographics and Descriptive Statistics

• There are lots of children in America, of all different races and nationalities.  22% of them live in poverty.  And they live in all kinds of families, parents together, step parents, single parents, divorced families.  
• Therapist must develop expertise in working with multiple family constellations

Child Development

• Infancy and toddlerhood
• Infants are completely dependent on their parents. Consistency and responsiveness in caregiving are required for the development of secure attachments.
• Toddler hood is marked by burgeoning independence, learning to walk, start to communicate their needs, wants, and preferences through 
• Preschoolers
• Language acquisition, use words to communicate.
• Still view events in an egocentric manner, the world is magical and animistic.  Imaginative play becomes increasingly complex.
• Middle Childhood
• Marked by a shift from egocentrism to perspective taking.
• exhibit increased mastery of their bodies, channel self-expression through involvement in sports, the arts, and other hobbies.  Peer relationships become more prominent.

Family Development

• Common tasks for families with young children
• With the arrival of children, parents now have to change their role definitions.  Who works, who cleans, having adult relationships, etc.
• Caregivers must learn to provide consistent nurturance without themselves becoming depleted, and find new forms of emotional gratification in the act of caregiving. 
• As children get older, the family must be flexible, and parents take responsibility by setting limits and exerting authority.
• Dynamics for different family constellations (how adding children changes things)
• Intact families
• two parent families
• the couple has to find ways to maintain "couplehood"
• renegotiation of family roles and responsibilities
• Single-Parent Families
• the demands of caring for a child or children by oneself can be overwhelming, both pragmatically and emotionally.
• Extended family members often play a vital role in care of young children.
• Extended Family
• Extended family members can serve as caregivers, often grandmothers.
• more common among certain ethnic groups.
• Divorced, Step, and Remarried Families
• lots of stresses: single parenthood, complexities of coparenting, custody and visitation, remarriages which bring there own challenges.
• Adoptive and Foster Families
• bonding, age of the adoption, forming a family  story about the adoption, divided loyalties, managing the child's curiosity about their biological family.
• Foster families deal with similar issues in addition to uncertainty of the length of placement.
• Gay and Lesbian Families
• Blended families, how did the child come, surrogacy, adoptions, a biological parent is out there.  These couples experience intense societal prejudices. 

Common Presenting Issues In Families With Young Children

• Child Problems
• Behavioral Problems
• ADD, ADHD, ODD, tantrums, overactivity, destruction of property
• Remember, disruptive behavior frequently reflects underlying emotional distress a a reaction to environmental stresses.
• Emotional problems
• Depression and anxiety are most common.
• signs: social isolation, limited peer involvement, fears, withdrawal from activities, low self-esteem, low appetite, and sleep disturbance.
• School and Learning problems
• Behavioral and emotional problems may contribute to learning and academic performance problems.
• Learning disabilities often lead to low self-esteem and disruptive peer, teacher, and family relationships, contributing to the development of behavioral and emotional difficulties.
• Developmental Disabilities
• Mental Retardation and pervasive developmental disorders
• Physical Symptoms and Medical Problems
• Children are often referred from doctors due to physical complaints, symptoms, and disorders.
• Can run the gamut, somatic complaints, to coping with chronic medical conditions
• Links Between Child Problems and Family Dysfunction
• Children can create problems or children take on stress of the family and become problems.
• Family Problems
• Parental Relationship Discord and Conflict
• High correlation between child maladjustment and marital discord, particularly for boys.
• Separation and Divorce
• Psychological difficulties in children postdivorce are predicted by levels of interparental conflict.  A lot depends on the childs contact with both parents, the child's anger, their ability to support their parents for help with emotional regulation.
• lower parent hostility and parental rejection combined with consistent and appropriate disciplinary practices equal better outcomes for the children, they adapt reasonably well.
• Remarriage
• Parenting Problems
• Family Violence
• Neglect
• Often child problems are because of child maltreatment, significant emotional, physical educational, or medical neglect.
• Parental Psychopathology
• Parents with psychopathology, their children are at a higher risk for various forms of maladjustment.
• Illness or Death of a family member
• Siblings Problems

Family Interventions For Young Children

• Family Therapy: The Treatment of Choice?
• Traditionally its been family therapy, but we are adding more modalities to this.
• When the child has sufficient ego strength, they can speak up, then family therapy might work.
• You may need to do individual and family therapy when:
• child manifest significant symptoms and the parents exhibit considerable psychopathology or marital dysfunction contributing to impaired parenting
• the parents are able to help their children with some but not all, aspects of their development
• the family engages in maladaptive interactions in response to the child's individual pathology
• the family exhibits inadequate role function and poor communication patterns
• Play in Family Therapy
• Focusing family therapy around play helps the family relax
• everyone of all ages can participate
• play lowers everyone's resistance to sharing and change.
• Ideas: Board Games, Family Puppet Interviews, Family art therapy, telling stories, family sculpting
• Child-centered Family Therapy
• short-term, developmentally focused, structural dynamic treatment intervention, uses a family-initiated model of system change.
• 5 structured activities: 
• family notebook, family photographs, family network drawing, living sculpture, and family role play
• Parenting Training
• Helping parents become better equipped to deal with child's problematic behaviors
• usually focuses on 1. behavior modification and 2. relationship enhancement
• Parent-Child Therapy
• Do therapy helping the child and parent play together
• Two phases: 
• child directed interaction
• parent directed interaction
• You help them learn how to interact, communicate, etc.
• Filial Therapy
• Therapy is a relationship enhancement intervention approach that incorporates client centered play therapy techniques.
• Basically you are help the parents become the play therapist.
• Infant-Parent Psychotherapy
• used primarily with high risk infants
• Three elements: 1. psychotherapy, 2. nondidactic developmental guidance, 3. concrete support.

Conclusion

• Although it is largely agreed upon that bringing children to therapy is beneficial, but therapist often don't include children. 

9/14/14-Shirk & McMakin: Client therapist & treatment characteristics in EBTs for adolescents and children

Despite evidence for positive treatment outcomes, research on treatment processes remains quite limited so even EBT's (evidence-based treatments) 1 in 3 times don't have the desired outcomes.  Therapists vary and no one has figured out exactly what matters about their style.

CLIENT CHARACTERISTICS
This section examines pretreatment characteristics that might predict the outcome of treatment for anxiety, depression, and disruptive behavior in adolescents.

Comorbidity
Most studies show that kids who come in with both anxiery and depression have poorer tx outcomes.  But some studies have shown the opposite effects.  And some even show better outcomes with comorbidity.  However, comorbid behavioral problems (ODD, Conduct disorder, etc.) could complicate the tx of other primary problems because they aren't compliant with tx.  This research is limited.  So as far as tx goes for comorbidity, you have to look at the specific issues and decide what would be most helpful to deal with first.  (duh...)

Developmental Characteristics
Older ages usually show better outcomes in tx.  However, sometimes older kids have more severe symptoms and stronger maladaptive strategies, so they're harder to work with.  We have to disentangle age and its confounding variables.  But overall, younger kids aren't suited to CBT as well as older kids.

Family Characteristics
In anxiety, maternal symptoms predict poor tx outcome.  In conduct disorders, higher parenting stress, depression scores among mothers, low marital satisfaction, adverse child--rearing practices, dysfunctional family environment, single-parent status, and lower SES are all associated with poor response to parent management training.  But improved parenting can help the outcomes over time.  In adolescent depression, their stress can predict negative outcomes a lot of the time.

Some research says adding families in treatment won't always improve outcomes.  If the mom is anxious it will help a lot though.  Disruptive behavior problems need family tx.  Adolexcent depression doesn't always improve with parental inclusion.

THERAPIST CHARACTERISTICS
The impact of therapists haven't really been studied because we are so focused on therapies right now.  But not all therapists are the same, so we need to study what makes an effective therapist--regardless of the model they are using.  One of the only things to be studied so far is how much training a therapist has.  In the studies, paraprofessionals produce larger tx effects than either students or professionals!  This could be, though, because professionals are given more difficult cases than paraprofessionals.  Professionals did better in two areas--when treating internalizing rather than externalizing problems, and when working with adolescents.
    In the future, we need to look at therapist competency, and relational capacity.

TREATMENT CHARACTERISTICS
Evidence for the specific treatment processes within effective therapies is thin.  But there are a few studies out there.

1) Treatment Adherence=better outcome
2) Children's participation in therapy: How engaged are the kids in CBT for working on their anxiety?  The more engaged=the better the outcome.  The metaphor is that even if you give a prescription for medication, if the patient doesn't take it, it doesn't matter.  They talked a lot here about alliance.  The only thing that helped children's alliance with the therapist they said was the therapist framing things in terms of a team--"we", "us", "let's", and setting goals together.  Being playful, pushing a child to talk about anxiety, emphasizing common ground, "me too!", etc. hurt the alliance.  They tried to measure positive ways of interacting with adolescents, but none of them predicted a strong alliance...haha.

SUMMARY
Overall, we really don't know anything, except that none of the factors are consistently predictive of anything really, so we need to work on researching the process of treatment!!