All posts by johnsommersflanagan

Information on Using Time-Out — Part II

One key to using time-out effectively is knowing your child well. Here’s the parent homework assignment from “How to Listen so Kids will Talk and Talk so Kids will Listen.”

Parent Homework Assignment 9-4

Following the Rules for a New-and-Improved Timeout from Reinforcement

Most parents use timeout like punishment, but punishment and timeout are really two different parenting techniques. Timeout is a less-aversive and more compassionate alternative to punishment.

  • Punishment is the application of something aversive or painful (spanking or scolding).
  • Timeout is the taking away of something positive (children are removed from opportunities to have fun or receive positive reinforcement). 

The differences between punishment and timeout are subtle but important. When using timeout from reinforcement properly, children should be calmly taken from their usually rich and rewarding environment, but they should not be punished through pinching, squeezing, slapping, scolding, or yelling.

There are two main types of timeout: behavioral timeouts and emotional timeouts. Behavioral timeouts are used in response to inappropriate misbehavior. Emotional timeouts are used to help with emotional de-escalation or calming.

Tips for Behavioral Timeouts

  • Timeout effectiveness is based on how much fun and good stuff is happening during time-in. If your child has lots of fun during time-in, timeout will be powerful
  • Timeout should be used in a boring and matter-of-fact manner. Avoid yelling and lecturing.
  • The first minute (or two) of timeout is the most important. Don’t extend timeout beyond 10 minutes.
  • There should be no pushing, holding down, or aggressive touch during timeout. Timeout is not a physical intervention.
  • Don’t use timeout as “thinking time” or demand an apology from your child at the end.
  • Don’t do more than about two timeouts a day or continually threaten timeout.
  • Teach your child about timeout through practice or rehearsals.
  • Praise your child for going to timeout.
  • Practice, simulate, discuss, and educate your child about what behaviors cause a timeout.
  • Praise your child for completing his or her timeout.
  • Stay quiet during your child’s timeout.

A behavioral timeout is used immediately after your child has misbehaved. When misbehavior happens, consider saying: “Uh-oh. That’s not okay. You need to go to timeout.” The timeout location should be a chair or pillow or other location where your child can be separated from the social or family activity. Maintain silence (other than praising your child for going to timeout). Set a timer for between 1 and 10 minutes. Two minutes is appropriate for most children. If your child refuses to go to timeout, don’t get physical; simply shift the consequence to something you can control (e.g., turn off the television or computer, send the friend home, end the family outing, assign a “when you/then you” chore, etc.). If you’ve rehearsed your timeout procedure, it should go smoothly. When timeout is finished, praise your child for completing the timeout and verbally release him or her. Explain the reason for timeout as needed.

Your child shouldn’t be required to say silent during timeout. Many parents incorrectly assume that timeout should continue until children calm down. Calming down and completing a timeout are two different issues. If your child is angry or crying, a consequence has already been delivered and so there’s no need to continue the scene until he or she is quiet. If your goal is a quiet child, timeout may not be the appropriate consequence. Instead, you may need to implement a quiet time in the child’s room or remove him or her from a social or public situation.

Tips for Emotional Timeouts

If your child has trouble calming down after one or two minutes, you may need to approach and comfort him or her. This is okay. After one or two minutes you can release your child from timeout. At that point, the behavioral timeout has ended and an emotional timeout may begin. 

During an emotional timeout children need soothing and comforting. They still may be angry or upset about not getting what they wanted and you shouldn’t give in and give them their desired outcome. Instead, give empathy, comfort, and support. Life is hard and most adults don’t like not getting what they want, either. Help them know this. Help them breathe deeply and think about happier times. Help them move past their distress and into a calmer and more comfortable place. This can be a powerful and positive experience for both parent and child. Behavioral timeouts are about limit-setting. Emotional timeouts are about parent–child bonding and emotional regulation.

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Time-in should always be more fun than time-out!

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A New Look at Time-Out for Kids and Parents

A New-and-Improved Timeout Procedure

This is the first of a two-part piece on time-out. Both parts (and more) are included in the book: How to Talk so Parents will Listen and Listen so Parents will Talk: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=sr_1_5?s=books&ie=UTF8&qid=1344118211&sr=1-5&keywords=how+to+listen+so+parents+will+talk+and+talk+so+parents+will+listen

Timeout from reinforcement is an immensely popular behavioral response cost procedure. Unfortunately, most parents use it like corporal punishment; when children misbehave, parents put them in timeout. The problem with traditional timeout as practiced in most households is that parents wield it like a stick when, technically, it’s supposed to be the taking away of a carrot.

It’s possible that problems with timeout arise because the term is so deceptively simple that most people believe they automatically understand what timeout is and how to use it. In reality, there are a number of do’s and don’ts that parents need to learn about timeout; these will be covered in part II of this special and exciting time-out series. 

Timeout from reinforcement is a very brief time period during which children are not exposed to the normally rich, exciting, and rewarding stimulation of everyday life. Timeout is not “thinking time” and it should never be more than 10 minutes. Timeout is simply a break from all potential forms of positive reinforcement (including yelling, lecturing, and glaring).

Timeout Problems and Timeout Solutions

As Kazdin (2008) suggested (see the book, Kazdin Method for Parenting the Defiant Child), if brief and humane timeouts are not working, parents should not escalate their consequences. Instead, they should make time-in more enjoyable and work with their child on positive behavior simulations (described in the next section). Escalating punishment is a bad idea.

Typical complaints parents make about timeout are: (1) My child won’t go to timeout; and (2) my child won’t stay in timeout. Kazdin (2008) described, from a behavioral perspective, how to handle children who don’t go to timeout:

“If you declare a time-out and your child folds his arms and says, No, I’m not going, and you [shouldn’t] drag him, what do you do? First, give him an extra minute penalty. You can do this twice: up the time-out from two minutes to three, then to four. Then, if that doesn’t work, take away a privilege—something significant but brief, like no TV today. Then turn and walk away. Don’t give in if he then says, Okay okay okay, I’ll do it, because then you’d be reinforcing an unwanted sequence. . . . Let the consequence do the work. Resist the temptation to add little zingers. . . .” (pp. 142–143; italics in original)

Kazdin is making several excellent points in this description of how to handle timeout noncompliance. One part bears highlighting: When children refuse to do something physical, parents should not force them into the act.  Forcing a physical act is beyond reasonable parent power and control and can result in ugly and undesirable outcomes. Instead, as Kazdin suggests, the parent should shift to a consequence over which the parent has complete control and authority (and the child’s physical movements is not one of these things).

Emotions and Emotional Timeouts

Timeouts will often elicit strong emotions and strong emotions will often elicit timeouts. This highlights the question of how to deal with children’s emotions before, during, and after timeouts.

Parents are the best experts on their own children’s emotional states and so the helping professional’s job is to help parents balance a reasonable response to misbehavior (a brief timeout) with their children’s need for empathy, emotional soothing, and emotion coaching.

Case: An Emotionally Soothing Timeout

Parent: When I try to put my child into timeout, he becomes an emotional basket case. He screams and cries and it’s really terrible.

Consultant: That sounds very hard. It really reminds me of how important it is for parents to set limits on misbehavior and provide empathy and comfort for difficult emotions at the same time. It’s possible to do both.

Parent: How do I do that?

Consultant: You need to stand firm on not giving in to whatever your child wanted before the timeout was called. So, if your child hit another boy and grabbed a toy, you would never give back the toy or put your child back with the other boy before the timeout was served. You stay firm because whenever your child is aggressive or obnoxious you cannot give in to him and give him what he wants. That’s a huge parenting rule.

Parent: Okay, I understand that.

Consultant: Then, you need to decide how much emotional support your child needs. If he’s heading toward inconsolable sobbing, you may need to make it a brief thirty-second to one-minute timeout. Right at the end, you swoop in and comfort and console and help him understand what he did wrong and what he could do next time to avoid the timeout. This is because if your child is sobbing, he’s already experienced the punishment and so there’s no need to prolong it.

Parent: But I’ve always heard you should keep your child in timeout until he behaves, or at least until he’s served one minute for each year of his age.

Consultant: There’s crazy information out there about timeout. The truth is: The first minute is the most important. Waiting for him to behave or calm down on his own could be too traumatic for both of you. And the one-minute-for-each-year is a general guideline that should be adjusted for individual children.

Parent: Okay.

Consultant: The only reason you might wait longer would be if you believed your child was pretending to be upset to get your attention. Even then, you shouldn’t wait long before offering emotional comfort, maybe two minutes.

Parent: Yeah, well, I’m pretty sure he’s not faking it.

Consultant: Another thing to keep in mind is that some children, and your son may be an example, need help with emotional soothing. He may need a calming timeout more than he needs a bad-behavior timeout. If that’s the case, find a big pillow or comfortable spot and have him do his timeout there. And if he’s really a wreck, spend the timeout with him and help him recover.

This dialogue illustrates some of the complexities and misconceptions of timeout. For example, when the consultant suggests using a big pillow for a timeout spot instead of the classic chair or corner, she’s illustrating that she understands that timeout is a response-cost procedure and not a punishment procedure. The purpose is not to inflict pain or discomfort, but to take away the “fun” of time-in. This is an important distinction for parents to understand and it can be much more productive and effective for children to serve their brief timeout in a comfortable spot (without toys or books). In fact, to promote emotional de-escalation it may even be appropriate for parents to take their child to his or her room and engage in gently playful activities while expressing empathy for the child’s emotional state and hope for emotional recovery.

Overall, when choosing to use timeouts as a reasonable consequence for specific behaviors (e.g., hitting a sibling or parent), parents should anticipate their children’s potential emotional reactions. These reactions can range from rage and anger to sadness, tears, and inconsolable sobbing. Parents should also consider emotional-recovery timeouts, during which emotional soothing takes place. Finally, parents can role-model timeout behavior by taking one themselves—especially when they’re emotionally upset and need to do a little deep breathing.

TOMORROW OR THE NEXT DAY I’LL POST PART II OF THIS TIME-OUT SERIES

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John puts himself in timeout. . .

 

Respecting the Client’s Perspective – Even When We Think We Know Better

There are so many ways we can . . . as therapists . . . subtly (or less so) disrespect our client’s perspective. Here’s a small example from the revision of Clinical Interviewing (5th ed).

Interviewers can negatively judge or disrespect the client’s perspective in many ways. Very recently, I (John) became somewhat preoccupied about convincing a client that she wasn’t really “bipolar.” Despite my good intentions (it seemed to me that the young woman would be better off without the bipolar label), there was something useful or important for the client about holding onto her bipolar identity. Of course, as a “psychological expert” I thought it was ludicrous. I thought it obscured her many personal strengths with a label that diminished her personhood. Therefore, I tried my best to shove my opinion into her belief system. For better or worse, I was unsuccessful.

What’s clear about this example is that, despite our general expertise in mental health matters, as mental health professionals we need to work hard to respect our clients’ worldviews. In recent years practitioners from many theoretical perspectives have become more firm about the need for the expert therapist to take a back seat to the client’s personal lived experience. It’s now more important than ever for interviewers to acknowledge and embrace client expertness. This may be partly due to our increasing awareness (as mental health professionals and advocates) that clients may have very divergent views of themselves and the world.

In the end, who am I to tell my client that she is better off without a bipolar label? What if that label somehow, perhaps even in a twisted way, offers her solace. Perhaps she feels comfort in a label that helps explain her behavior to herself. Perhaps she is not ready—yet—to let go of the bipolar label. Perhaps she never will—and that may be the best outcome.

Whatever their theoretical orientation, effective interviewers respect their client’s personal expertise or perspective. We need that expertise. If the client is unwilling to collaborate with us by sharing her or his expertise and experience, we lose at least some of our potency as helpers.

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John offers his brother-in-law some advice.

Thoughts on the Relationship Between Cleavage and Professional Counseling and Psychotherapy

The following is a short discussion about cleavage in counseling and psychotherapy.  We’re not especially trying to be provocative (which is one reason why no photo accompanies this blog post) and so we’re interested in your thoughts on this short excerpt BEFORE we include it in the 5th edition of our Clinical Interviewing text.

[Excerpt starts here] For the first time ever in a textbook (and we’ve been writing them since 1993), we’ve decided to include a discussion on cleavage. Of course, this makes us feel exceptionally old, but we hope it also might reflect wisdom and perspective that comes with aging. 

In recent years we’ve noticed a greater tendency for female counseling and psychology students (especially younger females) to dress in ways that can be viewed as somewhat sexual. This includes, but is not limited to low necklines that show a considerable amount of cleavage. This issue was discussed on a series of postings on the Counselor Education and Supervision listserv which includes primarily participants who teach in master’s and doctoral programs in counseling. Most of the postings included some portion of the following themes.

  • Female (and male) students have the right to express themselves via how they dress
  • Commenting on how women dress and making specific recommendations may be viewed as sexist or inappropriately limiting
  • It is true that women should be able to dress any way they want
  • It is also true that specific agencies and institutions have the right to establish dress codes or otherwise dictate how their paid employees and volunteers dress
  • Despite egalitarian and feminist efforts to free women from the shackles of a patriarchal society, how women dress is still interpreted as having certain socially constructed messages that often, but not always, pertain to sex and sexuality
  • Although efforts to change socially constructed ideas about women dressing “sexy” can include activities like campus “slut-walks,” the clinical interview is probably not the appropriate venue for initiating a discourse on social and feminist change
  • For better or worse, it’s a fact that both middle-school males and middle-aged men (and many “populations” in between) are likely to be distracted—and their ability to profit from a counseling experience may be compromised—if they’re offered an opportunity for a close up view of their therapist’s breasts
  • At the very least, excessive cleavage (please don’t ask us to define this phrase) is less likely to contribute to positive therapy outcomes and more likely to stimulate sexual fantasies—which we believe is probably contrary to the goals of most therapists
  • It may be useful to have young women watch themselves on video from the viewpoint of a client (of either sex) that might feel attracted to them and then discuss how to manage sexual attraction that might occur during therapy

It’s obvious that when it comes to clinical interviewers showing cleavage, we don’t have all the perfect answers. Guidelines depend, in part, on interview setting and specific client populations. At the very least, we recommend that you take time to think about this issue and hope you might also consider discussing cleavage issuesJ with your class or your supervisor.

Info on Clinical Interviewing – the text and videos – is at: http://lp.wileypub.com/SommersFlanagan/

 

In Honor of Swin Cash

     I just saw an advertising on ESPN.com with WNBA player Swin Cash is showing off her strength and power and it reminded me of an old newspaper column I wrote back in 1999 or so. When I wrote it I got a 10 page single-spaced piece of hate mail from a man who evidently hated women. I hope role models like Swin Cash make this sort of topic obsolete. Here’s the old column from the Missoulian newspaper.

Chess for Girls

“America today is a girl destroying place. . . girls are encouraged to sacrifice their true selves” 

                                                                                —  Mary Pipher, Reviving Ophelia                       

I recently learned about a special version of the classic game of chess.  This new chess game is designed especially for girls.  While I was busy irritating my wife by doing that male channel-surfing thing (we get 4 channels) I came across an advertising for a product called: “Chess for Girls.” 

The ad began with a boy and girl playing chess.  The girl made a move and the boy quickly countered, “Checkmate!  What a stupid move!”  The girl whined back, “I hate this game.” 

The ad rolls on.  “Aren’t you girls tired of that boring old-fashioned chess game?  You should try. . . Chess for Girls!” 

Chess for girls is just a bit different than chess for the rest of us.  It uses some of the same playing pieces as regular chess, but also includes Barbie and Ken and is based to a large degree on how fashionably the contestants can dress up their chess pieces and the Barbies.

As the ad ends, the girl wins and the boy slumps away muttering something like, “That’s not real chess.”

Turns out I was watching a Saturday Night Live advertising spoof.  Nevertheless, I got the point and those of you who watch television should get the point too.  Our culture goes the extra mile when it comes to messing with girls’ self-esteem. 

Some friends of mine recently told me that their daughter’s gym teacher scolded her for “running like a girl.”  And the teacher didn’t mean it as a compliment.  My friends went straight down to the school to express their concern.  The gym teacher said “Aw, heck.  I didn’t mean anything by it.  You know, it’s just an old saying.”  Of course, the problem is that the old saying is an insult to girls and women.  No one says “You run like a girl” or “You throw like a girl” or even “You play chess like a girl” and means it as a compliment.

Another group of students (boys and girls) at one of our local high schools were told that the reason girls aren’t as good as boys when it comes to math and the hard sciences is because of hormonally-based male-female brain differences. It’s doubtful that statements like that help girls achieve in those fields.

I know some girls who are joyfully in touch with their power.  Some of them flex their muscles for me when I see them.  They want me to know all about their toughness, swiftness, and agility.  Sometimes they’ll challenge me to an arm wrestling match or to race them across the park–or even to a game of chess.  And they really want to win.  They want to show me their power.  Unfortunately, none of these powerful girls are over 12.  Rarely do any teenage girls I know ever flex their muscles.  Usually, they don’t want me (or anyone else) to know about their power.

We need to teach teenage girls that it’s okay to be strong and powerful and smart.  Too often girls are taught that the only arena in which they should compete is with each other for the attention and approval of males.  Girls need to believe that it’s okay for them to compete fully in sports, math, and life.  They won’t always be victorious, but they should never have second thoughts about giving it their best.

In Reviving Ophelia, Mary Pipher describes common experiences of strong and smart girls:

“Many strong girls have similar stories: They were socially isolated and lonely in adolescence.  Smart girls are often the girls most rejected by peers.  Their strength is a threat and they are punished for being different.  Girls who are unattractive or who don’t worry about their appearance are scorned.”

Our girls need to discover and take pride in who they are–no easy task in the face of the loud and persistent messages they get about who they should be.  Pipher and others have offered tips on how to help our girls embrace their identities and survive to adulthood:

  • Encourage girls to find a safe place to explore who they are and what they value.  Usually this place has to be at home or some other place where they can turn off the television and not be oppressed by prominent cultural messages.
  • Actively point out the injustices and absurdities of the ways women are portrayed in the media.  Help them love themselves and their bodies just as they are.
  • Encourage exercise, sports activities, and solid academic effort as sources of development and pride.  Downplay girl-identities based on boyfriends.
  • Moms:  Model self-confidence and pride in being a woman. 
  • Dads:  Affirm your daughter’s worth as your beloved child and as a wonderful female with much to offer.  Communicate to her that you think girls are great, not because they can be like boys and not because they can dress up real pretty.
  • Help girls learn to say no and set boundaries.  Unfortunately, many girls are so busy worrying about how other people are feeling that they have trouble focusing on their own wants and needs.

I have a dream that I’m playing chess with my daughter.  We’re playing the traditional version of chess (not the Saturday Night Live version).  My king is on the run. . . my daughter’s queen is chasing him down.  She makes her final move and claims her victory.  “CHECKMATE,” she roars with laughter.  I smile.  I’m thinking we both just scored a major victory.

Who’s Afraid of a Little Coxsackie Virus?

Like the Papa in the Berenstain Bear series, I like to think of myself as not getting sick. And so when Rylee became feverish and lethargic and didn’t finish her dinner last week, I performed my usual fatherly function of not letting food go to waste. I finished off her plate.

When Chelsea called the next morning and informed us that Davis (age 2) and Seth (age 32) had begun showing symptoms of hand, foot, and mouth disease, my confidence remained unshaken. After all, the little coxsackie virus at the root of the hand, foot, and mouth disease lives happily in our intestines and most adults are immune anyway, having gotten the condition sometime during childhood.

But the last several days have now decompensated into a hazy malaise combined with annoying pimple-like blisters erupting on my hands, feet, and other less mentionable locations. So who’s afraid of a little coxsackie virus now?

Having for years scoffed my way through recommendations for handwashing and concerns about germ theory I am now appropriately contrite. Contrition is another detestable condition, by the way.

[Insert profanity here.]

Here’s what WebMD has to say:

Hand-foot-and-mouth disease is an illness that causes sores in or on the mouth and on the hands, feet, and sometimes the buttocks and legs. The sores may be painful. The illness usually doesn’t last more than a week or so.

I’m on day 4 or 5 [Insert more profanity here.]

The other problem with this is that I now have the energy of a sloth and attention span of a toddler. In fact, the fact that I’ve written this little essay and stayed on point strikes me as rather a remarkable factoid in this particular lived moment.

There are benefits, however. Because my throat has broken out in hand-foot-and-mouth blisters I’m forced to keep making myself milkshakes. I also discovered that our blender is an excellent ice crusher. Did you know if you add a can of fruit juice to about a dozen ice cubes and blend or frappe, you create a drink that can cool the blisters in your throat. [Very nice.]

Other updates and thoughts for the day:

  1. I am very sad for the victims of the Colorado shooting.
  2. The right to bear arms is in no way abrogated by regulating and tracking internet (and other) sales of ammunition.
  3. There are lies, damned lies, and statistics.
  4. Being sick sucks, but the measure of my pain is so minor compared to the multidimensional and ubiquitous nature of human suffering that I cannot help but embrace my new friend, the coxsackie virus, who, as it turns out, is named after Coxsackie, NY.

This is not Coxsackie, NY

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Help Children Deal with Frustration and Become more Persistent

Carolyn Webster-Stratton from the University of Washington has developed an incredible evidence based approach designed to “promote children’s social competence, emotional regulation and problem solving skills and reduce their behavior problems.” This approach is titled “The Incredible Years.” More information is at the website:  http://www.incredibleyears.com/About/about.asp

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Below is a short excerpt from our “How to Talk so Parents will Listen” book that focuses on one small dimension of Dr. Webster-Stratton’s program. Our book is at: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=sr_1_5?s=books&ie=UTF8&qid=1342904983&sr=1-5&keywords=how+to+listen+so+parents+will+talk+and+talk+so+parents+will+listen

Persistence Coaching

A part of the “Incredible Years” parent training curriculum includes a unit on what Webster-Stratton (2007) refers to as persistence coaching. Persistence coaching is especially designed for children with attention difficulties and provides an excellent example of intense and passionate social reinforcement. Webster-Stratton (2007) describes the procedure:

During persistence coaching, the parent is commenting on the child’s attention to the task. A parent might say to his child who is working with blocks, “You are really concentrating on building that tower; you are really staying patient; you are trying again and are really focusing on getting it as high as you can; you are staying so calm; you are focused; there, you did it all by yourself.” With this persistence coaching, the child begins to be aware of his internal state when he or she is calm, focused, and persisting with an activity. (pp. 317–318; italics in original)

This example by Webster-Stratton not only illustrates focused and passionate attention as a behavioral reinforcer, it also includes components of mirroring, solution-focused strategies, and character feedback. After getting intensive attention and specific feedback for persisting on a tower-building task, children are more likely to overcome negative beliefs about themselves and to begin seeing themselves as persistent and capable.

Some parents will say their child hates positive comments and prematurely conclude that these approaches are destined to backfire and be ineffective, perhaps even detrimental. This will be most likely when children display oppositional tendencies and/or have very negative internal beliefs about themselves. As if it were constantly Opposite Day, it will seem to parents as if praise is punishment and punishment is praise when they’re trying to work with their children. Webster-Stratton (2007) comments on this phenomenon:

Children with conduct problems usually get less praise and encouragement from adults than other children. When they do get praise, they are likely to reject it because of their oppositional responses. For some children, this oppositional response to praise and encouragement is actually a bid to get more attention and to keep the adult focusing on them longer. Parents can help these children by giving the praise frequently and then ignoring the protests that follow. Over time with consistent encouragement, the children will become more comfortable with this positive view of themselves. (p. 312) 

Our general policy is to closely watch for backward behavior modification and to counter it by teaching parents how to pay attention to positive behavior, ignore negative behavior, and administer passionate and surprise rewards and boring consequences. We’re sometimes surprised (and rewarded) by how quickly parents see that they’re inadvertently and destructively celebrating Opposite Day, when a regular day would suffice. (See Parent Homework Assignment 9-1.)