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Using empathy to re-build connection with children and young people

This last year of global pandemic has been a time of massive disruption to almost everyone. With it has come disconnection in various forms and the challenge of reconnecting at points when restrictions have lifted. Children and young people have faced their own particular challenges with school closures preventing contact with peers and friends, in addition to the stress of uncertainty about exams and other limitations related to online learning. At a time when many teens would normally be exploring social freedoms to the full, those who have kept to the rules have made do with scraps of interaction and often relied heavily on digital forums. Sadly, a considerable number have struggled to hold onto what fragile self-esteem and social confidence they formally knew. Even some of those used to thriving have found their resilience quashed and required additional support to pull through.

We are still in the early days of reconnecting with the world and all the structures of human engagement that we once took for granted and, with time, we will no doubt start to see the fuller picture of how people’s lives have been impacted by COVID and all that has come in its wake. For some, reconnecting is proving to be a battle. There are those for whom the protection of a smaller, quieter world felt safer and some are simply feeling rusty about conversing and interfacing with real live people.

Hardships faced by those whose lives COVID has touched in very tangible ways, have brought forth numerous stories of lived empathy in response to people encountering terrible pain and the loss of health and loved ones, empathy perhaps evoked by the realisation that these losses could become reality for any of us. Likewise, there has been widespread, heartfelt support for the thousands of frontline workers who have sacrificed their own safety for the wellbeing of others and for those who have lost jobs, income and businesses. Many have felt for children deprived of opportunities to learn and play as they usually would and this continues to be a time when the younger generation needs us to recognise and engage with what they are going through.

Children and young people with social and emotional difficulties always require our empathy as part of recovery and perhaps even more so in these times. Empathy is what helps them feel understood, paving the way for self-acceptance, which in turn makes it more possible to seek support from others. Daniel A. Hughes (pioneer of Dyadic Developmental Psychotherapy) places Empathy at the core of the PACE approach, along with Acceptance and Curiosity (see my other blogs on these two subjects). In his book, co-written with John Baylin (The Neurobiology of Attachment-Focused Therapy: Enhancing Connection and Trust) he talks about embracing “the child’s defensiveness, putting connection before correction” and offering “radical acceptance” of the child’s mistrust.

In this context, Hughes and Baylin were referring to the particular struggles faced by traumatised children with attachment difficulties but we could apply the same principle to supporting children and young people who are emotionally and socially adjusting to each “new normal” they are faced with, whether or not they have experienced additional childhood trauma pre-COVID.

Hughes and Baylin recognise that this is no easy task, likening it to “hugging a porcupine”. Social and emotional defences, by their nature, are often difficult to permeate and can repel. A child or young person who repeatedly gives off a vibe of wanting to be left alone can leave the person reaching out feeling confused, rejected, useless and resentful and can lead, understandably, to withdrawal. This makes it even harder for the child or young person to reconnect, risking further disconnection, isolation and all the ill-effects that these states can bring.

If we can catch ourselves withdrawing and find empathy within ourselves for how the child or young person may be feeling in that very moment when they are unable to allow us in, we provide a bridge back into connection. This is so powerful as it communicates that we have not given up and that we see the child or young person as worth sticking with – we still see that part of them which has the potential to be in relationship with others and the world.
Brene Brown, in a Youtube clip based on part of her Tedtalk on Empathy, beautifully describes how “empathy fuels connection”. She refers to Teresa Wiseman’s 4 qualities of empathy: recognising another person’s perspective is their truth, staying out of judgement, recognising emotion in others and then communicating this. This is about “feeling with people” she says. Being with others is so much more effective than trying to fix the situation by saying the right thing: “Rarely can a response make something better, what makes something better is connection.”

In taking an empathic stance, we make an active choice to suspend our own anxiety and impatience about the pace at which a child or young person is re-engaging with life post-lockdown. We accept where things are at and we take time to understand as best we can. We then make what Brene Brown calls a “vulnerable choice”, that is choosing to connect with something in ourselves which knows the feeling we have encountered in another. This vulnerable choice is a risk well worth taking if we are serious about wanting to mitigate against the secondary effects of COVID on the mental health and wellbeing of children and young people today.

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

 

References – 

See more from Brene Brown at: https://www.youtube.com/watch?v=jz1g1SpD9Zo

Read more from Baylin and Hughes.

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Executive Function (part 2): Ideas for Supporting Thinking Skills Development in Children

Referring back to my previous blog – Children and young people with Executive Functioning Difficulties need us to:

Accept that they have gaps and delays in these skills.

Learn, by spending time with them and observing, which Executive Function Skills need scaffolding and practice.

Support by being the air-traffic controller when a child can’t do this alone, building in steps like:

  • modify the environment – reduce noise/ remove other distractions, create comfort, provide easy access to resources, use visual aids/ prompts, movement/ sensory breaks.
  • simplify tasks – reduce language and instructions, keep tasks short and achievable.
  • support completion of tasks – help child get started and ensure he/ she understands and can access materials required – check in regularly; if needed, be alongside throughout a short task before child tries a similar one with less support.
  • Use memory cards – if child needs to wait for your support, write it down on a card for each of you – and if possible the approximate time you will return to the task with them.
  • build EF skills development through practice – carefully chosen activities/ games/ projects.

The best way to develop executive function skills is to do meaningful activities which require Executive Function (thinking) skills to be used. To be able to engage in these kinds of activities and draw on thinking skills, children need first to feel safe, regulated and connected – for this they need a regulated, consistent adult to support them. Children also need activities which interest them and which are achievable, matched to their emotional age and ability level or the level they could manage with support. The following ideas for activities and games are just a few of many which might help.

HOME-BASED ACTIVITIES
Many of these activities involve the use of working memory in order to plan, prioritize, and get organised. They may also require self-control to stay focused and flexibility to solve problems:

  • Build a bird box or bug hotel/ grow things/ make a wormery/ catch falling leaves/ watch birds
  • Bake/ plan and cook a meal/ make a rug/ make a puppet/ do a mosaic/ make fimo beads
  • upcycle furniture/ decorate a room/ mend a bike puncture/ junk modelling
  • start a collection/ invent games/ create hunts and trails for each other
  • do a jigsaw/ make lego models – either from the box or made up
  • make music or playlists/ make up dance routines/ do puppet shows/ role-play/ tell stories

MEMORY GAMES

  • Matching pairs (working memory, flexibility, self-control). Adapt this to suit attention span and memory skills by reducing the number of cards. Can be cooperative if you work as a team to see how many turns it takes you to find all the pairs.
  • I went to the shops (working memory). Take turns in a pair or group to add to a shopping list, repeating the full list each time – invent various (I went for a walk and I saw a …… ; I went exploring and I found a ……) – be as flexible as you need to be to keep child engaged – eg. give clues if they struggle to remember a word.

WORD GAMES

  • Word tennis (working memory, task initiation, attention, flexibility). Play cooperatively in pairs or a group. Take turns to pick a topic and see how many things you can name from that topic – pass a ball/ soft toy as you do it. Continue for as long as you can without repeating a word. If you wish, time how long you can all keep going for or count the number of words.
  • Cooperative Bananagrams (planning, prioritising, flexibility). For children not ready for the competitive version of this game, work altogether as a team to use all the letters to make lots of mini crosswords or one giant one. Adapt this for your child’s attention span by choosing how many letters you play with.

PICTURE / MOVEMENT GAMES

  • Jenga (self-control, flexibility, planning) – Adapt this game in any way that suits your child, eg. leave out the requirement to pile bricks on top, use a smaller stack, create a rule that when a brick is taken there are other actions to follow, which might be drawn from a pile of cards. Or, just use the bricks to create mini collaborative challenges. Eg. Let’s see how high we can make a staircase, What’s the tallest tower we can make? Can we make a domino rally in the shape of an S? Are there enough bricks to make an outline of both my arms?
  • Home-made Pictionary/ charades (flexibility, self-control) – Create your own bank of words/ pictures/ phrases to be drawn or acted out for others to guess – or use cards from published games. Avoid time limits if this creates stress. Play in pairs if this helps a child to participate – whisper together about how you’re going to draw or act out the word.
  • Freeze (focus, self control). Play music while everyone dances or moves in any way they want. Freeze when the music stops. Or everyone moves about and one person just shouts “Freeze!” Try holding your poses for a count of 5/10/ longer.
  • Dobble (focus, initiation, self-control) – a matching game done at speed – the twist is that matching pairs of images may be different in size and surprisingly hard to spot! There are different ways to play the game and various themed versions available.

STRATEGY GAMES

  • Forbidden Desert (planning, prioritising). This is designed as a cooperative game where participants work together to escape from a desert by finding pieces of a sun-powered flying-machine, whilst avoiding sandstorms and keeping water supplies topped up.
  • Quirkle (Planning, organisation, flexible thinking). A simple but original game based on matching colours and shapes on wooden painted blocks. Players need to think about where best to place their pieces for the maximum score. Work in teams if this suits your child best. And you could try using the blocks to make patterns – see what your child comes up with.
  • Rush Hour (Focus, flexible thinking, working memory, perseverance). This is the original version of a game which has been replicated on many apps. The real thing is a fun way of moving vehicles to enable an ice-cream van to leave a car park. There are 4 levels so it’s easily adapted.
  • Genius Square (Focus, flexible thinking, perseverance). This game can be played solo or against a partner/ other team. The task is to fit the blocks into the grid around where the dots are placed. There are always lots of possible solutions.

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

 

Further resources and ideas are available at:

HARVARD Centre for the Developing Child website for activity ideas by age group –https://developingchild.harvard.edu/guide/a-guide-to-executive-function/

UNDERSTOOD website for ideas on supporting different areas of executive function.
https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/executive-functioning-issues/executive-functioning-issues-strategies-you-can-try-at-home?_ul=1*2sfyod*domain_userid*YW1wLVppUDNOQ3JWZXUwSTIzekQyall5N3c.

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Executive Function Skills (part 1) – What They Are And Why Some Children Struggle With Them.

Executive functions are the cognitive skills we use to control and regulate our thoughts, emotions and actions to achieve goals. These three main areas of executive function work together:

  • Self-control/ inhibition – the ability to resist doing something distracting/ tempting in order to do what’s needed to complete a given task, helping us to pay attention, act less impulsively and stay focused.
  • Working memory – the ability to hold information in mind and use it to make connections between ideas, make mental calculations and prioritize action.
  • Cognitive flexibility – the ability to think creatively, switch gears and be flexible to changing requests and situations, allowing us to use imagination and creativity to solve problems.

For example, all three areas are needed in social pretend play:

  • Child needs to hold their own role and those of others in mind (working memory)
  • Child needs to inhibit acting out of character (employ self-control), and
  • Child needs to flexibly adjust to twists and turns in the evolving plot (cognitive flexibility)

The joint forces of our executive function skills can be thought about as . . .

  • the conductor of an orchestra, organising multiple instruments to make one unified sound or
  • an air-traffic controller managing safe take-off and landing for hundreds of air-craft

Executive functions are controlled by the frontal lobes of the brain which are connected with and control the activities in many other regions of the brain.

Hot and Cool Executive Functions
Hot executive functions are the self-management skills we use in the heat of the moment when emotions run high – they require concerted conscious effort and help us give up short term gain for the sake of a more important goal. Examples include: resisting temptation; focusing on a boring task; breaking an old habit; and biting our lip when angry. Cool executive functions are the skills we use when emotions aren’t really a factor. Examples include: remembering a list of numbers and repeating them back in reverse order and following a simple recipe.

Executive function skills are a vital part of learning. They help children to be in the right place at the right time with the right equipment, listen to the teacher, wait for a turn and not call out. They are also pivotal in managing frustration, getting started on a task, staying focused, accepting constructive criticism and asking for appropriate help. They enable children to notice and correct mistakes, prioritise, persevere and complete challenging activities, resist the urge to retaliate and feel more confident about managing in school.

Children with under-developed executive function skills may act without thinking, overreact to small problems, be upset by changes in plans, forget to hand in homework, delay starting effortful tasks, switch between tasks without finishing any, lose or misplace things, struggle to meet deadlines and set goals, and lack insight into their behaviour.

Factors which can make it harder to access our executive function include tiredness and sleep deprivation, dyslexia and more complex learning difficulties, neuro-developmental conditions like Autism and ADHD, environments which overwhelm our senses and create stress, one-off traumatic incidents and complex trauma as a result of Adverse Childhood Experiences.

Given their significance, difficulties with Executive Function can contribute to social, emotional and mental health difficulties if they are unsupported and children who are already vulnerable for any of the above reasons may experience a compounding of the challenges they face. It is therefore essential that we take time to understand what these issues look like for each individual and adjust parenting, schooling and community interventions accordingly.

Look out for my forthcoming blog –  Executive Function Skills (Part 2) for ideas on how to support children with these difficulties.

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

 

Additional resources –

  • UNDERSTOOD website: https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/executive-functioning-issues/what-is-executive-function
  • The book  Why Can’t I Do That? A Book About Switches by Fi and Gail Newood is designed to help children understand what Executive Function skills are and how they link to everyday challenges.

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Helping children to ride the waves of big emotions

Quite a few people this week have asked me about tips for supporting children at times of high emotional stress (e.g. anger, rage or anxiety). For this reason, I thought I would share with you some generic pointers for parents that I use in clinic, but which could apply to most children. These are predominantly drawn from the principles of Dialectical Behaviour Therapy (DBT) and Dyadic Developmental Psychotherapy (DDP), which you may have heard of.

1. When a child is calm, help them to understand that emotions (of any kind) are a bit like waves… they rise, they peak and they fall. They come and they go, but they DO eventually end.

2. When a child (or their parent) notices that they are starting to become distressed (or to ‘fall out of their window of optimum arousal’), they can be supported to try the TIPP approach:

T = TEMPERATURE
Helping a child to change their body temperature (e.g. by splashing the face with cold water or eating or drinking something cold) can help them calm, as the body naturally gets hotter when distressed or aroused.

I = INTENSE EXERCISE
Engaging in intense exercise to match the level of emotional arousal (e.g. star jumps or running) provides a healthy outlet for anxious tension. – Ideally this should be a rhythmic exercise as it is more likely to activate a child’s earliest neural pathways of feeling soothed from when they were rocked as babies.

P = PACED BREATHING
Slow breathing, concentrating on their breath and (importantly) breathing out for longer than they breathe in, helps children to regulate the bodies. This is because longer exhalation naturally slows their heart rate and activates the Parasympathetic Nervous System (PNS), which in turn helps the body to calm.

PAIRED MUSCLE RELAXATION
Supporting a child to tense and then relax parts of their body, supports muscles to release tension. Relaxed muscles require less oxygen, so heart rate and breathing naturally start to slow down.

3. Having a calm box – Supporting a child to develop a pre-prepared box of all their favourite textures, smells, photos, games, sensory toys, etc., can be a lovely way to start to talk about emotions with a child and help them to feel a sense of self-efficacy in managing their own emotions. As time goes on, a child might start to ask for their box before becoming overly distressed.

4. Parental matching of the affect – When a child’s brain is distressed, it regresses to a much earlier developmental form of itself, whereby it does not register language or logic in the same ways. For this reason, a parent needs to ‘match’ the emotional intensity of the child in their non-verbal behaviours (e.g. when a child is shouting: using a loud (but not angry) voice, using BIG physical gestures, maintaining intense eye contact, etc.). The very act of ‘mirroring’ a child to themselves helps them to feel held and contained. The parent can then gradually lower their voice and soften their gestures, which the child will match in turn. I think of this as ’emotional hand holding’.

5. Having a cuddle – Following an emotional outburst, close physical connection instigated by a safe adult, is one of the most soothing and regulatory activities to do with a child to bring them back into a state of optimum arousal. It also enables them to learn that no matter what they have done or said, they are still loved, which is so important for developing a secure and healthy attachment. Once they are physically and emotionally calm, you might then want to talk about the actual behaviour if this needs to be addressed, however, the key is…’Connection before Correction!’!

I hope that you find some of these tools helpful. It is of course important to note, however, that what causes (and maintains) emotional distress in children can vary hugely from child to child. It is also important to note that for some children, what causes and maintains their distress can be very hard to determine. In such cases, parents should feel empowered to seek professional advice regarding a targeted assessment of their children’s specific needs.

Happy surfing everyone…!

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

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Helping Children With Loss Through Story Books

Children, like all of us, encounter loss in their lives, temporary and permanent. They may lose a treasured possession, a loved one who dies, a parent who leaves or is imprisoned, a friend who moves away, or a valued teacher in the transition between year groups or schools. Some are unlucky enough to lose their health or abilities they once took for granted. Others lose their home or their country and there are those who lose their innocence through exploitation and with it perhaps their sense of self and any respect and trust they had for the world.

With loss comes associated feelings, held in the conscious or unconscious mind or both. Support in processing losses may or may not be available and the degree to which children show lasting difficulties will vary accordingly. Stories are just one tool which can help children connect with and work through internal emotional conflicts associated with experience of loss.

Like art, stories help us to take new perspectives and understand ourselves, others and the world differently. They can offer comfort or challenge, enliven or unsettle us. By engaging the imagination, not only can stories transport us to another time and place but they can also open up a rich emotional landscape which might otherwise be off limits to the defended conscious mind.

Most children speak and understand the language of play and they live stories, in their everyday playful interactions with food, sounds, textures, objects, animals and people. And, of course most are introduced to and love books, from a young age. Well-told children’s stories tap into a child’s thirst for make-believe, for adventure and for powerful emotive themes such as love and hate, despair and hope, failure and redemption.

For this blog, I have selected 6 story picture books which I will briefly summarise:

Amos And Boris by William Steig (1971)
This beautifully written tale of enduring friendship focuses on the unlikely alliance of a mouse (Amos) and a whale (Boris), who become acquainted when Amos falls off the boat he has made (which is sadly lost forever) and Boris rescues him. The two travel together, learn about their differences, survive a falling-out, share ideas and develop “a deep admiration for one another”, becoming “the closest possible friends”. Coming one from land, one from sea, the time comes for them to separate: “. . . we can’t be together . . . I’ll never forget you though.” Years later, Boris is beached by a hurricane and Amos, aided by elephants, is then able to save his life. The wrench of what may be
their final parting is sad and tender yet secure in the knowledge that each will continue to be remembered in the other’s heart and mind.

Badgers Parting Gifts by Susan Varley (1984)
This story opens with the inevitability of the ageing Badger’s death and his awareness of the loss his friends will feel after he’s gone. When he dies, Badger is sorely missed by all the animals but especially Mole, who feels “lost, alone and desperately unhappy.” The friends’ sadness is intensified by Badger’s absence, as it was he who had always been there for them in times of trouble. And in missing him, they start to come together and share memories. This, in turn, highlights to them the gifts which Badger has left behind, skills he taught each of them when he was alive which they can now remember him by and use to support each other. Gradually, sadness gives way to a comforting and emboldening remembrance and gratitude.

The Red Tree by Shaun Tan (2001)
This story tells of a girl who loses her sense of purpose and place in the world, and with it any sense of hope. Through unique, extraordinary, incredibly crafted images, and condensed, graphic text, we travel into the girl’s mind, inhabited by surreal, exaggerated and often frightening forms and scenes which overwhelm her. She is not seen, heard or understood and oscillates between these worlds of chaos and a relentless nothingness. A happy, colourful life is out of reach and all seems doomed and irresolvable. She has lost everything and become lost herself. And then, suddenly, life returns (thankfully!) and with it hope and joy. This speaks to the immense value there is in sitting alongside and fully taking in the realities of another person’s bleak experience. As the reader, we witness the
girl’s pain, perhaps helping her to mourn her losses and then re-discover herself.

The Day The Sea Went Out And Never Came Back by Margot Sunderland (2006)
Eric the sand dragon lives on a beach and adores the beautiful sea beyond, which in its daily rhythm comes and goes predictably, with the tides. One day the sea goes out and does not return. This is devastating for Eric who waits and longs for the sea to come back and is then overwhelmed with the pain of his loss. He becomes trapped and isolated inside himself. Eventually, attracted to the vulnerability of a dying wild flower, which he then saves, Eric is drawn back into life himself. He saves more flowers and a rock pool garden is created. Eric starts to feel safe enough to fully mourn his loss and in so doing discovers that remembering his beloved sea builds a treasure store in his mind which
he can keep forever.

The Lonely Tree by Nicholas Halliday (2006)
Set in the New Forest, this original book uses the seasons to chart the forest life-cycle through the friendship between an old, story-telling oak tree and a young, curious evergreen. As the oaks sleep for the winter, the evergreen becomes acutely lonely and, when spring finally comes, all hope is cruelly crushed when his oak-tree friend fails to wake up, his long life ended. The evergreen cannot comprehend what has happened but holds onto his cherished memories, through the sadness. Hope returns as a fallen acorn germinates and a new oak is born, destined to form a new friendship with the evergreen. Stories of the forest are retold and, as they are, the trees’ roots go “deeper and
deeper into the ground”, reminding us that with companionship we can endure and process the pain of loss and live a more enriched life.

The Heart And The Bottle by Oliver Jeffries (2010)
Beautiful illustrations alongside a concise narrative makes for great dramatic effect, telling the story of a delightfully curious and creative little girl who experiences the apparently abrupt and unexplained loss of an adored grandparent, with whom she had discovered and shared many wonders. She puts her heart into a bottle for safe keeping but as she grows up becomes limited and encumbered by its seclusion, which she finds she is unable to reverse. It is only through connecting with her own daughter’s zest for life that she allows her heart to be freed and re-discovers treasured memories of her beloved grandparent who she can now enjoy remembering. Her inner-child, in league with her actual child become the unwitting healers.

These books, like many others, model that feelings are okay, they are a normal response to loss and are to be expected. This is an important message to our children, particularly given that many of us are still filtering cultural and familial influences in our own lives which would have us discount feelings in order not to rock the boat or blow other people’s stiff-upper-lip cover. Children are expert at tuning into our sensitive pressure points and while they may push our anger buttons quite readily, they may avoid talking about sadness if they sense we may be uncomfortable and find it hard to hear and hold them. In turn, to avoid burdening others or being alone with pain, their own natural defences against connecting with sadness can become strengthened and entrenched.

A story book can serve as a helpful third party, a neutral but enriching messenger, able to venture into forbidden territory within the safety of metaphor. Connection with characters breeds understanding and empathy for one’s own pain. We can read the story exactly as it is or go off piste, filling in blanks with a child, co-creating a personalised narrative, re-writing the ending and reflecting all the while. Repetition can work wonders, enabling a child to use pictures as prompts and retell the story from memory. Each retelling can add meaning and a layer of digestion for the child, outside of his/her awareness, whether or not any overt life parallels are drawn.

All 5 of these books also convey a sense of hope, always integrated into the experience of loss. Again, this is a powerful lesson in a world which all too often splits artificially the good from the bad. We might not long for loss or wish it upon anyone else, but when it comes we, alongside our children, can do what we can to to feel it, to know it, to share it and to find new life somewhere within it.

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

 

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Supporting children and young people with stress and anxiety

Stress is caused by an existing stress-causing factor or stressor. Stress can be ‘routine’, related to everyday activities or ‘sudden’, brought about by a change or transition, or ‘traumatic’, in relation to an overwhelming event.

During stressful events our adrenal glands release adrenaline, a hormone which activates the sympathetic nervous system, our body’s defence mechanism which causes our heart to pound, blood pressure to rise, muscles to tense, and the pupils of our eyes to dilate. Historically, this prepared us to respond to attackers with one of three responses – fight, flight or freeze.

This stress response can still be helpful to us today. It provides a burst of energy which can help us to stay safe when suddenly facing a speeding car, for example. Or, it might help us meet deadlines and goals through increased efficiency and focus. Our stress response ceases to be helpful if it is activated too easily or at a level which is too intense or if it goes on for too long, preventing us from returning to a relaxed state.

Anxiety is stress that continues after that stressor is gone. When we are anxious, fear can take over whenever there is worry and apprehension. This can lead to irritability, low mood, social withdrawal, lack of motivation, poor concentration and nervousness, as well as physical symptoms like chest pains, disruption to eating routines, dizziness, shortness of breath, fatigue and panic attacks.

There are multiple triggers for stress and anxiety in young people today. Those most commonly reported include school, exams and future prospects; social difficulties including peer pressure, social media issues and bullying; family concerns such as conflict or financial problems; and major world events. For some, these factors can become overwhelming.

A good place to start when helping children and young people with stress and anxiety is to be aware of what we are thinking, feeling and doing ourselves. This will help us to tune in to kids and look after ourselves so that we can stay calm, alert and responsive. There are many routes to self-care – the 5 Ways to Wellbeing is one of them – How are you doing right now? What steps might help you to build your own self awareness and take care of your own support needs?

Secondly, psychotherapeutic work is naturally based on a belief that by talking and thinking about difficulties we create space for creative exploration, digestion/ processing, increased understanding and new perspectives/ opportunities. It can be helpful to take a moment to consider where you stand yourself with regards to talking about feelings.

And do you think your child/ teenager believes it is okay to have feelings? Whether the answer is yes or no, how might he/she have picked up this message? What do we think is likely to help give a message that it is okay to feel feelings and to talk about them?

We can begin by making time to notice how young people are doing, listen to their concerns without judgement and then take them seriously. In ‘How To Talk So Teens Will Listen’ and ‘Listen So Teens Will Talk’, Faber and Mazlish (2006) advocate: “Identifying thoughts and feelings . . . Acknowledging feelings with a word or sound . . . Giving in fantasy what you can’t give in reality . . . and . . . Accepting feelings as you redirect behaviour.” (p31).

To make the above possible, it helps if we can stay calm and avoid becoming either frustrated or overwhelmed with our own worries about the child’s worry. We also want to steer clear of trying to fix things too quickly as this can seem like we’re not really interested in a child’s felt experience.

Being listened to can start to give shape to what might often feel like a formless mass of uncontrolled emotion. Feeling understood can, in itself, help to bring anxiety under control. It then becomes more possible to actively build self-awareness through tools like a stress-graph or diary, which maps stress intensity across a day, week or year. Other visual systems using scales and colours can be helpful too. A 0-5 scale, for example, can enable children to identify the difference between a slight glitch, a small/ medium/ large problem, and a situation which feels quite huge or even like an emergency. Other systems like the ‘Zones of Regulation’ or the similar ‘Just Right State Program’ (widely used in Brighton and Hove schools) help young people to notice their emotional/arousal state at any given time and to learn what helps them either to up-regulate or down-regulate in those moments in order that they can relate and learn effectively.

Specific calming approaches can be taught such as deep belly-breathing or simple, unobtrusive techniques for the classroom like hand-breathing or square breathing. Positive self-statements can also help – in place of an ‘all or nothing’ catastrophic approach (“I’ve messed up this essay, I may as well give up”) the young person might say to herself, “I’ve done it before, I can do it again” or “this feeling will pass”. Others may benefit from being helped to express thoughts and feelings through writing or drawing. Others might need to move around, take sensory breaks, do Yoga, make a mess with clay, cook a meal together, make a special den, imagine a calm place, complete a puzzle, make a list or listen to a favourite story or a book about anxiety, like ‘The Huge Bag of Worries’ by Virginia Ironside. Lots of helpful ideas for activities can be found in Karen Triesman’s ‘Treasure Deck of Grounding, Soothing, Coping and Regulating cards’.

Young people who are feeling sufficiently safe and regulated might also be able to consider the bigger picture of how their thoughts, feelings, body sensations and behaviour all inter-relate and where they might be able to make one small change which could then have a beneficial knock-on effect. Read more on these approaches in books like ‘Starving the Anxiety Gremlin’ (Kate Collins-Donnelly) and ‘Overcoming your child’s fears and worries’ (Cathy Cresswell).

For young people who are specifically stressed about exams, the following links may be helpful:

– The #NoStressSuccess series of video clips on Youtube about a wide range of opportunities for education and training post-16, made by Brighton Met College students.
– The ASAP Science Youtube clips: 9 Best Scientific Study Tips and 7 Tips to Beat Exam Anxiety.

As supporters of children and young people, one challenge we have is to be regulated in the way that we offer help and ideas. If we overload with strategies and things to ‘do’ to make the stress go away, we can be in danger of increasing pressure rather than decreasing it. If we can remember to be accepting of our children and if we model self-acceptance ourselves, we might go a long way towards helping them effectively manage stress in their lives. Dan Millman has said: “Resistance creates suffering. Stress happens when your mind resists what is. The only problem in your life is your mind’s resistance to life as it unfolds.” And in a similar vein, the following Chinese Proverb tells
us that: “Tension is who you think you should be. Relaxation is who you are.”

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

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The Benefits of Yoga Breathing for Children with a History of Trauma

When children feel helpless, angry, or scared for long periods of time, it can be remembered in their bodies. This is particularly so in the case of trauma, whereby specific (trauma-implicated) body parts may start to feel somewhat disconnected to the rest of the body (e.g. headaches, neck pain, stomach aches, back spasms, etc.). Body tension is also common in children who were very young at the time of their trauma and, therefore, may have no conscious or verbal memory of it. This phenomenon can be hard for parents (and professionals!) to make sense of and can often lead to them seeking assessment and treatment for many things before considering the long-lasting impact of historical stress or trauma on child. An important task of a psychologist, therefore, is to help chronically stressed or traumatized children to tolerate physical sensations without being afraid of then. This includes teaching them how to regulate their own internal arousal.

The brain-body system that we target in this kind of work is known as the Autonomic Nervous System (ANS) – also known as our ‘survival system’. At its most basic level, the ANS is comprised of two discrete branches called the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). The SNS is associated with the release of chemicals such as adrenaline, which spur the brain and body into action. The PNS on the other hand, is associated with the release of chemicals such as acetylcholine, which enables us to be calm and to regulate important bodily systems such as our digestion and sleep. In a healthy child, the SNS and PNS work closely together to enable a child to have an optimum awareness of both themselves and their environment, so that they can respond to each appropriately. For some children, however, historical stress and trauma can cause the SNS too become too powerful, leaving the child vulnerable to quickly dysregulating in response to misunderstood internal sensations or external stressors.

One biological marker that has been identified as a strong indicator of how well the ANS is working is ‘heart rate variability’ (HRV). In healthy children, the very act of breathing leads to steady, rhythmical fluctuations in their heart rate, which in turn is a measure of their wellbeing. This is because inhalation activates the SNS (and therefore raises their heart rate), whereas exhalation activates the PNS (and therefore slows heart rate down). Good HRV – and therefore, good balance between the SNS and PNS, enables children to execute a reasonable degree of self-regulation, including being able to calmly appraise upsetting situations without dysregulating, such as disappointment or peer rejection. Poor modulation between the two systems, however, negatively affects how their body and brain responds to stress. Research indicates that people with posttraumatic stress disorder (PTSD) often have poor HRV (Hopper, et al., 2006).

One way to improve HRV, has been shown to be through focused breathing techniques. Indeed, simply changing the way one breathes, has been associated with a wide range of positive physical and psychological outcomes, including marked improvement in mood disorders, asthma, and back pain (e.g. Pilkington, et al., 2005; Sherman, et al., 2005; Streeter, et al., 2010). Focused breathing techniques for children can be found in many forms, but one particularly successful form has been shown to be via Yoga. This may be because Yoga supports children to pay attention to what is happening within their bodies rather than just outside of it – teaching them that all sensations peak and fall, with a beginning, middle and end (Van der Kolk, 2014). This can be of particular benefit to children who rely on either sensory numbing or over-stimulation, or who may need additional support to feel ‘safe’ in their bodies.

In my clinical experience, I regularly find that children, even without a history of trauma, can still benefit hugely from mindfulness-based breathing exercises. For this reason, I am very grateful to Dr Emma Stevens (Clinical Psychologist), for recommending a lovely book of breathing for young children based on the principles of Yoga – “Frog’s Breathtaking Speech” (Chissock and Peacock). My children have loved reading this story and learning the techniques. I hope yours will too!

 

References:

Chissock, M. & Peacock, S. (2020). Frog’s Breathtaking Speech How children (and frogs) can use Yoga breathing to deal with anxiety, anger and tension.

Hopper, J., et al. (2006). Preliminary evidence of parasympathetic influence on basal heart rate in posttraumatic stress disorder. Journal of Psychosomatic Research, 60 (1), pp. 83-90.

Pilkington, K., et al. (2005). Yoga for Depression: The Research Evidence. Journal of Affective Disorders, 89, pp.269-85.

Sherman, K., et al., (2005). Comparing Yoga, exercise and a self-care book for chronic low back pain. Pain, 115, pp. 107-17.

Streeter, C., et al. (2010). Effects of Yoga versus walking on mood, anxiety and brain GABA levels: A randomized controlled MRS study. Journal of Alternative and Complementary Medicine, 16, pp. 1143-52.

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

 

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Why behavioural approaches do not work for all children

One of the most frequently asked questions put to me in clinic, is why some children do not respond to traditional reward/punishment based behavioural strategies. The answer is simple – because, contrary to popular opinion, these strategies do not work for all children in all situations.

This is because the ability to make a mental link between a behaviour and a punishment, and to then be to be subsequently less motivated to use that behaviour again, actually involves quite sophisticated cognitive processes. It also requires specific parts of the brain to be functioning well. Difficulties with this may apply to children with learning disabilities or neurological conditions. It may also apply to children who are anxious, fearful or traumatised. This is because anxious or fearful children are often operating from a very primitive part of their brain that physically impedes their ability to access more developed parts of their brains. This in turn makes it harder for them to make cause and effect links, to generalise, to suppress their impulses, to make rational decisions, to maintain empathy for others and, in some cases, even to trust in the motivations of others. Punishing these children without supporting them to understand what is happening for them, therefore, is actually more likely to increase their fearful behaviours and further undermine their trust in those around them. For some children, it can also exacerbate feelings of shame.

A second concern with an overly heavy reliance on behaviourist principles when applied to children, is the theoretical and research origins upon which these principles are based. Behaviourism was largely developed in the 1950s and 1960s in laboratories with small mammals such as dogs, cats and rats – animals with significantly less developed brains than our own. Whilst these experiments can teach us a lot about how to shape behaviour in its purist sense therefore (i.e. classical and operant conditioning), they offer nothing in terms of how we build children’s self-esteem, build their intrinsic motivation, or even how to protect their attachment relationships. For instance, classically conditioning young babies to sleep by ignoring their attachment-seeking behaviours, can have detrimental effects on a child’s subsequent relational security and internal regulation skills. Similarly, a heavy reliance on operantly conditioning ‘good behaviour’ in young children with external motivators (e.g. star charts) has been shown to undermine a child’s natural desire to problem solve, be creative and to keep building on their successes when these external motivators are later removed.

Whilst some behavioural principles within a parenting repertoire can undoubtedly be helpful, therefore, when used to excess, and particularly when used in the absence of a broader context of sensitive, loving and developmentally appropriate care, they can quickly become damaging. This is because human children have brains that require so much more from the parent-carer relationship than simple behavioural conditioning.

Part of my role as a Clinical Psychologist, therefore, is to help parents, carers and professionals, to find new and more effective ways of supporting children to reach their full potential.

 

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Educational Psychotherapy (2) – developing empathy, mind-mindedness and self-discovery

In Educational Psychotherapy (1), I explain how Educational Psychotherapy first evolved and how, as an approach, it can help promote social and emotional development as well as the thinking skills required for learning.  This was illustrated through the aspects of a child’s first six months in therapy. Here, I highlight three areas of further progress over the next 12 months of work with the same child. Again, this account is disguised and anonymised.

Empathy and feeling understood

One of the most exciting benefits of Sammy’s becoming more emotionally literate was the opening it allowed for me to make connections between his experiences with family and friends and his feelings and then providing empathy for Sammy’s felt experience.  This enabled Sammy both to feel held and understood by me at an emotional level and to experience his feelings as making sense. Over time, Sammy came to welcome this and it seemed to encourage him to actively seek openings to make further connections between his experiences past and present and his thoughts, feelings and behaviours.

Mind-mindedness and social connection

Early on in the therapy, Sammy found it difficult to engage in wondering about his own mind or about others’ minds, in either imaginary or real contexts.  There were times when he seemed to think I should have already known what he was thinking. Things began to shift when trust developed and Sammy allowed himself to become more openly curious about me, what my life might be like and how I might perceive him.  He grew increasingly accepting of the idea that I had a mind separate to his and that learning about each other involved a shared process. He started to wonder about my own mental state and thoughts, perhaps partly in response to my modelling of a mentalising approach with him.  This capacity to be “mind-minded” was also reflected in Sammy’s accounts of social interactions at school when he openly wondered about various students’ motivations for particular actions and how they might have been feeling about a situation.  This included an understanding that people might have mixed feelings at times.

Therapeutic journey

It was Sammy’s journey of mental-emotional-social self-discovery which came to shape the bulk of our sessions and it was an encouraging and rewarding journey to be a part of.  The significance to Sammy of this work became increasingly evident as I began to talk about the sessions coming to an end several months before the final session.  Sammy found this very hard and would avoid or deny the subject in various ways.  However, in time, we were able to talk more about what this avoidance meant and Sammy moved into a period of some weeks when, unprompted, he became highly reflective about what the sessions had meant to him, bringing in memories of particular activities and commenting on changes which he felt had taken place within himself.  He also made reference to ways in which our working relationship had changed.  He spoke with confidence and resilience and a certain assurance that his memory would remain in my mind after our sessions had come to an end – and it has!

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

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Covid-19 – talking with children in uncertain times

How do we contain our children’s anxiety in such uncertain times, when we too feel anxious and unsure ourselves?

When children are nervous we may notice them continually searching for reassurance – the usual advice would be to acknowledge this but keep reassurances to a minimum, modelling to them that fundamentally the adults in their life believe that the world is a safe place.

However, here we are – smack bang – in the middle of unprecedented times where it may be difficult for us, ‘the grown ups’, to keep level heads ourselves around our families health and economic future.

Our most important job is to manage our own anxiety whilst engaging with our children honestly and openly about the developing situation. Their worlds of home and school have been thrown into orbit; they had to say a hastened, brutal goodbye to friends and teachers not knowing when they would see them again.  The novelty of not being is school has now probably faded a little – time at home with parents is usually pleasurable but sometimes not.  Relationships can be put under extraordinary pressure when we are in lockdown with an unclear future.

Whilst we need to talk to children openly and find out their understanding of the pandemic, our responses should contain reassurances aplenty but we must to be careful not to give absolute guarantees.

It is within human nature to endeavour to provide an environment for our children in which they feel safe. Maybe we can begin to appreciate how these trying times can be viewed as an opportunity for us to model kindness, resilience and compassion.  We can hope that our children will remember these formative times as a period in which they learnt important life lessons along with resilience for their futures.

 

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Further reading by Sharon Spindler –

Family Therapy for Beginners

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Tips for talking to young children about their behaviour

When talking to young children, most people know that ‘open’ as opposed to ‘closed’ questions are helpful. That is, questions that cannot easily be answered with a simple “yes” or “no” answer and invite the child to give more information. These questions typically start with “who..?”, “where…?”, “what…?” and “how…?”. What many people don’t realise, however, is that the most frequently used open-question starter – “why…?”, can be hugely counterproductive to conversations with young children.

This is because young children can easily experience the word “why” as threatening. A “why” question implies that the child should have (and the adult expects them to have) a level of insight about their behaviour that they genuinely might not have at this stage. For some children it can cause them to close down by becoming silent or simply saying “I don’t know”, which can feel infuriating to parents. Other children may feel the pressure to just give an answer – any answer – which might not even make sense (e.g. “I did it because my tummy was hurting”). This is because they just feel the pressure to say SOMETHING, which can also feel upsetting to parents. (Incidentally, when a child says that their tummy is hurting, that actually can be a sign of anxiety).

Much better, is to side-step the “why” question altogether with young children (e.g. “what made you do that?” or “when you did that, what did you think might happen?”) These kinds of questions keep the dialogue flowing and importantly, help the child to start to understand for themselves what their thoughts, feelings and motivations were when they used a particular behaviour.

This is an important foundation step towards impulse control and emotional regulation.

 

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Educational Psychotherapy: (1) supporting social-emotional development and learning

Educational Psychotherapy was developed by Irene Caspari in the 1970s, an Educational Psychologist working at the Tavistock Clinic in London.  She was interested in understanding learning difficulties from a psychoanalytic and attachment perspective. In order to address both learning needs and emotional difficulties together, she pioneered a method of blending structured (educational) tasks and free expression within a 50-minute weekly therapy session.  Treatment usually lasts 1-2 years but some work continues for longer or is adapted for shorter periods or extended assessments. Trainees are typically experienced teachers or learning support staff and undergo their own therapy during training. Many continue to work in schools and adapt their learning to therapeutic teaching and attachment-aware, trauma-informed practice.  

What follows is an anonymised, disguised case study which illustrates how Educational Psychotherapy can begin to support social-emotional development and learning.

11-year-old Sammy was referred for therapy by his key worker on account of difficulties he was having with relationships, expressing and understanding emotions and understanding the world. An earlier Educational Psychology assessment had suggested that high levels of anxiety were impacting on Sammy’s capacity to make full use of learning.  Therapy took place over 18 months.  

Sammy soon engaged with a variety of word, number and drawing games and activities, offered within the context of a supportive relationship.  Tasks which combined cognition, physical activity and relational connection proved an effective way to build trust, stimulate thought and enliven Sammy’s felt experience in the room.  Shared story writing and the free use of paint and clay facilitated expression and imagination. Conversation also had a significant place, at the point of checking in, within and around activities and, over time, for sustained periods.

Over the first 6 months of therapy, progress became evident in the following foundational areas:

Sense of self and reciprocal interaction
Sammy came to enjoy the process of co-creation with craft activities and solving problems together, including making up physical word and number games and negotiating the rules between us.  He became more comfortable with what he didn’t know  and embraced the opportunity to find things out, explore new skills and introduce me to new areas of learning.  Sammy also started to talk more about himself and grew comfortable with the routine of checking in at the start of a session, when he would share a happy achievement or discovery or an experience of frustration, disappointment or confusion.

Tasks and learning

Persevering at a challenging task requires the use of Executive Function skills, such as being able to monitor and evaluate where the difficulty lies, use problem solving skills to work out and plan the next steps, use working memory, inhibit distracting thoughts and so on.  Young people like Sammy, who have difficulties in these areas, require considerable “scaffolding” to help them develop and practice skills and tools for thinking. To begin with, Sammy found it hard to take instruction or support from me but as trust grew he became a little more comfortable with not knowing and clearly more curious.  My sense was that a space for thinking opened up in his mind which enabled him not to panic but to consider what was required next in order to proceed. 

Thinking about and talking about feelings

The development of a language for feelings was a significant area of development.  In early sessions, Sammy would habitually say that everything was “fine” or “normal”, almost seeming oblivious to the relevance of emotional experience or reflection.  After a time, Sammy disclosed that he had been getting into rages at home and taking out his feelings on objects which had sometimes become broken.  He acknowledged that this was confusing, upsetting and problematic for him and that he wanted help with it.  Activities like squeezing paint directly onto paper or working with clay enabled Sammy to express himself viscerally and then reflect on how he connected with the images created.  We also thought about activities Sammy could do at home to self-regulate.  

In time, thinking about feelings became an area that Sammy would actively seek.  He talked about experiencing fear and how this had caused him to adopt particular behaviours as an avoidance mechanism.  It seemed that the naming of these fears was enough to create some distance and enable Sammy to make a choice about how he wanted to act.  Sammy also talked about sadness and acknowledged that he had grown used to keeping his feelings to himself.  He started to voluntarily make links between his expressive material in artwork and his own thoughts and feelings inside.  

 

In part, these conversations involved psycho-education, helping Sammy to understand more about how feelings work, that it is normal to experience a wide range of feelings and that it can help to be self-aware and to share some of what we feel with trusted others.  At times, we were able to do this through playing board games or through role-play with miniatures.  Sammy showed that he could recognise the difference between actions held in mind and actions lived and that he could think hypothetically about possible future consequences of taking a particular course of action.  

This phase of the work paved the way for more profound developments which were to follow.  Sammy was now ready to take more risks. (Read more about this in Educational Psychotherapy (2) – article will be published shortly).

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us. Online therapy is available.

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Parenting Styles

Since the early 1960s, psychologists have been interested in the relationship between parenting and the emotional, social and behavioural development of children. 

Of particular significance to this field of study, is the early work of psychologist Diana Baumrind and colleagues, who conducted the first longitudinal study of more than 100 preschoolers through to their adolescence, specifically examining the impact of their parents approaches towards them on their subsequent development (Baumrind & Black, 1967). This study, which used a combination of naturalist observations and parental interviews, identified four ‘dimensions’ of parenting – (a) disciplinary strategies, (b) warmth and nurturance, (c) communication and (d) expectations of maturity and control. More than this, however, this influential study identified three ‘parenting styles’ which have since stood up to considerable empirical scrutiny. 

The first of the parenting styles identified by Baumrind is now more commonly referred to ‘authoritarian parenting’. This an approach to parenting which is generically low in warmth but high in control. Parents who fall into this category, typically hold very high expectations for their children’s behaviour and develop strict, non-negotiable rules for which they must live by. They are described as “obedience and status-orientated and expect their orders to be obeyed without explanation” (Baumrind, 1991). Failure to abide by their rules, or to meet their behavioural expectations, is typically met with punishment rather than with empathy or understanding. This type of parenting is often seen in adults who they themselves were raised by parents with a similar style of parenting [see my earlier blog on ‘family scripts’] and who therefore hold an authoritarian working model or ‘blueprint’ of what it is to be a parent. This style can also sometimes be seen in anxious parents, who respond to a fear of losing control of their children by exerting total control. The implications for their children, however, is that they are often left feeling angry, confused or upset internally, but have no capacity to process or make sense of these emotional experiences as they develop. Their children are also often limited in their opportunities for free play and exploration of the world, which is equally important for healthy emotional and social development. 

The second parenting style identified by Baumrind is that of ‘permissive parenting’. This style can be broken down into two further parenting styles – ‘permissive-indulgent’ and ‘permissive-indifferent’. A ‘permissive-indulgent’ parent is broadly defined as a parent who is very high in warmth, but very low in control. In direct contrast to their authoritarian counterparts therefore, permissive-indulgent parents make very few demands on their children, rarely discipline them and typically seek to avoid confrontation. They are described as “generally nurturing and often take on the status of a friend more than that of a parent” (Baumrind, 1991). The implications for their children, however, is that whilst their internal worlds are largely attended to (although negative emotions can still be feared), they lack the developmentally appropriate structure, boundaries and expectations that they need in order to develop into healthy, socially-adept adults. ‘Permissive-indifferent’ parents on the other hand, present as very low in control AND in warmth. These parents offer neither structure and boundaries nor warmth and affection for their children. They are what we typically consider to be emotionally neglectful parents, who in extreme cases, may actively reject their children, leading to inevitable attachment difficulties as their child develops.  

The third parenting style initially identified by Baumrind’s study is known as an ‘authoritative’ parenting style. This style bridges the gap between authoritarian and permissive parenting styles and is known in research circles as the ‘gold standard’ for child development. This is because parents who are able to approach caring for their children with this style of parenting are able to establish developmentally appropriate rules and boundaries, but can at the same time, remain responsive to and curious about their children’s internal worlds. This means that they can be open to trying to understand a child’s internal world (e.g. their thoughts, feelings, motivations, perceptions, beliefs, etc.) even if they do not accept their behaviour. Indeed, when their children fail to meet their expectations, an authoritative parent is more likely to respond with forgiveness, nurture and find structured opportunities for new learning, rather than with punishment. Similarly, they can remain democratically open to questions and challenges from their children about their rules. They are defined as being able to “monitor and impart clear standards for their children’s conduct. They are assertive, but not intrusive and restrictive. Their disciplinary methods are supportive, rather than punitive. They want their children to be assertive as well as socially responsible, and self-regulated as well as cooperative” (Baumrind, 1991). The benefits for children raised with this type of parenting style is clearly evidenced in their later performance on a broad range of emotional, social and behavioural indices. These include social responsibility, the ability to cooperate with peers and adults, independence, assertiveness, problem solving and high self-esteem. Support for this ‘middle ground’ approach to parenting is also offered by recent research which has identified that children with a history of severe developmental trauma and attachment disruption, respond most effectively to an ‘authoritative ++’ approach to nurture whilst in care – a specific type of parenting approach which is very high in both control AND warmth and nurture – also known as the ‘two handed’ approach to parenting (Hughes, Golding & Hudson, 2019). 

As alluded to earlier, the type of parent we become will be influenced in part by our own experiences of being parented. Whilst we can adapt this to a degree, however, when we are under stress, it is likely that we will move closer towards our ‘blueprint’ of what a parent is. For this reason, it is extremely important that as parents, we take the time to notice for ourselves when we are starting to a more extreme type of parenting style (authoritarian or permissive) as an indicator or ‘red flag’ that we need to take some time out to recharge in order to be the parents that we want to be, and which our children need us to be. If you are co-parenting, it can also be helpful to think about where you and your partner each naturally fall on the continuum between high warmth and high control as parents, and to spend some time thinking about the strengths and weaknesses of these respective similarities or differences in your parenting styles, as well as the impact that the combination of your parenting styles has on your child. When challenges or parenting styles feel unhelpful or entrenched, however, it can be worth seeking professional help. 

References – 

Baumrind, D. (1991). The influence of parenting style on adolescent competence and substance use. Journal of Early Adolescence, 11(1), 56­95. 

Baumrind, D., & Black, A.E. (1967). Socialization practices associated with dimensions of competence in preschool boys and girls. Child Development, 38, 291­327.

Hughes, D., Golding, K. & Hudson, J. (2019). Healing Relational Trauma with Attachment-Focused Interventions: Dyadic developmental psychotherapy with children and families. Norton

 

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Post Natal Depression in Mothers & Fathers

In this blog, I want to write about post-natal depression, revisiting and summarising a classic paper by Lawrence Blum, an American Psychiatrist and Psychotherapist. The paper was written originally in relation to postnatal depression in mothers, however, because it essentially explores the conflicts aroused in becoming a parent and caregiver, particularly in relation to our own experiences of caregiving.  I think it applies also to fathers and to same-sex couples and heterosexual couples where the caring of the infant is more equally shared.

Blum’s paper, titled the “Psychodynamics of Postpartum depression”, is available on the web.

The paper draws a distinction between baby blues which he defines as the hormonally induced depression resulting from pregnancy and childbirth, and post-natal depression, which has typical features of depression, – ‘sadness, crying, insomnia, or excessive sleep, low mood, low energy, loss of appetite, agitation and self-critical thinking.’ 

He describes the external factors that can contribute, such as prior anxieties and depressions, low external support, difficult relationships, difficulty conceiving, stressful life events, etc. He summarises the studies at the time into the results of different therapies and concludes that supportive counselling, CBT and Psychodynamic Psychotherapy were all superior to the control and that Psychodynamic therapy had the biggest impact on depression, as defined by the DSM 111. 

The focus is then on the possible  ‘psychodynamics’ of the depression and these are what I shall briefly outline here as these are what can really be usefully explored and alleviated by Psychotherapy. Three principle emotional conflicts are outlined; Dependency conflicts, Anger conflicts and Parent conflicts. 

Dependency Conflicts

In order to care for a baby, there is a need to be utterly depended upon, this is tiring and emotional and benefits from support. If there is a conflict about receiving support, self-denial of the caregiver’s own needs, they can seek to repress their own essential vulnerability and needs and get depressed.

Often people manage this part by becoming carers and end up in caring roles, such as therapists (a good reason as any why therapists need their own therapy!) This counter-dependent strategy can work until it doesn’t. Someone who seems to be managing everything well, suddenly finds the balance has tipped too far. A baby can stir up the caregivers previously unconscious or sleeping wishes to be cared for, hidden by a display of independence.

Anger Conflicts

A conflict with feelings of anger, which can feel counter to the role of the caregiver. Parents can feel they don’t have a right to be angry, feel guilty about it or frightened of it, yet may have experiences and histories, which have left them feeling angry. Anger can be felt towards the baby, either as a projection of past hurts or for the very real things it has done to the parents lives; tuned them upside down, deprived them of sleep, money, jobs, sex, etc, while carrying on with its incessant demands obliviously. The danger apart from depression in all of this, is that these feelings are denied and controlled and ‘loss of control can follow from over control as internal pressure builds up”, and has to be released, either threatening the relationship with the baby or more commonly being displaced onto partners.

Feeling the anger, tolerating it, and judiciously putting it into words, easy for the clinician to say, is the difficult and essential task for the person who is looking after the baby.

Parenthood conflicts

Caring for a baby can stir up unresolved and unprocessed feelings about the caregiver’s own experiences of being cared for, whether a mum or a dad by a mum or a dad. Although a negative experience of being cared for can positively inform the ways in which the caregiver feels they don’t want to be, it doesn’t necessarily translate into clear ideas of how or what to be. In addition, the caregiver, giving the baby what it didn’t receive, can be gratifying but can also stir up the wounds of what they, the caregiver, didn’t receive. 

I would like to finish with Donald Winnicott,’s, (a British paediatrician and Psychotherapist), funny but true reasons why a mother, (or father or caregiver), hates their baby, with the intention in which they were written, to provide relief from the day to day conflicts, that can be felt in the rewarding, important but by no means easy job of nurturing an infant:-

  1. The baby is not her own (mental) conception. 
  2. The baby is not the one of childhood play, father’s child, brother’s child, etc. 
  3. The baby is not magically produced. 
  4. The baby is a danger to her body in pregnancy and at birth. 
  5. The baby is interference with her private life, a challenge to preoccupation. 
  6. To a greater or lesser extent, a mother feels that her own mother demands a baby so that her baby is produced to placate her mother. 
  7. The baby hurts her nipples even by suckling, which is at first a chewing activity. 
  8. He is ruthless, treats her as scum, an unpaid servant, a slave. 
  9. She has to love him, excretions and all, at any rate at the beginning, till he has doubts about himself. 
  10. He tries to hurt her, periodically bites her, all in love. 
  11. He shows disillusionment about her. 
  12. His exciting love is cupboard love so that having got what he wants he throws her away like orange peel. 
  13. The baby at first must dominate, he must be protected from coincidences, life must unfold at the baby’s rate and all this needs his mother’s continuous and detailed study. For instance, she must not be anxious when holding him, etc. 
  14. At first, he does not know at all what she does or what she sacrifices for him. Especially he cannot allow for her hate. 
  15. He is suspicious, refuses her good food, and makes her doubt herself, but eats well with his aunt.
  16. After an awful morning with him she goes out, and he smiles at a stranger, who says: ‘Isn’t he sweet!’ 
  17. If she fails him at the start she knows he will pay her out forever.
  18. He excites her but frustrates—she mustn’t eat him or trade-in sex with him. 

Winnicott, D.W. (1949). Hate in the Counter-Transference. Int. J. Psycho-Anal., 30:69-74. 

 

Paul Salvage is a Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self-awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

The Therapeutic Relationship and the Unconscious

A Nation Divided

Adolescence: the trials and tribulations

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Curiosity: how can children’s behaviour help us understand what they need from us?

“Watch your plants and see what they’re telling you” (Ollie Walker, Hosta grower, Gardeners’ World, BBC2, 14.6.19).

Ollie Walker has fallen in love with the diversity of Hostas and delights in watching them grow.  This is some dedicated watching: the nursery he works at stock over 800 varieties.  Noticing small changes in thousands of plants, he knows exactly which nutrients are needed for the healthiest growth.

Many babies are fortunate enough to be watched with arguably much greater devotion than this.  For starters, the care-giver: cared-for ratio is much better – 1:1 attention at least.  The sense of wonder surrounding a new-born breeds connectedness which begins relationship. It gives the baby an experience of felt safety, of being held psychologically as well as physically. This is just as well.  We now know that early attachment relationships are a foundation for all forms of later development.  As Winnicott said, “there is no such thing as a baby.” [i]  Infants cannot exist independent of someone to look after them.

An attuned care-giver is open to a baby’s non-verbal communication -her cry, gaze, gesture, smell, touch or muscle tone – and finds meaning there. “Good enough” parents provide consistent, appropriate care and interaction enough of the time. Inevitable mis-attunements are further food for curiosity, opportunities for adjustment and repair which strengthen attachment and resilience. Toddlers and children of all ages, continue to require the mind of a benignly curious adult to scaffold development.  Behaviour is a window to a child’s inner world of thoughts, feelings and body states.

All children, at one time or other, behave in ways which cannot be dealt with easily or quickly and might be perplexing, concerning, maddening or all three.  Those children growing up in environments where their needs are not sufficiently met or where they are unsafe will be more likely to do this.  We may find that even our best intentions and the most tried and tested behaviour management strategies are not effective.  This is often because they have not evolved from a relational understanding of the child’s needs and what is being communicated through the behaviour.

Staying curious can be hard if there is pressure from friends or family to quickly stamp out unwanted behaviour. Or we may be driven by a need to make something better and hurry to provide instruction, fix a problem or eradicate pain without first considering what the matter might be.  These can also be the behaviours which trigger our own vulnerabilities.

In addition to highlighting aspects of our own internal make-up, intense emotional experiences inside of us can be an effective clue as to what children themselves are feeling.  This is central to Wilfred Bion’s development of Melanie Klein’s theory of Projective Identification.[ii]  Bion proposed that not only can unwanted feelings be projected into another person, who then feels those feelings, but that this process serves the purpose of communication.  For example, a looked after child who sabotages her own birthday meal after a lovely family day out may cause a foster carer to feel rejected and resentful.  This could be thought about as the child (unconsciously) letting her carer know about both early experiences of rejection and how hard it is to believe in her own capacity or deservedness to sustain states of joy in the present.

For children with experience of trauma, challenging behaviour and Projective Identification may be the only means they have of telling the emotional story of what has happened to them.  It can seem counter-intuitive, but we need to welcome this and, alongside setting appropriate boundaries, seek to find meaning in it.

Symbolism in the child’s play and other activity can be very revealing about a child’s inner world and language itself can be thought about beyond its literal meaning.  For example, a child who repeatedly says she is hungry, when we know she has recently eaten, may be letting us know she is hungry for connection, as opposed to food.

It is the wondering process here which is as or more important than the resulting care itself.  Through close observation and knowledge of the child and attention to his/her own emotional response to what is happening, a care-giver takes in the communication of discomfort, frustration, distress, fear and so on, reflects on it, digests it, and feeds it back in a more manageable form, often through words, as well as through tone/ gaze/ affect/ posture/ actions.  Correspondingly, the child feels accepted, held and understood and receives a message that his/her care-giver is able and willing to be alongside and help manage emotional pain.

This is what Bion called “containment”, the parent as “container” the child as “contained” – in my view, one of the greatest gifts we can give to the younger generation. Through repeated experiences of this kind, children develop their own capacity to think about and process feelings.

In addition to patience, true curiosity requires flexible thinking, open to the myriad nuances of human behaviour.  The same actions can have different meanings for different children or even for the same child, such as a troubled 7 year-old boy who would regularly take himself into the corner during a PE lesson and sit with his head in his lap.  Over time, staff learned that he would do this both when he was hyper-aroused (worked up) and needed space away from others to calm down and when he was hypo-aroused (switched off) and in need of company and livening up.

In psychotherapy with children (and in therapeutic parenting work) we are often dealing with issues which have felt too difficult to think about and make sense of.  The therapist’s task is to engage, observe, listen to, accept, be curious about and sit alongside a child, gently helping to make thinkable the unthinkable.  This takes time.  Emotional defences are there for a reason and require sensitive handling.

Holding steadfast to curiosity is one of our soundest investments with children.  If we can start to wonder about a child’s behaviour, we stand a much greater chance of coming up with an effective way to meet his/ her needs.  As Gerda Hanko (Educational Psychotherapist) and others have said: “Don’t just do something, stand there!”

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch with us by telephone or email. Online therapy is available.

 

Resources – 

[i] Winnicott, D.W. (1960). The Theory of the Parent-Infant Relationship. Int. J. Psycho-Anal., 41:585-595.

[ii] Bion, W.R. (1962b). Learning from Experience. London: Heinemann

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