Us and Them: Prejudice, Awareness and Understanding

By: Dr. Jan Hittelman

Whether we realize it or not, we are all prejudiced. That’s because our brains are wired to categorize and think in stereotypes based upon our experiences and perceptions. If we have limited experience interacting with individuals who are different than us in some way, we have to base our expectations on other information, like what we see in print and on television. That’s why the portrayal of various groups in the media is so important because it can shape our attitudes and biases. Similarly, we are all vulnerable to “Us and Them” thinking. That’s why we have gridlock in Washington, D.C. and ongoing international clashes throughout the world. Regardless of our ethnic, racial, or political views, most of us would agree that mutual understanding, respect, and world peace are important and admirable goals.

While Boulder is often viewed as a progressive, liberal bastion, the truth is that we have a long way to go in terms of our own understanding, respect, and perceptions of people who are different than us. Just ask a member of any minority group in our community about how they feel perceived by others when walking down the street or going into a store. Think about how most adult Caucasians might feel walking down an alley at night and coming upon a group African American teens. While we may not like to admit it to ourselves, all of us our vulnerable to prejudice and “Us and Them” thinking.

The solution starts with acknowledgement of the problem. Once we are aware of our prejudices we can change them by learning more truths about others to replace stereotypes, which are based on limited, distorted information. The best thing you can do for your children is to seek out diverse social opportunities for them so that they can have real experiences with folks that are different from them. Let’s shift from distrust, based on lack of knowledge and experience, to inclusion and acceptance. That way we all benefit.

Why Recess May be the Most Important Part of the School Day

By: Dr. Jan Hittelman

There’s a big difference between skills and abilities. While we are born with certain natural abilities, skills are learned and require practice to develop. It is important to remember that our children are not born with good social skills, but learn these skills through modeling and practice. There are numerous research studies that highlight the importance of healthy social skill development and their impact on academic development, school success, as well as success later in life. Conversely, children with poor social skills are at increased risk of difficulties in interpersonal relationships, peer rejection, poor academic performance, signs of depression/aggression/anxiety, and are at higher risk of involvement in the criminal justice system as adults. Social skill deficits can also impact school safety and have been a factor in the recent rash of school shootings.

In addition to focusing on developing good academic skills, we must also prioritize our children’s development of healthy social behaviors. Important components of good social skills include: nonverbal communication skills, empathy, problem solving skills, and conflict resolution skills. Here are some strategies parents can use to promote healthy social skill development:

  • Importance of good role models: A lot of what your child knows regarding social interaction is learned at home, not just from parents but also from siblings. Making conscious efforts to discuss, practice, and reinforce prosocial skills can make a huge difference.
  • Provide opportunities for social interaction: Ensure that your child has plenty of unstructured time to play and interact with others, as well as involvement in structured afterschool activities, will provide them with the critical opportunities for practice.
  • Teach Problem Solving Skills: Help your child develop problem solving skills by following these simple steps: Identify the problem, brainstorm possible solutions, predict the probable outcome for each solution, and choose the one that has the highest probability of success; if it fails choose another solution.
  • If needed, consider enrolling your child in an effective social skills group: Find a licensed therapist in the community who offers structured social skills training for your child’s age group.

Perhaps we need to start thinking about the four “Rs” in education: Reading, wRiting, aRithmetic, and Relationships. I’ve never met an elementary student who didn’t feel that recess was too short or a secondary student who didn’t wish that they had less homework in order to socialize more with friends. Maybe they’re onto something.

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.

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 .

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.”

Learn  more about Jeremy Dion, Licensed Professional Counselor

 

 

 

 

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?!