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.

 

 

Structured Activity Rewards: Clinical Case Studies

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

 

Bonus!

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

 

***Activity***

-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.

(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!)

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.

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.