Parent-Child ACTChris McCurry, Ph.D.
ABCD, Inc. Seattle, [email protected]
Disclosure
The presenter has a pitifully small financial interest in two books in
the bibliography
Objectives Participants will learn how ACT theory and
concepts help clinicians understand typical child development and important parent-child transactions
Case presentations will describe, from an ACT perspective, presenting problems commonly seen in child clinical practice
Research-informed strategies and techniques for improving child and parent functioning will be demonstrated
The Referral Path Children rarely refer themselves
Who owns the problem- The child? One parent or the other? The pediatrician? A teacher? A grandparent?
Relates to values and goals
The Hairball Model of Psychopathology
We need an understanding of
“Me? I thought you were raising them.”
Attachment Between about 6 months and 1
year of age a child will develop certain behaviors in response to the absence of the caregiver or the presence of a threat
These behaviors will coalesce into a predictable pattern marked by general distress, signaling, withdrawal or proximity seeking
Attachment Depending on the caregiver’s response,
a child may reliably obtain relief or not
A child’s “distress behaviors”, shaped by the parenting environment, will be subtle or dramatic, clear or ambiguous
Internal Working Models of how the world operates (safe or threatening, helpful or unhelpful) will develop
“Individuals whose needs for security are not met come to
view the world as comfortless and
unpredictable, and they respond either by shrinking from it or doing battle with
it”
John Bowlby
In Other Words
Avoidanceor
Control
Cognitive Development:Born Fused and Inflexible
Egocentric
Idiosyncratic / Magical
Literal (psychic equivalence)
Rigid
Binary
Fusion (internal and external)
Under stress, they (we) will
regress
A Common Process: The Distress Gambit
A child’s distressed behavior invites (compels) the caregiver to
participate in the distress as a witness, confidante, cheerleader, task master, lifeguard, or most
commonly, as a rescuer
The Distress Agenda
The child’s behaviors are an effort to engage the caregiver in the dance, in order to achieve …
Emotional Avoidance utilizing …
Escape/Avoidance Attempts at Control
Fear is meant to feel bad!!!
MomRescue
“Good”
Cry
“Mom”
Job
Mother
Yell
Spouse
GuiltStressMore
Stress
Danger!!
The Limits of Parent Training
Parent Management Training (skill building) has been shown to be helpful, but parent and child may have reverted to old patterns at follow-up
High stress families are most vulnerable to this erosion positive behavior change
Stress is known to constrict attention and enhance a negative attentional bias
The Parent-Child Ecosystem Parenting is a large and diverse
class of behaviors embedded within a larger ecosystem or “field”
Parenting behavior is influenced by distal, indirect, unhelpful, and (dare I say) unconscious factors- Setting Events
“It’s a magic potion that makes everything you say interesting”
The Reactive Dance1. Child becomes distressed (and regressed)
2. Child, seeking rescue, acts out his distress in dramatic, regressed, or confusing ways
3. Parent becomes distressed (and regressed)
4. Parent seeks escape from this situation
5. The immediate goal for both parent and child becomes escape or control in the present, avoidance in the future
Mutual Parent-Child Experiential Avoidance
Held in place by negative reinforcement, also known
as “the coercion trap”
Tolerance Inconsistent parenting leads to increases in
negative child behavior
Inconsistent parenting is often due to the parent’s behavior falling under the control of distal setting events, typically life stressors
Basic parent “leaning in” and “leaning back” must be under the control of the child’s behavior and what the current situation actually calls for
Team Captains
A Responsive Dance1. Child becomes distressed, regressed
2. Child acts out; seeks contact, communication, rescue
3. Parent is alert to becoming distressed, regressed
4. Parent models distress tolerance
5. Parent acknowledges distress with specific language and connects to cause
6. Parent orients child to the original goal, to a solution, or to appropriate coping strategies
Changing The Dance
1. Increase awareness
2. Shift the focus of attention
3. Take values-driven action
Increasing Awareness
Classic Definitions of Mindfulness
Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally
Bringing one’s complete attention to the present experience on a moment-to-moment basis
More “Active” Definitions of Mindfulness
Mindfulness Exercises Observing the breath Eating Listening Smell Touch Seeing Descriptions v. Judgments Taking your mind for a walk
S.O.B.E.R. Stop Observe Breathe Expand Respond
S.O.R.B.E.T. Stop Observe Relax Breathe Expand Teach
Graybar’s First Law of Human Behavior
“All behavior is a message, and a behavior won’t begin to change until the person
knows the message has been received”
Validation Closes the communication loop:
“message received” Provides accurate and nuanced
emotional vocabulary Replaces ineffective reassurance
in many situations Says nothing of the
“appropriateness” of that thought or feeling at the time
Validation Promotes mentalizing and
undermines fusion and psychic equivalence
Links outer events with private events and the wanna-do’s
Articulates the process; both currently and what’s possible
Validation Strategies
Simple and specific “Ah” statements; “Ah, you’re feeling …” “You’re having one of those ‘I can’t do it’ ideas
now”
Identify expectations; “You thought there would be popsicles” “Ah, you want me to carry you now”
“I wonder” statements
Shifting the Focus of Attention
Shift attention from unhelpful private events to actionable goals
Breathing and orienting to an “affect neutral” stimulus as a “pivotal response”
The Role of Attention
Isabelle
7-year old female
Diagnosed with Separation Anxiety D/O and phobias: the word “Zombie”
Can’t be alone in any room of the house: “Marco Polo”
Lots of avoidance or trying to control situations
Mother, Holly, is the primary “dance partner”
Isabelle and Holly’s Dance The Situation: Any transition or anticipated separation
Setting Events: Holly’s work stress, other children
The Initial Behavior: Resistance and inertia from Isabelle, then focuses on some stimulus that evokes a pantrum
Holly’s reaction: Cajoling, reassuring, then pleading, then yelling/threatening
And then...? Holly may angrily physically guide Isabelle through the transition or Holly may acquiesce to Isabelle’s implicit demands
For Isabelle’s Mother
Child Directed Play
Dictionary.comEnglish Portuguese
Dictionary.comEnglish
“I’m scared”
“It’s not fair”
“I’m a loser”
“I’m a loser”
Portuguese
“Tenho medo”
“Não é justo”
“Eu sou um perdedor”
Swahili
“Mimi nina loser”
Dictionary.com
English German
Sterling
Sterling and Alistair’s Dance The Situation: Getting homework started and completed
Setting Events: Alistair’s own history with school, plus marital stress
Initial behavior: Sterling’s avoidance, arguing that homework is irrelevant to his future
Alistair’s reaction: Argues, debates, throws up hands and leaves
And then…? Sterling’s mother steps in and helps Sterling complete the work step-by-step
Projective Identification or The Hot Potato: “He who
cares least has the most power”
Rule-Governed Behavior “Behavior that is controlled by verbal
specification of contingencies rather than by direct contact with contingencies”
Enormously helpful: “Don’t eat those, they’re poisonous”
And, behavior based on rules tends to be insensitive to feedback from the environment: e.g., buying lottery tickets
“And then it hit me: I’m salivating over a bell”
Defusion Exercises
Naming and cataloging
Emotional vocabulary
Boats on a river
Matt Smith
Common Categories of Private Events
Sterling
“Scorekeeping”
Frustration
Impatience
Worry
Alistair
Impatience
Frustration
Worry
Regret
Emotional Vocabulary Angry
Annoyed
Frustrated
Belligerent
Indignant
Dudgeon
Defusion Exercises
Naming and cataloging
Emotional vocabulary
Boats on a river
Matt Smith
Matt Smith is a big, fat idiot.
OKOK
“Homework is irrelevant and stupid”
OKOK
“It’s not fair”OKOK
“This kid will never learn”
OKOK
Taking Values-Driven Action
Orienting away from avoidance and control of thoughts and feelings and toward the goal
“Oh, yeah. What were we trying to accomplish before all this commentary showed up?”
“When you’re going through Hell, keep going!”
Willingness vs “wantingness”
Commitment
A pledge or promise: obligation
The act of committing, pledging, or engaging oneself
The motivational story we tell ourselves
The choice to limit our choices
Commitment and Acceptance: Two Sides of the Same Coin
Effort, Frustration, Sacrifice,
Thoughtfulness
To Be A Good
Team-mate
Commitment and Acceptance: Two Sides of the Same Coin
Effort, Frustration, Sacrifice,
Thoughtfulness
To Be A Good
Student
Commitment and Acceptance: Two Sides of the Same Coin
Effort, Frustration, Sacrifice,
Thoughtfulness
To Be A Good
Brother
Commitment and Acceptance: Two Sides of the Same Coin
?????
To Be A Good Parent
More Defusion Exercises
Passengers on the bus
Goggles
Fiona 15-year old female Anxiety by Hx- now emerging
depression; low mood, low energy, anhedonia
Starting to “try out” cutting Somatic: stomach aches, migraines Lots of school absences Comprehensive avoidance/paralysis
around school work Few friends
Fiona’s Family
Strategies For Fiona and Parents Facilitated Listening
Contingency and Sensitivity
Tolerance
Chess Board
Choices and Decisions
The Distraction Paradox Valued Living Questionnaire
(behavioral activation and parent-daughter time)
Acceptance
“Be equal to your fate”I Ching
“The Fates lead him who will. Him who won’t, they drag”
Seneca
Strategies For Fiona and Parents Facilitated Listening
Contingency and Sensitivity
Tolerance
Chess Board and losing an important piece
Choices and Decisions
The Distraction Paradox Valued Living Questionnaire (behavioral
activation and parent-daughter time)
Fiona’s VLQ (partial)
Carl Gustav Jung
“Life’s truly important problems cannot be solved, they can only
be outgrown”