Tag Archives: parenting

Supporting families on their autism journeys

By Lindsey Phillips May 1, 2020

Maria Davis-Pierre, a licensed mental health counselor (LMHC) in Lake Worth, Florida, first suspected her daughter might be on the autism spectrum when she was 6 months old and showed signs of sensory issues. Then at 10 months, her daughter, who had been saying simple words such as “mama,” “dada” and “ball,” suddenly stopped speaking. When Davis-Pierre and her husband tried to get their daughter to mimic them saying the words, she acted as if she had forgotten them. As a therapist, Davis-Pierre understood the importance of early intervention, so she was proactive about getting her daughter a diagnosis. But it wasn’t easy.

Her pediatrician referred her to health professionals who specialized in developmental delays in infants and toddlers. They tested her daughter and thought she had autism spectrum disorder (ASD), but because she was still so young (around 18 months), they didn’t feel comfortable officially diagnosing her. They recommended she see a pediatric neurologist.

After more tests (which cost the family thousands of dollars out of pocket), the pediatric neurologist agreed about the presence of ASD but was also uncomfortable officially diagnosing the child at such a young age. Davis-Pierre told the doctor she was going to sit in his office every day until her daughter got a diagnosis. One week later, that finally happened.

Davis-Pierre thought the next steps would be easy, especially given that both she and her husband are in the health care field. But what she experienced was more frustration.

“At no point — even with the neurologist — was there a check-in with the parent: ‘OK, this is the diagnosis. This is what happens next,’” Davis-Pierre recalls. “It was, ‘OK, here’s your paperwork. This is the diagnosis. Now, go figure it out.’” According to Davis-Pierre, the health care professionals didn’t provide her family with resources or give any consideration to how the family’s culture would factor into their daughter’s treatment.

When Davis-Pierre spoke with other parents of children on the autism spectrum, she found out that this treatment was the norm. And it left her — and the other parents — feeling overwhelmed.

This experience prompted Davis-Pierre, an American Counseling Association member, to start Autism in Black, a private practice that specializes in helping black parents of children with autism get the help they need.

In a blog post on the website GoodTherapy, Janeen Herskovitz, an LMHC in Ponte Vedra Beach, Florida, points out four areas in which counseling can help parents of children with ASD: adjusting to the diagnosis (which is often traumatic for parents), learning parenting skills, staying connected to their partners, and managing stress. Professional counselors can also help families prepare for developmental transitions, learn to effectively communicate with one another and extended family, and navigate cultural barriers.

Working through developmental transitions

ASD “is a neurodevelopmental disability, which means at different developmental stages, our clients are going to run into different developmental barriers, and they’re going to need us as counselors,” says Chris Abildgaard, a licensed professional counselor and director of the Social Learning Center in Cheshire, Connecticut. So, it’s important for counselors to understand where families are on their journeys, he points out. Is the family adjusting to the diagnosis? Are they struggling to communicate with their child? Are they helping a child through puberty? Counselors should also prepare to help families with life milestones such as going to prom, getting a driver’s license or grieving a death, Abildgaard adds.

Some families experience grief when they first learn about the ASD diagnosis, says Michael Hannon, an assistant professor of counseling at Montclair State University in New Jersey. These families will be reconciling a new reality and having to let go of certain elements of the relationship they expected to have with their child. “It’s really about [the family] learning to adjust to the needs, strengths, capacity, and some challenges of the people they love living with autism,” he adds.

Another challenging transition for parents and caregivers is when the child enters adulthood. Parents have likely been involved in every aspect of the child’s life, especially in the school system, so it is a significant adjustment when the child takes over this responsibility, Davis-Pierre says. She helps ease this transition by having parents teach their children to advocate for themselves before they reach adulthood. The more parents involve children with ASD in the day-to-day decisions about their lives and school, the more they realize that their children are capable of advocating for themselves, she says.

Abildgaard, an ACA member who specializes in ASD (and author of the 2013 Counseling Today article “Processing the ‘whole’ with clients on the autism spectrum”), has noticed that families sometimes push their child to do something that the child isn’t ready for or doesn’t want. For example, parents often ask him how they can make their child have a friend. Counselors need to educate parents that relationships take time and that individuals on the spectrum may not fully understand the intricacies of relationships and friendships. They will need support and coaching in this area well into their late teens, early 20s or beyond, he says.

Counselors can also help parents make plans and prepare for certain life events and developmental transitions, Abildgaard says. He finds visuals useful in helping families with a child on the spectrum to process events. Recently, he had a family who was going on a trip to a large city. He brought out his whiteboard and on one side wrote down all the thoughts and feelings the parents were having about the upcoming trip, such as feeling anxious that their child would have a tantrum and run from them. Then, Abildgaard asked the parents to consider their child’s perspective and why he might have a tantrum. On the other side of the whiteboard, he wrote down the child’s thoughts and feelings, such as being overwhelmed by all the lights and sounds.

This activity helped the parents realize the link between their own thoughts, emotions and behaviors and those of their child. It also started a discussion about proactive strategies the parents could take to decrease the likelihood of their child experiencing sensory overload. This, in turn, lowered their anxiety about the trip, Abildgaard says.

Helping families stay connected

Having a child with autism affects the entire family system, Abildgaard says. It affects how parents interact with each other, how parents interact with each of their children, how siblings interact with each other, and how the family interacts with extended family members.

Couples don’t typically preemptively discuss the possibility of a having a child with a disability, Davis-Pierre notes. So, when a child is first diagnosed with autism, parents often have to reassess the roles, expectations, responsibilities and core values of the family, she says.

Counselors may also have to coach families through complicated life events such as divorce. Abildgaard, an adjunct professor in the Department of Special Education at the University of Saint Joseph, reminds counselors that regardless of the situations that families bring to them, it is important to break these situations down into manageable parts for the clients.

When the parents of a client with ASD were going through a divorce, Abildgaard, a nationally certified school psychologist, brainstormed with the parents how best to explain the situation to their son. Abildgaard also learned from the client’s school that the child had been making comments about the divorce there. Abildgaard says his role as a counselor was to help the client process and express his feelings about the divorce. To do this, he said, “Tell me some things your eyes are noticing that are different at home.” He made his language concrete and specific, which allowed the child with ASD to talk about what he had been noticing, such as his parents arguing more. The boy also said he was scared to talk about these things with his parents, so he and Abildgaard worked through his anxiety together.

Then, Abildgaard brought the entire family into his office to discuss these issues. He chose to have them come in during the morning hours when his office would be quiet so the family would be more comfortable and not feel rushed or distracted.

Balancing the parenting of both neurotypical and neurodiverse siblings is another common challenge that Hannon and Davis-Pierre hear about from their clients. They try to help parents learn how to better communicate with their children and to maximize and be intentional about the time they spend with each child.

Hannon, a licensed associate counselor in New Jersey, uses empathizing strategies to help parents understand what their neurotypical child is feeling. For instance, he asks, “What would your neurotypical child say about this experience right now?” and “What would the child say about how you attend to the sibling with autism compared to how you attend to his or her needs?” This exercise allows parent to empathize and reconcile some outstanding issues with their neurotypical children, he explains.

Davis-Pierre’s clients also report struggling to know how to engage with their neurodiverse children. “We’re so used to looking for [the child to verbalize] … the actual feeling that we’re not looking at the behavior of what the child is showing,” she says.

She has parents role-play to gain perspective on what the child might be thinking or feeling and to increase awareness of behavioral patterns. (For example, Davis-Pierre has noticed that her daughter expresses happiness by flapping her arms and spinning in circles.) If appropriate, she has the child role-play with the parent, but if that is not possible, Davis-Pierre does it herself. To increase understanding, parents can also keep a behavioral journal or use the picture exchange communication system, which allows individuals with little or no verbal communication to present a feeling card to communicate their feelings, Davis-Pierre adds.

Children on the spectrum pick up on their parents’ and caregivers’ emotions more often than people think, Abildgaard points out. However, if they do sense these emotions, they often don’t know what to do with them. Children on the spectrum may appear to be ignoring the person or emotion, but in many cases, they just don’t have the language or perspective-taking ability to process the emotion and the “right” response to it, he explains.

So, Abildgaard works with parents to help them process their own emotions and then explain those emotions to their children so they aren’t left to interpret them on their own. In fact, parents can overtly model how to handle certain emotions such as anger or frustration. Abildgaard often suggests that parents (especially those with younger children on the spectrum) put themselves in “time out” to show their children that even adults need breaks.

Cultural implications

According to a 2014 report from the Centers for Disease Control and Prevention, 1 in 59 children in the United States have been identified with ASD. But this number doesn’t take into consideration cultural and racial implications such as delayed diagnosis. According to a 2019 news report on Spectrum, which bills itself as “the leading source of news and opinion on autism research,” black children with autism are often diagnosed later than white children, misdiagnosed more frequently with other conditions such as behavioral problems or intellectual disability, and underrepresented in studies of autism.

Hannon attributes the disparities in diagnosis rates to 1) inequalities in access to health care, 2) mistrust of health care systems among people of color and 3) greater misdiagnosis of symptoms in minority children as behavioral rather than developmental.

Davis-Pierre says the history of racism and discrimination in U.S. health care may persuade some black families not to be completely honest with health care professionals when discussing their children because they fear their children will be taken away. For example, frustration and exhaustion are normal responses for families caring for a child on the autism spectrum, perhaps leading someone to say or think to themselves in a particular moment, “I just can’t do this another day.” But many black families fear serious repercussions should they admit to such passing thoughts with a counselor, Davis-Pierre explains.

Even the treatments families choose for their children are often informed by one’s culture. Applied behavior analysis (ABA) aims to help individuals on the spectrum increase behaviors that are helpful and reduce behaviors that may be harmful to them by positively reinforcing desired behaviors. Debate has swirled, however, over whether ABA is helpful or harmful. According to a 2016 article on Spectrum, some have criticized the therapy for being too harsh in how it corrects maladaptive behaviors and for attempting to make people on the spectrum “normal” instead of advocating for neurodiversity.

But for some families, Davis-Pierre says, ABA makes sense. For example, a black child spinning in circles and banging his head against something in public will often be viewed differently than would a white child who exhibits the same behavior. In this instance, ABA can help protect the black child by helping him learn to replace the maladaptive behavior — one that could put him in danger — with a more socially accepted behavior, Davis-Pierre explains.

The harsh reality is that black people often have to operate differently in public settings because of prejudice and racism, she continues. So, she advises families to consider their child’s behavior and safety when choosing the best treatment for their child’s autism.

Davis-Pierre, author of Self-Care Affirmation Journal and Autism in Black, also finds that clinicians often don’t respect the culture of the home when treating children who are on the spectrum. A client once told Davis-Pierre that she had a therapist come into her home and not remove their shoes despite seeing a place for them by the front door. This act made the parent feel disrespected, and she no longer wanted the therapist in her house working with her child.

Another of Davis-Pierre’s clients was upset by a therapist who had made a decision involving her child without consulting the mother first. While the therapist and child were working together in the family’s home, the child wet himself. The therapist wanted to help the parents by changing the child herself. When the mother discovered that the therapist had gone through her child’s clothes drawers to find clean underwear, she felt as if the therapist had been snooping.

Abildgaard says his role as a counselor is to help clients on the autism spectrum adapt to different social situations and understand social context and social norms for particular settings and cultures. Counselors need to be aware of clients’ cultural and religious norms before instilling certain perceived social skills such as maintaining eye contact, he says. For example, as Abildgaard points out, some Asian cultures make eye contact only with certain people or in certain situations. So, counselors should understand the whole child before prioritizing what social skills or competences are most relevant to focus on in session, he asserts.

Religious beliefs can sometimes pose another barrier to seeking treatment. For instance, Davis-Pierre says, people in the black community are often taught to pray about their problems and not to discuss problems with anyone outside of the family. Counselors may assume that families who aren’t willing or enthusiastic participants in therapy are resistant, but as she points out, they may actually be having an internal struggle between seeking counseling and feeling that they are still maintaining their faith in God.

Davis-Pierre often uses genograms to help clients identify family patterns, such as other family members with a developmental disorder, or cultural values that have been passed along that no longer work for the family. Through genograms, she has noticed that her clients’ families often inherit a pattern of keeping secrets that hurts, rather than helps, the family dynamic. Davis-Pierre acknowledges that even she had a difficult time explaining to her extended family why she and her husband are so vocal about their daughter being on the autism spectrum.

Hannon and Davis-Pierre say that counselors have to be brave and willing to talk about clients’ and families’ cultures and about inequalities based on race and ability status. Starting this conversation can be as simple as including a question such as “What cultural traditions should I take into consideration?” on the intake form, Davis-Pierre says. This question shows that the clinician is already thinking about how culture affects treatment, she explains.

Supporting dads

Abildgaard argues that fathers are often overlooked when thinking about an autistic individual’s support network, so mental health professionals must do a better job of incorporating dads into the therapeutic process. He has noticed that mothers with children on the spectrum are often more proactive about independently finding and supporting each other, whereas fathers, even though they are involved in their children’s care, don’t tend to form support groups on their own. Abildgaard suggests that counselors could offer focused support services such as fathers’ groups or “dad’s night out” events to help these men learn from and bond with other fathers in similar situations.

Such support groups matter when it comes to providing care to individuals on the spectrum. Hannon, an ACA member who specializes in the psychosocial aspects of autism on fathers and families, often co-leads a group for fathers who have children with ASD. These men have reported that just being connected with other fathers who share similar experiences can be life-changing. In these groups, dads find others who speak their language and understand their journeys, which makes them feel heard, Hannon says. Groups also help fathers become more aware of their own needs and challenges and discover effective coping and adjustment strategies, he adds.

Fathers also spend a significant amount of time thinking about their children’s prognoses, their children’s futures, and the ways they can prepare their children to live full lives, Hannon says. In his dissertation, he studied the experiences of black American fathers of individuals with autism. At the ACA 2018 Conference & Expo, Hannon presented his findings from a grounded theory study on how diverse fathers orient themselves to their children’s diagnoses. Fathers often want to help their children who are on the spectrum, he continues, but if they have been raised with certain gendered expectations, counselors may need to take a few extra steps to help these dads increase their efficacy with day-to-day activities such as helping with temper tantrums.

Counselors may also need to help fathers retain focus on their emotional journeys because men are often task-oriented in how they solve problems, Hannon points out. Also, because men have often been socialized to engage only with specific emotions such as lust and anger, counselors may have to dig deeper with them to reveal the other underlying emotions. For example, counselors could suggest, “You’re angry, but it sounds like the source of your anger is fear for your child’s safety.”

Generational pushback

Parents sometimes face generational challenges in caring for their children. Hannon describes a common scenario that fathers often share with him: They leave their children in their grandparents’ care, providing suggestions for ways to best communicate with the children and guidance on particular eating preferences. To which the grandparents might respond, “We’re not doing any of that. We’ll do what we want with our grandchildren. They just need a good talking to.”

Such scenarios often leave parents of children on the spectrum feeling frustrated. If the parents and grandparents have a good, healthy relationship, then counselors can help parents learn to communicate openly and honestly with the grandparents. Hannon advises parents to lead with love and acceptance before critiquing the grandparents’ interaction with the children. Parents can first emphasize how the grandparents love their grandchildren before saying that they just want to show them additional, special ways to show love to a grandchild on the spectrum. 

When Abildgaard works with grandparents who need help accepting their grandchild’s diagnosis of ASD, he starts by saying that he could use the grandparents’ help to allow him to better understand their grandchild. Once this barrier is broken down, he finds that grandparents tend to ask more questions and start honest dialogues about grandchildren who are on the spectrum. 

Counselors can also help clients realize that while it is OK to establish boundaries with extended family, they should aim to set realistic boundaries that honor both the child on the spectrum and the family, Davis-Pierre says. For example, if a family depends on grandparents to provide child care, then the family must be particularly careful in setting boundaries. At the same time, the family can still have a respectful conversation with the grandparents about the needs of the child and family.

Adjusting language

Abildgaard’s clients with ASD sometimes complain that their parents always ask the same question after school: “How was your day?” Because, from their perspective, their days are always the same, the children wonder why their parents ask something they already know the answer to. 

Abildgaard advises parents to instead use concrete language such as “Tell me two good things about your day and one thing you would have changed.” This phrasing gets to the heart of what parents actually want to know from their child and makes the conversation more productive, he says. 

Abildgaard is also careful about the language he uses with clients with ASD and their families. Recently, the mother of one of his clients (a boy in sixth grade) told him that her son ran out of his classroom at school. When the boy walked into his office, Abildgaard said, “Tell me two good things about your day and one thing you would have changed.” This prompted the client to tell Abildgaard he had run out of his classroom.

After admitting this, the boy looked at Abildgaard, seemingly waiting to be chastised. Instead, Abildgaard asked the boy, “What do you think I’m thinking right now?”

The boy responded, “You’re thinking you are mad at me.”

Abildgaard drew a thought bubble on a whiteboard and wrote the client’s thought inside the bubble. Then he drew another thought bubble and wrote what he was actually thinking: “I’m wondering what made him run out of the room.”

The boy’s body language instantly relaxed. This exchange took Abildgaard out of the authoritarian role and shifted the conversation from focusing on the problem to focusing on how to solve the problem.

Similarly, Hannon recommends that counselors focus on strengths, and not just deficits and challenges, when working with families who have a child on the spectrum. He makes a point of asking parents about the victories they have had that week or month.

This question prompted one of Hannon’s clients to share how his son had used appropriate language and displayed empathy — a skill the child had previously struggled to demonstrate — that week.

The child’s mother had said, “I’m going to run through the shower.”

The child on the spectrum responded, “No, you can’t do that because you’re going to fall.”

Even though the child hadn’t grasped the true meaning of his mother’s words, he had shown concern for his mother and responded appropriately, which was a huge victory for this family, Hannon says.

Support often makes all the difference. Davis-Pierre and her family’s autism journey may have had a challenging start, but they eventually found health care providers who worked with them as a team. With this support, Davis-Pierre and her husband were able to stop focusing so much on the challenges and instead start enjoying their child for who she is.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Exploring the ties that bind

By Bethany Bray April 24, 2020

Family therapy pioneer Virginia Satir famously said, “If we can heal the family, we can heal the world.”

Satir believed the family to be the “factory” where all people are made. She was among the first to champion an idea now commonly acknowledged among counselors: A person’s family of origin and family relationships influence that individual’s health, personality and life patterns — and, when explored in therapy, provide a fuller picture from which to help the client. That understanding can be expanded even further when the individual consents to involving family members in counseling sessions.

When considering whether it is appropriate to involve a client’s family in counseling sessions, “I look at what the primary focus of our work will be,” says Esther Benoit, a licensed professional counselor (LPC) with a private practice in Newport News, Virginia. “If the primary focus is on relational [issues], I want to bring in as many people as can possibly show up to sessions.”

Regardless of whether professional clinical counselors work with family groups, couples or individuals, an exploration of family issues can provide a more holistic picture of clients and what is contributing to their presenting issues.

Heather Ehinger, a licensed marriage and family therapist in Connecticut, urges practitioners to ask questions that dig into the traditions, boundaries and roles in the family systems in which clients operate. For example, perhaps clients perceive their role within their family to be that of the troublemaker or the placater. How did they arrive at that role? Is it a role that they desire
to inhabit?

“Using a family systems lens to treat anyone is very important,” Ehinger says. “Even if all you do is treat individuals … [using] a holistic lens, a family systems lens, in their assessment … will enrich any counseling that did not include that already.”

Trauma and transitions

Although discussing a client’s family background or involving family members in counseling sessions can enhance work with clients regardless of what brought them to counseling, there are a number of issues for which family work can be particularly helpful. The counselors interviewed for this article report that issues related to trauma and transitions — such as blending two families after a second marriage — come up repeatedly in their work with families.

Trauma, including past sexual, physical or emotional abuse, can often lead to problems with attachment in families, notes James Robert Bitter, a counselor educator who supervises graduate students at East Tennessee State University’s (ETSU’s) on-campus community counseling clinic. There is also the trauma of separation. Bitter says several students he supervises are counseling young clients who are in foster care or being raised by grandparents because their parents are incarcerated or struggling with addiction.

“[In] family therapy these days, in our area, we’re not working so much with children and families because they are structurally misaligned or have difficulty with psychiatric disorders. We are much more working with trauma and working with families to be more effective in how they raise children,” says Bitter, a professor of counseling and human services who specializes in family counseling and the Adlerian method. “When there’s been a rupture in attachment issues, helping clients [relearn attachment] in a compassionate way is hard. The people who have been traumatized are way outside the natural bond.”

Kristy A. Brumfield, an LPC at a group practice in Philadelphia, finds that working with families in groups can often help those who are struggling with transitions such as the arrival of a new baby, a move, or the particulars of co-parenting after a divorce.

Transition challenges can also crop up naturally as families grow and age, Benoit adds. For example, families may find that formerly established patterns that used to work well around the areas of discipline and boundaries begin to cause friction as children turn into teenagers. Professional counselors can serve as valuable sources of support and guidance as families take a step back and examine the patterns within their systems, says Benoit, who specializes in relational work with individuals, couples and families across the life span.

“Working through developmental things is huge [with families], as well as attachment and focusing on relationship patterns,” Benoit says. “Also transition points. Anytime there’s an expansion or contraction of a family system, that’s when people often seek help. It can be a birth, a death, a divorce or a blending of a family. Sometimes, what was working before is no longer working.”

Getting together

The term “family counseling” may invoke thoughts of the traditional nuclear family, with juvenile children and parents sitting together and talking with a clinician. This arrangement can and does happen, but family counseling also encompasses groupings beyond the immediate or traditional family unit. It can involve any constellation of family members willing to participate who are relevant to or involved in the family’s presenting issue and who could benefit from work on communication patterns and relationship issues.

When involving multiple people in counseling sessions, counselors must first identify who the client is and what that entails, including privacy issues. In some cases, the individual who first sought counseling will be the client; in others, a couple or the entire family group will be the client. (Find out more about this essential conversation in the 2014 ACA Code of Ethics, including Standards A.8. and B.4.b., at counseling.org/knowledge-center/ethics/code-of-ethics-resources.)

Benoit says she always begins counseling with family groups by fully explaining and defining the therapy relationship and letting the family decide if they would be comfortable with a group format. “I like to put the ball in the client’s court and give them a chance to decide if this modality feels right and will address what they want it to in counseling,” says Benoit, a member of the American Counseling Association.

Recently, Benoit received a call from a couple seeking counseling for their twin teenagers struggling with stress related to being in high school. The twins were both gifted and very bright. Benoit first met with the parents, without the twins, to learn more about the situation and to explore the family dynamics. She quickly saw that the family’s relationship was strong and healthy, which meant that wasn’t the issue of concern. Instead, the twins needed space to process some complicated emotions — feeling close and supportive of each other and yet sometimes simultaneously competitive with each other in academics, sports and extracurricular activities.

When Benoit had her first session with the twins, she talked over several options with them: individual work with different counselors, seeing her together for sessions, or having the entire family involved in counseling. Benoit stressed that if the twins decided to come to her together for therapy, they would need to stay together for sessions. She gave the twins time between their first and second sessions to think it over.

“Because of the uniqueness [of their situation] and how connected they were to each other, they felt it was most appropriate to be seen together,” Benoit recalls. “Ultimately, they decided that this felt like the best option [for them].”

Benoit emphasizes that this process will look different for each client and must be tailored to fit each client’s needs and presenting issues. For example, she has another set of juvenile siblings on her caseload who see her separately as individual clients. Their presenting issues are very different, and their counseling work does not overlap, so individual sessions work best for them, she explains.

The symptom carrier

Ehinger owns a group family counseling practice with two locations in Connecticut. Her staff of therapists is able to collaborate and co-treat family groupings and individuals within families who need counseling on separate issues simultaneously.

Frequently, in families, there is one identified person who is symptomatic and causes the family to seek counseling, such as a teenager with an eating disorder or a child with attention-deficit/hyperactivity disorder. Even so, the problem often runs deeper and affects the entire family. “The idea is that one person is holding the symptoms, but it’s not the only problem within the family system,” says Ehinger, an ACA member with a doctorate in counseling education and supervision.

This is especially common when couples have an unhealthy relationship or are going through a divorce, she says. Their child may be the one who is symptomatic, but the issue is rooted in the parents. “The child may be afraid to go to elementary school and has a lot of anxiety. The parents have talked with the school and find that it’s not anything academic, and the child is not being bullied,” Ehinger says. “Then we might find out from the parents that the father moved out two months ago, there’s a lot of fighting and there are lawyers involved. They may say, ‘We’re not fighting in front of the kids.’ [But] whether they’re fighting in front of the kids or not, this child is absorbing the energy and knows there’s something going on.”

Ehinger and a colleague at her practice co-treated a family in which a teenage son was identified as symptomatic. The parents initially sought counseling for the 16-year-old because they said he was grumpy and defiant, staying out past curfew, skipping classes and experimenting with substance use.

The teenage son started individual counseling with a male clinician at Ehinger’s practice. Because the practice specializes in family systems issues, the clinician viewed the teen’s troubles from a systems perspective and soon uncovered a larger challenge. The answers the teen gave to questions about his family life indicated there was tension in the home and that his parents were having trouble.

The family also had a daughter who was a freshman in college. When she came home for holiday break, she refused to return to school and started displaying defiant behavior and some of the other symptoms her brother had shown. As these challenges unfolded, Ehinger began working with the parents, while her colleague worked with their children. Sometimes they would all convene for sessions together, with four family members and two clinicians in the same room.

Ehinger’s conversations with the parents in counseling revealed that the couple had experienced an issue with infertility and that both of their children were adopted. The couple hadn’t resolved their grief over their infertility, and that contributed to them struggling with their adopted children gaining their independence and beginning to “launch” from home, Ehinger says.

Within a few months, the symptomatic teenager was no longer “the problem” — the couple’s marriage was, Ehinger says. The son’s symptoms dissipated as counseling helped him find autonomy, and he subsequently stopped acting out as often.

This family’s presenting issue was due to problems with attachment, Ehinger explains. “The parents hadn’t really grieved the loss of having the ability to have their own children. They were extremely sensitive to being ‘perfect’ parents. They felt they would be failures if they weren’t perfect parents to these adopted kids and were pointing fingers at each other out of frustration.”

The issue was exacerbated, Ehinger recalls, because the parents had large extended families with lots of children, so they felt inadequate and insufficient compared with their relatives.

Ehinger worked with the mother to boost her self-esteem and process her infertility grief in individual sessions. With the couple, Ehinger also focused on grief processing, as well as finding safety within their relationship. They talked about “how to be intentional with each other, how to relate to each other, what their idea of marriage is, and how they [could] be more intentional to get to that,” she says. She also provided psychoeducation on why transitions, including child development during the teenage years, are so hard for families.

Ehinger often uses narrative therapy with families, and in this case, it was particularly helpful. In this family, the narrative was that the husband and wife felt like “bad parents,” the son was the “troublemaker,” and the daughter had always been the “good one,” although she later struggled when she came home from college.

“We worked to change that story: The parents were not bad but hypervigilant. We taught them about attachment, normal teenage rebellion and helped them recreate the narrative of their family,” Ehinger says. “We talked about roles: How did [the son] get the role of the troublemaker? Did he want to keep it? Did he ask for it? Who would resist him shedding that role? What other role could he [and other family members] become?”

Uncovering patterns

Benoit finds structural family therapy and experiential family therapy helpful in her work with family clients. Both modalities focus on interaction patterns within family groups.

“A family’s whole systemic interaction pattern can be shifted by changing small behaviors. That’s why it’s so important to identify those patterns,” says Benoit, a full-time faculty member teaching online at Southern New Hampshire University.

One way counselors can encourage families to shift long-held and unhealthy patterns is to raise family members’ awareness of the roles they play within the system. “For example, sometimes one member will be the family’s harmonizer, smoothing over all conflict,” Benoit says. “Those roles often dictate how members interact in day-to-day interactions, but also during conflicts and transitions. Understanding the roles that are played and how those influence interactions can help challenge family members to explore alternatives and to try on new roles as their family systems grow and change over time.”

Benoit’s focus on patterns involves careful listening and close observation of the ways that family members talk and interact, both verbally and nonverbally, in sessions. This includes body language as well as the tone and subtext of what is said verbally. “I’m taking it all in,” she says.

Perhaps the family members always sit in the same order for each session, for example, or one child always sits with one parent and distances themselves from the other, or the children always look at their mother before saying anything. Often, families don’t even realize that these patterns are happening or that there might be deeper meaning behind them, Benoit says.

Her method is to gently point these patterns out to the family, framed by curiosity. Her approach doesn’t paint the behaviors necessarily as being bad, but rather just as something to ask about and gather more information on.

“With family counseling, families are coming to us to get information and feedback, so pointing out patterns can help,” Benoit says. “Over time, I might point [a pattern] out to the family and say, ‘This is what I’m seeing. Help me understand where this comes from, and how it helps in your relationship. … Tell me about what this behavior means to your family.’”

For example, a child may always sit between his mother and stepfather in session. What might this symbolize? Is it a physical representation of the bridge-building role the child plays in the family? Benoit would bring up this observation, framing it as a question or a “tell me more” prompt.

“It’s something to explore. It doesn’t always mean something, but it’s worth asking,” she says. “And I get it wrong all the time. Sometimes the family will say, ‘Gosh, no!’ and then it just helps me to learn more information” about the family system.

Behavior patterns within families can also be rooted in culture or context, Benoit adds. For example, a young child who always defers to his or her parents or waits to speak in counseling sessions can be exhibiting a sign of respect taught within the family or culture.

Uncovering patterns and the meanings behind them demands that practitioners be present and focused on each moment in session. It also requires keeping a curious mindset, Benoit says. “One of the reasons I love relationship counseling so much is that instead of working with one person, you’re working with multiple people. But more importantly, you’re working on the space between people,” she says. “It’s really dynamic and powerful work.”

Processing trauma

Bitter counsels clients with the internship and practicum students he supervises at ETSU’s on-campus counseling clinic, which offers free services to members of the community, many of whom have minimal or no health insurance coverage. Bitter says he starts thinking about other family members who could be involved in counseling work within the first session with a client. From his perspective, all issues that bring clients to counseling are family issues in one way or another.

“Everything is a family issue,” says Bitter, who will be publishing a third edition of his book, Theory and Practice of Couples and Family Counseling, with ACA this fall. “Instead of family or couples [counseling], a broader term might be relational counseling. From the moment we are born, we are in a relationship. We can’t survive without them.”

Bitter recalls one client whom he has counseled for multiple years (beginning when the client was 14), with various counseling interns also being involved in one-semester intervals. Initially, the client’s aunt contacted ETSU’s counseling center to request help for her nephew.

The client’s mother struggled with addiction and had been married four times, in addition to having multiple other relationships, all of which had been immersed in drug culture. The youth — the second of his mother’s five sons — had seen “a constant stream in his young life of drug dealers and men with whom his mother was having relationships,” Bitter says. By the time the boy was 5 or 6, he had taken on the role of unofficial parent and caretaker for his younger brothers. He would get them up and dressed in the mornings and make sure they had food to eat, and he would clean the house.

When he was 9, the boy and his older brother went to live with their father, who had alcoholism. There, the client also took on caretaking tasks for his brother and, to an extent, his father. Bitter notes that the boy would have to ask his father repeatedly for money to buy food for the household.

At one point, the youth called his aunt and asked if he could stay with her. The aunt took him in and called the ETSU counseling center for help. Initially, Bitter saw the teen as an individual client (at the teen’s request). But in sessions, the youth would claim that he was “fine” and never bring up anything to talk about.

“The trauma and neglect in this boy’s life led him to be depressed but also led him to be very secretive. He had a very, very hard time telling me what was going on in his life,” recalls Bitter, an ACA member. “When you grow up being a little boy who has to take care of everyone else, you have to present a really good face to the rest of the world and learn to act as if everything is fine, until it is not.”

Eventually, Bitter worked with the youth to involve his aunt and grandmother — the most supportive family members in the client’s life — in counseling sessions. In their work together, Bitter focused on ways to rebuild the teen’s broken family while removing the caretaking role he had shouldered for so many years. “I asked the adults to be a family, and the aunt and grandmother were willing to do that,” Bitter says.

A year and a half later, counseling began to include a focus on the teenager transitioning from living with his aunt to moving back in with his father, who had worked to get sober and secured a job as a landscaper. “The counseling center helped with that transition and rekindled relationship and also reversed the pattern of trauma [in the family],” Bitter says. “We helped him to live as a child again and rely on the adults in his life. Now he has an aunt, grandmother and father who are functionally caring for him.”

The teen will soon turn 17. He’s doing well but is “still careful and cautious in relationships,” Bitter says. “He has two good friends and can’t really handle more than that.”

The teen and family’s recovery came “after two years of [counselors] constantly seeing this family, encouraging them and literally teaching them how to talk to each other, helping them with how to respond to each other,” Bitter says.

Effective parenting

In addition to working through unresolved trauma, much of what Bitter focuses on with families in counseling is changing unhealthy parenting patterns. Parents often come to the counseling clinic at their wits’ end because of behavior problems with their children.

The world has changed dramatically over the past century, but parenting styles, on the whole, have not, Bitter contends. With what counselors know about attachment and the benefits of using boundaries rather than punishment with children, practitioners are well-equipped to offer psychoeducation to parents who are struggling, he says.

“The majority of people parenting today, when we’re at our best, we sometimes parent better than our parents did, but when we’re at our worst, we all parent at about the same level our parents did — and we have to assume they did the same thing,” Bitter says. “Most of parenting is teaching [clients] how to form really good bonds with children and help them grow and develop.”

Bitter says a counselor’s role is to offer guidance rather than explicit instructions or commands to parents. “I wait for the client to say what they did and then ask, ‘Did that work for you? How did it go?’ If you had to spank your child [multiple] times per week, then it’s not working. Let’s talk about what might work [instead].”

Counseling can also normalize parents’ challenges, sending the message that they aren’t alone in their struggles. “They get to see that they’re like every other family — if you have children, you’re going to make a mistake every day,” Bitter says. “Often, parents are doing a pretty good job but just need [extra] help. But those who are dealing with trauma, or dealing with a bond between a child and parent that has to be reconnected, that takes some time and patience.”

Bitter draws on a number of methods to help parents, including Jane Nelsen’s positive discipline approach, Michael Popkin’s active parenting system, the Systematic Training for Effective Parenting (STEP) program, and James Lehman’s Total Transformation trainings for parents. However, Bitter emphasizes the “natural consequences” concept when it comes to child discipline.

As a child, Bitter says he hated Brussels sprouts, but his father loved them, so the pungent vegetable often appeared on the family dinner table. This circumstance frequently escalated into verbal battles, with his father insisting that Bitter was going to eat Brussels sprouts and Bitter insisting otherwise. Use of the natural consequences philosophy can circumvent such parent-child power struggles.

“Now we know that if parents serve a variety of things and a balanced diet, over time a child will make good choices,” Bitter says. “If you make [healthy] food available, a child will eat it. I recommend that parents model good eating habits but not get into fights over what the child is or isn’t eating. [When a child refuses to eat something], say ‘OK, don’t eat that.’ The natural consequence is that the child will get hungry. If they say, ‘I’m not eating breakfast’ [with the rest of the family], a parent should say, ‘OK.’ The child will come back at 10 a.m. and say, ‘I’m hungry.’ The parent can respond [by saying], ‘OK, lunch is served at noon, and you’ll make it until then.’”

If these types of patterns are repeated often enough, children will learn from their experiences and realize the natural consequences of their choices, Bitter points out.

He gives another example: Perhaps a mother who is struggling with a defiant adolescent finds that the child pushes back on her instructions to come out of the mall to be picked up at 3 p.m., despite having been dropped off for shopping with friends hours earlier. Bitter says he would ask the client, “What would happen if at 3 p.m. [when the child isn’t there], you just pressed on the gas in your car and drove away?” When the child calls to ask why Mom isn’t there to pick him or her up, she can calmly explain that she was there at 3 p.m. but the child wasn’t. Now, Mom has other things to do but will return to get the child when she can, Bitter says.

The crux of this method is for parents to learn to control themselves, Bitter says. Once they learn and find control, their child (or children) will follow.

“This is not difficult stuff. It’s hard to put into practice but easy to understand. Part of this is just helping couples and families get there,” Bitter says. “It takes patience on the part of the parent. The parents we are seeing are extremely frustrated because what they’re doing isn’t working. … If you put these [concepts] into practice, [parents] will have a more harmonious life with their children. It’s just a question of getting started.”

Playing together

Brumfield is a registered play therapy supervisor and has used play therapy not only with children, but with adults and families, for 18 years. While play therapy with children is mostly unguided, Brumfield provides prompts and gentle guidance for the adults and families on her caseload, often in the form of games and activities. This can include asking a family to create a puppet show or to play out a story using puppets in session. Among the many benefits of this approach, Brumfield says, is helping adults “reconnect to the playful parts of themselves.”

Brumfield, a member of ACA, also uses music and art in her work with families. For instance, she might ask family members to draw their answer to a counseling prompt. Or she’ll pass out rhythm instruments and have the young children beat a pattern, while the parents are encouraged to add to it or to repeat it back to the children on their own instruments.

Observing how the family interacts during these activities tells Brumfield a lot about the relationships, patterns and roles within the family. For example, is one person dominant and leading the entire plan for the family puppet show? Or does everyone work on drawing on their own, almost as if no one else were in the room? “While watching them interact, I see the gaps and places where the family might grow,” explains Brumfield, who is also a counselor educator at Immaculata University in Pennsylvania.

In addition to in-session activities, Brumfield encourages families to make time for activities together at home. These can run the gamut from a game of hide-and-seek or a family bike ride to board games and puzzles. She recommends games that encourage conversation and that are cooperative rather than competitive. One of her personal favorites is the Ungame, a board game that directs players to answer various questions to encourage conversation but has no winner. Similarly, families can use a conversational card deck — a number of which are available online — to spark healthy discussion at mealtimes.

When it comes to “assigning” families activities to do outside of session, Brumfield likes to have each family member think of three things they would like to do together. “Children often have ideas readily, and the children are really the ones teaching the parents. I ask the parents to think of their own childhood and what they enjoyed or things they wished they were able to do when they were a child,” Brumfield says. “The primary goal is connection and helping them be more cohesive and work together.”

Boosting family connection typically involves taking a break from technology, Brumfield adds. She often requests that clients try to unplug during family activities. An exception is when technology prompts bonding, such as when a teenager invites his or her parent to play a nonviolent video game together.

Playful activity — inside and outside of counseling sessions — helps families to be less guarded with one another, Brumfield notes. It also boosts communication, joy and vulnerability. Parents might feel silly at first, and that’s a good thing, Brumfield asserts. She reassures parents that letting their guard down to play does not lessen their authority or diminish boundaries.

“When family members are more vulnerable, they’re more able to be seen. It can increase [the family’s] understanding of one another,” Brumfield says. “The children can see their parents differently — as more human. The parents are able to feel reconnected and able to have fun with their children, which can help balance more challenging times for families. … For younger children, mastery can be learned. It can be a confidence boost to be able to participate and learn to be a part of their family. For parents, they’re able to see the things that their children are capable of. Parents often want to do everything for a child, [and play] helps them discover what they can do for themselves.”

Brumfield encourages counselor practitioners to remember the power of play, regardless of whether they specialize in play therapy. “We all — counselors and clients alike — need to be connected with the playful parts of ourselves,” she says. “Remember the importance of humor in our work. It can even be a form of self-care. Think of play as a way to release, stay centered and help in other facets of life.”

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Families and technology

Heather Ehinger, a licensed marriage and family therapist in Connecticut, says conflict over technology use comes up over and over again in her work with families.

This includes fighting between parents and children (and among couples) about which technology is being used and how often. In addition, a couple may have differing views over the age at which their children should have access to technology (such as their own cellphone) or whether they should be allowed to have a computer or video game system in their bedroom.

The conflict that arises over one or more family members’ use — or abuse — of technology can be a flashpoint or an indicator of deeper issues. Technology isn’t necessarily what brings a family in to counseling, Ehinger says, but it’s often a contributor to their presenting issue.

“Technology is not the problem exactly, but it is part of the problem. It feeds into authority issues and discipline,” Ehinger says. “Technology is like a thorn in the family’s side, but it actually turns into the lens through which we see whether the family is functioning or not.”

Ehinger worked with one family who had a son in fourth grade. He was acting out at home, having tantrums and pushing back against boundaries with his mother, who was a stay-at-home mom. He wanted to play Fortnite all the time and would sneak his mother’s cell phone away from her to do so. She would find her son upstairs, still in his pajamas, playing the online video game when it was time to leave for school in the mornings.

This was partly a problem of overstimulation and obsession on the son’s part, but there was also a disconnect on the part of the mother, Ehinger says. Sometimes, disagreements over technology use are generational. In this case, the mother didn’t realize that her son was using the game as a way to socialize and communicate with peers. Adding to her frustration was the fact that she had previously worked in a corporate environment and was used to people listening to her, Ehinger observes. Now, as a stay-at-home mom, she was locked in a battle of wits with her young son.

When it comes to addressing issues of technology use, Ehinger says that psychoeducation about family roles and setting boundaries can be particularly helpful for families in counseling. She often talks with parents about setting limits, taking televisions out of children’s bedrooms, and establishing regular “no tech” nights, when the home’s Wi-Fi is switched off for the evening, to spend time together as a family.

Ehinger also moderates conversations with couples in counseling to get them on the same page regarding their family’s technology use.

“Often, it turns out to be a couple’s problem,” Ehinger says. “They need to define roles when it comes to discipline and boundary-setting — which is all affected by their family of origin. They have to create an ‘our way’ [instead of ‘my way’] and stop bickering and fighting with each other.”

 

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Contact the counselors interviewed for this article:

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Find out more about family counseling from the International Association of Marriage and Family Counselors, a division of ACA, at iamfconline.org.

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The Counseling Connoisseur: How to talk to children about the coronavirus

By Cheryl Fisher March 17, 2020

The novel coronavirus, which causes the respiratory disease COVID-19, has made headlines for several weeks and has drastically impacted life as we know it. The outbreak, which the World Health Organization recently labeled a pandemic, has disrupted global commerce, shaken the United States stock market and led to travel restrictions and international border closures. Here in the United States, in an attempt to slow the coronavirus spread, major events have been canceled, educational systems are resorting to online forums, and organizations are recommending that employees telecommute. Medical providers are offering telehealth services, and places of worship are examining alternatives to in-person worship services. As of March 13, President Trump declared a national emergency, which may bring additional restrictions.

The coronavirus and children’s mental health

Global anxiety is high, and our clients are negatively impacted as they stockpile supplies and prepare for the unknown. Meanwhile, in the midst of the chaos, children struggle to make sense of all that they are seeing and hearing. Overwhelmed with information, children are responding in a variety of ways. Professionals who work with children report an increase in insomnia, rumination, intrusive thoughts, nightmares, and acting out behaviors.

“After twenty years of successful classroom management, I am finding it hard to command the attention of kids whose energy is so amped up,” says Steff Linden, an educator and children’s mindfulness yoga instructor in Annapolis, Maryland. “They are running around, tripping over themselves, and bumping into each other. These behaviors are examples of children who are overstimulated. They know something is going on, but they don’t know how to react, and they feel helpless and stuck.”

Children can’t escape the tension created by the viral crisis, so they begin creating an understanding which is often complicated by misinformation. “I had a kid poke his finger in my arm and yell, ‘You’ve got the coronavirus! I touched you!’” Linden reports.

Children are acting out their fears through behavior and play. Therefore, it is vital to address their concerns in a way that is reassuring and honest. Here are some tips for talking to children about the coronavirus: The acronym CAPES.

C: Create a calm setting. Children pick up on the emotions of the adults around them. Adults need to manage their anxiety before attempting to address the concerns of children. It is essential to provide a calm setting before talking with children about COVID-19.

A: Ask what they already know. Children are already talking about the virus. They may have misinformation that needs to be corrected. Ask children what they have heard about the virus? Ask them about their concerns and fears. Children tend to worry about their own safety and those in their immediate world such as friends, family members, and even pets.

P: Provide age-appropriate answers. Answer children’s questions with honest, factual and age appropriate answers. Provide answers that are bias-free. Explain that COVID-19 is caused by a new virus and makes people feel sick with a cough and fever. Help battle stigmatizing any particular population by emphasizing that the coronavirus is no one person or country’s fault.

E: Empower them with tools. Children feel powerless over this big virus that has people buying out toilet paper and Clorox wipes. Provide them with actual tools to use that will be empowering by teaching them to wash their hands using soap and water while singing a happy tune for twenty seconds, cough or sneeze into their elbows—not their hands—or a tissue that they immediately toss in the trash and use no contact greetings such as jazz hands or Namaste.

S: Safety. Children turn to adults for a sense of safety and well-being. Assure children that it is not their job to worry about the virus and that you have a plan in place to care for them. Explain ways that you are keeping them safe by making sure they get enough sleep and providing them with nutritious meals. Tell them that their regular visits to the pediatrician and daily vitamin (if they take one) help keep them healthy. Even with school closings, provide daily structure that includes time for non-directed play to help children act out and process feelings. Help them make a list of ways they are healthy and safe. There are a lot of unknowns with COVID 19, so focus your conversation on what is known.

 

As counselors, we can help parents and our child clients better manage the plethora of information that is available. We can assure children that the adults in their lives are up for the task of taking care of them. The acronym CAPES can remind us how to be superheroes in an effective way to the young members of society who are powerless.

And, as always, we must remember our own self-care during this challenging time. Take a peek at my thoughts around a counselor’s guide to surviving flu season my column from February 2018, “The Counseling Connoisseur: Compassion and self-care during flu season.”

 

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Important links:

COVID-19 update and resources from Counseling Today

COVID-19 related resources from the American Counseling Association

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Uncovering the root cause of mother-daughter conflict

By Rosjke Hasseldine January 8, 2020

An experienced counselor recently admitted to me that she felt out of her depth when a mother and adult daughter both came to see her for help with their incessant arguing. She said that she struggled to identify the core reasons for their arguments, and she knew that the communication skills and boundaries she tried to instill in them did not address the core reasons for their relationship difficulties.

Sadly, this counselor is not alone. Colleagues frequently tell me that they feel unprepared when it comes to working with mothers and daughters. They blame the absence of specialized training. This lack of focus on the mother-daughter relationship creates unnecessary anxiety among counselors and psychotherapists, and frustration for female clients. For example, only in 2016 was the Adult Daughter-Mother Relationship Questionnaire developed (for more, see Julie Cwikel’s article in The Family Journal). And in my office, all too often I hear mothers and daughters voice their frustrations about the lack of specialized help.

In this article, I share two insights that will help counselors understand the dynamics between a mother and daughter of any age. These insights come from the mother-daughter attachment model I have developed through my 20-plus years of listening to thousands of mothers and daughters of all ages from different countries and cultures. The model makes the complicated dynamics between mothers and daughters easy to understand, explains why mothers and daughters fight, and teaches how mothers and daughters can build strong, emotionally connected relationships.

I chose to specialize in the mother-daughter relationship back in the 1990s because that relationship is central to women understanding themselves. My relationship with my mother had shaped who I was, and when my daughter was born 30 years ago, I knew I had to change the harmful themes that were being passed down the generations. What began as a personal quest became my professional mission.

Mothers and daughters frequently tell me that they feel ashamed about their relationship difficulties. They feel that they “should” be able to get along because popular wisdom tells them that mothers and daughters are supposed to be close. This societal expectation makes mothers and daughters blame themselves for causing their relationship difficulties. The truth is, if my years of experience providing therapy are any indication, many women currently experience mother-daughter relationship conflict.

Based on the inquiries I receive from mothers and adult daughters from different countries, I believe that a larger, societywide dynamic is contributing to their relationship conflict. Often, I hear “hormones” being blamed as the cause for relationship problems, whether it is the teenage daughter’s or pregnant daughter’s hormones, or the menopausal mother’s hormones. Another common reason mothers and daughters give to explain why they are not getting along is their differing or similar personality traits. I have never found hormones or personality traits to be the core reasons for mother-daughter relationship conflict, however. Rather, I have concluded that society sets mothers and daughters up for conflict.

In the first insight, I show that the mother-daughter relationship is not difficult to understand once we realize that mothers and daughters do not relate in a cultural vacuum. In recognizing that mothers and daughters relate within a sociocultural and multigenerational environment, the dynamics between them become easier to grasp. We see how life events, restrictive gender roles, unrealized career goals, and the expectation that women should sacrifice their needs in their caregiving role all shape how mothers and daughters view themselves and each other and how they communicate. To illustrate this dynamic, I share the story of my work with Sandeep, a young college student from England (name and identifying details have been changed).

In the second insight, I explain how patriarchy’s way of silencing and denying what women need is the root cause of most mother-daughter relationship conflict in different cultures around the world. To illustrate, I share my work with Miriam, a doctor from Sweden who comes from a feminist family (name and identifying details have been changed).

Miriam and Sandeep come from different countries and cultural backgrounds, and their families are on opposite ends of the women’s rights continuum, yet their core relationship problem is the same. Both Miriam and Sandeep come from families in which women have not learned how to ask for what they need.

Insight No. 1: Mothers and daughters relate in a sociocultural environment

As is the case with any couple, mothers and daughters rarely fight over what they say they are arguing over. Sandeep and her mother were no exception to this rule. Sandeep was a young college student who lived at home. Her parents immigrated to England from India before Sandeep was born. Sandeep had three brothers, but she was the family’s only daughter.

Sandeep came to see me because she was feeling depressed about how critical her mother was. She was struggling to juggle her college work with the housework her mother and family expected her to do. She said her mother would accuse her of not being a good enough “housekeeper” and not caring enough for her mother when she was ill, which was often.

Sandeep had consulted a counselor before me who had suggested that her mother might be suffering from a personality disorder. I never got to meet Sandeep’s mother and work with her clinically, so I was unable to validate whether this might be the case. Regardless, even if Sandeep’s mother did have this diagnosis, it did not provide Sandeep with the answers
she needed.

Instead, Sandeep needed to understand the multigenerational sociocultural environment in which she and her mother lived. She also needed to understand what was going on in this environment that apparently caused her mother to be so angry and critical, and what caused Sandeep and her mother to believe that it was Sandeep’s responsibility to do all the housekeeping.

When I start working with new clients, I map their mother-daughter history. This is the primary exercise in the mother-daughter attachment model. It is an adaptation of the genogram exercise that family therapists use. The maps focus on the three main women in the multigenerational family, which in Sandeep’s case was Sandeep as the daughter, her mother and her grandmother. I map the experiences the three women have had in their lives, including the gender roles that have defined their lives and limited their choices and power. I also map how the men in the family treat their wives and daughters. Mother-daughter history maps provide an in-depth analysis of the multigenerational sociocultural environment in which the women in the family live and what is happening within that environment to cause mothers and daughters to argue, misunderstand each other, and disconnect emotionally. (Detailed instructions on using this exercise with clients are available in my book The Mother-Daughter Puzzle.)

Sandeep talked about her grandmother’s and mother’s lives and arranged marriages and shared how verbally abusive and controlling her father and grandfather were. She said the males in the family were encouraged to go to college and build their careers, while the females were expected to stay at home to help their mothers. As Sandeep provided these details, her family’s patriarchal structure came into sharp focus. Sandeep represented the first woman in her generational family to finish school and go to college.

Sandeep’s family believed in what I term the “culture of female service,” a global patriarchal belief system that views women as caregivers, not care receivers. Families that subscribe to the culture of female service expect mothers and daughters to be selfless, sacrificial, self-neglecting caregivers. This belief system does not recognize women as people with needs of their own.

Although I never met Sandeep’s mother, it was apparent to me (based on Sandeep’s descriptions) that she had internalized this family belief and did not know any other way of being. This meant that she did not understand Sandeep’s desire to go to college or her fight for her independence. I suspected that Sandeep’s independence felt threatening to her mother. Several reasons explain why Sandeep’s mother was so critical of her daughter and why she behaved in an emotionally manipulative manner — for example, by becoming ill just when Sandeep was busy with an assignment or exam.

First, Sandeep wanted to live a different life than her mother and grandmother had lived, and this likely made Sandeep’s mother feel alone and abandoned. Her only understanding of being female was that of women as caregivers and of “good daughters” stepping into their mothers’ shoes and walking repeats of their mothers’ lives. Sandeep’s mother had done that, her mother had done that, and she expected Sandeep to follow in that role. I suspect Sandeep’s wish for a different life and different relationships felt like a rejection to her mother. It made her feel that her daughter was criticizing the life and values she believed in as a mother.

Second, Sandeep’s mother could have been jealous of her daughter’s freedom and opportunities, even though she probably was unaware that her criticism and anger were rooted in jealousy. Sandeep’s freedom and opportunities might have been an uncomfortable mirror for Sandeep’s mother, reminding her of the freedom she never had and the dreams she had to relinquish.

Third, the mother’s attempts to keep Sandeep from graduating and leaving home could have been linked to her own fight for emotional survival. Sandeep reported to me that she was the only person who gave her mother love and care, so the thought of Sandeep leaving home must have been terrifying to her mother.

For mothers and daughters to build a strong, emotionally connected relationship, it is optimal for both parties to engage in couples therapy. However, if one person is not able, or willing, to participate, healing is still possible. In Sandeep’s case, her mother did not want to participate in therapy. This did not prevent Sandeep from working on understanding and improving her relationship with her mother, however. When one person changes their behavior, the relationship changes to incorporate the new behavior. Of course, Sandeep and I had little control over how her mother would respond to the changes Sandeep needed in their relationship.

My work with Sandeep involved teaching her how to listen to her own voice. Sandeep had become an expert on responding to what her mother needed and being a “dutiful daughter,” but she had little idea about what she wanted for herself, beyond finishing her degree. Sandeep did not know how to ask herself what she thought, felt, or needed emotionally because that conversation was not spoken in her family. My role as a mother-daughter therapist was to help Sandeep uncover the sexism she had inherited from her mother and grandmother that had silenced her voice. I helped her understand the gender inequality her family and culture normalized, and I taught her how to claim her own ideas of who she wanted to be and what she needed in her relationship with her mother — and in all her relationships.

I also helped Sandeep navigate the pushback she got from her mother and father when she stopped complying with their demands to be the family’s unpaid housekeeper. I helped her to understand her mother’s and father’s perspectives so that she had empathy for them and encouraged her to recognize that their anger and criticism weren’t as personal as they felt, originating instead from their cultural beliefs. Alongside Sandeep’s increased understanding of her family’s sociocultural environment, I helped her increase her entitlement to speak her mind, reject unreasonable demands, and carve out her own life path.

Sadly, Sandeep’s parents did not react well to her behaving differently from what they expected of a “dutiful daughter.” After Sandeep left home, her family’s anger and accusations that she had dishonored the family became alarming, leading her to obtain a restraining order against her parents and siblings. Through her therapy, Sandeep learned the degree to which her family members did not tolerate women challenging their long-held beliefs about what women could and could not do and could and could not wear. I had to help Sandeep stay safe and grieve the loss of her family even as she gained her own voice and life.

Insight No. 2: Mothers and daughters fight over their denied needs

My clients have taught me that the denial of what women need, especially when it comes to women’s emotional needs, ripples below most mother-daughter relationship conflict. As I write in The Mother-Daughter Puzzle, when a family does not speak the language that inquires after what women feel and need, mothers and daughters are set up for conflict. It creates an either-or dynamic in which the mother and daughter fight over who gets to be heard and emotionally supported in their relationship because they do not know how to create a normal in which both are heard and supported.

In every mother-daughter history map I draw, I see how the silencing of women’s needs harms women’s emotional well-being, limits their ability to advocate for themselves in their relationships and workplaces, and perpetuates gender inequality. I see how this dynamic makes women invisible, and how being invisible makes women hungry for attention. The inability to openly and honestly ask about what they need creates emotionally manipulative behavior between mothers and daughters and sets daughters up to have to mind read their mothers’ unspoken and unacknowledged needs.

Miriam, a client from Sweden, contacted me for help with her adolescent daughter. Miriam and her mother had benefited from the women’s movement fight for women’s rights. Miriam and her mother were doctors, and Miriam’s husband and father were extremely supportive of their careers. But just like Sandeep and her mother, Miriam and her mother had internalized and normalized the culture of female service, and Miriam’s daughter was angry about her mother’s selflessness.

Miriam’s daughter felt that she had to mind read what her mother really felt and wanted, and she was tired of it. She desired an emotionally honest relationship with her mom. She wanted to feel free to say what she felt and needed and for her mother to speak her mind and stop the guessing games. Miriam’s daughter did not want to feel responsible for meeting her mother’s unvoiced and unacknowledged needs.

The silencing of women’s needs is an intergenerational dynamic that gets passed on from mother to daughter because the mother is not able to teach her daughter how to voice her needs openly and honestly. When the daughter is expected, often unconsciously, to listen for and meet her mother’s unvoiced and unacknowledged needs, the daughter is learning to become an expert on understanding what her mother needs, not on what she needs herself. This means that the daughter will grow up to be as emotionally mute as her mother, thus setting up her future daughter to try to learn to interpret and meet her unvoiced needs.

Women’s generational experience of being emotionally silenced and emotionally neglected is a common theme between mothers and daughters. Happily, I am seeing a huge shift from adult daughters in their 20s, 30s and 40s who are waking up to this patriarchal theme and wanting change. These daughters recognize that they have learned — from their mothers and from society in general — to be far too tolerant of being silent and practicing self-neglect. More daughters are asking their mothers to join them in therapy so that together they can change these inherited behavioral patterns. Mothers and daughters are teaming up and pioneering a new normal in their families — a normal where women are speaking up and demanding to be heard. And they are passing on this new normal to the next generation of sons and daughters.

Mothers and daughters have always led the call for women’s rights. When we understand that mother-daughter attachment disruption or conflict tells the story of how sexist beliefs and gender role stereotypes harm women’s voices and rights, the mother-daughter relationship becomes an unstoppable force for change at the worldwide and family levels.

Sadly, Sandeep’s mother was not able to join Sandeep in her fight to challenge her family’s sexist cultural beliefs. I inferred that too much neglect made Sandeep’s mother emotionally unable to think her way out of her powerlessness. Miriam, having had a far more supportive and empowering upbringing, was able to join her daughter to find a new normal for women within their family. This mother and daughter team coached each other as they decontaminated themselves from their internalized sexism and self-silencing habits.

The mother-daughter relationship has tremendous power to change women’s lives around the world. When mothers and daughters band together, they create an impenetrable wall of resistance against family members who are threatened by women claiming their rights. I have had the honor of working with many pioneering mothers and daughters who dared to dream of a reality in which mothers and daughters are no longer starving for attention and fighting for crumbs of affection. These brave mothers and daughters recognize the harm that patriarchy, sexism, and gender inequality inflict on women, and they have decided that enough is enough. In essence, they are saying, “With us, it must end.”

 

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Rosjke Hasseldine is a mother-daughter relationship therapist, author of The Silent Female Scream and The Mother-Daughter Puzzle, and founder of Mother-Daughter Coaching International LLC (motherdaughtercoach.com), a training organization. She blogs for the American Counseling Association and has presented her mother-daughter attachment model at professional conferences, on Canadian television, and at the United Nations Commission on the Status of Women. Contact her at rosjkehasseldine@gmail.com or through her website at rosjke.com.

 

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

When yelling doesn’t work

By Lindsey Phillips April 29, 2019

Stop! Stop throwing that toy! Put it down. Put it down now! Don’t make me say it again. If you don’t stop that right now …” We all know how this story ends — with a frustrated parent and an upset child. But the story doesn’t have to end this way.

In Play Therapy: The Art of the Relationship, Garry Landreth asserts that to improve future adult populations, counselors must equip parents with counseling skills and help them become therapeutic agents in their children’s lives. This plan sounds simple, but how do counselors broach the topic of child discipline, especially when working with clients from cultural backgrounds that differ from their own?

Christa Phipps, a therapist and clinical supervisor at Hickory Grove Counseling Center in North Carolina, notes that parenting and discipline can be touchy subjects, and counselors often fear mentioning it. In fact, she says, the counselors she supervises are terrified to talk with parents about anything that may rupture the therapeutic relationship, so they often skirt around the issue of child discipline. Phipps has also noticed that the one African American counselor she supervises is apprehensive about discussing discipline with clients from other cultures, while her white supervisees are timid about approaching the issue with parents of all cultural groups, including their own.

Phyllis Post, a professor of counseling and director of the Multicultural Play Therapy Center at the University of North Carolina at Charlotte (UNCC), advises counselors to address cultural differences outright rather than pretending that they don’t exist. Post, as an older white woman, acknowledges the cultural differences between her and her clients and asks clients directly how they feel about having her discuss child discipline and parenting with them.

Peggy Ceballos, an associate professor of counseling at the University of North Texas, says that parenting style and child discipline are both closely linked to one’s cultural background. “The main mistake I see is people avoiding those [cultural] conversations” in counseling, she says.

Carla Adkison-Johnson, a professor in the Department of Counselor Education and Counseling Psychology at Western Michigan University, agrees that counselors often avoid the topic of discipline because that is where the cultural aspects of raising a child come into play. Rather than neglecting the topic or making assumptions, counselors should ask clients about their child-rearing values and traditions, she advises. They can do this by asking questions about their parenting: What types of disciplinary methods are you using to prepare your child for adulthood? What behaviors warrant discipline? What are you struggling with right now? Do you feel comfortable with the boundaries between you and your child?

Adkison-Johnson, a licensed professional counselor (LPC) and a member of the American Counseling Association, also points out that how people were disciplined themselves often plays a role in how they parent their own children. Thus, she says, counselors might ask clients how they were disciplined when they were children, whether they are using any of these methods with their own children, and what disciplinary methods their parents used that the clients found ineffective.

In the 2015 article “Child Discipline and African American Parents With Adolescent Children: A Psychoeducational Approach to Clinical Mental Health Counseling,” Adkison-Johnson described an activity that helps identify how parents define discipline and what child behaviors they consider problematic. In the activity, a counselor shows parents a video clip or a written example of a child displaying inappropriate behavior. The counselor then asks the parents what an appropriate behavior would be and how they would handle the problem.

Ceballos advises counselors to introduce the topic of child discipline in ways that are nonjudgmental and accepting. Parents are typically more receptive to learning new skills — including skills related to appropriate discipline methods — when counselors establish a relationship in which clients feel accepted.

Post, an LPC supervisor and registered play therapist, agrees. “I never tell a parent that what they are doing is wrong,” she says. Instead, she introduces alternative parenting techniques.

Counselors should assure clients that their role isn’t to tell parents what to do, Ceballos says. Instead, they are there to offer additional parenting skills, to process those skills with clients, and to see whether clients might want to try the skills because they think that the techniques might work for their families.

When clients feel there is a parenting skill that they can’t incorporate, Ceballos, an ACA member, talks about it with them. She says she wants clients to feel safe and comfortable having these difficult conversations with her rather than telling her that they will try a new skill and then not following through.

Putting discipline in (cultural) context

Ceballos and Adkison-Johnson agree that before discussing child discipline with clients, counselors need to be aware of their own biases and beliefs around parenting. For example, how does a counselor define “good” parenting? How does the counselor’s cultural background influence this definition?

Adkison-Johnson, who co-edited Counseling African American Families in ACA’s Family Psychology and Counseling Series, argues that counselors also need to understand the current and historical context when broaching the topic of child discipline. For example, African American parents are often viewed in society in a pejorative way, as incompetent parents, she says. Thus, counselors must be intentional about dismissing this false perception and reminding themselves that African American clients are competent parents who have goals, ideals and values for their children. Discussing child discipline also means addressing assumptions, she says, including the fact that most counselors may still determine what is in a family’s best interest on the basis of a widely white, middle-class, mainstream perspective.

Rather than waiting for clients to bring up these cultural contexts, counselors should take on the responsibility of learning more about what their clients experience, Adkison-Johnson stresses. For example, counselors should know that African American parents often engage in racial socialization practices as a part of their parenting activities, she says. This involves communicating messages and behaviors to children to bolster their sense of identity, especially given that their life experiences may include racially hostile encounters.

Parents who are undocumented immigrants may instruct their children to behave well at school because they fear being called in for a meeting or having someone look into their family if their child misbehaves, Ceballos adds. For these families, establishing trust in the counseling relationship is crucial because it may be difficult for them to openly discuss how their undocumented status affects their parenting, she explains.

Ceballos advises counselors to use cultural humility when learning about clients’ belief systems regarding parenting and what parenting means within their cultural context. She also recommends that counselors get involved in the community to build trust with parents. For instance, she finds that partnering with schools helps make Latinx parents more comfortable with getting counseling services because it allows counselors to meet these parents in a place that is familiar to them and where they may have already established a level of trust. In addition, schools often have people who know clients’ cultural backgrounds and speak their native languages, she adds.

Yung-Wei Dennis Lin, an assistant professor in the Counselor Education Department at New Jersey City University, points out that some cultures may not be familiar with the counseling profession. A Taiwanese family who immigrates to the United States may not be aware of the role that school counselors play, for example. So, he explains, if a school counselor suddenly contacts the parents in reference to their children, the parents may wonder who this person is and what the person’s role is with their children.

Adkison-Johnson and Lin, an ACA member who specializes in play therapy and filial therapy, say that counselors — including those who have been out in the field for a while — would benefit from interacting with different cultural groups under supervision.

Multicultural development is a lifetime commitment, not just one workshop, class or book, Ceballos adds. She challenges counselors to continue working on recognizing and addressing their unconscious biases. “We learn best through experiences, so … expose [yourself] to different cultural groups, to different cultural experiences … within the community,” she says.

Spanking and the discipline continuum

“When we think of child discipline, we only think of spanking, and I think that’s where we’ve missed the mark,” Adkison-Johnson says. “In general, across all racial groups, child discipline is a broad program of parenting. … It’s [parents] teaching children basically how they want their children to be, how they want to socialize their children within their family structure.”

Spanking generates a lot of heated opinions and often overshadows other aspects of child discipline. Counselors can be prone to taking a position on spanking and focusing exclusively on that aspect of discipline while ignoring all the other parenting tools that people may use along with spanking, Adkison-Johnson says. However, research indicates that “children are more impacted by the whole program of discipline than just the isolation of spanking in and of itself,” she argues.

Spanking also evokes stereotypes of minority cultures relying heavily on physical discipline. In fact, Ceballos did focus interviews with Latinx mothers and found they were cognizant of a pervading stereotype of Latinx parents spanking and abusing their children. The mothers discussed the distress this stereotype causes them and how it made them feel unsafe to discuss child discipline openly with just anyone.

Similarly, Adkison-Johnson acknowledges the stereotype of African American parents primarily using physical discipline to address inappropriate child behavior.

However, Post says, research indicates that parents in all cultural groups spank. “It is not just that some cultural groups spank more,” she adds. In fact, as recently as 2013, two-thirds of parents in a Harris Poll reported that they had spanked their children.

When parents ask Phipps her thoughts on spanking, she tells them that what she thinks is not important and turns the conversation back to what is working for them. “Usually they say that spanking is not working for them. They feel bad about it, but they don’t know what else to do,” she says. “They feel powerless.”

Lin, the recipient of an ACA Best Practices Research Award in 2016 for his work on child play therapy, says that spanking often hurts parents emotionally. Plus, parents often realize that spanking requires double the work. He explains that parents spank to stop the behavior, but then they must wait until the child calms down from crying — as a result of the spanking — to communicate why they spanked them.

Adkison-Johnson finds that physical discipline is often used as a last resort with children. People opposed to spanking typically equate it with violence, she says, and because they consider it a violent act, they feel it is inappropriate. “A blanket injunction with spanking when we have not provided empirical research to support that blanket injunction is problematic because that’s more of an opinion,” she argues.

She notes that parental use of physical discipline is a topic of much debate in the social science and legal literature. Several studies, including a meta-analysis by researchers Elizabeth Gershoff and Andrew Grogan-Kaylor (2016), associate physical punishment with negative childhood outcomes, which supports the premise that physical discipline is equated with violence. However, the most commonly cited studies on the consequences of spanking are correlational and do not show a direct causal link between physical punishment and long-term negative effects on children (see, for example, Robert Larzelere, Ronald Cox and Gail Smith, 2010).

“And from a culturally competent perspective, we’re actually still pushing our own [counseling or psychology profession] agenda because this is the way we want society to be regardless of whether it adequately addresses the child-rearing goals of parents,” she adds.

For this reason, Adkison-Johnson thinks that spanking, which is only one aspect of child discipline, has received too much attention. In fact, from her research with African American parents, she has found that child discipline happens on a continuum — one that is context and age specific. “That means … what the child does warrants the type of discipline that they will receive,” she says. “There’s no spanking randomly. There’s no discussion randomly. There’s no withdrawal of privilege [randomly]. Child discipline in African American homes is comprehensive and strategic and is dictated by the context [of the disciplinary situation] and age of the child.”

With the first behavioral offense, parents may explain what was wrong and tell the child not to do it again, she says. However, if the child has to be told repeatedly not to do something, then the parents may use a more severe form of discipline. As children age — roughly 6 to 11 years old — the discipline may become more restrictive (with physical discipline as a last resort) because the parents realize their children are interacting with the world, peers and the school system, and they want their children to behave a certain way regardless of what others do or say, Adkison-Johnson continues. When children become adolescents, parents typically use less physical discipline and more withdrawal of privilege unless the child commits a serious offense such as disrespecting the parent, she adds.

Several studies (such as one published in 2012 by Jennifer Lansford, Laura Wager, John Bates, Kenneth Dodge and Gregory Pettit) reveal that the negative effects of spanking often seen with white American children aren’t mirrored with African American children, probably because of how and when spanking is used, Adkison-Johnson says.

ACT, don’t react 

Post, Lin, Phipps and Ceballos all use child–parent relationship therapy (CPRT), a play-based treatment for children with behavioral, emotional, social or attachment disorders. The aim of CPRT is to teach parents how to use play therapeutically to strengthen the child–parent relationship and to reduce child behavioral problems and parent stress. CPRT skills include responsive listening, reflecting feelings and limit setting.

One CPRT rule of thumb is for adults to act as thermostats, not thermometers. This saying reminds adults that they control the situation (i.e., the “temperature” in the room) even when a child engages in negative behavior. If the adult is not in charge or not in control of his or her own emotions, then things can turn into a power struggle between the adult and child, further escalating the situation, Ceballos explains.

Because CPRT’s aim is to build a stronger relationship with one’s child, the approach is culturally congruent with Latinx culture and familismo (a Latinx cultural value of dedication, commitment and loyalty to the family), Ceballos says. Thus, when Latinx parents are exposed to CPRT, they are often receptive to learning the associated skills, she adds.

Once when Post was teaching child-centered play therapy skills, an African American student told her that he didn’t see how the child-centered approach would work for his culture, which preferred a more authoritarian or directive parenting style. By the end of the class, however, the student had a new appreciation for the approach. Because African American children grow up in environments that can be racially hostile to them, African American parents often see a need to engage in racial socialization practices — for example, teaching their children to be compliant for their own safety. However, the student eventually recognized the value of also providing these children with a safe space in the playroom where they could freely communicate who they were and what they were feeling. He reasoned that this would help them to grow more confident and competent.

Phipps, an LPC supervisor and a registered play therapist supervisor, recommends an IDEAL response for discipline — one that is:

  • Immediate (within three seconds)
  • Direct (be within 3 feet and make eye contact with the child)
  • Efficient (be measured and use the least amount of firmness possible)
  • Action-based (have the child model appropriate behavior to create motor memory for making future choices)
  • Leveled (aim the response at the behavior, not the child)

Phipps, a member of ACA, also teaches parents how to listen, acknowledge and accept children’s feelings even if they don’t agree with those feelings. For instance, she will often hear a child say, “I feel anxious,” and the parent’s response is, “There is nothing for you to feel anxious about.” That statement is not helpful, Phipps says.

Parents often need help discerning the difference between children’s behaviors and their feelings, she continues. She explains the distinction with the following example. It is OK for a child to feel angry at his or her parents, but it is not OK for the child to hit the parents. Many parents do not recognize the difference between the two, and they discipline the child if he or she gets angry, Phipps says.

Fussing at children because they are not behaving at home or school will not make them feel safe or secure, notes Post, a member of ACA. She advises adults to use the 30-second burst-of-attention technique. For example, when a parent is on the phone and a child is tugging on his or her shirt, the parent should stop for 30 seconds and attend to the child. After the parent gets on the child’s level and listens, then the parent can say, “I’m going back to my phone call now.”

Post, who currently trains teachers to use these skills, recently witnessed the power of listening to children rather than simply reacting to bad behavior. A young boy was being disruptive — throwing things and yelling — in a classroom. Instead of yelling for him to stop or threatening to call his parents, the teacher used CPRT skills. She got down on his level and in a calm voice said, “You feel sad.” The boy was silent for a time, and then he told her that the night before, someone had broken into his home while he was sleeping, and it was chaotic. After the teacher listened to his story, the boy calmed down and returned to the classroom.

Acknowledging feelings is the first step of the ACT model of limit setting. The subsequent steps are communicating the limit and targeting an alternative. Post and Phipps presented on this topic at the ACA 2018 Conference in Atlanta.

Post provides an example of using ACT to correct a child’s behavior. If a child is walking around when the family is eating dinner, the parent would say, “I know you want to get up from the table while we are having dinner, but now is the time to stay at the table and eat with the family. But you can walk around after dinner is over.” In this instance, the parent is providing the child with a way to meet his or her need at another time, Post explains.

Phipps, an adjunct professor at UNCC, practices the skills of the ACT model of limit setting with her counseling students, her counseling supervisees and her clients. With parents, she provides a scenario of a child misbehaving (e.g., throwing a toy), and then they discuss how to respond to the child using ACT. Sometimes, parents even write down the wording to practice later. Next, Phipps brings parents into the playroom so they can watch her execute these skills or even do them along with her. This helps parents feel more comfortable using the skills on their own later.

Although limit setting can be a difficult skill to learn, it is one of the most powerful tools that counselors have, according to Phipps, whose dissertation revealed its effectiveness. She worked with a child who was displaying aggressive behavior at preschool. After two sessions that involved limit setting, the child’s behavior improved at school. Phipps’ study also showed that as the child’s behaviors improved, so did the behaviors of his classmates.

Letting children take control

What happens when setting limits isn’t enough and the child continues to misbehave? Counselors and caregivers can turn toward choice giving. Landreth explains the skill of choice giving in his Choices, Cookies & Kids DVD, which Post says is a great resource for parents because it is humorous and contains relevant examples. When Post was in private practice, she would let parents watch the video while she worked with their child.

Phipps knows from personal experience that setting limits may not always be enough, and she says that choice giving is an easy skill for parents to use. She once had a young client who decided to throw sand in her office rather than play with it. First, Phipps tried setting limits: “I know you want to throw the sand, but the sand is not for … ” The boy threw sand in her face before she could finish her sentence. So, Phipps tried again, getting out the entire sentence this time before he threw sand in her hair. The third time that he picked the sand up, she set the limit again, and he decided to drop it. But when he picked the sand up for the fourth time, Phipps had had enough. She decided to use choice giving: “If you choose to throw the sand again, you are choosing to lose the sand.” The boy decided not to throw the sand.

“When you get to choice giving,” Post says, “do it once and be sure that you can follow through on your choices. [Also] be absolutely sure that you’re ready for this.”

Post advises using the word choose or choosing four times and leading with the positive choice first. She provides the following example: A child is walking around the classroom and won’t sit in a seat. First, the teacher sets a limit: “I know you want to walk around, but now is the time to sit in your seat. You can walk around at recess.” If that doesn’t work, the teacher gives the child a choice: “If you choose to sit in your seat right now, you are choosing to use the iPad for five minutes this afternoon. If you choose not to sit down in your seat, you are choosing not to have your iPad this afternoon.”

“Then that’s it,” Post says. “Then that child has to decide.” If the child is still walking around, the teacher says, “Oh, I see you’ve chosen not to have your iPad this afternoon.” The language should always emphasize that the child, not the adult, is the one choosing, Post explains. If the child gets upset, the teacher can say, “Oh, I am sorry you chose not to have your iPad. I would have chosen for you to have your iPad.”

The decisions the child is allowed to have control over will differ based on the developmental age of the child, Post continues. For example, a 3-year-old shouldn’t be allowed to decide if riding a bike alone around the block is a good idea, but the parents could let the child pick out his or her clothes for preschool.

With both limit setting and choice giving, children learn to control their behavior, begin to think of themselves as choice makers, and assume responsibility for their decisions, Post explains.

Phipps agrees. In her example of the boy throwing sand, the aim was not just to get him to stop throwing it and making a mess. It was for him to learn how to make decisions that would work for him in the real world.

Similarly, counselors can help parents view discipline from a completely different perspective — as a means to help children learn how to make decisions for themselves and control their own behavior, Post says. “It’s not to stop a child from doing something in the grocery store right this minute,” she explains. “It is to help a child learn that they make decisions for themselves and that their decisions count.”

Dealing with resistance

Parents who have been court ordered to attend counseling or whose children have been removed from the home because of the parents’ discipline practices are likely to be resistant to therapy, Adkison-Johnson notes. In such situations, counselors first need to confirm that the parents have a right to be angry, she advises. Counselors must also remember that their duty is to the client (the parent or parents), not the agency that made the referral, she says. (See sidebar, below, on the counselor’s role as a witness in court on physical discipline.)

When working with issues related to child discipline in such cases, counselors should prepare themselves to experience the full brunt of clients’ emotions, Adkison-Johnson says. Sometimes, white counselors feel uneasy with African Americans’ emotions, especially when those emotions involve anger, she adds.

“Be comfortable with the resistance. Be comfortable with the anger. Be comfortable with the fact that the client may not want to talk to you,” Adkison-Johnson advises. “They may have short responses at first. Sometimes they may not want to come back [to] the next session, but [they] come back anyway because they have to.”

Adkison-Johnson stresses the importance of counselors addressing these clients formally (unless they indicate otherwise), shaking the parents’ hands, and using their child’s name. These simple actions show respect for the family dynamic of authority, she explains.

The mental health field has a checkered past when it comes to its treatment of racial minorities, so African American families may also have a healthy paranoia that the clinician isn’t really operating in their favor. As a result, counselors must take baby steps to establish trust, Adkison-Johnson says. She advises doing this by acknowledging the parents’ fears and anger and by showing that the counselor is knowledgeable on the topic and understands the depths of the situation. Another important step toward establishing trust, she adds, is clearly explaining informed consent, limits to confidentiality, and clients’ right to remain silent.

Lin’s counseling students conduct free parenting training, and they post flyers to find parents who are interested. Although the parents are participating voluntarily, the training is sometimes recommended to them by their children’s teachers, and this can cause parents to have a bad attitude initially. Sometimes, parents also complain that they are too busy and don’t have time to complete the homework assignments, such as having uninterrupted playtime with their children for 30 minutes once per week. When parents come in with a negative attitude, Lin reminds his students that they must listen and avoid blaming the parents. One of the first skills counselors teach to parents is how to reflect children’s feelings, so counselors must model this behavior themselves, he stresses.

Sometimes, parents’ resistance to counseling stems from personal or cultural differences. When working with immigrant Taiwanese parents who identified as Christian, Lin’s counseling students voiced frustration that the parents were arguing with them about spanking, including quoting Bible verses on why it was appropriate to discipline their children this way. Lin’s advice in such situations is simple: “Never argue with parents. They have their own value system. They have their own beliefs.”

Instead, he advises counselors to focus on providing parents with additional parenting skills such as limit setting. “The more skills [parents] have, the better,” he says. “They don’t want to hold that stick in their hands all the time.”

Raising an adult 

While reading Michelle Obama’s book Becoming, Post found herself nodding in agreement with the parenting philosophy of the former first lady’s mother, who said she was raising adults, not children. According to the former first lady, “Every move she made, I realize now, was buttressed by the quiet confidence that she’d raised us to be adults. Our decisions were on us. It was our life, not hers, and always would be.”

Today, however, parents often assume their children’s responsibilities rather than viewing their role to be raising future adults. This is a tendency that crosses cultures. Lin recounts a saying in Taiwan: “If I give birth to a child and I don’t teach, then it’s my fault as a father.” This saying relies on the inaccurate belief that parents are responsible for their kids’ behavior, he says.

“When [parents] are so out of control in their own emotions when their kids are throwing a fit, usually it’s because they don’t have a clear boundary between themselves and their kids,” Lin says. With CPRT and filial therapy techniques, counselors can teach parents that children need to learn to be responsible for their own actions. This perspective will help parents remain calm and not become so upset if they misbehave, he adds.

Phipps’ belief is that parents are doing the best they can — whether she agrees with all of their parenting decisions or not. “We need to have a humbler approach to parents. … I have to walk humbly with a parent because I’m not walking in their shoes. I don’t experience that [child’s] behavior every single day,” she says. “I am the expert in the skills, but parents are the experts on their children.”

 

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Being a witness in court on physical discipline

According to a 2013 Harris Poll, nearly 8 in 10 Americans believe that spanking children is sometimes appropriate. The question is when does corporal punishment become abuse?

That answer is complicated because it varies by state. The most common approach, used in more than half of states, says that parents may use reasonable force if necessary to maintain discipline.

Counselors may be asked to inform the courts on this distinction. Being an expert witness on child discipline is a pressing issue right now, notes Carla Adkison-Johnson, a licensed professional counselor and a professor in the Department of Counselor Education and Counseling Psychology at Western Michigan University. In fact, much of her work has moved into expert testimony, which involves discussing her research to inform the court whether a parent should be brought up on criminal charges just for spanking their child. She works to inform court judges on how to distinguish between child discipline and child abuse when dealing with families.

As anti-spanking groups gain more political clout, they put pressure on child protective services to carry out their perspective, and this puts families of color at risk, Adkison-Johnson contends. She says that because of racial bias in our society, African American parents are disproportionately brought up on charges of physical abuse related to the child discipline practices they follow. The large majority of her cases as an expert witness have involved African American parents who have had their children removed from the home and who face potential jail time or a felony because they spanked their child.

Adkison-Johnson says that clinicians might also be called to serve in court as “witnesses of fact” (which differs from the role of an expert witness), particularly if they are working with families that have been mandated to attend counseling. In this role, counselors are working directly with the parents to help them but are also being asked to inform the court about the facts of the case. Thus, the questions that counselors ask these parents and the approach they take in counseling the parents are crucial, she stresses. Counselors must find out what parents have done, and they should ask specific questions about the goals and aspirations parents have for their children. This information will help address the “why” and “how” questions when evaluating parents’ disciplinary approach, she explains.

Adkison-Johnson points out that today’s parents often wrestle with establishing healthy boundaries and may have become more lenient in terms of discipline. The current parenting generation has been told not to spank or to use strict discipline with children and has been directed to instead negotiate with children on what the rules will be, she adds.

Counselors may also be asked to write letters on the progress they are making with clients. Adkison-Johnson advises counselors to let clients read these letters before sending them to the outside agency. “See if the client feels comfortable [that it is] an accurate portrayal of how they parent and what they believe took place in the counseling session, and be open to that discussion,” she says. She finds that clients will sometimes remember a detail that the counselor forgot or overlooked.

“Also, let them know that you are their counselor and not an agent for the court or child protective services and that you are committed to them and the success of their family,” she adds.

— Lindsey Phillips

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at consulting@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.