Parenting, Therapy with Adolescents

More Than Praise — Other Ways Parents Can Be Positive With Their Children

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Exploring the Differences between Praise, Mirroring,

Character Feedback, and Solution-Focused Questions

This is a homework assignment from “How to Talk so Parents will Listen and Listen so Parents will Talk.” More info on the book is at: http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118012968.html

If you’ve been given this homework assignment, you’re probably already using many good parenting techniques with your child. This assignment will help you refine your parenting approach to intentionally include even more ways of being positive with your child.

Imagine that a father is busy taking care of household chores while he’s parenting his 5-year-old daughter. She’s creating some excellent 5-year-old crayon art and approaches her daddy with a finished product and a beaming smile. Dad looks up and takes a break from his chores to admire his daughter’s artwork. He returns her grin and says one of the following:

  • “This is beautiful!” (An example of praise—a form of direct power)
  • “Thanks for showing me your drawing. You look very happy with your picture.” (An example of emotional mirroring or encouragement—a form of indirect power)
  • “You love doing artwork!” (An example of character feedback—another form of indirect power)
  • “How did you manage to create this beautiful drawing?” (An example of a solution-focused question—a form of problem-solving power)

If you can increase your awareness of these different strategies, you’ll feel more capable of being intentional and positive when interacting with your children. The result usually includes fewer power struggles and more positive parent–child relationship dynamics.

Using Praise

Using praise is simple. For example, praise includes statements like: “Great work,”  “I’m proud of you,” and “Look at what a good job you’ve done cleaning the bathroom!” When you use praise, you are clearly communicating your expectations and your approval to your child.

Think about how much praise you use with your children. Are you being clear enough with them about what you want and are you letting them know when they’ve done well? As a part of this homework assignment, consider increasing how much you praise your child and then see how your child reacts.

Using Mirroring

Sometimes children don’t have a clear sense of how their behaviors look to others (which can also be true for adults). The purpose of mirroring is to help children see themselves through your eyes. After seeing (or hearing) their reflection, your child becomes more aware of his or her behavior and may choose to make changes.

For now, we recommend that you practice using mirroring only to reflect your child’s positive behaviors. For example, if your daughter has a play date and shares her toys with her friend, you could say, “I noticed you were sharing your toys.” Or if your son got home on time instead of breaking his curfew, you might say, “I noticed you were on time last night.” The hard part about using mirroring is to stay neutral, but staying neutral is important because mirroring allows your children to be the judge of their own behaviors. If you want to be the judge, you can use praise.

Using Character Feedback

Character feedback works well for helping your children see themselves as having positive character traits. For example, you might say, “You’re very honest with us,” or “You can really focus on and get your homework done quickly when you want to,” or “You’re very smart.”

Usually, as parents, instead of using character feedback to focus on our children’s positive qualities, we use it in a very negative way. Examples include: “Can’t you keep your hands to yourself?” “You’re always such a big baby,” and “You never do your homework.”

For your homework assignment, try using character feedback to comment on your children’s positive behaviors, while ignoring the negative. You can even use character feedback to encourage a new behavior—all you have to do is wait for a tiny sign of the new behavior to occur and then make a positive character feedback statement: “You’re really starting to pay attention to keeping your room clean.”

Using Solution-Focused Questions

Problem-focused questions include: “What’s wrong with you?” and “What were you thinking when you hit that other boy at school?” In contrast, solution-focused questions encourage children to focus on what they’re doing well. For example, “How did you manage to get that puzzle together?” “What were you thinking when you decided to share your toy with your friend?” and “What did you do to get yourself home on time?”

Solution-focused questions require us to look for the positive. For practice, try asking your child questions designed to get him or her to think about successes instead of failures. After all, it’s the successes that you want to see repeated. Of course, when you ask these questions, don’t expect your child to answer them well. Instead, your child will most likely say, “Huh? I don’t know.” The point is that you’re focusing on the positive and eventually these questions get your children to focus on the positive as well.

Parenting, Therapy with Adolescents

Four Roads to Helping Your Children Develop Positive Self-Esteem

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Four Roads to Healthier Self-Esteem

This case and the discussion that follows is excerpted from “How to Listen so Parents will Talk.”

Father: I’m a single dad and so I have the job of two parents. It’s hard, but it’s especially hard because I’m a worrier. My girls don’t have a mom around and so I get obsessed about their self-esteem. What can I do to boost their self-esteem?

Consultant: That’s a great question . . . and a big question. But before we talk about the answer, tell me, what sorts of things are you doing now to build their self-esteem?

Father: I compliment them as much as I can. I praise them. I constantly say “I love you.”

Consultant: Can you give me an example of how you compliment them?

Father: Like last night. The girls were coloring and they kept showing me their pictures and I would say, “That’s beautiful!” and “That’s wonderful!” and “You two are great artists.” Stuff like that.

Consultant: I should say first that I think it’s wonderful that you’re so positive with your daughters. I wish more parents were positive like you.

Father: Thanks, but, uh, what else can I do?

Consultant: You’re great at using praise and compliments and that’s really important, but I’ve got other ideas about how to expand your self-esteem-building repertoire.  Can I share a few?

Father: Go for it.

Consultant:  Let’s take the coloring and picture-drawing example. You’re giving out praise and compliments, which is very important. But praise and compliments are what we call “external” or “outside-in” strategies. They build your daughters’ self-esteem from the outside in. You’re the outside expert and you tell them they’re great. There are three other things you could add to that. I’ll describe these three options now, but I have a tip sheet that describes them, too.

First, instead of praising and complimenting, sometimes you could use a technique called “mirroring.” Mirroring is more of an “inside-out” technique for building self-esteem. To use mirroring, you should watch your children and mirror their positive feelings back to them. For example, you could say, “You look really happy about your drawing,” or you could ask a question: “What do you like best about your drawing?” By using these mirroring responses, you’re encouraging your children to judge their own drawings. That’s why we call it an inside-out approach, because it draws out your children’s internal feelings and judgments.

Father: Okay. I think I get that, but what if one of my daughters doesn’t like her drawing—or, even worse, what if she says ‘I hate my drawing’?

Consultant: Good questions. You’re so good at praise, your daughters may be depending on you for their compliments. If one daughter can’t think of anything positive, that’s okay. No need to get worried. We all sometimes produce things we don’t like. But you might try several things. You could just reflect back her feelings and see what happens by saying, “I guess you don’t like this drawing so much.” Or you could push her to identify to positives and negatives with a comment like, “Well, I see something about it I like, but I don’t want to go first. So, first you tell me what you like and then I’ll say what I like.” Or, you could help her focus on her next drawing with empathy and encouragement by saying, “Hmmm. You don’t seem too happy with this drawing. Maybe you’ll like your next one better.” The thing that’s important to remember is that false praise or too much praise doesn’t help your children build self-esteem from the inside out. Pretty soon, they’ll recognize that you always say something positive and they might start wondering if you really mean it.

Father: Okay. I get it.

Consultant: That’s mirroring. The key is to draw out or reflect your child’s judgments. It’s even okay to mirror back if she doesn’t like her drawing. This is part of respecting her judgment. If she doesn’t like the drawing, that’s okay, just reflect that back. You can even move a little bit away from mirroring and if you really like her drawing you can disagree with her and say something like, “I see you don’t like your drawing, but here’s what I like about it.”

Father: All right.

Consultant: The next method after praise and mirroring is character feedback. Character feedback is when you say something like, “You’re the kind of girl who loves to draw.” What you’re doing with this method is you’re making a positive behavior into a character trait. Try that out. Think of a character trait that one of your daughters has and put it into the sentence, “You’re the kind of girl who . . .”

Father: My older daughter likes to keep all her school stuff organized. So would I say, “You’re a girl who’s organized”?

Consultant: Sure. Almost anyway you say it is fine. What you’re doing is helping her build positive character traits so she begins seeing herself as an organized person.

Father: How about my other daughter? She’s very disorganized. Do I tell her, “You’re a disorganized girl”? That doesn’t seem like a good idea.

Consultant: Exactly. When we use character feedback, we almost always use it for positive character traits. With your less organized daughter, you might wait for a time when she displays even a tiny bit of organizational skill and then say, “I notice you can really get organized when you want to.” For character feedback, just think of yourself as a mirror that reflects positive behaviors and forms them into character traits. What’s interesting about this is that most parents, including me, tend to watch for our children’s weaknesses and negative qualities and comment on them. For example, lots of parents and teachers see children misbehaving and can’t resist making comments like, “What’s wrong with you? Can’t you keep your hands to yourself?” or “You’re lying again, aren’t you? You need to get over that lying problem.” Basically, when we repeatedly comment on our children’s negative behaviors we help them construct a more negative character. They end up thinking, “I’m the kind of kid who just keeps getting into trouble.” The magic of character feedback is that we can use it to intentionally construct positive character traits. I know it’s manipulative, but it’s being manipulative in a positive way.

Father: That’s interesting. I do have trouble not commenting when my daughters misbehave. Should I  ignore misbehavior?

Consultant: Not always. We should just focus most of our attention on our children’s positive behaviors and only a little of our attention on the negative behaviors. Sometimes our children need corrective feedback or input. But if we focus too much on the negative, the negative will tend to grow, because it’s getting so much attention.

Father: Okay. I think I get that. You said you have a handout on this, right?

Consultant: Right. And there’s one last method. The last method is called solution-focused questioning. Here’s an example with your less organized daughter. Let’s say she shows a flash of organizational skill. Then, you could ask something like, “Wow. How did you manage to get your school work all organized?” Be careful to be curious and impressed, but not too surprised. You know how some parents will say things like, “Who are you and what have you done with my child?” as a joke. Well, that’s a funny joke, but it plays on the fact that the child is acting in an unusual way. What we want to communicate is that it’s normal for your daughter to be organized when she wants to and so you’re showing curiosity about how she manages to get organized. Solution-focused questions with children almost always ask them to reflect on how they accomplished something positive. For example, you could say: “How did you manage to be honest and tell the truth in that hard situation?” or “How did you figure out how to get that puzzle together?”

Father: Okay. This one is about focusing on solutions.

Consultant: Right. Let’s try one. What’s something one of your daughters did well this past week?

Father: My organized daughter had a terrible tantrum and then apologized to me.

Consultant: That’s great. What would be a solution-focused question?

Father: Um, how about this? “What were you thinking when you decided to apologize?”

Consultant: Yeah. That’s pretty good. But that might feel like you’re investigating or analyzing her thoughts. I might change it a little and throw in a positive character trait, like, “How did you find the courage to come and apologize to me?” That sends her a message that it takes courage to apologize and as long as you agree with that, it might be a nice way to combine a solution-focused question and a little character feedback.

Father: I like that.

Consultant: I should also say that often when we ask solution-focused questions of children they just shrug their shoulders and say, “I don’t know,” which is perfectly fine. The point is that hopefully we’re building into them a tendency to reflect on how they managed to do something that was positive or successful.

Father: Right. I can imagine my daughter saying “I don’t know.”

Consultant: Now, I know we’ve covered a whole lot of ground in the last few minutes, but parenting can be complicated sometimes.

Father: You’re telling me? I’ve got two daughters and pretty soon they’ll be attracting boys and that will be even worse.

Consultant: Yeah. I guess I don’t need to tell you that parenting is complicated, but what I want to say is that I’ve got this tip sheet for you on praise, mirroring, character feedback, and solution-focused questions and you can take it and just try out the ideas we talked about today that are in this tip sheet. Just practice away and see what happens and we can talk about it more next week.

In this case we see the consultant squeezing lots of nuanced parenting information into a brief time period. This is a very educational approach and most likely to work after the practitioner has established a positive working relationship with parents who are in the action stage of Prochaska and DiClemente’s (2005) transtheoretical model. Even in the action stage, most parents can’t absorb all this information at once, which is why tip sheets and homework assignments can be so important.

Although the methods illustrated (praise, mirroring, character feedback, and solution-focused questions) are fairly complex, most parents intuitively understand the differences. These methods are only partly designed to improve parent–child relationships; they’re also good behavior management and self-efficacy-building techniques and so they can be used with parents who are being either too negative or too positive with their children.

You can find the “How to Listen . . .” book at: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=sr_1_1?ie=UTF8&qid=1345003465&sr=8-1&keywords=how+to+listen+so+parents+will+talk

 

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice

Two Sample Mental Status Examination Reports

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JSF Dance Party

This is a photo of me checking my mental status.

Generally, mental status examinations (MSEs) can have a more neurological focus or a more psychiatric focus. The following two fictional reports are samples of psychiatric-oriented MSEs. These sample reports can be helpful if you’re learning to conduct Mental Status Examinations and write MSE reports. They’re excerpted from the text, Clinical Interviewing (6th edition; 2017, John Wiley & Sons). Clinical Interviewing has a chapter devoted to the MSE, as well as chapters on suicide assessment interviewing and diagnostic interviewing (and many others chapter on other important topics). You can take a look at the book (and some darn good reviews) on Amazon: https://www.amazon.com/gp/product/1119215587/ref=dbs_a_def_rwt_bibl_vppi_i0

If you’d like to see a short video-clip MSE example, you can go to: http://www.youtube.com/watch?v=1lu50uciF5Y

Sample Mental Status Examination Reports

A good report is brief, clear, concise, and addresses the areas below:

1.  Appearance

2.  Behavior/psychomotor activity

3.  Attitude toward examiner (interviewer)

4.  Affect and mood

5.  Speech and thought

6.  Perceptual disturbances

7.  Orientation and consciousness

8.  Memory and intelligence

9.  Reliability, judgment, and insight

The following reports are provided as samples.

Mental Status Report 1

Gary Sparrow, a 48-year-old white male, was disheveled and unkempt on presentation to the hospital emergency room. He was wearing dirty khaki pants, an unbuttoned golf shirt, and white shoes and appeared slightly younger than his stated age. During the interview, he was agitated and restless, frequently changing seats. He was impatient and sometimes rude in his interactions with this examiner. Mr. Sparrow reported that today was the best day of his life, because he had decided to join the professional golf circuit. His affect was labile, but appropriate to the content of his speech (i.e., he became tearful when reporting he had “bogeyed number 15”). His speech was loud, pressured, and overelaborative. He exhibited loosening of associations and flight of ideas; he intermittently and unpredictably shifted the topic of conversation from golf, to the mating habits of geese, to the likelihood of extraterrestrial life. Mr. Sparrow described grandiose delusions regarding his sexual and athletic performance. He reported auditory hallucinations (God had told him to quit his job and become a professional golfer) and was preoccupied with his athletic and sexual accomplishments. He was oriented to time and place, but claimed he was the illegitimate son of Jack Nicklaus. He denied suicidal and homicidal ideation. He refused to participate in intellectual- or memory-related portions of the examination. Mr. Sparrow was unreliable and exhibited poor judgment. Insight was absent.

Mental Status Report 2

Ms. Rosa Jackson, a 67-year-old African American female, was evaluated during routine rounds at the Cedar Springs Nursing Home. She was about 5’ tall, wore a floral print summer dress, held tight to a matching purse, and appeared approximately her stated age. Her grooming was adequate and she was cooperative with the examination. She reported her mood as “desperate” because she had recently misplaced her glasses. Her affect was characterized by intermittent anxiety, generally associated with having misplaced items or with difficulty answering the examiner’s questions. Her speech was slow, halting, and soft. She repeatedly became concerned with her personal items, clothing, and general appearance, wondering where her scarf “ran off to” and occasionally inquiring as to whether her appearance was acceptable (e.g., “Do I look okay? You know, I have lots of visitors coming by later.”). Ms. Jackson was oriented to person and place, but indicated the date as January 9, 1981 (today is July 8, 2009). She was unable to calculate serial sevens and after recalling zero of three items, became briefly anxious and concerned, stating “Oh my, I guess you pulled another one over me, didn’t you, sonny?” She quickly recovered her pleasant style, stating “And you’re such a gem for coming to visit me again.” Her proverb interpretations were concrete. Judgment, reliability, and insight were significantly impaired.

 

To receive alerts about this and other related topics like clinical interviewing and counseling and psychotherapy, you should follow this blog. Also, if you want me to come to your organization to provide a workshop or keynote on this or on a related topic, email me at john.sf@mso.umt.edu.

Parenting, Therapy with Adolescents

Tips for Parents on Using Natural and Logical Consequences

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The following is an excerpt from the bestselling (hahaha) book, “How to Listen so Parents will Talk and Talk so Parents will Listen.” Check it out at: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=sr_1_8?ie=UTF8&qid=1344466265&sr=8-8&keywords=how+to+listen+so+parents+will
 
The Beauty and Power of Natural and Logical Consequences

Life is not easy and children (and adults) learn through struggles, failures, and disappointments. Your goal, as a parent, is to create a reasonable, consistent, and loving home and then let your child struggle with the demands of life. These demands include very basic things like:

  • Not getting to watch television after a certain time
  • Participating in housecleaning
  • Not getting attention 100 percent of the day
  • Having to get ready and get to school on time
  • Having to wait your turn to get served dessert or to play with an especially fun toy
  • Not getting to eat your favorite food for every meal
  • Having to tie your own shoes

As you might gather from the preceding list, even little things in life can be hard for a growing child; but to learn, children need to directly experience frustration and disappointment.  

Natural or logical consequences are a necessary part of learning. They help your child get better at surviving disappointments in the world and in your family home. Natural and logical consequences are always related in some way to the misbehavior and are not given out with anger or as “punishment.”

Here are some examples:

1. Your children leave toys in a public area of the house, even though they’ve been told to put toys away when done playing. Logical consequence: Use a “Saturday box” or put the toys in timeout. This involves picking up the toys and putting them in a box and storing them away until the next Saturday (or whatever day), when they’re given back. This logical consequence avoids the overreaction (“If you don’t put your toys away, then I’ll give them away to someone else”) and the attention-giving lecture (“Let me tell you about when I was a child and what would happen if I left my toys out . . .”) and instead provides children with a clear, consistent, and reasonable consequence.

2. Your children argue with you about a consequence or about you being unfair. Logical consequence: You let your children know, “I don’t feel like arguing about this” and leave the area. You may want to go to the bathroom to take time away to further develop your planned response. While remaining friendly, another important message to give is, “I know you’d like things your way, but we have rules and consequences for everyone in our family.” Of course this may trigger another argument and you can walk away again and tell your children, “I know you can figure this out and not have this consequence next time.”

3. You cook dinner, but your children don’t show up on time. Reasonable rules and logical consequences: If you cook dinner, everyone needs to show up on time and be respectful about the dinner-eating process. That doesn’t mean everyone has to eat every bite or provide you with lavish praise for your most excellent meal, but respectful attendance is a reasonable expectation. If your child is late for dinner, one reminder is enough. No drama or excess attention is needed. Just sit down and start eating and enjoying the mealtime process. Possible logical and natural consequences include: (1) Your child prepares the next meal; (2) you put away foods after you dish yourself up and so the child has to get them out and serve himself; (3) you got there early and prepared the food and so your child gets to stay afterward and clean up; (4) no special rewards (e.g., eating dinner in front of the television); instead, your child eats alone at the table.

To do logical and natural consequences, it’s helpful to work on the following:

1. Take the “punishing” quality out of your voice and the interactions. This is not about punishment; it’s about what’s logical, reasonable, and natural. You can even be friendly and positive.

2. Prepare in advance. Because you’ll be emotional when your children are noncompliant, it’s critical that you have a list of logical and reasonable and natural consequence ideas in your head. Otherwise, you will overreact. Going to parenting classes or talking with other parents can help you identify a wider range of reasonable consequences.

3. Use small consequences. Your purpose is to teach your child. Your purpose is not to hurt or humiliate. Learning occurs best if children are not emotionally overwhelmed by large consequences. Small consequences provide plenty of feedback.

4. Use mirroring and encouragement. Reflect back to your children what they’re feeling (“It’s very upsetting that you can’t play with your toys for the rest of the week”). Let your child know that you think things will go better the next time around (“I know, if you want to, you’ll be able to remember to put your toys away next time”).

5. Don’t lecture or shame. Let the small consequence do its work.

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The natural and logical consequences (for Leah and Tommy) of growing up in Absarokee, MT.

Parenting

Information on Using Time-Out — Part II

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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!

Parenting

A New Look at Time-Out for Kids and Parents

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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. . .

 

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Uncategorized

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

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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.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice

Thoughts on the Relationship Between Cleavage and Professional Counseling and Psychotherapy

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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/

 

Uncategorized

In Honor of Swin Cash

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     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.

Personal Reflections

Who’s Afraid of a Little Coxsackie Virus?

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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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