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  1. Difficult Parents: AND YOU THOUGHT THE KIDS WERE THE PROBLEM Lilly Landikusic LMFT, Founder and Director, EMPOWERMENT COUNSELING SERVICES Talon Greeff CPCI, Director of Residential Care, UTAH YOUTH VILLAGE

  2. Introduction “The thing that impresses me most about America is the way parents obey their children.” -Edward, Duke of Windsor, Look, 5 March 1957

  3. Tools for Use With Parents Types of Difficult Parents and Specific Approaches Conclusion Introduction

  4. Tools for Use With Parents • Traditional Therapeutic Tools • Effective Assessment • Relationship Building • Build Trust • Effective Intervention Tools • Pragmatic “real world” Solutions • Role-play Approach • Linking to Services and Resources • Tools for Tough Times • Effective Confrontation and Teaching • Avoiding Negative or Emotional Baiting • Addressing Emotional Outbursts with Parents

  5. Effective Assessment Relationship Building Build Trust Traditional Therapeutic Tools

  6. Effective Assessment • Assess underlying need • Constellation of issues • Find “pain” • Magic question • Common problem thread • Take time (Boy’s Town study) • Parents pain can be core to problem in children or marriage • Identify underlying issue, secondary gain • Guilt over abuse, neglect, divorce • Family of origin pattern of conflict • Enabling parental style

  7. Relationship Building • Parents unable to accept feedback or need to change • Focus on child’s issues • Child presents special needs and challenges • Outside the range of normal child behavior • Use specialized tools to help with child • Parents will say, “I don’t like my child” • Without relationship, child may act out to punish parent • Consequences lose effectiveness • Ask for small change i.e. 15 minute activity weekly with child • Gently move parent from negative to positive perspective • Empathy statement • Highlight positive child trait or progress

  8. Relationship Building • Be careful not to assume parents’ emotional state • One of you needs to be in a problem-solving state • Leads to emotional burnout • Recognize their hopelessness, frustration, anger or sadness • Physiological indicators: tense muscles, breathing quickly • Work on parents’ issue first then referral agency issues • Praise specific, genuine progress or strengths

  9. Build Trust • Regular reviews of progress, goals, what is working and what is not • Ignore baiting, allow venting, address continued combative statements • Use humor, honesty, openness, support their decision-making by working on one of their issues • Assess, collect information, wait until they ask for advice before giving it

  10. Pragmatic “real world” Solutions Role-play Approach Linking to Services and Resources Effective Intervention Tools

  11. Pragmatic “real world” Solutions • Give small assignment to identify willingness to work • Identify the “mover and shaker” within the family • Remind parents of their own childhood • Use your own childhood perspective to help them • Think outside the box “scheduled meal preparations to TV timeline” • Close sessions with summary, plans, goals and homework

  12. Pragmatic “real world” Solutions • Simple changes can lead to dramatic results • 15 minutes per week • Specific description of behavior • Predict results, solutions need to fit their environment and resources • Simple, small lasting change better than complicated, super-healthy unachieved goal

  13. Role-play Approach • Processing information is not an efficient way to teach skills needed for productive changes • In learning new skills for teachers, Joyce and Showers in 2002 found: • Theory and discussion led to 10% passing a test on the material, 5% being able to demonstrate the skill and 0% skill use in the classroom • Adding demonstrations led to 30% passing the test, 20% being able to demonstrate the skill and 0% skill use in the classroom • Adding practice and feedback to training led to 60% passing the test, 60% being able to demonstrate the skill and 5% skill use in the classroom • Adding coaching in the classroom led to 95% passing a test on the material, 95% being able to demonstrate the skill and 95% skill use in the classroom

  14. Role-play Approach “It is one thing to say with the prophet Amos, ‘Let justice roll down like mighty waters,’ and quite another to work out the irrigation system.” -William Sloane Coffin, Social activist and clergyman

  15. Role-play Approach • After teaching a skill, strategy or technique: • Discuss specific application, ask for real world scenario • Role-play: therapist as parent, parent as their child • Role-play: parent as parent, therapist as child • Role-play: parent with child, therapist as coach • Coach: observe parent with child, provide feedback on implementation and refinement

  16. Linking to Services and Resources • Look at underlying needs: economics, lower functioning, lack of informal support, employment issues • Identify patterns which impact family functioning and children’s issues • Describe disability or mental health issues openly, without embarrassment or emotion • “special needs or vulnerabilities” • By diagnosis • Help find effective supports that will last after you terminate services and are self-sustaining • Religious • Neighborhood • Family • School • Friends

  17. Effective Confrontation and Teaching Avoiding Negative or Emotional Baiting Addressing Emotional Outbursts with Parents Tools for Tough Times

  18. Effective Confrontation and Teaching • At service initiation, inform them that you will give feedback to help with change • Balance rapport with solution thinking • Criticism by suggestion • Empathy/praise • Define situation and parent’s solution • “Have you ever thought about…?” • “Are you willing to try it?” • Humor through confrontation • Normalizing • Plan for initiation, mid-intervention and closure • Prepare them for progress and change • Prepare for support • Emotional closure • Support for follow-up • Prepare for “end of service” crisis

  19. Effective Confrontation and Teaching • Work on their agenda and priorities • Assess and address their “pain” • Refocus on family’s goals • Bridge from developed strengths to referring agency’s issues • Help identify emotional trigger points within adults and family • Discuss them with parents • Develop plan to de-sensitize parents and set boundaries • Teach how to recognize physiological changes before emotions • Model disengaging for parents • Avoid hooks by staying focused on issue • Be specific about recommendations and behaviors avoiding “judgment” words • Use parent rationales • Empathy “I understand you are upset, I am just doing what I can to help your family”

  20. Avoiding Negative or Emotional Baiting • Specific tool for disengaging • Waiting • Agreeing • Listening • Re-focusing • Emphasize the power of remaining disengaged • Careful! Don’t get sucked into parents’ emotional baiting, especially when it seems reasonable • Transference that fits family system • Use in discussion about family patterns

  21. Addressing Emotional Outbursts with Parents • Use disarming techniques • Agree/empathize • Wait until they are done speaking • “Did I do something you did not like or agree with?” • “What would you like to see happen?” • Assess needs and underlying message, rather than words • Avoid emotion, stay specific and avoid adjectives when describing situation • Accept their feedback • Support their emotional needs • Teach them how to meet needs without emotional outburst • Remain calm because it’s not personal

  22. Types of Difficult Parents and Specific Approaches • Self-Sabotaging/Victim Stance • Permissive • Controlling/Overly Strict • Borderline • Suspicious • Needy • Lower Functioning • Crisis/Drama Lifestyle • Depressed/Apathetic • Disabled • “Munchausen's Syndrome by Proxy”

  23. Self-Sabotaging/Victim Stance • Give assignments • Follow-up on small tasks • Phone reminders, if necessary • Empathy with confidence statement • Set boundaries and avoid enabling • Test: Do they use the tools provided? • Example: Don’t drive client, help client find resource

  24. Permissive • Assess: why they are permissive-disengaged or a best friend? • Address issues within the home and use family strengths • Rationales for change “It will help your child succeed” • You need to say “no” • Conflict and limits develop independence in adolescents, natural tension • Build in “outs” for discipline like positive correction • Short but hard consequences • Reward system with no negative consequences

  25. Controlling/Overly Strict • May have trouble with feedback • Rationales of increased control, use with rewards • “You may want to go through the back door on that one” • Consequences often porous or limited • Criticism by suggestion • Identify and modify “trigger points” • Emphasize progress • Will you try it?

  26. Borderline • Regular support for you, staff with others • Communication with family, referring agency and stake holders critical • Refocus on written goals and treatment plan • Documented treatment planning • Be willing to agree the fit isn’t working

  27. Suspicious • Work on family’s “pain” or agenda • When possible, separate yourself from referral source • Be open with information and confidentiality limits • They may “test” you, be upfront and clear

  28. Needy • When preparing to disengage, be deliberate and plan ahead • Access outside resources and supports • Add “develop independence” to treatment goals • Informal supports • Religious groups • If possible, its ok to be a “long-term monitor”

  29. Lower Functioning • Normalize their situation “you are who you are” • Creative problem-solving that is concrete • Focus on skills and strategies, avoid processing • Role-play is critical and highly effective • Linking to services such as DSPD, Workforce Services, Deseret Industries

  30. Listen De-escalate, calm client, address tone Refocus on main issue, avoid joining in drama Develop healthy strategies that encompass the crisis/drama rather than replace it Avoid tilting windmills with client Short-term goals and homework Crisis/Drama Lifestyle

  31. Depressed/Apathetic • Medical referral • Informal supports for long-term help • Strategies that address issues in small steps • Link with family members or community resources for activities and solutions

  32. Disabled • Address environmental factors • Don’t be afraid to ask about disability and limitations • Get comfortable with client’s disability • Learn about it from a professional or research it

  33. “Munchausen's Syndrome by Proxy” • Parent wants to be case manager rather than caretaker • Identify specific issues which are documented to address • Validate parent and emphasize role as expert in providing care

  34. Conclusion “The problem with children is that you have to put up with their parents.” -Charles DeLint, Fantasy and science fiction author

  35. Specific Tools and Techniques to Help Parents: RAD, CONDUCT DISORDER, ANGER AND OTHER CHALLENGING ISSUES Lilly Landikusic LMFT, Founder and Director, EMPOWERMENT COUNSELING SERVICES Talon Greeff CPCI, Director of Residential Care, UTAH YOUTH VILLAGE

  36. Introduction “Before I got married I had six theories about bringing up children; now I have six children, and no theories. ” - John Wilmot, 2nd Earl of Rochester 1647 - 1680 Rake, Soldier, Courtier and Poet

  37. Introduction • Overview of Common Tools • Anger/ODD • Conduct Disorder • RAD • ADHD • Self-Harming • Encopresis

  38. Overview of Common Tools • Create understanding that change will take time and commitment • Normalize problems-all families have problems • Avoid power struggles or engaging • Agree, “say OK” • Give options • Be careful not to argue • Focus on “If/then”

  39. Overview of Common Tools • Disengaging • Waiting • Agreeing • Listening • Ask “What do you want to do?” • Shifting to a positive remark or behavior • Re-focusing • Teach parents how to use a calm voice tone • Identify triggers • Role-play • Positive, calming self-talk • Use praise or empathy before correction

  40. Role-play Approach • Processing information is not an efficient way to teach skills needed for productive changes • In learning new skills for teachers, Joyce and Showers in 2002 found: • Theory and discussion led to 10% passing a test on the material, 5% being able to demonstrate the skill and 0% skill use in the classroom • Adding demonstrations led to 30% passing the test, 20% being able to demonstrate the skill and 0% skill use in the classroom • Adding practice and feedback to training led to 60% passing the test, 60% being able to demonstrate the skill and 5% skill use in the classroom • Adding coaching in the classroom led to 95% passing a test on the material, 95% being able to demonstrate the skill and 95% skill use in the classroom

  41. Role-play Approach “It is one thing to say with the prophet Amos, ‘Let justice roll down like mighty waters,’ and quite another to work out the irrigation system.” -William Sloane Coffin, Social activist and clergyman

  42. Role-play Approach • After teaching a skill, strategy or technique: • Discuss specific application, ask for real world scenario • Role-play: therapist as parent, parent as their child • Role-play: parent as parent, therapist as child • Role-play: parent with child, therapist as coach • Coach: observe parent with child, provide feedback on implementation and refinement

  43. Overview of Common Tools • Work with parents to identify: • Personal issues/triggers • Thinking errors impacting parenting • Myths about parenting, marriage, children and families • Teach realistic expectations • Picking battles and shaping behavior

  44. Overview of Common Tools • Be specific in describing behavior and avoid judging words • Avoid triggers such as always/never • Emphasize pragmatic solutions vs. diagnosis or theory • Reframe issues as strengths, such as the oppositional child who demonstrates ego strength • Teach parents how to explain choices and when possible, give them • Allow children time to make a good choice to avoid a power struggle “Take 5 minutes to decide what you are going to do”

  45. Overview of Common Tools • Help parent structure the home with 7-10 rules • Discuss appropriate consequences and rules • Teach charting and contracting for “point” solutions • Use positive correction • Child has earned negative consequence • Provide opportunity for child to engage in positive behavior to earn up to ½ of consequence back • Example: Child yells at parent and is grounded for two days. The child could earn one day back for using pleasant voice tone during the next 24 hours. • Example: Child has to clean the living room for being late from school. The child could only have to vacuum the living room if they do a small worksheet about getting home on time.

  46. Anger/ODD • Role-play avoiding power struggles • Identify and practice ignoring triggers and baiting • Emphasize relationship building • Identify antecedents to behavior-correct before blow-up • Role-play with child taking a time out or other small consequence • Apply consequence after “flare up” • Use positive correction • Teach parents when to call the police

  47. Conduct Disorder • Identify necessary structure • Write out clear expectations • Youth need to have accountability at earliest possible age • Random checks with rewards • Use consistent, non-emotional consequences • Avoid enabling, fear-based thinking • Use positive correction to teach appropriate skill

  48. Reactive Attachment Disorder • Behavior deteriorates as relationships develop, over time • The better they know you, the more they fear harm from you as part of their life experience • Remaining calm and engaged over time critical • 24 hour “restart” helpful in keeping child engaged by motivation system • Parents should emphasize the child will stay no matter what • Clear expectations with rewards and consequences • Relationship building must continue to occur through crisis times • Respite provided in-home rather than providing respite outside of the home • Children look for rejection or signals of rejection

  49. ADHD • Assess if it is physiological or a function of the family system • “Did you notice a significant difference after a few days on the medication?” • Structured, predictable routine • Simple target goals • Calm, focus • Simple task completion • Calming through frustration • Break down tasks into manageable pieces • Short periods of time on task followed by activity, return to task • Be behaviorally specific in expectations

  50. ADHD • Emphasize getting started • Focusing tools • Eye contact • Assist in task completion • Let go of perfection • Calm “record player” verbals • Increase waiting skill with praise • Waiting to leave bed • Waiting to talk • Waiting for reinforcer