Is your child’s therapist listening to you?

Is your child’s therapist listening to you?
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 True story:

After a lengthy 2-hour session and a series of questions asked of both mother and teenaged son, the psychiatrist wrote:  “the mother is over exaggerating her son’s behavior.  He can’t possibly have all the symptoms she describes.”  Later, the mother said, “I was completely ignored; this doctor affirmed [my son’s] disrespect for me, in front of me, and [my son] got the idea I was full of it and didn’t need to take his meds.”  She felt her authority had been undermined, and that she lost an opportunity to get treatment for her son sooner.  He was eventually diagnosed with schizophrenia, and hospitalized several times.

 

What makes this situation tragic, to me, is that early medication, prior to the first psychotic break, prevents the loss of gray matter that occurs in schizophrenia.  This doctor’s unprofessional and judgmental behavior hurt the recovery prospects for this family.  And sadly, this kind of dismissal of parents is common.  I’ve heard many complain that doctors, therapists, or teachers don’t listen to them, or that they subtly or overtly blame parents for their child’s problems.  Researchers found this to be widely true.  In an article titled “Uncharted Waters – The Experience of Parents of Young People with Mental Health Problems,” the author writes:

 

“Parents’ distress is exacerbated by their need for expertise, but from those who don’t take their concerns seriously.”

Harden, J, 2005. Qualitative Health Research, 15(2), 207-223.

 

I always appeared to be overly upset and stressed whenever I brought my child to see her psychiatrist because, leading up to any appointment, were a series of challenges and acts of resistance that were stressful and frustrating.  It appeared to the psychiatrist, time and time again, that I was the problem… just like she suspected.  All I could do was sit in the waiting room while my daughter was in session, and imagine she was saying terrible things about me.  All I could do was wonder if the psychiatrist could see through it all and know that I, the mom, was doing everything possible to help my daughter, that I was a good parent. Could the doctor see this and give me some hope?

 

Don’t accept being treated this way.

 

Insist that the whole family get time with the therapist, without the troubled child or teen, to check-in and see how everyone is doing.  Make the appointment and tell the therapist why.  Your family needs to say things they wouldn’t ordinarily say when the child is around.  They need to open up secrets and let out difficult feelings without the fear of setting off an explosion later.  The therapist should be astute enough to get the full story, and use this as an opportunity to help the family work through challenges in ways that support everyone’s well being.

 

Insist on being told what to expect.  Another common experience is that parents are not told what to expect from treatment or why.  You need to know everything they know, even if the professionals are still unclear about a diagnosis or treatment approach.  Your child may have many physiological or psychological tests, expensive medications, or visits to many different kinds of ‘ologists’, and you may still not be clear on where the inquiry is going, why, and what the doctors or therapists are looking for.

 

Insist that they consider your daily experiences.  Since a therapist observes your child only during an appointment, they aren’t fully aware of the types of situations that aggravate your child’s behavior.  You are the expert on your child and their behavior patterns; you are the expert on what drives them, and on what drives them crazy.  You know that, behind-the-scenes, much of what your child does is easily missed by a psychologist, psychiatrist, or therapist.  An experienced professional will listen to you and ask more questions.  You should expect them to seek clarity on your child instead of assuming they already know everything about them and your family.

 

Team up.  It takes both you and the professional working together to comprehend your child’ nature and arrive at a working diagnosis and treatment that works.  Develop a partnership and a shared vision with the therapist so you can, together, do what’s best for your child.  And don’t forget, since you have all the responsibilities, your needs must always be considered in spite of what a therapist thinks is best.  If your family is not included, then it’s not the best.

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What to do when you’re blamed for your child’s behavior

What to do when you’re blamed for your child’s behavior
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Our sick kids deserve compassion too

Our sick kids deserve compassion too

I have yet to meet one family with a troubled child that has not felt blamed or judged by close people in their lives:  best friends, family members, a religious community, co-workers, even medical and mental health providers.  Nothing could be more wrong or more hurtful to the family’s well being.  Blame adds emotional burdens on top of what they already face, and can undermine an already shaky hope and faith. 

 

Parents like us are aware that many people are not comfortable around a child with bizarre or extreme behaviors, like our child.  We understand this.  After all, who else knows more about the stress they create?  But it is unacceptable to be blamed or judged by others on our parenting, our character, our child, and/or presumed to be abusing our child.  This is simply not true for the overwhelming majority of families with troubled children.

 

These are some things that have helped caregivers cope with, and overcome, the debilitating effect of judgment and blame.

 

First, resist defending yourself; it will only attract more unwanted attention and disagreement.  You don’t have the time or emotional energy to teach someone who resists and challenges everything you say with countless questions and misinformation.  Avoid people like this (even friends and family!).

 

Second, actively seek out supportive people who take the time to listen, just listen.  You need as large as possible a network of compassionate people around you.  Stop and think about this, you have many around you already.  They may be waiting in the wings, at a polite distance so as not to interfere or add to your stress.  If you think you can trust someone, ask them to be your friend.  You will be surprised at how many people are out there who have a loved one with a mental or emotional disorder, and how many are willing to help because they completely understand what you’re going through.

 

Third, politely and assertively say thanks but no thanks.  If judgmental people ask why you haven’t contacted them or returned calls, tell the truth, also without blame or judgment.  “Our situation is not good, but we are getting the best professional help, and we have been pulling back to take care of ourselves.  Thanks for showing interest, and thanks for your understanding and for giving us space.”  No apologies.

 

There is a curious phenomenon where craziness seems to attract “crazy” people.  You must block them from your life.  They might be obsessed with a religious, medical, or philosophical belief and want to make your child’s life their cause.  If this happens to you, don’t hesitate to end contact with anyone that wants to entangle themselves in your lives without your permission.  You are never responsible for meeting another’s needs or fitting their beliefs!

 

I once had a co-worker who had strong feelings about “natural” health care, who offered a steady stream of articles and comments about what could help my child.  I had to firmly insist that if she could find one piece of research proving that her preferred treatments helped even one person with schizophrenia, then I would listen.  This ended the unsolicited advice. 

 

Fourth, be prepared to grieve lost connections.

 

A single mother with a 16-year-old daughter sought help in a support group:  “Can someone help me?  I need someone to call my sister or mother and tell them that I and [my daughter] are not criminals or sickos.  They’ve stopped calling, they refuse to have us over or visit for Thanksgiving and Christmas, and I just want someone else to tell them that she’s fine now because she’s taking meds, and that her behavior is not her fault or my fault.”

 

Let go of those who blame, and move forward with your priorities.  Very often, they eventually turn around and make an effort to understand.  Many really do change and apologize for their insensitivity. I’ve experienced this and observed this, but it is not your job to make this happen.

 

Your criteria for friendship will change.  You will find out who your real friends are, and they may not be family members or current friends.  Real friends let you talk about feelings without judgment or advice, they are always around to listen, they help out with little things:  go out for coffee; call to check in on you; or watch your other kids in a crisis.  They may be people you never felt close to before but who have reached out to you with compassion.  Accept their help.  Don’t be too private or too proud to accept the offer of support.  Someday, after you have turned your family’s life around, find another family who needs your support.  Make a promise to help others in need, and to give back to the universe.

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You CAN get your power back and reduce your child’s backlash.

You CAN get your power back and reduce your child’s backlash.
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If you have lost control of your child or your household (like the rest of us!), you know how hard it is to get it back.  Each time you try to enforce a rule, it’s ignored or your child creates such a backlash that it feels pointless.  Who wants to invite more stress in their lives?  Who wouldn’t give up and just learn to get by and muddle through?

 

But you CAN face that backlash AND get your power back.  This seems counterintuitive, but the more your child fights back, the more you recover your authority, and the more you will be able to bring order in the home.  BRING IT ON.  Fighting back against new rules and boundaries is a normal psychological response that is called an “extinction burst.”  We all do this.  It has been measured through behavioral observations of people of all ages and has nothing to do with troubled behavior.  The term “extinction burst” is even used by dog trainers to describe a phase of training!

 

Psychological studies show that this negative and extreme response, or the extinction burst, peaks at the first few attempts to enforce a rule or set a boundary.  Then it falls off quickly.  If you can stick it out emotionally, you will see the backlash extremes decrease over time, and the episodes become fewer and farther between.  Little by little, simple rules will be followed, or they’ll be followed most of the time (you will always be tested).  But by this point, enforcement becomes easier.

 

For explosive and aggressive children, it can be scary or dangerous to be a on the receiving end because you know about the potential for violence and harm.  If you can plan for this ahead of time and recruit loyal help for the inevitable emergencies, and if you can stick it out emotionally, you will see the backlash extremes decrease over time, and the episodes become fewer and farther between.  It works, but one must be like a rock and have that support.

 

Run a tight ship at home, but only have a few hard-and-fast rules, maybe 2 or 3, as this is easier to enforce.  Pick the rules carefully because they need to make sense and feel fair to everyone, and they need to be about safety and family unity, examples:  we will eat every dinner together as a family; curfew is 8 pm; if there is any outburst, the person must stay in their room for one hour…  Rules should be few, fair, and strictly enforced.  The first two make the last one easier.

 

You may be surprised how relieved everyone will be after living through chaos for so long!  When I put on my armor and set about getting my power back, it was exhausting and stressful.  But I got more respect the more I was in control.  Consistent order brings a sense of security and safety, but use common sense and be flexible, set aside some rules temporarily if your child is in crisis or the family is too stressed at the moment.  Be very strict on only a few critical things, for example:  have zero tolerance for violence against others (and pets).

You are the king or queen of your home, it is not a democracy.  Make reasonable fair rules, enforce the rules with an iron hand at first, and then relax bit by bit, and live in a peaceable kingdom.

ALWAYS protect with respect and love
ALWAYS protect with respect and love

 

 

 

 

 

 

 

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When parents disagree on discipline

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Your primary relationship comes first

Stress can affect the most solid relationships. Families like yours, with a troubled child, have a higher divorce rate than the general population, 50% higher. Coping with your child will bring out any and all relationship issues that may have been manageable under normal circumstances. If your relationship is falling apart, and it was mostly healthy before this period of stress, then it must be a priority over the child for now. Get counseling, if not together than singly. Or ask for help from supportive friends–prayers, cheerleading, or the opportunity to vent. Partners must stand by each other and present a solid front as the family leaders. This is just as important for your child as it is for you. Let this draw you closer together rather than pull you apart.

Stand strong, shoulder-to-shoulder

When you disagree, together make a list of the things you agree on and worry about the disagreements later. This list should include:

  • Focus on your respective strong points.  Each make a list strengths of the other.
  • Never argue in front of the children (or, make a rule for how and where to argue).  This creates many problems that worsen your child’s behavior.  Stress is obvious.  But what about kids who manipulate their parents to get their way with something?  What about those that thrive on chaos?
  • An agreed-upon role for each parent, which is something that they’re good at.  When one parent is competent at handling a specific challenge, the other steps back, and vice versa.
  • Take turns managing the household for a period while the other takes a break.
  • Set aside personal feelings temporarily to co-manage one specific little problem at a time, a problem you both agree on.

Have each other’s back

A true story with names changed: Susan and her daughter Pam were constantly fighting over who hurt who the most by what each said. Jason, the husband and father, was frustrated by these conflicts, but avoided interfering because he knew he’d upset both his wife and daughter. Yet Jason was always able to calm Pam down quickly because their relationship was different. One day, Jason took his wife aside and asked that they try something. He suggested that Susan step back from certain daily interactions with Pam, those which always ended in fights, and let him do the communicating. Susan did not like the idea that Pam had “won” by getting all of her dad’s attention, nor did she like the implication she couldn’t handle their daughter! But Jason came up with idea that if he saw Susan and Pam slipping into a fight, he would use a code phrase, like “Hey dear, can you help me find the _____?”, and Susan would catch herself, save face by stepping out to look for the ____, and let Dad take over. This worked wonders rather quickly. Nothing was ever discussed openly, but after a few weeks, both mother and daughter started to catch themselves starting a fight, and one or both would find some reason to step away from the situation.

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Help your child or teen ‘recover’ from a disorder or addiction

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What recovery looks like – A person with a mental or emotional disorder who is in “recovery” lives a normal life and aren’t affected by their disorder.  They look and act normal.  At the least, they have stable relationships, a steady job, a place to live, a regular diet, cleanliness, and regular mental health check-ins.  Recovery is maintained when the person pays attention to themselves to notice if the symptoms are starting, and then takes action to stop the symptoms.

Recovery is like the alcoholic who stops drinking–they still have an addiction, but they stop using.

What your child will need to sustain recovery as an adult:

INSIGHT  +  STABILITY  +  RESILIENCE

INSIGHT– self awareness

Insight allows a child to recognize they have a problem, and choose to act to avoid the problem.  If insight is not possible, they need a toolbox of options that help them to respond appropriately, instead of reacting to chaotic messages in their brain. Knowing and admitting they have a problem, or knowing techniques for avoiding problems, are very powerful skills they need as adults.

STABILITY – fewer falls or softer falls

Your child is like a boat that’s easier to tip over than most other boats; any little wave will capsize them, and everyday life is full of waves, big and small.  Your job is to notice when the troubled child is starting to capsize and show them how to right the boat, or if that doesn’t work, how to use the lifesaver.  Eventually, your child will learn how to sense when trouble is coming on, avoid the thing that causes problems, and ask others for help.  Sense it.  Avoid it.  Ask for Help.

RESILIENCE – bounce back when they fall

Troubled children have a much harder time bouncing back from problems.  They have extreme responses to simple disappointments like breaking a toy, or poor grades, or something as serious as the parents’ divorce.  Some even fall apart in joyous times because the emotional energy is too much!  You must be acutely aware of this–they will not get back on track by themselves.  Don’t worry that helping them will spoil them or “enable” them.  Eventually they will learn from you how you do it.

“…We are all born with an innate capacity for resilience, by which we are able to develop social competence, problem-solving skills, a critical consciousness, autonomy, and a sense of purpose.”

“Several research studies followed individuals over the course of a lifespan and consistently documented that between half and two-thirds of children growing up in families with mentally ill, alcoholic, abusive, or criminally involved parents, or in poverty-stricken or war-torn communities, do overcome the odds and turn a life trajectory of risk into one that manifests “resilience,” the term used to describe a set of qualities that foster a process of successful adaptation and transformation despite risk and adversity…”   http://www.athealth.com

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Your troubled child’s “recovery”–how you help them achieve it

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What recovery looks like – A person with a mental or emotional disorder who is in “recovery” can look and act like anyone else.  At the least, they have stable relationships, a steady job, a place to live, a regular diet, cleanliness, and regular mental health check-ins.  Recovery is maintained when the person pays attention to themselves to notice if the symptoms are starting, and then takes action to stop the symptoms.

What your child will need to sustain recovery as an adult:

INSIGHT  +  STABILITY  +  RESILIENCE

INSIGHT– self awareness

Insight allows a child to recognize they have a problem, and choose to act to avoid the problem.  If insight is not possible, they need a toolbox of options that help them to respond appropriately, instead of reacting to chaotic messages in their brain. Knowing and admitting they have a problem, or knowing techniques for avoiding problems, are very powerful skills they need as adults.

STABILITY – fewer falls or softer falls

Your child is like a boat that’s easier to tip over than most other boats; any little wave will capsize them, and everyday life is full of waves, big and small.  Your job is to notice when the troubled child is starting to capsize and show them how to right the boat, or if that doesn’t work, how to use the lifesaver.  Eventually, your child will learn how to sense when trouble is coming on, avoid the thing that causes problems, and ask others for help.  Sense it.  Avoid it.  Ask for Help.

RESILIENCE – bounce back when they fall

Troubled children have a much harder time bouncing back from problems.  They have extreme responses to simple disappointments like breaking a toy, or poor grades, or something as serious as the parents’ divorce.  Some even fall apart in joyous times because the emotional energy is too much!  You must be acutely aware of this–they will not get back on track by themselves.  Don’t worry that helping them will spoil them or “enable” them.  Eventually they will learn from you how you do it.

“…We are all born with an innate capacity for resilience, by which we are able to develop social competence, problem-solving skills, a critical consciousness, autonomy, and a sense of purpose.”

     “Several research studies followed individuals over the course of a lifespan and consistently documented that between half and two-thirds of children growing up in families with mentally ill, alcoholic, abusive, or criminally involved parents, or in poverty-stricken or war-torn communities, do overcome the odds and turn a life trajectory of risk into one that manifests “resilience,” the term used to describe a set of qualities that foster a process of successful adaptation and transformation despite risk and adversity…”   http://www.athealth.com

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Are you trying to reason with an irrational child?

Are you trying to reason with an irrational child?
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I regularly talk with parents with children with a brain disorder and a history of serious behavior problems.  Sometimes I meet a parent who is truly at the end of their rope and has to talk to someone.  The parent is exasperated by their child’s relentless acting out, and utterly exhausted by trying to contain their behaviors.

They plead for answers: “Why does he keep doing this?, or, ” Why doesn’t she stop after I’ve explained things over and over.”  Then they answer their own questions:  “It’s because he always wants his way,” or, “She’s doing this to get back at me.”

The parent then lists all the ways they’ve tried reasoning with their child, and/or disciplining with consequences.  As they tell their story, they continue to ask questions and provide answers, going around and around and around:  “He does this just to make me mad;”  “She manipulates the situation because she wants more (something) and I won’t give it to her.”  What’s interesting to me is that these children can be quite young (4 or 5), too young to expect reasoning in the first place, or they can be young adults (early 20′s) who have a long track record of doing things that don’t make sense.

If saying something a 1000 times hasn’t worked, why would 1001 times?

A lot of parents’ stress and frustration can quickly vanish the moment they realize and accept that their child is not ready to consistently reason nor consistently control their behaviors.  They are irrational, but it’s not their fault or the parent’s fault. Irrationality is the hallmark of brain-based problems, and chronically challenging behaviors are the evidence.  If you feel you have run into brick walls over and over again, and your child is not learning what you’re teaching, do both of yourselves a favor and stop trying the same things that still don’t work.  Stop assuming that if you say something a thousand times they’ll finally get it, and stop the paranoid assumptions that your child or teen has some evil plan to get back at you.

When you find yourself trying to reason with the unreasoning, step back and calm yourself, and ask what your child needs in the moment.  Then change your whole approach.  Try different ways of communicating, such as softening your tone of voice.  Pay attention to whether they respond best to words or images, and use what works most naturally for them.  Try using touch to communicate, or withdrawing touch if that’s threatening to them.  Post polite signs in the house as reminders for things they need remember every day.  Show your child or teen how to do something instead of telling them how.  Avoid explaining how their behavior will hurt them in the future.  Children and teens often cannot track how pushing one domino leads to all the dominos falling.

If you’ve nagged and harped and chided your child, forgive yourself.  It’s normal.  You are still a good parent who wants the best for your son or daughter.  Over the many years I’ve facilitated parent support groups, I’ve heard so many regret how they’ve treated their child once they begin to understand that it won’t work.  You are not alone.  Raising a child like yours is tough, but you’ll move on and figure things out.  Keep trying.

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Mental illness more deadly than cancer for teens, young adults

Mental illness more deadly than cancer for teens, young adults
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Why isn’t everyone more upset?  A disease is killing our children and it’s worse than cancer and leukemia.  Why is pychiatric research 30-40 years behind cancer, as well as the development of pharmaceuticals and other treatment modalities?

We don’t get casseroles when our child is hospitalized for a mental health crisis

Out of curiosity, I did some research on child mortality rates from various causes, because I wanted to know how death from mental illnesses compared with other fatal illnesses of childhood and adolescence. The results were astonishing, unexpected, and disturbing.

Childhood Illness Age Range Annual Deaths per 100,000 Children
Cancers, leukemia: 5-14 yrs 2.6
Cancers, leukemia: 15-19 yrs 3.6
Childhood diabetes: Avg. 15 yrs 2.2
Anorexia: 15 – 24 years 6
Suicide ** 10 – 14 years 1.6
Suicide ** 15 – 19 years 9.5
Suicide ** 20 – 24 years 13.6

(The chart columns are in the order listed in the box, somehow I couldn’t get the right grays!)

* The starting point for the data on the medical illnesses was the website for the Center for Disease Control and Prevention www.cdcp.gov  in Atlanta; the starting point for the mental illnesses was the website for the National Institute for Mental Health, www.nimh.gov.

** The suicide data was from those with depression, bipolar disorder, schizophrenia, and psychotic disorders-unspecified.  (Suicide from other mental health causes, such as borderline personality disorder and co-morbid substance abuse, is also prevalent but I could not find data for young adults.)

This screams out for a changes in attitude, policy, and investment in children’s mental health treatment!  I had no idea that death rates from mental illness were 3 to 4 times higher than the feared cancers and leukemias.  It is imperative that young people with mental health issues receive aggressive and sensitive treatment as would be expected and demanded of medical doctors treating cancer.

The data was difficult to find, requiring searches in many different medical journals and numerous articles, as nothing like it was compiled in one place.  I chose to use the cancer, leukemia, and diabetes data because deaths from all other causes were insignificant by comparison.  The death rates for cancer and leukemia are averages for the different forms of each, and in the journals they were presented together.

I welcome additions or corrections of this data from any other sources, and encourage readers to investigate this for themselves.

 

How am I doing?  Please “like” this post if you found it useful, thank you.

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Filed under bipolar disorder, borderline personality disorder, depression, mental illness, mental illness, parenting, psychiatry, schizoaffective disorder, schizophrenia, suicide, teenagers