How do I get my kid to sleep in his or her own bed?!

Jan 19, 13 6:21 PM

mom frustrated by depressed daughterFirst I should state that co-sleeping, or kids sleeping in the same bed as their parents, is a culture bound phenomenon that is inherently neither healthy or dysfunctional. So, if you’re from a culture where this is common, and none of the caveats I describe below are in play, no worries. However, there are instances when co-sleeping is symptomatic of an underlying problem. In my experience, the most common of these are marital disturbance, adult loneliness, anxiety–in the child and/or the parent(s)–or some combination of the three. The purpose of this post is to suggest strategies for dealing with situations when you wish for your child to sleep in his/her own room but s/he is freaked out about that (the other problems could be addressed in counseling; you may also find articles pertaining to those topics within this blog site).

Avoidance is rarely an effective strategy for coping with fears that your child has regarding developmentally appropriate activities or situations. As none of we engaged parents are happier than our least happy child, it’s natural for us to support avoiding those (developmentally appropriate activities or situations) that distress our child. But, avoidance is a jealous strategy; the more it is used the more it pulls to be used. Plus, avoidance doesn’t deal with the underlying problem. Keeping in mind that you may need professional and tailored consultation, here are some strategies to try on your own (some of these are merely strategies for promoting sleep hygiene).

• Set up an incentive program for sleeping alone. If your child is younger, or the asian boy looking up white backgroundproblem is a mild one, a star chart may suffice (i.e., each successful night earns a star on a chart). Make it so that that your child earns something s/he desires after so many stars are on the chart. If your child is older, or the problem is more significant, it may be more effective to establish a daily incentive program (i.e., sleeping alone earns the privilege of watching TV the next day). There are multiple possible permutations of this that I review in Chapter Five of my parenting book. However, the bottom line idea is to make it in your child’s best interest, as s/he perceives such, to sleep alone.

• If your child is showing a lot of distress about this, you could use the technique of shaping. With your incentive program in place, let the first phase be a reward for something that is a small step forward from where you are at now (e.g., you lay with your child helping her/him to fall asleep in her/his bed, then leave, for a week; then progress to being in a chair in her room as s/he sleeps; then you are in the hallway, etc.).

child sleeping in bed• Install a nightlight if that comforts your child.

• Allow your child to fall asleep to soothing music or to an audio book of familiar material (you don’t want him/her trying to stay up to hear the next development in the plot line); just make sure it shuts off after a designated time. Alternatively, you could read your child a book. (You could also use shaping for both of these strategies).

• Your child may find a lavender aroma in the room to be soothing.

• A bath or shower before bed can be relaxing and prepare your child for sleep.

• Try to keep your child from consuming caffeinated beverages in the afternoon and evening. A balanced diet is also something that can make a positive contribution to most behavioral problems that kids display.

• Try to ritualize the hour before bedtime (i.e., usually the same procedures followed in the same order).happy jumping black boy, white background

• Having had at least an hour a day of physical activity (i.e., sweating and breathing hard) can facilitate a good night’s sleep.

• Try to avoid intellectually demanding or exciting activities the hour before bedtime.

If these strategies don’t resolve the problem in a short period of time, and in consultation with your child’s pediatrician, it would usually be advisable to seek out the services of a qualified mental health professional. Click here for a referral.

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Don’t Let Parenthood Kill Your Marriage

Jan 11, 13 8:29 PM

man and pregnant woman in disputeResearch indicates that couple satisfaction, over the course of a long-term relationship, is like a U shape. It is higher before couples become parents and after kids leave the home. I speculate this happens because we too often treat our marriages like self-sustaining cacti instead of orchids. In other words, and despite how willful and determined we may be in other areas of our lives, we are often not disciplined in our relationships. So, my fellow parent-spouses/committed partners, here are ten tips for orchid care.

#1. Have a date night each week. Yes, yes, yes, this is tough. So too is getting weekly aerobic exercise. But, there is no being fit without it. And, how difficult is it to live with the long term consequences of not being fit? Nothing says this has to be expensive or even occur outside of the home. It just needs to involve FUN WITHOUT THE KIDS. And, don’t let the babysitting issue stand in your way. Tap relatives, seek out local college girls, ask your pastor/rabbi/iman if s/he can recommend a responsible young woman, trade services with other parents, or medicate your children. (One of the preceding is a joke….can you guess?)

#2. Assume your partner has good motives or has a good reason for doing what s/he does. We get into trouble when we don’t give our partner the benefit of the doubt and privately conclude “he’s selfish,” “she’s cold,” and so forth, when that may not be so. Better to give the benefit of the doubt, assume that your partner has a good reason for showing the unfortunate behavior at hand, and (maybe) talk about it later when you are both calm and reflective.

#3. Vary your sex life. It’s amazing how much sex can become like flossing teeth. Share your fantasies, if only in writing. Get a sex book that list ideas (e.g., watch some videos and act out the scenes, roll play, purchase sexy clothing). Take some risks with your partner in terms of sharing what excites you.

#4. Create separations before going nuclear. We can all feel those moments black couple arguingcoming on when we want to say the most hurtful things because we ourselves are hurt. How many of us have later regretted speaking during such moments? A lot I’m guessing. But, how many of us later regretted creating a separation, calming down, and then dealing with the issue(s) at hand? Not many I’m guessing. You can even agree on a signal with your partner (i.e., once one of you gives the agreed upon signal, all dialogue stops).

#5. Don’t use the “D” word when suffering from transient brain dysfunction. If one or both of you are enraged; or, if one or both of you are highly stressed; or, if one or both of you have been drinking, it is so, so, so, so easy to start threatening a divorce. This is like planning weeds in your orchid’s soil. Over time, they may kill it.

marital communication cartoon#6. Talk about more than division of labor, kid stuff and mundane current events. We can get dead eyes and dead tone with our partners when we don’t open up, share our dreams, share our vulnerabilities and share our existential musings. So, try taking some risks. Click here for a handout   that includes four levels of conversation prompts. (Each level calls for a deeper level of intimacy. Take it easy now. Don’t try to go too deep too fast. One shouldn’t scream at an orchid “flourish!!”)

#7. Learn to speak a foreign language. So often we and our mate express affection and caring differently. If the only signs of affection and caring I recognize are the kinds I’m inclined to offer, I’m likely going to be left concluding negative things about my partner’s feelings or character. Try to recognize your partner’s language and appreciate what s/he is able and willing to give you.

#8. Apologize and make reparation. Over the course of a typical long-term relationship couples hurt each other a lot. Try to be open to how you might have hurt your partner, whether intended or not, whether facilitated by your partner or not, and make a heart felt apology and effort to repair the damage. Sometimes repair might mean fixing what was wronged, or making a kind gesture, or doing some work on yourself to avoid making the mistake again, or something else. And, try to avoid getting caught up in the conditions game (e.g., I’ll apologize only if s/he does too. I’ll make reparation only if s/he meets me halfway). We apologize and make reparation because it is good for our individual wellness and contributes to the health of the orchid, whether a unilateral or a bilateral effort.woman hitting man with pillows

#9. Recognize symptoms of distress and take action to reduce them. Feeling sexual tension and a desire to engage a sexual dalliance with someone besides your partner? Spending a lot of private time feeling some negative emotion towards your partner (e.g., resentment, fear)? Doing a lot of measuring and counting in the relationship? Using the D-word a lot? These are signs of relationship distress and, in my experience, are highly likely to worsen unless you take action to repair the underlying problem(s). And, please, please, please know that affairs are like an icy steel boot slamming down on the orchid; it may survive, but it will be vulnerable in stormy weather. (By the way, illicit sexual tensions, like mushrooms, thrive in the dark. If you want to weaken one, throw some light on it by discussing it with a therapist or a wise confident and put distance between you and the other person…right now.)

marriage counseling characters#10. Seek our relationship counseling when distress can’t be reduced by your own interventions. At the risk of mixing my metaphors, relationships are very mechanical things. Often the engine is sound but the maintenance schedule is wacked. Meeting with a skilled and experienced relationship technician can go a long way to rediscovering just how sound your engine is and that taking it to the scrap heap, or trading it in, is not in your best long-term interest. For a referral click here.

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Avoiding and Responding to Cyberbullying

Jan 5, 13 12:24 PM

cyber bullying Cyberbullying is bullying delivered through an electronic venue. According to the most recent research sited by the Cyberbullying Research Center, 40% of kids report having been a victim of cyberbullying over the course of their lifetime while 20% say they have perpetrated such. Moreover, a 2011 national survey sponsored by the Center for Disease Control found that 16% of high school students reported having been electronically bullied in the past year. The effects of cyberbullying on kids can be devastating. For instance, and according to stopbullying.gov, these can include substance abuse, truancy, school refusal, experiencing in-person bullying, a decline in grades and damage to self-esteem. This entry is designed to give parents six tips for both avoiding and responding to cyberbullying.

To avoid cyberbullying

• Spend one hour a week doing “special time.” This facilitates an open channel of communication about current events. Click here to download a handout on how to do special time. (I also explain the exercise more fully in the first chapter of my parenting book.)

• Put age-appropriate controls on internet technology. For a blog article on some strategies click here (or see Chapter Three in my parenting book).

• Intermittingly monitor your kids online communications. This is a complicated topic that is best summarized by describing the ends of the continuum. Too little monitoring risks leaving your kid walking in mine fields. Too much monitoring risks quashing independence and effective social engagement. It is the shifting middle ground where the most effective parenting strategy resides. Regardless of where you place yourself on this continuum, let your progeny know that you reserve the right to inspect any of his or her hard drives, cell phones, internet pages or electronic storage devices whenever you wish. It is this sense that mom or dad could find out that leaves a kid thinking three times about doing something risky or objectionable.R1

• Ask you child if s/he is aware of examples of cyberbullying, exploring her/his perceptions. You will likely be more effective in making your points if you share your opinions last, affirm what you like about your kid’s perspectives and end your sentences with question marks whenever possible (e.g., “what do you think it would be like to have several people laugh about your looks online?”).

• Promote adaptive and regular social contact with kids who seem to be doing well. Sitting on the fringes of the herd makes a kid more vulnerable to attack. Moreover, kids who are effectively engaged with successful peers are less likely to fall victim to an assortment of maladies.

• Limit access to sedentary electronic pleasures to two hours a day. This is a recommendation of the American Academy of Pediatrics. It makes sense because if a kid is plugged in more than this each day s/he is probably shorting other important developmental needs (e.g., to be physically active, to invest sufficiently in academics).

Responding to cyberbullying

cyberbullying2• Make a plan for involving others. If your child is being bullied decide whether it’s best to approach a trusted school official, the parent(s) of the perpetrator(s), a clergy person, some other relevant trusted adults or a combination of the above. In these discussions consider whether there is value in letting the owner of the electronic venue know about the bullying (i.e., a growing number of states have laws prohibiting this behavior). The goal here is to find the most effective and kind way to have the bullying stop.

• Seriously consider seeking out the services of a qualified mental health professional. Being the victim of bullying can be a symptom of a compromised standing with peers. Moreover, and as I indicated above, being the victim of bullying can be devastating. Also, perpetrators of cyberbullying may likewise be hurting and stand to benefit from mental health services. Seeking out this assistance stands to do a world of good. For a referral, click here.

• Keep an eye open for some of the symptoms indicated above. If you see any, quadruple the importance of the preceding recommendation.

• Let your child know that you have his or her back 100%. This means being an empathic sounding board for painful feelings (which is very difficult to do given how much our kid’s pain hurts us), affirming his or her strengths, and staying active in solving the problem.

• If your child has witnessed cyberbullying, consider with him or her, how to let others (i.e., parents and school officials) know about this. This might range from a direct report to an anonymous note. (Services are also cropping up that allow students to make anonymous reports about bullying. For instance see “Talk About it.”

• If the cyberbullying does not stop after your initial round of interventions, legal booksconsider consulting an attorney and/or law enforcement official. In this scenario I would also do a serious pro-con analysis on eliminating, or seriously restricting, your child’s access to the technology where the cyberbullying is occurring.

If you are interested in learning more about this topic, click on the first two links in this post.

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What Do I Say to My Kids About a High Profile Shooting?

Dec 14, 12 3:31 AM

Many parents are confused about what to say to their children after a story breaks regarding a high profile shooting, This entry addresses  three qualifications, three guidelines and three questions.

Three qualifications:

1.    Most children who were free of psychiatric problems prior to being exposed to a trauma do not develop a psychiatric condition after the exposure. Children can be surprisingly resilient.

2.    Advice from mental health professionals is most effective when it supports and informs, but does not supplant, your intuition. You are one of the world’s leading experts on your child. Suggestions from experts should be filtered through that lens.

3.    Some of the suggestions below would not apply for children who were already demonstrating psychiatric symptoms or who develop such symptoms after learning about this story; for such children it would be best to consult with a mental health professional in order to develop a tailored plan.

Three guidelines:

1.    Let your children know that you are available to talk about this story but do not try to force a conversation. Children are like adults; sometimes we cope by trying to put something out of our mind. Assuming a story upsets your child, he or she might not be in the mood to talk about it at the same time as you. Following your child’s lead can communicate that you are sensitive and respectful.

2.    Try to create a venue and manner that makes it easier for your child to communicate with you. For instance, some older children might find it easier to discuss difficult feelings and thoughts while not making eye contact (e.g., while driving or during a walk) while younger children may communicate through their play. Regardless of the age range, though, it is important to not jump in too quickly with reassurances. Once we parents start self- disclosing, even if for the purpose of being reassuring, it can have a dampening effect on our child’s self-disclosure.

Once your child has finished with his or her initial statements reflect back what you’ve heard and provide empathy (e.g., “I understand why you could feel scared about going to the movies”). This may cause your child to tell you even more. When it seems that your child is finished that would be the time to offer your thoughts and feelings based on the next guideline.

3.    Let your awareness of your child’s developmental level and/or vulnerabilities guide your self-disclosure. No matter your child’s age, it is important to not say things that you do not really believe. Doing so is often ineffective and may damage your credibility. Selective truth telling would seem to be advisable; selective based upon your child’s developmental level and vulnerabilities.

For younger or vulnerable children you may want to only share those thoughts and feelings that are optimistic and positive. For older children, who are also doing well, you may choose to share some thoughts and feelings that are unpleasant. Sometimes life is painful; honestly acknowledging that, with an older child who can handle it, can be educative and facilitate a closer relationship.

Three common questions:

1. What amount of detail should I let my child know about the shooting?

This question is for parents of  preschool through early elementary school years.  (Older children are going to hear about it in one way or another anyway–e.g., TV, radio, social networking, friends–and younger children either wouldn’t understand and/or parents control access to high profile stories.) For this age group, and assuming your child is free of psychiatric symptoms, I would only share a very brief account and use the other guidelines in this entry to guide my approach. I would have three goals by initiating a discussion about this tragedy with my child. First, I would want my child to get their initial account of this story from me. This way if my child hears about it from someone else (e.g., another child) my child already has a frame for listening, instead of being presented with a perspective that I believe is ill informed or ill advised. Second, my job as a parent is to help my child to live effectively in this world which means offering gradual and age-appropriate introductions to its painful aspects. Third, it gives me the opportunity to begin practicing some of the other communication guidelines reviewed in this post, some of which are not easy and take practice (e.g., when our kids hurt we hurt worse, so we share a vulnerability to try to suppress or live in denial regarding our child’s painful feelings).

2. What do I say to my children about our safety?

Much of this will be determined by how you rationally answer this question for yourself. What do you believe are the odds that your family will experience a similar trauma? Once you have answered these questions for yourself, selective truth telling–based on the principles listed above– may be advisable.

3. Is there anything I can do to protect my children from all the fallout?

Any of the following may help:

• Metaphorically speaking: make sure you’re oxygen mask is secure before helping your child. If I am afflicted I will have a more difficult time helping my child.

• Try to maintain functional rituals and routines. Few things give a child a clearer message that life is safe than adaptive routines and rituals (e.g., maintaining the same adaptive routines at meal time, bed time, holidays, birthdays, etc.).

• Keep your child’s developmental level and wellness in mind when deciding how much he or she should have access to ongoing developments about this story in the news.

• Try to turn a sense of passivity into an active plan for healing and helping. Your family may decide to pray for the suffering, make donations, write letters, create art, and join community efforts to heal and to help.

• Maintain a healthy lifestyle for the entire family. This would include things like spending time having fun together each week and maintaining good diets and schedules for physical activity and sleep.

• If you child seems to be having a hard time adjusting, or otherwise has changed for the worse, seek out a professional consultation. Doing so may improve your child’s adjustment. To find a psychologist click here.

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Are Meds Alone Sufficient to Treat My Child’s Psychiatric Symptoms?

Dec 8, 12 11:05 PM

teenandmedicationMany parents wonder about the efficacy of using only medication to treat their child’s psychiatric condition. While a full treatment of this question far exceeds the scope of a blog, it’s possible to briefly summarize some important themes and issues.

Clinical work limited to an initial interview and medication therapy risks misdiagnosis.

This is an example of an evidence-based, cost effective and clinically effective, outpatient evaluation for a child’s or teen’s mental health symptoms (assuming medical causes have been ruled out): a family interview, an interview alone with the youth, the collection of parent, teacher and child behavior rating scales and a review of relevant records. This is complex business and I worry about the accuracy of a diagnostic formulation if one or more of these elements is missing. Moreover, it is possible for a child to improve on a given medication without the child actually having the disorder that the medication is supposedly treating (e.g., low doses of stimulant medication will often improve the concentration of any child, regardless of whether or not that child has ADHD. Of course, sometimes it isn’t possible to do more than a brief interview and a medication trial, but if it’s possible to add the other elements that would probably be advisable in most instances.

Treatment with medication alone is rarely indicated.medication

There are some mental health conditions in youth for which medication treatment will almost always be a part of an evidence-based treatment plan (e.g., ADHD, bipolar disorder, schizophrenia). However, the best designed research studies on these conditions almost always indicates that evidence-based talk therapies (usually behavioral treatments) significantly improves the efficacy of the medication treatment (e.g., decreasing the dosage of medication needed, speeding along the management of the symptoms, strengthening the degree of  improvement, reducing the odds of suicidality). Moreover, in the very large majority of instances, children with a psychiatric diagnosis have at least a second diagnosis as well, and many of these co-occurring conditions are either best treated with evidence-based talk therapy alone or are  better treated when evidence-based talk therapy is added to the treatment plan.

Certain diagnoses, while perhaps improved with medication treatment, may not need such if evidence-based talk therapy is tried first.

teenfamilytherapyFor example, for mild to moderate depressive disorders and anxiety disorders, cognitive-behavioral therapy or other evidence-based treatments (e.g., interpersonal therapy for adolescent depression) may sufficiently manage or heal the presenting symptoms without the need to add medication therapy to the treatment plan. While these treatments take more effort than swallowing a pill, they may be preferred by parents who wish to avoid artificially altering their child’s brain chemistry when talking treatments may do the job as well or better.

There are many instances when the science on medication treatments leaves important questions unanswered.

There are many unanswered questions about the pros and cons of providing childmedicationmedication therapy to very young children as there are regarding the long term consequences of being on the same medication and the degree to which medication treatments alter the development of a youth’s brain. If a child needs medication treatment in order to avoid significant here-and-now impairment, most would agree that such questions often need to take a back seat.  But, if a youth’s symptoms can be effectively treated either by not taking a pharmaceutical, or by taking a lower dose, that would appear to be a preferable choice in many instances.

The short-term conveniences affiliated with medication treatments should give us all pause.

I believe the best available evidence would support the position that effectively moneyandpillsdelivered talk therapies for youth spares money, aggravation and pain over the long run. However, in the short run, talk therapies may offer more hassles (e.g., additional costs and inconveniences) than medication treatments. Moreover, considering only short-term costs may create incentives for decision makers (e.g., insurance companies, clinicians with capitated insurance contracts, hectic parents) to gravitate towards treatment plans that only include medication therapy. Such factors should cause us all to pause and reflect on both the available scientific evidence and issues affiliated with longer term consequences.

A take home point is that it is usually a good idea to have a mental health professional on your child’s treatment team who is aware of the relevant science and clinical practicalities and who can help you to effectively navigate your choices. If you’re interested in speaking with a psychologist more about these matters, please click here.

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Six Tips for Having a Thankful Thanksgiving

Nov 16, 12 6:25 PM

Ever feel like you didn’t get as much out of Thanksgiving as you wanted? Here are six tips to try to have a truly festive, uplifting and rejuvenating turkey day this year.

• Be mindful. The mindfulness movement blends the best of eastern traditions with western science. In short, it involves paying closer attention to the here and now. It’s remarkable how much doing so can promote peaceful feelings. For example, try eating your first few bites of each type of food slowly. Savor the nuances of the tastes. Try also smelling the food and enjoying its aroma. The same goes for beverages.

• Be calm. Try to create some moments when you breathe deeply into your stomach instead of your chest. At the same time try relax your muscles, settle into the furniture and take in what’s around you. Notice the details: the beauty of someone’s hair, the love you feel for someone, a wonderful smile.

• Be thankful. There are so many ways to do this. Write and deliver a gratitude letter. (This can also be done as a family exercise.) Encourage everyone to say something they are thankful for before digging in at mealtime. Let your Higher Power know about that which you are thankful. Try to linger in the glow of such thoughts.

• Be patient. Thanksgiving often produces stress on those responsible for aspects of the day, on relationships that are not peaceful, and on those who may be hurting going into the day. If irritations flare, try to not react in kind. Instead, try to appreciate the human condition explaining the irritation and be soft and gentle, even if it means turning the other cheek. (By the way the psychological wisdom behind the concept of turning the other cheek recently occurred to me. When one doesn’t turn the other cheek, the resulting activity consumes one’s life.)

• Be affirming. Proportionate and specific praise for things you believe can create uplifting moments for both you and the person you are affirming (i.e., instead of keeping such thoughts to yourself). I know when I’m the recipient of such, I try to create ways to remember the moment so that I can unpack it when I’m soul weary.

• Be kind. So often these days don’t go off as planned. Try to be a person who lets everyone know that that’s okay (including yourself) and even to be expected. Problems are like dust mites, they are woven into our existence. (I like the saying: “People make plans and God chuckles.”)  However, if I clench my fists at the heavens and protest why a problem is happening I now must suffer two kinds of pain: the pain imbued within the problem and the pain of my reaction to the problem. It’s remarkable how often kindness works, both towards oneself and towards others.

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Teens Are Going to Have Sex and Drink, You Can’t Control That…Not!

Nov 10, 12 12:41 PM

National survey’s conducted by authoritative bodies have indicated that 40% of high school seniors report having drank alcohol in the past month (National Institute of Drug Abuse, 2012) and that 47% of high school students state that they have had intercourse (Youth Risk Behavior Survey, CDC, 2012). The communality of these behaviors causes some parents to throw in the towel and declare that they can’t be stopped. However, it’s pretty clear that it’s ill advised for teens to use substances and have sex. (What sense does it make to throw a toxin at a brain that is still developing? What sense does it make to allow a teen to engage in the most intimate, and potentially risky, of interpersonal behaviors when that teen isn’t mature enough to live independently?)  As a clinician I see the havoc that can occur when teens have sex and use substances. So, for those of you who are prepared to fight this fight, here are some tips for keeping your teen safe:

#1: Carve out an hour of one-on-one time each week. An open channel of communication makes it more likely you’ll be in the loop. During this time all you should do is listen, affirm (legitimately and proportionally) and express positive sentiments. This free download explains the exercise, as does Chapter One of my parenting book, WPTF. You may also value reading Conversation Starters for You and Your Teenager.

#2: Be open to your teen changing your mind when he or she makes a good argument. Research suggests that teens are more likely to lie to their parents when they believe they can never win an argument, no matter how much they are in the right. I wouldn’t give in for the sake of giving in, but I would be open to being in the wrong and letting your teen know when he or she has made a good point.

#3: If your teen wants to do something, and you’re inclined to say “no,” ask yourself three questions. This thing your teen wants to do: is it physically dangerous? Is it psychologically damaging? Is it too expensive? If the answer to all three is “no” then I’d seriously rethink the “no” as promoting independent decision making is a very important parenting goal.

#4: Try to be the first one to discuss all sexual topics with your child. You don’t want the popular media, other kids or other adults to be the ones to define a certain topic as they may not share your values. This means staying ahead of the curve and starting sex education early. By the way, I wish all teens would read Seductive Delusions: How Everyday People Catch STDs, if only the first chapter on herpes.

#5: I would want to have four questions answered to my satisfaction before my teen leaves my eye-line outside of school: Where are you going? What are you going to be doing? Who are you going to be doing it with? What adult is responsible for monitoring (which can be at a distance, if appropriate)? Judge Judy has a tagline regarding teenagers. She asks, “How do you know when a teen is lying?” Her answer, “When their lips move.” While I doubt Judge Judy means that literally, her point is well made. I’m also becoming increasingly favorable towards technologies that allow parents to track where their teens’ cell phones are. Finally, keep in mind that you are trying to create in your teen’s mind that he or she should think six times about doing something risky because you’re apt to find out.

#6 Maintain open lines of communication with the parents of your teens’ friends. For instance, I know one mom who organized a monthly breakfast where experiences could be shared. And, I wouldn’t let my teen go over another teen’s home unless I felt confident that the adults who lived there shared my ideas about monitoring. (You wouldn’t believe the stories my teen clients tell me about the things they do in homes where adults are present.)

#7: Support the pursuit of your teen’s competencies. Bottom line: a teen who is on display for his or her competencies is less inclined to engage in risky behaviors, has less free time to do so and is associating with teens who are in the same competency boat. (I cover strategies for pursuing this in WPTF.)

#8: Pursue rituals. The bottom line: rituals are a protective shield against life’s slings and arrows. Adaptive rituals also leave less time available for risky behaviors. Two rituals that rock, in terms of being correlated with a plethora of positive outcomes for teens, are family meals and practicing a religion. (See WPTF for more.)

#9: Talk about and model healthy behaviors. Of course, it is way better to be a hypocrite and expect healthy behaviors even when not modeling them, than to throw in the towel.  But, it’s a more effective sell if you walk the talk.

In closing keep in mind that it’s your teen’s job to rail against your efforts (i.e., to promote his or her independence). That’s healthy. Indeed, I might worry a little about a teen who doesn’t push back. They’ll thank you later, though probably not until after you’re dead ;-).

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What To Do When a Crush Dumps Your Teen

Nov 3, 12 12:34 PM

We engaged parents feel like we can be no happier than our least happy child. When our kids hurt, it seems like we hurt worse. Our love is a crazy, over-the-top kind of love that makes us lunatics sometimes. While there are probably important evolutionary benefits to our experiencing love to this degree (i.e., upon reflection of the reality in which we find ourselves as a parent, we might otherwise leave our kids at the hospital ;-), there are also disadvantages, unless we are careful. One such situation is when our kids are hurting. Because of the depth of our love we sometimes try to rush in and make the pain go away in ways that either deprive our kids of important outcomes or damage our relationship with them (e.g., see my entry Failure: An Important Part of a Psychologically Healthy Childhood). This entry is designed to help you to avoid both of the latter when your teenager gets dumped by a significant other.

Tip #1: Limit your first response to listening with empathy. This is the hardest part, listening without trying to make your teen’s pain go away. To be subject to a one-way dumping hurts a lot, especially if it is unexpected, the attachment was a strong one or the relationship was your teen’s first significant romance. As you hear the story you can make empathic comments: “That’s terrible.” “You must feel like your guts are being ripped out.” “I’m so sorry that she is being so unfair.” “It must really hurt that he cheated on you.” Being empathically present as your teen cries and laments, without trying to make the pain go away, is a major gift. It may not feel like it at the time, but it is. (This is often confirmed later by your teen’s expressions of gratitude or by him or her opening up to more to you.)

Tip #2: Try to help your teen get clarity about what he or she wants to do but avoid sounding like your trying to get him or her to do this or that, with one exception. Of course, you will have opinions about best next steps. But, you want your teen to learn to thinks these things through for himself or herself now, when under your care and the stakes are lower (though important), than later, when living on his or her own and the stakes are higher (e.g., should I marry this person?). Maybe the relationship is salvageable, maybe it isn’t. Maybe it’s best to make a closing statement to the other person, maybe it isn’t. Maybe it’s best to seek out an explanation from the other person, maybe it isn’t. You can serve as a sounding board, exploring pros and cons of each choice–including pointing out risks and benefits that your teen might be missing–until clarity descends. The only time it’s usually advisable to give firm but kind directives would be in situations when your teen wants to do something that could be dangerous (e.g., going to the other person’s house at 1 AM in the morning), psychologically damaging (e.g., arranging to declare love over the loudspeaker at school) or unduly expensive (e.g., purchasing an expensive piece of jewelry). Otherwise, it’s usually best to encourage your teen to make his or her own call, even when you might wish for a different choice; in the latter scenarios I’d even say something like “Brandon, that probably would not be the way I’d do it in your shoes, but I think it’s more important that you do the thing that you think is best because you’ll be the one experiencing the consequences. Plus, who knows, I’m just an old fart and you could be right.”

Tip #3: Educate, but only once your teen’s thoughts and feelings have been vetted. Let your teen know that it may take a while to get fully over the pain (e.g., going through the holidays and changes in the seasons will bring up painful memories of closeness with the other person) and that this is okay, it is to be expected and it will pass with time. This is a wonderful time to share your stories along these lines. (Crisis = pain + opportunity. The pain you experienced from being dumped can now be an opportunity in your relationship with your teen.)

Tip #4: Help your teen to focus on maintaining good regiments for diet, sleep and physical activity. Getting dumped can cause the behaviors that support these foundations of your teen’s wellness to go into the tank. So, cheerfully supporting each of these can be very helpful. (See other blog entries for tips on maintaining each of these.)

Tip #5: Encourage pleasurable activities. Such a loss is like being in a sea of pain. Experiences of pleasure, even if muted, can be like a raft while on that sea. Try not to show frustration if your teen rejects many of your offerings but keep them coming at a pace that works for your relationship (i.e., not too often, not too infrequently but just right).

Tip #6: Encourage safe social contact. Your teen may feel like he or she is in an abyss. While that sucks it’s a better to be in the abyss with company than alone. But, the company needs to be patient, understanding and disinclined to be scornful of melancholy. Initially this contact may be best accomplished with family and close, mature friends.

Tip #7: Seek our professional help if your teen is experiencing significant impairment accomplishing primary responsibilities (e.g., academic work), is showing a serious symptom (e.g., wishing God would strike her dead), or has mild to moderate symptoms that aren’t getting better after a couple of weeks (e.g., insomnia). If you’re in doubt, go. And, don’t wait for your teen to agree. (I tell parents “it’s your job to get him into my office. It’s my job to deal with him not wanting to be there.”) For a referral, click here.

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What Can I Do If My Kid Freaks Out About Routine Dental or Pediatric Appointments?

Oct 13, 12 10:18 AM

Trips to the pediatrician and dentist are commonly feared by kids. This fear ranges from mild discomfort to debilitating anxiety. Let me offer six strategies to help:

#1: Avoid unhelpful reassurances. As I’ve written in other entries, a reassurance is a cue that danger is approaching. While parents don’t intend for their reassurance to be heard this way, kids often hear “okay, time to start freaking out.” Think about this for a second. If you were meeting with me in my office and I told you not to be worried about the ceiling collapsing on our heads, you, of course, would start to wonder about the security of my ceiling. Wait until your child shows distress before reassuring, and then keep them brief and proportionate. If they don’t work, as they often don’t, try the other strategies listed below.

#2: Prepare. Confronting fears is like swimming in a cold lake. At the end of the day, it is sustained exposure to the feared object that calms a person down (i.e., one gets used to it).  Some people know this intuitively and are inclined to cannon ball in. But, many prefer to go in slowly, getting used to the water as they go. This is what preparing your child for the appointment is akin to. If you go to Amazon and type in search terms like “kid, dentist” under books, you’ll get a myriad of choices that will allow you to discuss what the medical appointment might be like. You can also get books that generally help with anxiety. My favorite along those lines is the Scaredy Squirrel series by Melanie Watt. (I have the entire series in my office, including a Scaredy Squirrel puppet.) A related technique is to visit the office on a day when your child doesn’t have an appointment, spending time in the waiting area while doing the next strategy.

#3: Relax your child. A relaxed body and anxiety are like oil and water: they can’t mix. So, you can try to train your child to flush anxiety out of his or her body. The three elements to this are breath, muscles and mind. I tend to focus on the first two with kids. I ask kids to pretend that their lungs are in their lower belly, instead of their chest, and to breath deeply, but comfortably, in and out from there. I also ask them to try to make all of their muscles like a cooked, rather than an uncooked, piece of pasta as I walk them through their muscle groups in a soothing voice. There are also resources you can acquire to facilitate your child’s training along these lines. One of my favorites is the relaxation CD that my friend Dr. Mary Alvord and her colleagues have created. Also, and if the cost benefit ration seems worth it, you can acquire a small, portable biofeedback device that can help your child get into a relaxed state; I like the emWave2 for this purpose.

#4: Distract. Once in the office, try to distract your child with something interesting. I was on the sidelines of a baseball game recently when a young girl, who was barefoot, stepped on a wasp. She started crying in terror and pain. I broke out a couple of magic tricks (I keep them with me) and distracted her, reducing both her pain and her anxiety (and delighting her mother). There are an endless number of ways to do this: read a story, play an electronic game, discuss the details of a fun activity coming up that weekend, and so forth. If the medical procedure your child is going to receive allows for this, distract your child during it as well; if it doesn’t, ask if he or she can listen to a portable music player that you provide.

#5: Reward. I wouldn’t do this unless you know that your child is going to struggle. But, if you’re confident that’s the case, tell your child that if he or she is brave, and doesn’t put up a fight, that you will reward him or her afterwards, specifying what the reward will be. Try to keep the reward proportionate to the level of challenge your child is experiencing. So, the reward can be as small as going to ride swings at a local park or as big as a trip to a water park. Then reward, or don’t, based upon how cooperative your child was.

#6: Get help. If these techniques fail please consider consulting with a qualified child mental health professional. Often these kinds of problems can be remedied quickly with treatments that beat having a couple of adults restrain a terrified child. To get a referral near you click here.

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What Do I Say To My Teen When Another Teen Has Committed Suicide?

Sep 29, 12 2:47 PM

Few tragedies make us wonder more about the order of our lives than when a teenager or young adult commits suicide. Sadly, this is too common as suicide is the third leading cause of death among those aged 15-24. Moreover, a recent national survey by the Center for Disease Control indicated that 16% of U.S. high school students report that they think seriously about suicide and half of those state that they have made an attempt.

As we consider this topic we also all do well to keep in mind that there is a risk of contagion whenever a teen commits suicide (e.g., a risk of another teen committing suicide). I’ve never known an adult who intended to glorify suicide. But that can be exactly what happens when a teen suicide is sensationalized or overly memorialized.

With those comments in mind, here are a few tips for approaching your teen about this topic:

• Don’t force a conversation about the suicide, but make it clear you’re interested in discussing your teen’s thoughts and feelings about it if he or she is open to that.

• Let your teen take the lead in the discussion. Try to avoid sharing your perspective until your teen’s thoughts and feelings appear to have been fully vetted. (In my experience this is hard for many of we parents to do).

• Offer empathy in response to whatever your teen says. Empathy to a teen is like a warming sun to a spring tulip: it facilitates more opening up.

Some things to consider offering once it is your turn:

• Let your teen know (or affirm the point if your teen has already made it) that suicide constitutes the worst possible choice a person can make. There is nothing about suicide that is worthy of glory, reinforcement, romanticizing or undue attention. It is a tragic and terrible behavior engaged in by people who are experiencing overwhelming pain and/or confusion.

• Ask your teen if he or she has ever thought about hurting himself or herself. (It’s a myth that asking this question, by itself, will promote or worsen suicidal thinking or behavior.) If he or she states that he or she is thinking about committing suicide arrange for an immediate evaluation by a qualified mental health professional (you can call the emergency services unit of your local community mental health center or take your teen to your local emergency room).

• Consider asking your teen what he or she thinks it would be like for you if he or she ever committed suicide. Then, either agree with what he or she has said or share more. This would also be a good time to reaffirm your deep love for your teen and the specific things that your teen says or does that you value.

• If your child knew the teen who committed suicide let him or her know that a grieving response is normal and expected. The balance is to give those thoughts and feelings the time and space they need while also trying to live life as normally as possible.

• If your child knew the teen who committed suicide stress that there is no way to know the causes of that particular teen’s suicide. Very little insight can usually be gleaned from the circumstances of the teen’s life (e.g., the degree of academic success, how much cohesion appears to be in the family, etc.). As a psychotherapist my clients usually let me in to very private and hidden areas of their lives; however, even I do not often know every important factor that causes them to behave in a particular way.

• Let your teen know that you will arrange for him or her to speak privately with a qualified mental health professional about these issues if he or she would like that.

There are many preventative strategies Here I will share three (I am more thorough about this in my parenting book):

√ Spend at least one hour a week doing special time with your teen. A regular line of communication makes it more likely you’ll be in the loop if your teen’s mood darkens. Click here for a download on how to do this weekly exercise.

√ Do all that you can to make sure that your teen has identified his or her competencies and is manifesting them in the world.

√ Try to ensure that your teen is sleeping at least 8.5-9.5 hours a night, is eating a balanced diet that limits processed carbohydrates and sweats and breathes hard an hour 5-7 days a week.

In closing, if your teen is showing signs of mental health disturbance, please err on the side of caution and arrange for a qualified mental health professional to do an evaluation, even if your teen is opposed to the idea. For a referral, click here.

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