The Grieving Process: What is Normal and When to Seek Help

Written by: Miki Fire, PsyD

For many people, the process of grief is one of the most challenging and painful experiences in our lives. Whether it is grief following the death of a loved one, the ending of a relationship, the loss of a job or a home, the death of a pet, or even just the experiences of loss that come with the myriad endings we face each day, the experience of grief can be overwhelming.

Grief is one of the most common of human experiences, although it can feel absolutely strange and frightening. Grief impacts us on every level of our being; emotional, psychological, physical, mental, spiritual, and social. We may experience feeling of overwhelming sadness or anger; we may literally feel like we are going crazy; we may feel like we can’t breathe, can’t sleep, can’t eat; we may feel numb and disconnected from the people in our lives; we may even feel like life is not worth living. In some ways grief itself is like a vicarious death and we ourselves feel like we’re dying. These are just a few of the many different ways in which grief moves through our systems.

Many people wonder: Is what I’m experiencing normal? You may have heard that there is a normal process to grief and that there are specific stages of grief that everyone goes through in a specific order. The truth is that when it comes to grief, there is no one defined way that every person experiences and processes grief. Some people may feel the different emotions we associate with the classic stages of grief model described by Elizabeth Kubler-Ross in 1969 (denial, anger, bargaining, depression, acceptance), but not everyone feels these exact emotions, nor do people feel them in this order or only once. In addition, these experiences only describe the emotional/psychological levels of the experience, but not necessarily all of the other ways in which grief is experienced, like for example on the physical level.

When it comes to grief, your grief process may look entirely different from someone else’s, and whatever you are experiencing is normal. Really.

People often ask, “But, do I need to seek help?” When it comes to grief, seeking “help,” can often be incredibly useful, no matter where you are in your grief process. Seeking help does not need to be seen as a last resort, but potentially an integral part of the process. Many people come into therapy feeling like they have somehow failed because they were not able to “get through it” alone. In actuality, seeking support, whether that means reaching out for the support of friends and family or seeking the guidance of a therapist or support group, does not need to be a last resort option, but can be seen as an important tool in processing your grief in a healthy way. Grief is a completely normal, universal, human experience and in this way it actually has a way of moving through our systems quite naturally, if we let it. But, most of us have lots of reasons why it is hard to just let the process do its thing, and outside support, can be useful in helping us see where we might be impeding the process and making things harder on ourselves.

In addition to using outside help to support a normal grief process, there are some additional situations in which seeking help is recommended. The following are a few of these situations:

  • If you feel that you are at risk of hurting yourself or another person.
  • If you do not feel you are able to attend to your basic needs such as food, clothing, and shelter.
  • If you feel unable to attend to the basic needs of your children, or any other people or pets that are dependent on you for their basic needs.
  • If you are concerned that the ways you are coping might be hurting you (e.g. excessive alcohol or drug use, self-harming behaviors like cutting or burning, etc).
  •  If you do not feel that your grief process has in any way changed after what you consider to be a reasonable amount of time, and you feel like it is debilitating your ability to engage in important areas of your life, such as work, relationships, etc, and you are unsure of how to move forward.

In addition to therapy, which can be incredibly helpful for processing the experience of grief, there are many different types of support groups specifically designed to help individuals in the grieving process. Groups can be one of the most effective supports for grief because of how powerful it can be to recognize that you are not alone in your experience.


Grieving is a process that can take a very long time. Especially in the beginning, it may feel like it will never end. As cliché as it sounds, time does heal in many ways, but even when years have passed and there is a sense that the grief has really moved through, there may still be moments where the sense of pain and loss comes flooding back; like anniversaries of various kinds or important life events. This too is completely normal, and you can trust that having been able to live through the early days (and months and even years) of grief, even in the unexpected moments when the grief returns, you will have the capacity to be with it and get through it. Although it may be hard to believe this if you are in the early stages of coping with a loss, grief is incredibly powerful in its ability to change and even transform in positive ways. The process is not an easy one, but it is a profound and universal one; it is an experience that we all go through in some way at some time, and that changes us forever.

(If this blog resonates with you in any way, or if you have any additional thoughts, suggestions or questions in regards to this topic I welcome any comments!)


How To Tell the Difference Between the Blues and Symptoms of Depression: 6 Tell-Tale Signs

By Sunda Friedman Tebockhorst, PhD, LPC

“The opposite of depression is not happiness, but vitality.”
This quote from writer Andrew Solomon contains some important wisdom about the nature of the beast we call depression. It is normal to experience sadness, to have days of feeling grumpy or down. We all have days like this, sometimes a few in row. It is normal to feel sad in response to distressing life events – these are the bumps in the road of life, and for most of us, we navigate over the bumps and get on with the life we recognize as ours. However, when the obstacle is not the normal vicissitudes of daily life, but rather a run-in with depression, this can be altogether a different story. Life becomes a foreign and exhausting experience, where it feels like there is no respite and no hope for a more engaged tomorrow. Here are some things to look for if you aren’t sure whether or not you might benefit from help for depression. If you have found that, for more than two weeks or so:
1. Everything is exhausting: the tasks of daily living – getting the mail, taking out the trash, doing the dishes, talking to friends or family – are overwhelming and extraordinarily demanding. If it feels like doing the little things of everyday life is just too much to face, you may be dealing with depression.
2. Everything is annoying: for many people, and this can be especially true for men, who in our culture our discouraged from acknowledging that they feel down or sad, depression shows up as extreme irritability. If you find that you are responding to the other people and events of your life with intractable bouts of extreme irritability not in proportion to the events in question, you may be dealing with depression.
3. Everything is overwhelming: you used to find that life was a pretty comfortable place for you, but now find that even minimal levels of stimulation are overwhelming for you. People in your life talk too much or talk too loud, bright colors are intrusive, any change in plans or routine is unbearable, even music, books or movies you used to enjoy demand too much energy – if this sounds familiar, you may be dealing with depression.
4. Everything is un-interesting: you used to enjoy your hobbies, had activities or events in your life that predictably brought you pleasure, but now, nothing is pleasurable or enjoyable. If food tastes bland, jokes are never funny, you don’t look forward to things you used to, you can’t seem to care what’s going on around you, you may be dealing with depression.
5. Anything could provoke tears: if you find that you cry frequently, sometimes for reasons you don’t understand, or for no reason at all, you may be dealing with depression.
6. Nothing provides relief: if you have come to a place where you feel no hope that things will change or improve, and/or you feel helpless to gain traction and return to a place where life held some pleasures, if a sense of defeat and purposelessness has invaded your daily routine, you may be dealing with depression.
It’s important to note that, if several or all of these things ring true for you, you do not have to just suffer through it. There are effective tools for managing and resolving depression, most notably, therapy and medications. Statistically speaking, the best outcomes in terms of recovery happen when we use both of these approaches together; you will have to find the specific remedy that best suits your particular needs. What’s most important is that you know that you don’t have to keep struggling and you certainly don’t have to accept that this is just the way things are. Depression is an awful monster that can take over people’s lives, whisper horrible things in their ears, and prove a relentless and formidable burden. While you may not know what to do to get rid of this monster if it has invaded your life, you don’t have to do it alone. A skilled therapist can help you move back to a place of vitality and engagement in life. Please – if this describes you or a loved one – know that we as a community of experienced therapists would like to help you begin the work of taking back your life from this monster. There is hope, and there is help. Finding the right therapist can be a great first step.

Pet Loss: How to Help Your Child Cope with Grief

Pet Loss: How to Help Your Child Cope with Grief

By Jenny Key, LCSW

My earliest memories center on our lively, red-haired family member, Donovan. He was the star of our summer outings, ate too much birthday cake, and made holidays chaotic.  He was my constant companion and first adventure buddy.  I recall vividly, despite my young age of four, when I realized that Donavan was missing.  I walked into my mom’s room as she was making her bed and asked where Donovan had gone.  Like most moms, she struggled with how to tell her child the beloved family dog died.

Be Authentic

Coping with pet loss can be a difficult, yet cathartic time for families.  It is often a child’s first experience of death.  Parents struggle with if, when, and how to involve children in this process.  Instincts tell you to protect them from the pain of pet loss, while logic argues that they should understand that death is a part of life.  The grieving process is unique for each family member, but when approached with openness and patience, it provides an opportunity to become closer.

There are many factors to consider when helping children cope with pet loss.  First, remember that you are working through this together. As the parent, you are the guide and model, but it is okay to admit your own feelings of grief.  Parents often want to hide their sadness in order to keep from burdening children.  In most cases, being transparent with your emotions will give them permission to share theirs.  Be mindful that your son or daughter may react differently to pet loss than you do, or even than other children of similar age.

Age Considerations

Parents seek to understand age-appropriate ways to incorporate children in the illness and death process.  Although developmental stages are helpful, your gut will tell you how much they are ready to know.  Most children from the age of two will have a sense of grief that comes with pet loss. While they may not be able to comprehend death as a permanent state until after the age of seven, you should be transparent and truthful.

Most of you can recall a story like Donovan’s: mom panicked and said the pet went to live on a farm.  Children sense that this explanation is not plausible, which causes them confusion or perhaps more distress.  Because they are learning about the permanence of death, they wonder why a part of the family was taken away.  They also may link their actions to the pet’s removal from the house.  Reassure your children they were not the cause of the pet’s death.  For younger ages, provide enough information so they understand their friend was sick.  With older children, give more details as necessary.

Children often react in ways that seem idiosyncratic or inappropriate, but this is especially true for teens.  Some may act out or express anger in situations not directly related to the loss.  Parents want them to confront their feelings directly by talking about the death. If your child is not ready, offering patience with their emotional ups and downs will better serve them.   Refrain from having a timeframe for grief resolution.

Create a Memorial

Make your home an accepting environment for all respectful reactions to grief.  Some children may accept death readily, having no reaction.  For others, reactions may come at a later time.  Involving your children in a memorial can help them find peace.  Ask them to do something in memory of the pet, like make a collage together or pick out picture frames for a pet corner in your home.  Invite them to write a letter to your pet saying goodbye as a way of helping them express their feelings.

Finally, when your family has suffered a pet loss, allow for extra time together.  Going for a drive, taking a walk, or similar activities promote conversation naturally.  Respond to their thoughts with validation, seeking to know more. If they choose to be silent, soak up the extra moments with your family, feeling gratitude for the time shared.  A pet enters into your life for a few precious moments and teaches your children about unconditional love, but their lessons stay in your family’s heart forever.



Hot Under the Collar

8 Common Anxiety Symptoms and a Few Ways to Begin to Cool Off

By Rachael Bonaiuto, LPC

When you have anxiety, it’s easy to feel like others don’t understand what you’re going through. Anxiety itself can make you feel as though you’re suffering from symptoms, worries and concerns that are not only pronounced – they also feel inherent. Despite how personal this anxiety is to you, the truth is that anxiety is surprisingly common. I witness anxiety symptoms in most people I encounter on a daily basis – clients, students, friends, and family – in the store, at the bank, even at a red light.  Anxiety is uncomfortable at best, and can become paralyzing and defeating.  And it is common…. so incredibly common.

You are at home, preparing to go to a dinner party with work colleagues. You don’t want to go, you dread it, you think of reasons not to go, fantasize about your favorite elastic-waisted pants and the flavor ice cream that would accompany the movie night you’d rather have. You finally surrender to going, but begin to notice tightness in your chest.  As you stare, hot and bothered, at your closet of ‘not quite right’ clothes, your neck begins to hurt and the pain causes even more fear. You snap at your partner, who gently reminds you that you need to get going. You ignore the texts from co-workers asking you if you’ve left your house yet. You can barely breath and you are frozen.  You are experiencing anxiety and it is profoundly challenging.

So, what are some common symptoms of anxiety? Below are eight typical symptoms of anxiety and a few ways to manage this persistent condition.

  1. You feel constantly worried, tense and on edge
  2. You are plagued by fears that you know are irrational but just can’t shake
  3. You avoid situations/activities because they cause you nervousness & stress
  4. You have difficulty thinking, speaking, and following conversations
  5. You experience pain, stiffness, tension, pressure, soreness, or immobility
  6. Your body temperature increases or decreases without external reason
  7. You feel chest tremors, pounding heart, and/or labored breathing
  8. You don’t feel like yourself, detached from loved ones, emotionally numb

Many common anxiety symptoms show up in your body. You may first experience a knot in your stomach, and then you realize you are totally freaked out about an upcoming presentation. You feel a rapid heartbeat and tightness in your chest and later notice that you are completely anxious to drive in snowy weather.  Your jaw is clenched and your breath is constricted just before you unleash the pent up worry and resulting irritability toward your child.  If you can begin to notice the signals from your body that suggest you are anxious, you may find opportunity to take pause, check in, and navigate what you need in the moment.

Here are a few body-oriented tips for how to deal with anxiety:

1.     Pause:

  1. Find pause through breath. Inhale. Exhale. Feel your belly rise and fall. Notice the air come in through your nostrils and exit out your lips.
  2. Find pause through your senses. Pause to notice what you see. What do you hear and smell? Can you feel your clothes against your body? Experience your feet in your shoes, on the floor. Can you taste the salt on your lips or the flavor from your most recent meal?
  3. Find pause through movement. Go for a walk. Put on your favorite song and dance. Shake it out. Stretch your arms wide. Spread your legs and feel your feet rooted into the earth. Put your hands on your heart or give yourself a massage.

2.    Check In:

  1. Notice what is happening with your breath, senses, movements
  2. Notice, without judgment, what thoughts and feelings you have
  3. Simply observe what is happening in your inner landscape
  4. Scan your body for tension, tightness, fear, irritability, disorientation

3.    Take care:

  1. Ask yourself what you need? Remind yourself (or have someone else remind you) that it is okay to have needs.
  2. If you are having trouble accessing what you need, take another pause, a longer pause, lie on the earth and feel it beneath you.
  3. If you are in need of support, ask for help – from a friend, a loved one or a professional.

Anxiety can negatively impact your quality of life – the way you show up for others and for yourself. Knowing the common symptoms of anxiety can help you recognize when you or a loved one is experiencing unease. When you realize you feel anxious, it can be so valuable to pause, check in and take care of yourself in the moment. Building a deeper understanding of the symptoms and an awareness of what is happening in your body can provide access to your available resources through breath, sensation and movement. When you have access to your internal resources, you can also appreciate more deeply when you need additional support and when you are able to navigate your internal terrain on your own. This self-awareness provides empowerment, freedom and a deeper sense of compassion for self and other. Most importantly, if you are experiencing significant anxiety, seek professional help. Psychotherapy can be very effective in providing relief from the debilitating symptoms of anxiety.

Three Benefits of Practicing Mindfulness Parenting

Three Benefits of Practicing Mindfulness Parenting

By Debbie Mayer, LCSW

Mindfulness parenting is all the rage these days, and there’s good reason for it.  The general idea behind mindfulness is the ability to practice being present and aware without judgment.  Now, combining this approach with parenting is not necessarily what you might instinctually think to do.  ‘You mean, you want me to be more present when my child is screaming at me?? Those are the times I want to check out most!’  If you are able to tune into your experience in the moment – such as feeling overwhelmed, judging yourself for the fact that your child is upset (“If only I would have…then he wouldn’t be acting this way”), finding that you are checking out (“I wish she would just stop yelling all the time” vs. “wow, she’s really feeling overwhelmed right now”) – then you are already practicing mindfulness!  As awareness increases, so does an ability to focus on being more present, which can result in your child feeling more heard and respected as well as you feeling less focused on what’s driving you crazy.

As a parent myself, I can easily find focusing on what I think might need to get done and get lost from what is presently happening.  Just the other night when my child was having a more challenging night going to bed, and I was exhausted from a long day myself; I found my thoughts drifting off to what I wanted to get done that night. Fortunately I caught myself in this pattern, and stopped to pay attention to the present moment.  What was my child asking of me?  What was my child’s emotional need in this moment?  How could I be more present for my child and support my child during this challenging time?  What I found was, the more I was able to be fully present with my child, the more calm the environment became as an experienced sense of understanding was incorporated into our interaction.

While mindfulness parenting encompasses many aspects I’m going to explore a few areas specifically: being able to slow down to heighten awareness, increase a connection with your child, and letting go of judgment.

Let’s first look at the idea of slowing down to increase your sense of awareness. This can be supported by asking yourself questions like: What is going on around me? What sounds do I notice? What am I feeling? What is my child feeling? When you are able to recognize that your thoughts are drifting off away from what is happening in the present, you are better able to be attuned to your child’s needs and meet your child where he or she is.  The more ‘distant’ you are, the more your child may be expressing himself in ways to seek your attention.  When you are able to connect and be truly present, your child will know and respond in ways that acknowledge you are there. When you are present with your child you can often experience a sense of slowing down life, being in the moment, not the past or future, but there actively with your child.  This can happen at nighttime like how I shared above, during playtime in the day, at meals, in the car, at the grocery store, in a museum, or at the park.

Another benefit of incorporating mindfulness practice into parenting, is increasing a connection with your child.  When you connect deeply with your child on her or his level, where your child knows you are present and desire to be there, your child is experiencing being valued, loved, and respected.  Attachment theory teaches us how children’s sense of self is increased when they have a relationship where they experience being safe and feeling secure. Mindfulness parenting goes hand in hand with this notion; when you are placing your attention in the present moment you are able to enjoy singing a song with your child, delighting in them running on the soccer field, feeling the cold of the snow together, or laughing together as you bite into yet another piece of burnt toast.  These connections are building blocks for your child in building a healthy sense of self-esteem, and in time feeling confident in abilities for school, peer relationships, sports, future romantic relationships, employee interactions, etc.

The third area I’ll talk about here is practicing mindfulness parenting without judgment.  In discussing the many benefits children can receive through mindfulness parenting, there is also the support we provide ourselves.  Mindfulness parenting can help you not only practice increasing your awareness to the present, but also to not judge yourself. Practicing letting go of thoughts such as: My child is upset, I should have… or I’m no good at this mindfulness thing, I keep thinking about all the things that need to get done. The reality is thoughts will drift in and out, that is natural. When we treat ourselves with kindness verses judgment we are more likely to treat our children that way too.  I am having a hard time being present right now, that is ok.  Let me tune back in to what my child is doing… or I realize now that I could have handled that situation differently, I’ll talk with them to repair that situation. Judgment can come from voices in our past (parents, teachers, friends, experiences), however being able to free ourselves from those to truly be in the moment with our child is an invaluable experience for both parent and child.

I challenge you to find one way today to incorporate an aspect of mindfulness parenting with your child. Find a time where you notice that you are smiling and connecting with your child, where you find your thoughts drifting off and you say that’s ok but now I’m going to tune back into being here, where you feel overwhelmed and need to take a break, or you find an activity your child enjoys and spend time noticing what it is about the activity that truly makes your child happy. And remember, practicing mindfulness parenting is just that, a practice! Feel free to welcome the days it’s easier and the days it’s more challenging. Practice at your own pace, and explore how mindfulness parenting fits for you and your family.

Debbie Mayer, LCSW helped create the content for this page. Debbie is a licensed clinical social worker who has been helping families with parenting issues since 2002. Debbie has specialized training to work with very young children, including infants, and their families.
Book Review: The Whole Brain Child

Book Review: The Whole Brain Child

Book Review: The Whole Brain Child: 12 revolutionary strategies to nurture your Child’s developing Mind (2011)

Authors: Daniel Siegel, MD and Tina Bryson, PhD

By Mia Bertram, LPC

The Whole Brain Child, is a must read for every parent and caregiver. This valuable resource offers easy ways to help nurture the parent child relationship while understanding ways to foster a child’s emotional development.  Neuropsychiatrist, Doctor Bruce Perry and parent expert Doctor Tina Payne Bryson offer effective parenting strategies that are backed by cutting edge research on brain development and speak directly to the child’s brain. The author’s use of cartoons, personal stories, hands on techniques and strategies to help implement and understand what may feel like otherwise overwhelming material about the brain and neuroscience. They even offer quick reference sheets to put on the fridge for easy review as well as ways of helping teach children about their own brain that are fun and easily doable. By paying attention to the everyday moments with your children and practicing and integrating these strategies both within the good and tough times will help foster happy, successful children who feel good about themselves and enjoy their relationships.

Not only is having an understanding of the brain essential in your relationship with your child, but also the authors convey the importance of integrating the different parts of the brain and its impact on creating more balanced, meaningful and creative lives. Understanding the different parts of the brain- left, right, up and down creates a way for us to conceptualize where a child is coming from, what their perspective is, and how to work with these parts so integration, awareness and connection can take place. Such conceptualization allows us to have appropriate expectations, language and understanding during the challenging moments we have with our children. It helps, according to the authors, to move from surviving to thriving in our relationships and day-to-day functioning.

In times of challenge and struggle, Bryson and Siegel teach us to connect and redirect with our children. Appealing to both sides of the brain is important and there is a formula to follow so that integration and connection take place. In times of big upsets and emotional charge, initially responding to the emotional right side with empathy and understanding creates emotional connection.  Once the big emotions have settled and the child is calm, the logical and linear left-brain can come on line. This is where redirection, and discipline can take place, helping the child form an understanding of their experience. Such connection and integration strengthens relationship, emotional development and the developing mind.

The authors provide 12 strategies to help nurture the child’s mind, create connection and promote healthy growth.  Using the body and movement to help shift your child’s emotional stare is great in the “Move It to Lose It Strategy”, along with the “SIFT” game that helps bring awareness to sensations, images, feelings and thoughts within. Teaching children how to shift feeling stuck in emotional states in the “Let the Clouds of Emotions Roll by” helps children understand that feelings are simply states and not traits. The “Name it Tame it”, helps children work through taming intense feelings through storytelling. Additional strategies include helping to work through memories while exercising control, engaging in focused attention and “Engage Don’t Engage” which appeals to the logic and planning of the left-brain rather than the emotions.

I think every parent, caregiver, teacher, counselor, or anyone involved in the life of a child could benefit from reading and learning this valuable information. The whole brain approach to parenting creates deeper connections and greater understanding of our children.  It is a resource that I offer and sometimes require in my practice.  It normalizes our experiences and offers strategies on how to work with our children, creating moments of challenge into triumphs and mistakes into opportunities.  The information presented within is user friendly, accessible and valuable. More importantly, if utilized and implemented can help create children who are more self aware, emotionally attuned, congruent, resilient, and evolved.



Aliveness: Finding Presence through our Bodies, Finding Love through our Presence

By Rachael Bonaiuto, LPC

“Spirit lives in you; it lives within your body, in every cell. You can touch the great Spirit by touching into your aliveness.”  – Brooke Medicine Eagle

 How do we touch into our aliveness? I ask myself this question often… My best guess is embodiment… to be in our bodies, to feel our cells and tissue, to directly experience our senses, to be in the present moment, to be one with our breath and our heartbeat… this is embodied presence and embodied presence is aliveness.

 This morning it was snowing… this afternoon I laid down on the ground, basking in the sun. Aside from the peculiarity of Colorado weather, I felt a deep sense of connection to the Earth, lying on her moist bed, feeling the sun warm my skin, the pulse of the land beating with my heart… I felt Spirit alive within my being… I felt my Soul connect with the ground and the sky… I felt alive.

 Being in my body does not always prove to be blissful. In fact, the body is also home of pain, trauma, heartbreak, illness, dis-ease… It can be rather uncomfortable to be embodied at times… But it is never dead. It is always alive, growing, changing, transforming, and regenerating… The body has endless information; it is the gateway to awareness and the bridge to consciousness. It is not a question of pleasure or ecstasy alone, it is a question of how we want to move through our lives… do we want to exist or do we want to LIVE? Do we want to be in our bodies – know, trust, listen and allow – or do we want to live fearful of what might be reveal if we awaken to our embodied experience? It takes courage to LIVE in our BODIES, and it takes presence to make contact with our world and be alive for our experiences.

Structured Activity Rewards: Clinical Case Studies

By Dr. Jan Hittelman

When I first introduce the idea of using a type of behavior modification, parents often dismiss it by saying, “We’ve already tried that and it doesn’t work; what else have you got?”  This is because there are several common pitfalls that will effectively sabotage a behavior modification approach with children.  These pitfalls include: using an overly complicated system (usually including grids and charts), choosing unmotivating “rewards”, not including the child in the creation of the plan, no plan for phasing out the system, lack of clarity regarding the behaviors themselves, expecting perfection, bribing versus reinforcing and poor parental follow through.

The Structured Activity Reward techniques used here are both simple and effective.  In fact, the results are often immediate and dramatic.  Chronic negative behaviors often improve within weeks!  In addition, the technique can be used with a wide variety of undesirable behaviors.  It is a structured approach that focuses the child on the desired behavior and provides fun activity rewards that are motivating to the child.  As a result, the child is also taught how to get parental attention in a more appropriate, positive fashion.  This is very important, as most undesirable child behaviors are actually fueled by the parent’s negative attention to those behaviors.  To better illustrate this approach, consider the following case examples.

Alex, Age 6

Alex was a feisty, highly intelligent boy who was diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) and was on related medication.  Children with ADHD display unusually high levels of inattention, impulsiveness, and hyperactivity for their age.  As is often the case with very bright children, Alex was very manipulative.  He had a history of aggressive behaviors which included biting others, as well as himself.  What better way to get immediate and consistent negative attention!  Alex’s parents were seeking assistance for his increasingly unmanageable behaviors in school.  His most recent exploit involved running out of the school building and climbing up a tree.  When the school staff attempted to talk him down, he growled loudly!

During my first session with Alex, he explained to me that he liked biting himself when he was “bored and hungry”.  He smilingly reported behaving well in school “unless someone antagonizes me.  Like if you antagonized me, I’ll bite you!”  Needless to say, I made every effort to stay on Alex’s good side, as I’m sure others in his life felt compelled to do.

The next week, I met with Alex and his father, who informed me that the school began a point system to provide the parents with daily feedback regarding Alex’s behavior.  He could earn up to four points a day.  We integrated this into our Structured Activity Rewards Contract (see Figure 1).  As soon as Alex accumulated eight good behavior points, he earned a fun activity with Mom or Dad.  To maximize motivation, we also included a “bonus for perfection”.  If Alex obtained four points every day in a school week, he got to choose an additional activity.  The next week, parent reports indicated a good week in school, earning three points most days.  This continued the following week and by the third week, Alex got his bonus for perfection.  Because structured activity rewards allow highly manipulative children to be manipulative in a positive way, it is often quite effective.  After five weeks, we increased the number of points required to twelve and eventually phased out the system completely.


Contract for Alex

When Alex gets 8 Good behavior points

Then he can choose a reward activity



If Alex has a perfect week

Then he can pick an extra activity.

Reward Activities

  • Go to the lake
  • Play a board game
  • Play a card game
  • Play Wiggle Bridge
  • Play math games


Monica, Age 8

Monica was a socially sensitive, needy child who easily got into conflicts with her mother.  Mom reported that Monica would experience anxieties/frustrations, take it out on her mother, who would then get angry at Monica.  Later, her mother would feel guilty and try to make up.  This scenario occurred repeatedly within their relationship.  Consider how this behavioral sequence would result in and was being reinforced by so much negative attention.

One area of specific difficulty common to so many families is getting homework done.  When it was homework time, Monica would engage in a variety of avoidant behaviors including: eating, fooling around, playing with her younger sister, etc. Her mother indicated that Monica would procrastinate until or through dinner and all the way up to and often past bedtime, requiring “hundreds” of reminders (or “yelling” according to Monica) to no avail.  Mom tried “everything” including rewards like playing video games, which Monica loved, but then she would just rush through her homework in a haphazard fashion.  Consequently, for the last year, Monica was not allowed to play video games during the week.  In addition, Monica wanted to play with her friends after school, but couldn’t due to this time consuming negative homework ritual.  This only compounded her social problems, by reducing her opportunities for needed socialization experiences.

We negotiated a Structured Activity Rewards Contract which addressed these issues (see Figure 2).  If Monica did her homework well after dinner and before bedtime with no more than 3 reminders, she could play video games and be with her friends the next day.  In addition, these good homework days would result in a fun activity with her mother or father.  A week later, her mother reported that the contract was working “really well”, and Monica indicated that Mom was yelling less.  While we addressed other therapeutic issues, homework continued to go well over the next 6 weeks at which time we were able to phase the contract out, as Monica had developed appropriate homework skills.

Contract for Monica

When Monica does her homework well after dinner and before 8:15pm (no more than 3 reminders)

Then the next day Monica can play video games (1/2 hour) and play with her friends after school

Also 3 good homework day results in one of these fun activities:

Reward Activities

  • Going out to ice cream
  • Going bowling with Dad
  • Dinner with Mom
  • Playing video games with Mom
  • Coffeehouse for tea and a muffin with Mom
  • Softball with Dad
  • Sleep over


____________________                       ___________________

Monica’s signature                                  Mom’s signature


Omar, Age 10

In our initial session, Omar presented as a respectful, well-mannered adolescent who was eager to please.  He was referred for a very common problem that had manifested into a variety of unusual behaviors.  His mother indicated that Omar was, “Scared of being alone and darkness.  He needs to have somebody with him at all times when it’s dark”.  Until age 3, Omar shared a room with his sister, who is one year older.  “Then he became scared to sleep by himself.”  This developed into a pattern of behavior in which Omar would initially fall asleep in his room and during the night, go into either his sister’s or parents’ room where he would remain until morning.  Another set of behaviors also developed around the fear of being alone.  Whenever Omar went to the bathroom or showered, one of his parents had to stand outside the door.  In addition, Omar was fearful of going upstairs alone or washing the dishes downstairs alone.  Keep in mind that these behaviors continued for many years.  What precipitated their finally seeking treatment was Omar’s recent desire to go on sleepovers.  It would have been awkward for Omar to ask his friend’s parents to stand outside the bathroom door!  Despite his being highly motivated to conquer his fears, he was unable to break these behavioral patterns.

In our second session we discussed some basic cognitive-behavioral strategies to help cope with these fears.  Omar learned a deep breathing technique to foster relaxation and created a calming statement of reassurance that he could repeat to himself.   The following week we constructed a Structured Activity Rewards Contract (see Figure 3).  We were able to move quickly in large part due to Omar’s motivational level.  At his suggestion, we set a fairly challenging goal of 5 out of 7 “good” days.  In addition, we added a “bonus for perfection”.  Again, we utilized basic activity rewards with Mom or Dad.  Two weeks later we met again and to my amazement, Omar proudly reported being successful every day!  We revised the contract to 6 out of 7 days and one month later phased it out.  Each subsequent week resulted in 6 or 7 good days.  Once again consider the behavioral sequence.  Consider the inordinate amount of parental time and attention that Omar’s problem behaviors resulted in.  While it’s possible that the cognitive-behavioral techniques alone could have eventually gotten the same results, providing Omar with a way to earn positive parental attention insured rapid success.


Contract for Omar

When Omar

  • showers on his own (going upstairs with the door closed) 5 out of 7 days
  • bathroom on his own (again with the door shut) 5 out of 7 days
  • sleeps on his own (in own room and doesn’t call anyone) 5 out of 7 days

Then Omar can choose one activity on Sunday



-Lake with Mom                   -Go to mall with Mom

-Craft with Mom                   -Gardening with Mom

-Build model with Dad         -Fishing with Dad

-Lake with Dad                    -Bike ride with Dad

-Play catch with Dad            -Play a sport with Dad

***Bonus*** For a perfect week, Omar picks another activity

I have read and agree with this contract.


______________                 _____________          _____________

Omar’s signature                Mom’s signature          Dad’s signature


Ryan, Age 5

Initial parent reports indicated that Ryan was a, “Perfect child for the first five years.”  Four weeks earlier he had begun a new pre-kindergarten program.  Since the first day of school, Ryan had been having increasing difficulties adjusting.  It began with his dislike of a forty-five minute “sleepytime” toward the end of the school day.  Ryan was not a napper and probably found sleepytime to be tedious and boring.  His mother attempted to solve the problem by picking him up earlier, thus avoiding sleepytime altogether.  To the parents’ dismay, his adjustment problems worsened.  At this point Ryan resisted going to school at all, wanting only to be with his mother.  Despite a prior history of positive and frequent socialization experiences, Ryan was having tantrums every morning before being forced to go to school.

Let’s stop for a moment and consider the behavioral sequence.  Ryan’s initial adjustment difficulties result in leaving school early, to be with his mom.  In addition, there were certainly countless talks with Ryan regarding his concerns, trying to soothe his fears.  Not only do his adjustment problems increase, they now are unrelated to the initial issue of sleepytime.  All of the adjustment difficulties do, however, have one thing in common.  They all resulted in parental attention.  While the parents may not be yelling or punishing, it is still negative attention in that it fuels and even escalates the undesirable behaviors.

After sharing my negative attention theory, Ryan’s parents were doubtful that this could apply to their son based upon his very well adjusted first five years.  Despite this, they agreed to try utilizing structured activity rewards and we created a contract for Ryan (see below).  Ryan’s parents telephoned me prior to our two-week follow-up appointment.  They were pleasantly surprised to report that Ryan’s difficulties had dramatically improved and they would call back to reschedule if problems reoccurred.  I spoke with them sometime later on a different issue and was told that their son’s school adjustment problems were much more infrequent (i.e., normal).

Contract for Ryan

When Ryan has a good school morning (crying only in room, no grabbing Mom before school)

Then Ryan gets a Happy Point

2 Happy Points = 1 Reward Activity

Reward Activities

  • Go out for pizza with Dad
  • Go to grocery store with Dad
  • Play a game with Dad
  • Bike ride with Mom
  • Go out with Mom/Dad for ice cream
  • Go out with Mom/Dad for Chinese food

Bonus 5 Good Mornings = Clock


Jason, Age 11

Jason was also diagnosed with Attention-Deficit Hyperactivity Disorder.  Through prior therapeutic contacts and a good response to medication, his symptoms were kept under control.  Jason’s father had a variety of medical conditions that he had suffered with and, to his credit, learned to cope with fairly well.  Approximately three months earlier, Jason’s father had a sudden mysterious attack which left him temporarily paralyzed and seemingly, catatonic.  His family, who was with him at the time, feared he was dead.  While he completely recovered hours later, it was certainly a traumatic experience for everyone.  This was particularly true for Jason.  Ever since this incident, Jason insisted on constantly being with his father to make sure that he was all right.  As his father put it, “He just won’t leave me alone!”  It had gotten to the point where Jason insisted his dad sleep with him in his room every night.  Even the garage, which used to be Dad’s private sanctuary was now always shared with Jason.  While Jason and his dad previously always had a close relationship, he was driving his dad crazy!

This case is a good example of a very common behavioral process.  Jason’s initial concerns and behaviors were completely appropriate and understandable.  The unanticipated consequence, however, of a significant increase in parental attention inadvertently fueled the behavior to a more dysfunctional level.

We agreed to utilize a Structured Activity Rewards Contract, but given the dynamics of the case, all of the reward activities were with his father (see below).  In our two-week follow-up, his father was ecstatic to report eight good days.  One month after initiating the contract, their relationship was returning to normal and both were forgetting to monitor the contract.  In this case the system was successfully phased out “naturally”.

Contract for Jason

When Jason gives Dad his space for a day

  • Not  bother Dad in Garage after 8:00pm
  • Dad sleeps in his own room

One warning per day for first week only!

Then Jason earns 1 Point

3 Points =  1 Activity Reward

Activity Rewards

-Buy a model                        -Work on a model

-Go fishing                           -Rent a video game

-Go mineral mining          -Play a board game

-Work on a project in garage

-Go to park, throw ball around

-Fly/work on a model plane

I read and agree with this contract

_____________________            __________________________

Dad’s signature                              Jason’s signature


Taylor, Age 8

According to Taylor’s parents, he “always” had a problem complying with their requests.  They described him as, “very impulsive”, “overemotional” and stated that he “tantrums whenever we discipline him”.  Even when he did comply it usually required at least 6 reminders and often, endless debates.

A review of Taylor’s school records and early developmental history indicate that at age three he was diagnosed with speech/language delays and had a history of frequent ear infections.  A pre-kindergarten screening noted specific weaknesses in auditory memory (remembering what you hear) and receptive language (understanding what is said to you).  Taylor benefited from ongoing speech/language therapy and was reported to currently be within the normal range  for his age.  While “not listening” is easily one of the most common child disciplinary issues, it is quite possible that Taylor’s noncompliance was initially a function, at least in part, of his real language difficulties.  I hoped that an effective structured activity rewards contract would give him the extra motivation needed to break these very early habits and foster new skill development.

We negotiated our Structured Activity Rewards Contract (see Figure 6).  For each parental request, Taylor was allowed one reminder.  Three good days would earn him an activity reward.  At our two week update session, Taylor had earned eleven good days out of fourteen.  I was pleasantly surprised with his progress.  Considering his developmental history, his parents were also very pleased with his progress, but did mention that he often waits for his one reminder.  To address this issue, Taylor and his parents added a bonus reward of money, which reportedly Taylor wanted more than anything, for needing no reminders.  Preferring activity over monetary rewards, I reluctantly agreed to this revision (see below).  The following week Taylor had accumulated six more good days, three of which were bonus days of no reminders.  Mom confided that the days without reminders took so much effort on Taylor’s part that she had succumbed to the fact that he just needs a reminder or two.  His success continued and we phased out the contract after five weeks.

Contract for Taylor

When Taylor does what is parents ask him to do all day

Then Taylor will earn one (1) point

Reminders!Taylor is allowed one (1) reminder for each request

Three (3) points = one(1) activity reward

Bonus!! 1 Day no reminders = 25cents/3 in a row = $1 

Activity Rewards

  • Go for a drive to see a relocated friend
  • Draw or paint with Mom
  • Build something with Dad, like racetrack
  • Go to a movie with Mom or Dad
  • Play Monopoly with Dad
  • Go to Blockbuster to rent a movie or game
  • Go out to eat with Mom or Dad
  • Go out for ice cream/frozen yogurt


I have read and agree with this contract

________________    ________________    _______________

Taylor’s signature                   Mom’s signature          Dad’s signature


Matthew, age 6

In 1992,  a significant earthquake rocked southern California at approximately 5:30 in the morning, waking most of us.  Matthew, like most children (and adults!) became quite frightened.  To help Matthew feel more secure, his parents allowed him to spend the remainder of the night with them in their bed.  In my opinion, this was a completely appropriate response.  The next night, Matthew awoke at 2:00 am and asked to sleep with his parents again due to his continuing earthquake fears.  As you may have guessed, this pattern continued for days that turned into weeks.  Consider the behavioral sequence that, of course, culminates in enormous parental attention.  Attention which, while initially quite appropriate, was now fueling Matthew’s earthquake anxiety behaviors.  Keep in mind that Matthew’s fears were also initially appropriate.  Inadvertently fueled by parental contact/attention, his fears became more severe and maladaptive.

Matthew’s parents reported that he was always a worrier.  He was even easily startled  as an infant.  Consequently, Matthew may have also been more predisposed to having anxiety difficulties.

As our initial session was ending, I began to feel somewhat anxious myself as I was going away on a two-week vacation the next day and Matthew’s parents were desperate.  With great reluctance, I agreed to meet with Matthew later that day and quickly formulated a Structured Activity Rewards Contract with the family.  I like to work quickly, but not that fast!  We were, however, able to complete our contract later that day.  The system encouraged staying in his bed, but even if he came in once, he was still rewarded (see figure 7).  If he came in more than once, his parent’s would simply help him back to bed.  He could not, however, stay in his parents’ room.  Right before the family left, Matthew looked up at me and his eyes watered up.  He then quietly said, “I don’t think this is going to work.”  At that moment I was afraid that because I had moved too quickly, he would be right.  At our two week follow-up session, we reviewed Matthew’s progress.  During the first five days, Matthew visited his parents repeatedly on three nights and only once on two nights (thus earning two points).  Then to everyone’s amazement, Matthew remained in his room the following nine nights!  Matthew proudly indicated that he did wake up on some of those nights but was able to deal with it on his own.  We then proceeded to revise/phase out the contract (see below).

I met with the family two years later about some compliance difficulties and was told that there was no reoccurrence of these earthquake anxiety/behaviors.

Contract for Matthew 

When Matthew stays in his bed all night

Then he will get 3 smiley faces


If Matthew only gets out of bed one time

Then he will get 1 smiley face

 Activity Rewards (5 Smiley faces)

  • Wild Animal Park
  • Sea World
  • Zoo
  • Ice skating
  • Buy and play with bow and arrow
  • Marine Museum


New Contract for Matthew

When Matthew stays in his bed all night

Then he will get 1 star 

Activity Rewards (5 Stars)

  • Wild Animal Park
  • Sea World
  • Zoo
  • Ice skating
  • Buy and play with bow and arrow
  • Marine Museum
  • Go to a movie
  • Stay up ½ hour late
  • Bowling
  • Go to tide pool


Cindy, Age 7

Cindy presented as a sweet, friendly child whose eyes sparkled when she smiled.  In reviewing her case history with her parents, she seemed to almost be the perfect child.  Cindy adjusted “extremely well” to school, which she still “loves”.  Her interactions with peers were observed to be “excellent”.  Her parents also indicated that she was “very responsible” and she even willfully helped with chores! You may ask, “Why bring her to a psychologist?”

Cindy was referred for chronic bed-wetting.  She was toilet trained at age two and had no accidents until age five.  For the last two years, however, she wet her bed almost every night. Cindy’s father left very early each morning for work.  Prior to leaving, he would check on Cindy.  If she wet her bed he would wake her up, change her sheets, and put her back to bed.  Her medical history indicated frequent urinary tract infections, which were probably a contributing factor.  At age six, Cindy went to a urologist for a comprehensive medical evaluation and was even placed on medication for a year.  Despite this, however, her frequent bedwetting continued.  Not sure what else to do, the urologist sent her to me.

At that time the most effective treatment for bedwetting was a device called a “Pad and Bell”.  To use the device, the pad is placed under the bed sheet and is attached to a bell next to the bed.  Any moisture that touches the pad completes a circuit, which activates a loud bell.  The theory is that this trains children who are usually heavy sleepers, to be more aware of the body sensations that wake us up when we have to go to the bathroom at night.  (I’ve always wondered how this classical conditioning tool affects its subjects later in life.  When they hear a door bell, do they get the urge to go to the bathroom?)  I discussed this approach with Cindy’s parents and located a pharmacy, which sold the pad and bell device.

Prior to purchasing the pad and bell, I suggested that we assess motivational factors by setting up a Structured Activity Rewards Contract.  I explained to Cindy’s parents that I didn’t expect the contract to help much, but I wanted to see if increasing her motivation would have any effect at all.  We also explained to Cindy that we’d try it and if it didn’t work, it was no big deal.  We constructed a contract that included daily rewards and bonus rewards for multiple dry nights (see below).  We met a week later and to everyone’s surprise, Cindy was dry five out of seven nights!  The following week she was dry seven nights straight!  During the next week, Cindy only had one wet night.  At this point we began phasing out by modifying the contract (see Figure 10).  Cindy was also required now to change her own sheets.  Approximately six weeks after initiating the contract, we phased it out completely.  One month later, Cindy continued to have all dry nights.  I couldn’t help but wonder if the daily one-on-one attention from Dad each morning inadvertently fueled the behavior.  Interestingly enough, her parents began to notice an increase in attention seeking /defiant behaviors from this seemingly “perfect” child. While she was staying dry at night, she was getting more “pissed-off” during the day!  We addressed these issues in subsequent family therapy sessions.


Contract for Cindy

If Cindy has a dry night

Then she can choose 1 daily reward

Daily Rewards

-Lunch at school                  -Time alone with Mom or Dad

-Later bedtime                      -15 minutes in parents’ bed

-Dad’s seat for dinner           -Sleeping on the floor


Bonus!      2 Dry nights = 1 Bonus

3 Dry nights = 2 Bonuses

4 Dry nights = 3 Bonuses

Bonus Rewards

-Nails with Mom                               -New notebook

-Mom cleans her room                   -New markers

-Front car seat on weekend           -New book

-Bath with Mom                               -Mermaid cards

-Ice cream with Dad                      -Having a friend over

I have read and agree to this contract

_____________________            _______________________

Parents’ signatures                                        Cindy’s signature


New Contract for Cindy

When Cindy has two dry nights

Then she can choose 1 special reward

Special Rewards

-Lunch at school                   -Time alone with Mom or Dad

-Later bedtime                      -15 minutes in parents’ bed

-Dad’s seat for dinner           -Sleeping on the floor

Bonus!      3 Dry nights = 1 Bonus

4 Dry nights = 2 Bonuses

5 Dry nights = 3 Bonuses

Bonus Rewards

-Nails with Mom                           -New notebook

-Mom cleans her room                 -New markers

-Front car seat on weekend         -New book

-Bath with Mom                            -Mermaid cards

-Ice cream with Dad                    -Having a friend over


I have read and agree to this contract

_____________________            _______________________

Paarent’s signatures                              Cindy’s signature


These case histories attest to the powerful impact of systematically shifting parental attention from negative to positive.  It is important to point out, however, that these seemingly simple contracts were carefully constructed to maximize their chances of success.  The next chapter will provide you with everything you need to know to construct an effective Activity Rewards Contract for your child.  The key element to this system is the use of parental attention that fuels the child’s motivation to practice the desirable behavior(s). To get your own step-by-step instructions on creating your own Structured Activity Rewards Contract, download Dr. Hittelman’s free report: “Change Your Child’s Behavior in 30 Days” by clicking HERE .

Grief and Loss in Parenting

By Miki Fire, Psy.D.
Clinical Psychologist

As a relatively new parent, I have spent a lot of time reflecting on the experience of this new role. Like many of you, my experience in parenting has come with some unbelievable moments of joy; the feeling of holding your baby for the first time, of seeing your baby laugh or smile at you, watching as your baby begins to crawl and then stand and eventually walk and run. Of course, there are all the challenges as well; trying to soothe a colicky baby, endless hours of rocking and bouncing and shooshing your little one to sleep (not to mention your own sleep deprivation), or trying to communicate to a toddler that he needs to have patience and wait a few seconds before you can give him that toy he’s reaching for. Alongside these there might also be myriad challenges in parenting alongside your partner who may have his or her own different ideas of what’s best.

Most of what we are exposed to—in the popular media, in our pediatrician’s office, in the conversations at the playground and even at most new parent support groups—are these kinds of ups and downs.

What we hear much less about, if ever, is a much more subtle experience, yet one that is absolutely felt, and that is the grief and sense of loss that is also associated with parenting. Especially in the early years of being a parent, the feelings of sadness and outright grief and mourning can be quite intense, yet are rarely discussed. Because we don’t often talk about this grief, we sometimes wonder if it’s normal, we may pathologize it, push it away, or simply keep it to ourselves

Have you ever noticed, as a parent, how painful the experience can be? How much that sense of love for your child also brings with it a sense of sometimes overwhelming heartache? How in each moment, even if that moment has been unbelievably trying, there is sometimes a surprising sense of nostalgia for that same experience once it has passed?

Why is there such a sense of grief and loss in parenting?

I think that the first days and weeks and months of parenting can be so new and, for many of us challenging, that we tend to feel primarily the relief and joy with each new development. “Ah, she is finally sleeping five hours straight! She doesn’t need to be burped every time she eats! I can put her down for a few minutes and make myself a cup of tea without her fussing!” But what we don’t always feel as strongly, at least not on the surface, is the ending that comes with each new moment, each achievement.

Not one instant can be held on to. Not one day is the same. The minute a new milestone is achieved whatever preceded it is gone, simply folded into the next movement. Your baby’s balancing on two knees becomes a crawl, then a crouch, which becomes an unbalanced stand, a first step, a walk, a run. Even with language, those little gurgles and raspberries which become babbling and eventually actual words. Once you have a child that has mastered the art of language, it might be hard to imagine that you lived with an essentially non-verbal being for a couple of years! Whatever the development, each new movement echoes some past experience, but we never go back, ever. Our tendency is often to focus on the new step our baby has taken, but we don’t necessarily say goodbye to the previous stage that has now been mastered.

Of course there will be more firsts. In fact, all there ever will be are firsts. But every first is also a last. As parents we often joke about how once you have finally mastered some aspect of your child’s development she is on to the next milestone, leaving you to have to figure out a whole new set of tricks. There is joy and relief in moving onto what is new, but there is also a sense of ineffable loss for whatever phase has now come to an end.

If we really think about this experience for a moment, we can begin to touch on the poignancy of this ongoing experience. In a way, being a parent is to witness what it truly means to be alive, as a human being. To know that each day, each moment, each breath, comes and then goes. Parenting, in this way, gives us a very palpable sense of impermanence.

And of course this reflection of impermanence so perfectly revealed in our children is true for everything. As adults we tend to not see the subtle changes that are happening; maybe because they appear so much less dramatic they are missed, easily overlooked, or even denied. Changes tend to blend into one another affording us the illusion that things are essentially the same. It may not be until we are much older, or witnessing the aging process in our own parents, that we have a palpable sense of the passing of time. But it is simply impossible to not see how quickly everything ends when you are in the presence of your child.

And for many people, this constant experience of endings brings with it a feeling of deep heartache. People may have warned you about many of the other challenges of becoming a parent, but rarely do people warn you of the bittersweetness that comes as each day comes to an end and your child is one day older. Yes, there is a deep sigh at the end of a long day, after all the toys have been cleaned up and you can finally sink into the couch with a good book. But for some people there is also a sense of loss. This feeling may be experienced as a sense of depression even. It may be felt as a general fatigue or apathy. Maybe a tearfulness that you cannot explain, or even a feeling of agitation or irritation. We sometimes talk about post-partum depression or “baby blues,” but we rarely acknowledge that these feelings of malaise may actually be normal and appropriate grief for this new experience.

Because in addition to the sense of loss that can come with watching your child change so rapidly is also a very reasonable experience of mourning that may come with the huge transition you are experiencing as a parent. There may be a sense of loss for the person you felt you were before you had children, or the relationship you and your partner had that was just the two of you. If you already have children there may be a feeling of sadness and loss that you no longer can spend all of your parenting time with your other child or children, that this energy is now shared.

We are generally told that we should be happy and grateful to bring children into the world. But rarely are we told that it is okay to also feel pain for the life we have left behind. And this life is truly behind us, even when our children are older and we can work more, spend more time with our friends and alone, it will never be the same.

A part of you may wonder, what can I do about all of this? What should I do about all of this?

Grief is an experience that many people attempt to bypass because it can often be so painful. But my clinical experience has repeatedly shown me that grief is an incredibly important experience that, if possible, is best travelled through, not around. Especially for anyone who has experienced bouts of depression or anxiety that have not lifted easily, there may be a fear that if you turn towards the feelings of sadness and loss, they may just get bigger and more stuck. When you first turn towards your grief, it may feel like it does get bigger, more poignant, or more painful. This is normal. If it is too much to be with, then let yourself turn away towards something else. But notice when you are intentionally avoiding feelings of grief. Even just this noticing is a subtle acknowledgment of the grief that might be there. Here are a few suggestions for how to be with your grief.

  1. Begin my simply acknowledging that all of the feelings you are having as a parent are completely normal. Give them permission to be here.
  2. When you notice a difficult emotion, like sadness or some pain, just let yourself acknowledge it is there. You don’t have to do anything more. In fact, with the busyiness of parenting, you may not have space to really do more than this.
  3. Find a time in the day when you can turn more fully towards whatever feelings have been coming up. Maybe this is while your child is napping, at school, or in bed for the night. During this time, just give your whole body and mind permission to feel whatever feelings may be there and have been there. Even this is enough. You don’t have to do anything with the feelings, just feel.
  4. If it is hard to just stay with your feelings in an unguided way, here are some suggestions for ways to turn towards, and acknowledge your grief: Use a journal and let yourself write openly about your grief, paint, draw, or engage in any other art form on the theme of grief, set aside 10 minutes to simply sit quietly and invite your feelings to be with you. Just by setting an intention to be present with your feelings, any activity has the potential to be a practice in more fully processing your grief.
  5. Talk with someone. A friend, your partner, a therapist. Naming your feelings can be one of the more powerful ways of working with grief. When we put words to our inner experiences it often leads to a shift in the experience itself and a deeper sense of meaning.

In essence, my suggestion is, take it all in, let whatever feelings you might have in this process be here in their complete fullness. And know that, even whatever you are feeling now will not be with you forever. Grief (unlike some clinical depressions) does have a way of moving and changing. The grief you may feel as a parent will inevitably shift as your child changes.

And remember, really being honest about these feelings and letting yourself really feel is an extraordinary gift, not only for yourself, but also for your child. You are teaching him or her that emotions, even difficult ones, are okay, survivable, and can even serve as doorways to something new.


How To Motivate Teenagers

by: Ryan Dawson, MA, LPC

If you are like many parents, you have at times experienced difficulty motivating your teen for school, chores, family outings, following simple instructions, being nice to their siblings, doing homework, limiting screen time, etc. It’s a fundamental parental question that baffles parents around the world: how to motivate teenagers who seem to have an agenda all their own?

Many parents come to my practice looking for support and someone that can get through to their child. However, in my experience working with adolescents for the past 20 plus years, any influence I have resides in my abilities to effectively utilize the same fundamentals that I recommend to these parents.

Spoiler alert– It is all about cultivating a consistent and positive relationship.

Validation. Let your kid know how amazing you believe they are. I have yet to meet a teen who has escaped the major identity transformation of adolescence without self-doubt. This can become a larger and persistent problem without proper support. Your son or daughter needs someone who consistently reminds them of their brilliance and believes in them. Even if they act like they are too cool to hear it, they are listening. Be prepared to not be appreciated for your cheerleading but know your words are being deposited in the bank of your childʼs resiliency.

Empathy. When negative things happen to your child as a result of poor life choices and strategies, be empathetic towards them. Even if they rebuffed your suggestions along the way, and you feel like reminding them of your sagacious advice, it isnʼt a good time to do that when they are hurting. Empathize with their pain and express sorrow instead of offering an, “I told you so.” Then, when they are ready to hear it, offer your guidance as a consultant. Remember how hard it was to feed apple sauce to a toddler who didnʼt want it? The same goes for advice to a set of ears which arenʼt ready to listen. In summary, always empathize before you educate.

Giving choices. Most humans strive to feel in control of their lives; teenagers included. Presenting acceptable choices or parameters to your child rather than trying to force them to follow your will, will give them a sense of empowerment, independence, and responsibility. Additionally, they are then less able to lay the blame on you if things donʼt work out the way they expected or, conversely, they get to feel the glory when it goes well.

Planting seeds. If you have a desire for your teen that involves how they spend their free time or what might be “good for them”, sometimes the indirect road is the one to travel. Plant idea seeds and let them germinate. Slowly help them to understand the value of your idea. Give it time to grow. Come back to water it with love and warmth and a gentle reminder if needed. Allow them to have control when to implement it (deadlines can be helpful) and let them know that if they choose this path you will be there, without judgment, ready to support them.

Emotional intelligence. This subject isnʼt often taught at schools. Therefore, helping your child to understand what they are feeling and how to deal with it is important. Life often creates internal distress. Unfortunately, happily-ever-after is just a fairy tale. There will be unexpected and unsettling twists and turns on the path of life. Teaching them that they can tolerate negative mood states and still move forward is key to increasing their willingness to try new things. Sometimes motivation looks like moving toward what is important even when we donʼt feel great on the inside.

Ryan Dawson is an expert on issues of teenage psychology. Contact him to learn more about how to motivate teenagers or to discuss your teen’s issues.

Feel Empathy To Create the Power of Connection

Feel Empathy To Create the Power of Connection

By Jeremy Dion, Licensed Professional Counselor

My 7-year-old daughter came home from school the other day and told me that she just had the “worst day of her life.” To be fair, this is not exactly an uncommon routine in our household, and we average two to three “worst days ever” per month. On this particular day, she went into detail about a friend who didn’t want to play, a teacher who didn’t understand, and an art project that did not come out the way she had hoped.

As she’s sharing all this, I listen and give her my undivided attention. When she finishes, there’s a pause. I breathe. This next moment is pivotal. It’s the moment where I’m going to respond. And how I respond is going to be determined by two things—first, and most importantly, my own internal state. Am I calm, cool, and connected?  Or am I stressed, rushed, and distracted?  Do I feel empathy or am I too preoccupied to connect? We’re usually somewhere in between, though most of us think we’re less stressed than we actually are.

The second factor that will influence my response involves my perception of the events that just unfolded. When my daughter is telling me about the hardships of her day, do I see it as an openhearted act of vulnerability on her end, and an opportunity for connection between us?  Or do I see it as a bit dramatic, mostly complaining, and symptoms of a bad mood I’d like to change?

Feeling Calm Allows Us to Feel Empathy

When I’m feeling more calm and grounded, I have more capacity to feel empathy — to dig into the hard stuff. My tolerance for discomfort expands, which is always helpful. But if my system is more stressed, I am inclined to shut down her uncomfortable feelings, because I’m less willing to feel my own.

My cultural conditioning often encourages me to be “helpful” to my daughter by pointing out the bright side of her story, trying to add the silver lining to her “worst day ever.”  Because that’s helpful, right?  It’ll make her feel better. In this mode, I’m inclined to say something that begins with, “Well at least…”  Or I may try to fix her problem by trouble-shooting it:  “Did you try…”  Or, “What can you do next time so that…”  It’s easy to fall into the trap of thinking these are helpful responses. And the truth is that they can be. But only after I’ve completed a crucial and often overlooked step:  Empathy.

The simplest definition of empathy involves recognizing the emotions of another person, and feeling with them. Showing empathy is a vulnerable choice. In order to truly connect with my daughter in this moment I have to connect with that part of myself that knows these feelings – those parts of me that know first hand what it’s like to feel left out, misunderstood, and disappointed.

The Four Qualities of Empathy

For a more nuanced explanation of empathy, I look to the work of nursing scholar Teresa Wiseman. She highlighted these Four Qualities of Empathy:

1. Perspective taking – recognizing this perspective as their truth.
2. Staying out of judgment.
3. Recognition of emotion in others.
4. Communicating that recognition.

Empathy sends the message that I hear you, I’ve felt those feelings, and they’re painful. I can feel them now. You’re not alone. I’m so glad you’re shared this with me. When I’m able to respond with that type of empathy, we share a connection that wouldn’t happen otherwise. And often times, that connection is enough, and nothing more is needed.

As author and researcher professor Brene Brown says, “The truth is that rarely will a response make something better. What makes something better is connection.”






Parenting Styles: How To Deal With Differences

Parenting Styles: How To Deal With Differences

By Kat Austin, Licensed Marriage and Family Therapist

Parenting is hard. Each parent and each family approaches parenting in a different way, and parents often subscribe to different parenting styles. Parenting styles develop from reasons such as how we were raised as a child, the need for control, personal insecurity, or wanting to be liked by our children.  What happens to parents and kids if parenting styles are very different even polarized?  Often we see one parent as the “strict” parent and the other as the “lenient” parent. Polarized parenting can create intense conflict between parents and can be confusing to children, which will lead to children experiencing anxiety and acting out in a variety of ways.

Different Parenting Styles Can Create Anxiety

Not only do discrepancies in parenting styles create anxiety for kids, but also for parents.  Parents may attempt to alleviate some of their anxiety by becoming rigid or fixed in their parenting style thus creating more polarization.  Here is an example:  An adolescent is acting out—not coming home on time, using alcohol, and being disrespectful to both parents.  The more “lenient” parent becomes even more nurturing and forgiving to the adolescent.  This parent believes the other parent is too strict and the adolescent is suffering from the way the other parent is parenting.  The “strict” parent then becomes more frustrated and anxious.  This parent views the child as entitled or spoiled, and the parents as failing to provide the appropriate skills to launch.  Thus, this parent becomes stricter.  This is a cycle that can spin out of control very quickly.

Once this cycle becomes engrained, parents can shift the focus from the child’s behavior to blaming one another.  Children can be very perceptive and aware of this parental dynamic, particularly adolescents.  Children can take advantage of the parental split that is created by polarized parenting.  With children working to split the parents even further, the wedge is driven deeper into the parental hierarchy creating more conflict and difficulty co-parenting.  These interactions are taxing on child/parental and spousal relationships.  They also increase the child’s anxiety because the child senses his/her parents are not sufficiently in charge of the family.

The Goldilocks Parenting Style

When working with families with this dynamic, I find it important for each parent to understand the reason they are pulled to a specific parenting style.  Creating awareness about family of origin issues, insecurities, and the need for control will help each parent develop understanding of why they are pulled to engage with their child in a specific way.  I often have parents learn about Baumrind’s parenting styles. Baumrind divided parenting styles into three types—Authoritarian, Permissive, and Authoritative, the latter being the Goldilocks “just right” kind.  I also remind parents that they are working towards the same goal: to raise healthy and happy kiddos who will be successful transitioning into adulthood.

For expert help with parenting issues contact Kat Austin, Licensed Marriage and Family Therapist

Helping Children Regulate Feelings and Emotions

Supporting your child’s emotional development

The following are tools you can use in any location at any time. These will not only help your child create a stronger self-esteem, feel respected and valued, but will also strengthen your relationship together.

Emotional Support

  • Provide opportunities and a safe space for your child to share what they are feeling or thinking. Be careful to not make judgments about what your child shares. Read books about feelings with your child. This helps normalize that all children and people have different feelings, and can help provide an outlet for them to share with you about what they are feeling.
  •   Validate your child’s emotions. “You are allowed to feel scared.” Help your child understand it is healthy and they are allowed to have different emotions; and that they can learn how to handle the emotions in a safe way.
  •   Remind yourself that behaviors communicate to adults that a child is overwhelmed and needs your help.
  •   Listen to what your child says is their concern, and why they are upset. Reflect what they share. “I hear you are upset because you thought we were going to stop at the park, and now it’s raining.”
  •   Your child is still learning how to calm down; help regulate your child externally. Use a comforting tone of voice, loving touches, hugs, holding, rocking, ‘I hear you,’ ‘I’m here to help you feel better,’ sit next to them, breathe. During times when they are calm, practice how to handle challenging emotions or situations. Have your child help teach a stuffed animal/toy/sibling/parent how to handle the same challenges your child faces.
  •   During times when your child is upset, get your child moving! Research shows that moving can help reintegrate the brain and increases emotional regulation. Take a ‘snake’ breath, do a jumping jack, throw a ball into the couch, stomp their feet, crayon scribbles, stretch.
  •   Self-care. It is vitally important for you to take care of your own emotional needs. When you are overwhelmed, anxious, mad, etc. it becomes increasingly difficult to support your child. Find something you enjoy doing and incorporate that into your day. It could be taking 5 minutes to work on a cross-word puzzle, closing your eyes and taking a deep breath, going for a walk, talking to a good friend; find something that helps you and make a commitment to yourself (which is also for the betterment of your child) to incorporate this at some level.Incorporate the following
  •   Use choices. Allow your child to choose between two or three options. This gives a sense of control, yet you are ultimately choosing which options are ok. This is particularly important for children who are experiencing transitions.
  •   Hold realistic expectations for your child’s age and abilities.
  •   Be predictable. Using consistent actions and keeping to routines, you decrease the stress of not knowing what to expect. This includes providing consistent meal and sleep times.
  •   Be aware of your child’s sensory needs. Do they get overstimluated with bright lights? Are there scents that are calming? Use sensory activities to help meet needs of your child.
  •   **Spend 1:1 time with your child where they get to pick what activity you play – safety and respect are the rules, follow your child’s lead. No phones, tv, or computer during this time.

By Debbie Mayer, LCSW

Secret Stash: Where Young Adults Hide Drugs

(23 places young adults hide drugs:  a “Where’s Waldo for clueless parents)

Posted by:

Linda Cain, MSED, At Risk Alternatives, L.L.C.

Finding Options Supporting Success

1. Hidden behind things on shelves

2. Hidden in a slit cut into my mattress

3. Hidden in custom sewn pockets in my clothes

4. Hidden in dashboard of my car or tiny compartment revealing their most common secret stashes of drugs.

5. Hidden in pillow cases in my closet

6. Hidden in shoes underneath sole

7. Hidden in fridge/freezer

8. Hidden inside A/C and heating vents and drop down ceilings

9. Hidden inside an empty deodorant bottle

10. Hidden inside guitar or guitar case

11. Hidden inside handle bars of my bicycle

12. Hidden inside my bra/underwear

13. Hidden inside my makeup case

14. Hidden inside my retainer case

15. Hidden inside my VCR, or in any discarded equipment (TVʼs, PCʼs, etc.)

16. Hidden inside my wallet / purse

17. Hidden inside old snowboard boots or any seasonal equipment or clothing

18. Hidden inside pockets of clothes hanging in the back of the closet

19. Hidden inside socks and stuff in toes of shoes

20. Hidden inside stereo speakers

21. Hidden inside stuffed animals

22. Hidden inside the battery compartment of old TV remote controls

23. Hidden inside video game boxes, DVD and CD Cases


The young people in this survey were all “professionals”

in the field of drug and alcohol abuse, i.e. everyone had a

primary struggle with drug and alcohol related issues.


Do Not Reprint Without Written Permission

© 2006 – Sober College ™

Families in Transition

Is Your Family Struggling To Adapt To A Change Within Your Family System?

Is your family struggling to adjust to a significant family transition, such as a new baby, new developmental stages for your children, adolescent angst or launching a teenager? Is this new shift in your family triggering conflict, uncertainty or imbalance within your home? Are you finding your new role difficult to navigate, instigating self-doubt and self-judgment? Is this new phase for your family causing stress between you and your partner? Is the change and newness leading to increased disconnection or upset between family members? Do you wish you felt more confident in your ability to lead your family through the change and ensure that everyone’s needs are being met?

Much like children go through developmental stages, families also experience stages called transition cycles. These cycles – or shifts in the family dynamic – typically occur following births, at pivotal times in childhood and adolescent development and when teenagers enter adulthood and leave the home. They can also occur when adult children take on the role of caring for their aging parents. Much like a child entering into a new development stage, family cycles can come with significant challenges, fears, conflicts and confusion. Struggles can be compounded, however, when the whole family system – and not just an individual member – is tasked with accepting newness and adapting to new family roles and other necessary changes within the home. During these cycles, it’s common to feel anxious and overwhelmed, and to question your ability to navigate change and adequately support all members of your family.

It is Common For Families To Struggle With Transition Cycles

Most families experience difficulties adjusting to the newness and uncertainties that arise when major shifts occur within their home environment. Not knowing how to be in a new family situation or uncertainty concerning what new roles will look and feel like can elicit conflicts, increase stress between family members, and make everyone feel unsettled and fearful. Change is hard. It disrupts the familiar and it’s common for everyone within the family – especially children – to be resistant, angry or inflexible. Children – who need structure – may become fearful and act out or withdraw. Teens may try to cope by self-medicating or developing other, unhealthy coping mechanisms. And, the stress of change may be impacting your relationship with your partner and/or causing you to experience self-doubt and anxiety. Thankfully, it’s also very common and beneficial for families to reach out and ask for help during these significant family transitions. A BPS therapist who is highly trained and experienced in families in transition matters can help you navigate change with greater ease and help your family adapt to change.

Therapy Can Help Your Family Accept, Adjust to and Embrace Change

Your family is always changing and changes – especially significant transitions – require everyone within your family system to be flexible and adaptable in order for family cohesion to occur.  And, you or you and your partner are charged with leading the way. Therapy can be extremely effective in helping you learn how to navigate this new terrain and help your family adapt to change.

Your BPS family therapist can help you understand the dynamics of family transitions, determine what’s occurring within your family system that is creating unease, and help guide you through this tricky time. As well as coaching you and offering concrete, practical strategies to try at home, your therapist can help your family connect during a time when people often pull away. In therapy, all members of your family will be given a safe space and time to talk about these changes and the feelings they may be experiencing, which may be difficult to discuss in daily life. Your family can learn better conflict resolution skills, including how to fight fairly. With help, you can lead your family through a transition with more ease and fluidity and get the support and guidance to make change easier on your children, partner and yourself.

The changes and challenges your family is experiencing now can become an opportunity to understand each other better, increase closeness, improve communication and strengthen your family connection. Although you may feel overwhelmed now, with help, it is possible to navigate this newness with more ease. All members of your family can adjust to and accept what is new and learn to embrace your new family cycle. And, addressing the issues that come up for your family when confronted with change now can help you better navigate the inevitable changes in your family’s future with more ease, confidence and clarity.

But, you still may have questions or concerns…

I think therapy could be helpful, but I’m concerned about costs.

This is your family’s lives and wellbeing. Addressing family transition issues now can lead to both immediate and long-term benefits. It can also prevent difficulties within your family from getting worse. Therapy is an investment in building confidence, creating balance and developing a workable structure for your family. It can help your family adapt to change in healthy ways and lead to increased connection within you family now and in the future. Therapy is also an investment that can lead to more security, consistency and wellbeing for your children.

Many people come to BPS having worked with other therapists who were not trained to work specifically with family transition issues or who they or their family couldn’t relate with – which is a waste of time and money. At BPS, we’ll conduct an increase the likelihood of a good fit, BPS offers an online therapist directory and match your family with a therapist who is trained and experienced to help with transition issues and whose personality is a good match for your family. Once you find that good match, making a commitment to yourself and your family may be one of the most valuable investments there is. Imagine everyone in your family feeling and functioning better now and in the long-term on a regular basis and ask yourself what that’s worth.

If money still is an issue, you can talk with your BPS therapist to see if they work on a sliding scale. They may also be able to help you find other lower cost resources in the community.

Our schedules and lives are so hectic right now. I’m not sure that it’s possible to get everyone in one room at the same time.

We live in a busy culture and many families struggle with the juggling of schedules, shifting routines and conflicting needs. While it can be hard align everyone’s schedules for an hour a week, doing so during a transitional period is important. It can help your family connect and honor your family system. Alternatively, not doing so can create further disconnections and increase conflicts.

Your BPS family therapist can create a therapy structure and schedule that meets the specific needs of your family. And, once therapy has begun, your therapist may suggest working with different members of the family at different times, on various issues – alleviating the need for all members to be present at every session. You can talk to your therapist about your time concerns and develop at strategy and structure that fits your family. Therapy can be a fluid and dynamic process.

I’m afraid that therapy will shine a light on all that’s not working within our family and make everyone feel and/or behave worse.

You may be right. Oftentimes, things have to get worse before they can get better. But, it can get better. And, your BPS family therapist can help support and guide you through the upset that often occurs before healing can begin.

It’s also important to note that not addressing the issues that are occurring within your home can lead to further disconnection between family members and increased conflict as negative feelings deepen and problematic behaviors become entrenched. And, if your family is unable to adjust to current transitions, issues and conflicts can be compounded when the next transition  – which is inevitable – occurs. Alternatively, therapy during a change cycle can lead to closer family bonds and help your children – and yourself – develop a healthy ways to handle change. With help, all members of your family and your family system as a whole can become more flexible and adaptable now and in the future.

To increase the likelihood of a good fit, BPS offers an online therapist directory which will help you to determine what your family’s specific issues are and ensure a good match between you, your family and a BPS therapist in terms of personality, style and expertise.

You can also check out our free, online therapist directory, which will match you and your family with a therapist who has expertise working with family transition cycles and related issues.

kat-austinBPS therapist Kat Austin, LPC, LAC, LMFT helped create the content for this page. Kat is specifically trained in family therapy and has been helping families through family transition cycle issues since 2005.

What I say before I even open my mouth:

The value and importance of understanding non-verbal communication

By Rachael Bonaiuto, LPC

”The most important thing in communication is hearing what isn’t said.” –Peter F. Drucker

 Why Non-Verbal Communication?

The World English Dictionary defines nonverbal communication as “those aspects of communication, such as gestures and facial expressions, that do not involve verbal communication but which may include nonverbal aspects of speech itself”.  There are popular statistics asserting that most communication (75%-90%) is nonverbal and that nonverbal behavior is the most crucial aspect of communication. And wholesome communication, as you probably already know from personal experience, defines the health of so many of your relationships. Further, healthy relationships are the pillars to a quality life with increased joy, abundance, health, and happiness.

So why don’t you pay more attention to your body language, your posture and gestures, your tone of voice, eye contact and somatic patterning? We live in a culture that places so much value on the spoken and written word, on what you say and how you articulate your experience. If it’s true that what we pay attention to grows, and conversely, what we don’t pay attention to dies away, it is important to acknowledge, attend to, and develop our non-verbal communication skills in order to engage in thriving relationships with our children, partners, co-workers, friends and fellow citizens. So, how do you begin to tune into your non-verbal communications and what impact will it have on your life?

”The human body is the best picture of the human soul.” –Ludwig Wittgenstein

 How do you develop your Non-Verbal Communication Skills?

Paying Attention and Practicing are two foundational elements for your non-verbal communication development. From wherever you are in this very moment, read the following words and then pause – noticing right now: how you are sitting, the pace, rhythm and quality of your breath, the angle of your spine, the location of your feet and the direction of your gaze. Don’t feel like you need to change any of these things, in any way, just simply notice. As you survey and take stock, you are paying attention. The practicing part comes in the frequency and diligence with which you take stock, survey and notice your body. Do it often – as you are driving your child to school, standing in line at the bank, talking to a friend in need, asking for something you want, ordering your morning coffee, telling someone you love them – what is your body doing? What are you communicating without words?

Below are a few areas to identify, pay attention to and engage in practice. Let’s take an example of an everyday interaction – sitting at the dinner table with your family – and examine these various aspects of non-verbal communication.

Posture – How are you sitting at the table? Where are your elbows and hands? Is your spine upright or are you slouching? Are you facing the other family members at the table or are you positioned away from them in some way? Do you feel grounded? Are your feet on the floor? Is your crown open toward the sky? Are you ‘awake’ in your posture?

Proxemics (Personal Space) – Where are you in relationship to the others at the table? Have you distanced yourself in a way that feels appropriate? Are you invading another’s space? Do you feel that someone is too close to you? Are you wishing you were a bit closer or further away? Is it okay to move your positioning? Are you ‘awake’ in your personal space?

Gestures – How are you expressing yourself? Are you using your hands to say something that you are not saying with words? Have you tilted your head in a way that either affirms or denies someone else’s experience? Are you engaging or disengaging in conversation with your movements? Are you ‘awake’ in your gestures?

Facial expressions – There are some 43 muscles in the face and we are often using them in ways that we are not aware of. What are your eyes saying? Did your lip turn up or curl down when something was shared? What direction are you tilting your nose and chin? What are you communicating with your face as you respond to your environment? Are you ‘awake’ in your facial expressions?

Paralinguistics: tone of voice, volume, inflection, pitch – Have you ever experienced something that someone said as incongruent with the actual words they spoke? What is your tone of voice expressing when you ask about your lover’s day? How is your inflection when you question your child’s participation in a school activity? Are you speaking loudly about something that makes you nervous? Are you ‘awake’ in your voice?

Eye Gaze and Contact – So much is communicated through the eyes. Have you made eye contact with your family members during dinner? Are you scolding someone with your gaze? Are you paying attention with your eyes? Have you been looking at your feet throughout the entire meal? Or gazing up at the ceiling? Are you ‘awake’ in your eyes?

Somatic Patterns – We all have somatic patterns that are often unconscious, communicating something that we are unaware of. Are you twirling your hair while your husband talks about his work day, appearing bored or disinterested? Are you nodding as your child shares about his science test? Do you rub your eyes when sadness begins to creep in, trying to conceal an emotion? Are you ‘awake’ in your body patterns?

Appearance – How we appear communicates so much to others, often without our cognizant choice. Did you come to dinner in your pajamas? Have you changed into something comfortable or perhaps loosened your tie and taken off your shoes? Have you spent the entire dinner looking at your phone? Is the hat you are wearing covering your face? Are you showing through your appearance respect, presence, disapproval, disinterest? Are you ‘awake’ in your appearance?

”What you do speaks so loud that I cannot hear what you say.” —Ralph Waldo Emerson

 What will improve as you develop your Non-Verbal Communication Skills?

As you imagine paying attention to and practicing your non-verbal communication skills, you might also imagine aspects of your life changing for the better. Among other things that will surprise, delight and inspire you, you will develop healthy, clear boundaries, enhance intimacy, deepen connections, communicate feelings and needs, and establish safety and trust. And who wouldn’t want these healthy upgrades improving our relationships and increasing our quality of life?!



Strategies for Parenting the Older Adolescent

Steering Versus Fueling

By Dan Fox, LPC

Let’s use the metaphor of life as a car.  If your daughter’s life was a car, when she’s little, it’s your job to steer.  We’ve got to keep them safe, provide a rational structure, help them when they are stuck emotionally or with one of life’s many challenges.  Still, by the time they are truly adults, they need to be able to steer their own car, to pick a destination and know how to get there, to stay safe despite the dangers of the road, to keep their car running in a healthy way.  By the time your daughter is an adult, your days of steering are long over.  Your role has changed.  It’s time to focus on fueling.

Steering is trying to control.  Steering is checking to make sure that they’ve made a doctor’s appointment.  Steering is giving them money if they get good grades.  When you call with a list of concerns that you hope to make them aware of, that’s steering too.  So is telling them that you won’t pay for any more classes if they fail again.

Steering isn’t inherently bad; but as your child gets older, it just does more to support perpetual adolescence than to support a launch towards adulthood.  And if you are like many parents, you know from hard earned experience that it’s hard to steer someone else’s life very effectively.

When we steer older adolescents, the tendency is for our kids to feel a little judged or a little inadequate.  It’s like we don’t trust them to be able to handle life’s challenges.  Or we create conflict.  We come across as being too alarmist or a nag.  We can end up unsure whether or not we got our point across, and whether or not it was worth it even if we did.

Rather than trying to figure out how best to steer, the parent journey at this life stage is more about how to fuel.  If you are like many parents, sometimes contact with your son or daughter is strained.  To fuel is to be able to have contact with them where they leave less stressed or anxious, not more.  Fueling is about believing in them, keeping the faith in whom they are and whom they will become, even if they don’t feel confident.  Fueling is about being able to hang out and enjoy the time together, without any particular agenda.  If they don’t call you back, if they give one-word answers, if you feel like you’re being avoided, let’s face it – these are all signs that despite our best intentions, they are not feeling fueled.

Most parents do a pretty good job of fueling.  But at this life stage, it’s worth becoming an expert fueler.  Two skills to work on:  (1) being able to identify your interactions as either fueling or steering, and (2) deliberately practicing communication that fuels rather than steers.

Understanding the Common Challenges of Adopted Children

By Karen Wilding, LCSW

 To begin with, I am an adopted child. I was adopted in the 40’s in a closed adoption, but I believe that although adoption has changed since the 40’s to having many more open, family and foreign adoptions, there are issues that are common to all adopted children. These issues include abandonment issues, identity development issues especially in adolescence, and feelings of not belonging. Some kids feel strongly about some of these things and not others.

First, I want to say that adoption is not a psychological condition it is a life condition. It is a permanent condition regardless of the traits, strengths, talents and special qualities of the child who was adopted. This special status comes up in expected and unexpected ways, which may cause stress and distress for the child – persisting even into adulthood. For instance, my children were asked to draw a family tree in school – do I use my adopted family or have my child disclose my adoption and leave a section of the tree blank?

At first glance, adoption seems like a perfect arrangement. Parents get a child and the child gets a loving home.  But this arrangement has some problems:

1)    Parents tell the adopted child they are “special” – that they are lucky to have found a good family. Adopted children often wonder if they are good enough to meet their new family’s expectations.

2)    Children, in order to understand that they were adopted, have to grapple with the fact that first they were abandoned. Again, the question arises of why they weren’t good enough to keep. So there is the dual challenge for kids who feel they need to be perfect to have a new family, and that they must feel grateful for this situation.

3)    A chosen child has some “ghosts” that can become active fantasies, or just low level what-ifs: the ghost of who they would have been if they were not adopted, the ghost of the birth mother and birth father, and the ghost of the adopted family’s child that might have been. When I was thinking about this, I realized that I have said on many occasions that my first cousin ( the daughter of my mother’s brother)– who is beautiful and looks like my adopted mother – “She looks like what I was supposed to look like.” This is a ghost echo for me.

So this is not to say that adoption is too much to handle – it is just an experience that requires lots of attention and understanding.  The three main issues we can address  are abandonment, identity development, and feelings of not belonging.

1)    Abandonment – this is the big one. How could someone leave you before you were even big enough to know anything? This loss is sometimes called a “primal” loss. It has to be acknowledged to be healed. In reaction to this reality, adopted kids often go through phases of being detached, clingy, over worried about people leaving and not returning, fear or curiosity about illness and death, and difficulty with transitions of all kinds.  I’m sure you all have examples of how this has occurred in your families.

2)    Identity issues – this is where we get into the roles of the good adoptee and the bad adoptee. One of the major developmental jobs of growing up is to develop an independent and cohesive identity.  Some adopted kids seem to be trying to connect with the “ghosts” we talked about by either acting the image of the adopted parents natural child (generally the good adoptee), or living life according to the fantasy of his or her birth family (the bad adoptee). These birth family fantasies can lead kids to try identities involving criminal behavior, excessive use of alcohol and drugs, or sexual acting out. This kind of behavior also serves the purpose of testing the commitment of the parents, to see if they will send you away and abandon you again. I remember a teen I was seeing who threw a serious fit, yelling ‘you can’t get rid of me’ when his parents wanted to send him to a prep school.

3)    The third issue common to many adopted children involves the feeling of belonging. As soon as a child begins to grapple with the fact that he or she is adopted, he/she starts looking for similarities and differences with his adopted parents.  I recently had an adopted teenager in my office who wanted to measure how tall he was by standing next to his adopted mother. Children look to their parents, aunts and uncles, for information about how they will turn out – what characteristics do they carry coded in their genes. For adopted kids there is confused genetic mirroring, either physically or psychologically. So it can also be a challenge for an athletic, artistic child to be adopted by an intellectual family full of lawyers and scientists.  When kids realize how different they are, there is often a period of looking for people like you – your tribe. As a friend of mine recently said: It’s all about the feelings.

What can we do to help adopted kids deal with the feeling issues we have identified – abandonment, identity formation, and feeling that you don’t belong? The overall aim here is to stay connected with the child or person you are dealing with – project the feeling that you will never give up on them.  This is the classic instruction of separating the behavior from the person’s basic being.  “I am mad that you lied to me, but that doesn’t mean I don’t love you.” Here are a few specific techniques to consider:

1) The first technique to maintain connection is active listening – which is actually listening to the feelings not the content. In active listening you say things like: It sounds like you are scared, nervous, worried, sad, upset, etc.

2) Technique two is pointing out the positives – I know you are good at sorting things out – or being a good friend – or getting what you need – so you can do this.

3) The third technique is asking a question – Do you want to know what I think? Or what I would do in this situation?

4)    The fourth technique is total confidence – I know you will figure it out. This works best with older kids who have some experience making good decisions.

5)    The last technique is to articulate what you are doing – I love you and I think you will be incredibly successful in the future, and I want to help you make good choices today.  Is there anything I can do to help? In other words, I am there for you.

Addressing adopted children’s unique challenges can be tough. By following these strategies you will be able to more effectively address these concerns and help the adopted child know that he or she is heard, loved, and wanted.

Considering Medication for Your Child’s Psychological Issues

Q: Some parents I know seem in a rush to have their children go on medication for things like depression and hyperactivity. What should parents do before making the jump to medication?

A: For psychological disorders, a thoughtful and accurate diagnosis is key to developing an effective treatment plan. What elementary child does not have occasional concentration problems in class? Does this mean that he/she has Attention Deficit Hyperactivity Disorder (ADHD)? Similarly what adolescent isn’t moody from time to time? Do we diagnosis him/her with Bipolar Disorder? Many mental health professionals would agree that these two disorders are highly over diagnosed in children and adolescents. This is a significant concern because both ADHD and Bipolar Disorder are typically treated with strong psychoactive drugs. Once diagnosed, patients may be on these drugs for the rest of their lives.

The accuracy of a diagnosis is a function of gathering information from multiple sources and thoughtfully ruling out other variables that may better explain the symptoms. For example poor concentration is also a symptom of depression. Some would argue that mood swings are a normal function of hormonal changes in adolescence. While it can be costly, considering formal testing by a trained psychologist can dramatically increase our objective data and thus increase the accuracy of our diagnosis. There are specific psychometric tests that can assess attention impairment (e.g. the TOVA), mood disorders (the MMPI), and other psychological conditions. A comprehensive psychological evaluation would include a battery of tests; an analysis of the child’s medical, family, educational, and social history; as well as surveying parents, teachers and children, in order to get a convergence of multiple data points as to the source(s) of the presenting problem. In the end the cost of a thorough psychological evaluation may be far less than the impact of an incorrect diagnosis.
When accurately diagnosed and treated, medications can prove to be a great blessing in treating conditions like ADHD and Bipolar Disorder. We just want to do everything we can to be sure of the root cause, which allows us a much better chance of developing a treatment plan to address it.

Helping Your Teen Have a Successful Summer

Q; How can I help my adolescent have a fun, productive, and safe summer?

A: Summers can be a unique challenge for parents of adolescents. On the one hand we want to honor their desire for making more of their own decisions regarding summer activities, as the shift to independence is a key developmental task for adolescents. On the other hand, we still need to encourage healthy choices and ensure that their summer includes opportunities to enhance their social and emotional development.

When adolescents are bored and have nothing productive to do, this often leads to an increase in engagement in a wide range of at-risk behaviors. Specific concerns include experimentation with drugs and alcohol, engaging in risky behaviors that can result in physical injury, and unsafe sexual behavior. Research has shown us that when adolescents under the age of 15 experiment with drugs and/or alcohol, their risk of developing addiction and/or psychiatric issues later in life significantly increases. We also know that summers can often represent a shift in new and increased experimentation with drugs and alcohol for young adolescents. It is important to strike a balance between well deserved down time and participation in fun, structured activities.

Consider a respectful, collaborative discussion with your adolescent about summer plans and activities. Let them know that while you want to see them doing some structured activities, it is important that they feel good about what those specific activities may be. Take advantage of the activity information in this month’s Thrive newsletter as a springboard for these discussions. Whether it’s getting a job, recreational activities with the family, participating in an art class, signing-up for a one-week camp, or working on home projects with Mom and/or Dad (and getting paid?), try to create a balance of down time and structured activities. Periodically checking in with them over the summer can also be beneficial.

Helping your adolescent proactively develop an effective summer plan now will be more effective than waiting until problems emerge over the summer and attempting to deal with them reactively.

Helping Your Child Transition to Adolescence

Q: How can I help my soon-to-be middle school child adjust to adolescence?

A: Just when we start to figure out effective parenting techniques, the onset of adolescence makes a lot of what we do as parents obsolete. If our parenting and discipline strategies do not evolve with our children’s development, we quickly find ourselves battling with them seemingly all the time. To understand why, we must first understand the key developmental task of adolescence: individuation. This is our child’s transformation from being dependent on us to becoming a self-sufficient individual. This process begins at the end of elementary school and continues into young adulthood. It includes profound emotional, social, physical, hormonal and neurological changes. No wonder our child suddenly becomes such a handful!

The trick is to support this process instead of fighting it. More specifically, consider the following suggestions:

• Honor the transition: Create opportunities to celebrate this monumental shift in your child’s life by acknowledging it through discussion, ritual and recognition.
• Talking with instead of talking to: Like it or not, the days of lecturing are over. It’s time to start listening more than talking.
• Use empowerment strategies: When conflicts arise, look to your child to contribute to the solutions. Encourage your child to have a voice in the discipline plan.
• Join the experiment: As scary as it may seem, experimentation is also part of normal adolescent development. When appropriate, allow for short-term negotiated agreements that give your child more control over his/her life. If the experiment fails, process that together and revise your plan.
• Shift from control to advice: Your advice will prove valuable for the rest of their lives. By making this shift now, it is much more likely to be considered in the future.
• Express feelings of pride and love; While adolescents may act like they don’t care, don’t be fooled. They need your positive feedback more than ever.

Parenting an adolescent can feel an overwhelming and, at times, impossible task. By using effective strategies and hanging in there, your child will successfully come out the other side. And so will you!

Self-Harm Behavior

By Dr. Jan Hittelman

“My 13-year-old daughter is a cutter. She also smokes. I have done everything I can to stop her, but she did it again last night and I took her to the emergency room. On the way home, I asked her what I could do to help her stop cutting. She said if I would let her smoke cigarettes at home, that would help, because smoking soothes her and helps alleviate her need to cut.”

“What should I do?”

Cutting and cigarette smoking share a common thread; both are unhealthy ways to deal with negative emotions. While all of us struggle with feelings like sadness, anger, and anxiety, we each deal with our feelings very differently. Some adolescents have tremendous difficulty experiencing and working through their negative emotions and are limited to self-harm behaviors as a maladaptive coping mechanism. It is difficult for most of us to understand, but for some individuals cutting can seemingly provide their only source of relief and often develops into an addictive behavior that is very difficult to stop.

Common misconceptions regarding cutting are that it is a suicidal gesture and/or attention-seeking behavior. Those that cut use it as “a way to survive” and are usually not looking to kill themselves. Given how effectively they hide their scars by wearing long sleeves and purposely cutting in areas that are generally under clothing, this is clearly not an attention-seeking behavior. Rather, cutting is a desperate behavior that demands our attention.

Self-harm behaviors are a serious indicator that the individual needs professional help. It is important that the mental health professional have expertise in not only treating adolescents but also self-harm behaviors. Common co-occurring issues that also need to be treated or ruled-out include: history of sexual abuse, family dysfunction, risky sexual behavior and substance abuse.

Finding the right therapist for your daughter, who can help her learn how to deal with negative emotions in a more effective way and thereby reduce (and eventually extinguish) her self-harm behaviors (including cigarette smoking), would be the critical next step.

Screen Time Addiction

Q: How do I know when my child is spending too much time on the computer or playing video games?

A: As more people engage in high tech recreation, there are increasing concerns regarding the effects of these activities and the potential harm of excessive computer and video game use. Some of the key factors to consider are:

Time dedicated to computer and video game use: Many experts recommend limiting use to two hours a day. A more practical time guideline can be based on the individual and the impact of use on daily functioning.

Impact on healthy daily functioning: Excessive use is more of a concern if it negatively interferes with school performance, peer socialization, family interaction, exercise/weight control, and interest in other activities.

Behavioral Effects: There are numerous studies that show a correlation between exposure to violent video games and aggressive thoughts or behavior. None of these studies, however, can demonstrate long-term impacts or conclude that video gaming itself causes aggressive behavior.

What’s a parent to do? The first step is to have an open discussion with your children regarding computer and video game use. If your child has a healthy social life and continues to function well at home and in school, simply monitoring use may be sufficient. If the amount of daily use time is excessive and/or you have concerns about your child’s social, emotional or behavioral health, try setting clear guidelines. In addition, consider gaming and recreational computer time as a reward for completing homework, household chores, or engaging in prosocial activities. Help your child replace use time with other fun activities. Simply taking away the activity and leaving a vacuum, will likely lead to conflict and efforts to “get around” newly imposed rules.

It is also important to understand that excessive videogame/computer use may be a symptom of underlying emotional issues (e.g. depression, anxiety, social adjustment, etc.). Addressing the surface behaviors without treating these issues will only result in a reoccurrence of the undesired behaviors and/or new ones taking their place. If you have concerns about your child, consider an assessment by a mental health professional to determine the extent of the problem and better understand the underlying issues that may be fueling the behavior.

Dealing with a Difficult Teacher

Q: What’s a parent to do? Your child confides in you about a teacher’s behavior in the classroom, but expects you to keep silent about comments/actions that are demeaning, hurtful, even abusive.
How does one bridge not wanting to speak forth for fear of reprisal on a child already stressed and scared — against feeling the need to communicate with administrators, who should be made aware of what’s happening in the classroom. How do we advocate our children’s concerns without creating conflicts or damaging relationships?
Signed, Between a rock and a hard place

A: There are certain factors that must first be considered before deciding on a plan of action. These include: accuracy of information reported, severity of reported misconduct by the teacher, and the child’s age. Based on these factors let’s consider some scenarios and possible responses:

If we believe that the information is accurate and the misconduct severe, it is important that it be addressed. Consider meeting with the teacher first and give your child the option to attend (the older the child, the more appropriate the invitation). If this meeting is unsatisfactory, request a meeting with the principal, who should decide whether or not to invite the teacher to this initial meeting. Continue working with the principal until a mutually agreed upon plan of action is developed. While you can then go beyond the principal, if you have been reasonable it is unlikely that this will be necessary.

If the situation is less clear and/or the misconduct is not severe, first make sure you’re your child feels heard and supported. After allowing your child to fully share his/her thoughts and feelings, brainstorm possible next steps together. Discuss options (e.g. talking with the teacher, talking with the principal, writing the teacher a note, trying not to let the teacher’s style be as upsetting, promising to let you know if it happens again, etc.) and empower your child with the final say on what approach to use (the older the child, the more appropriate the empowerment). If these issues continue, consider the recommendations as outlined above.

It is also important to remember that our children will need to effectively deal with a variety of teachers, some more challenging than others, throughout their educational career. If the circumstances are not severe, helping children learn how to deal with these issues on their own (especially as they get older) will help them deal more effectively with challenging people in other areas of their lives as well.