help4yourfamily

Create the family you want to have

Parent Affirmation Monday- being present- 12/3/2012

Christmas lights on Aleksanterinkatu.

Christmas lights on Aleksanterinkatu. (Photo credit: Wikipedia)

written by, Kate Oliver, MSW, LCSW-C

This week’s affirmation is simple and meant to be a reminder to help your holiday season happier for you. Have you ever noticed how the holidays have changed since you had children. They can go from a time you anticipate all of the wonderful surprises, to a time you find yourself constantly working to make sure everything gets done. When you are planning the holidays around your children, while also keeping up with the regular routines in your life, the joy of the season can become lost in favor of muddling through and getting it all done. My hope is to simply remind you to take time to stop and enjoy yourself along the way.

I remember my wedding day. It was scheduled to be outside in the summer at the end of a long drought in our area. It was actually scheduled for what I now call “the day the drought ended.” About an hour and a half before the ceremony, the drought ended with a bang, thunder, lightning and a heavy downpour. I guess because I don’t take myself very seriously, I really didn’t fret about it. My friends kept telling me how sorry they were for the bad luck and kept reminding me rain on your wedding day is lucky. I just laughed and told them it was all going into my memories of a special day. I decided the minute the rain started that the day would be special, rain or not.

My point is, that at some point, it is all just going to be memories. If the kids are too scared to sit on Santa’s lap for the perfect picture? Memories. If you burn the turkey and everyone lives on side dishes? Memories. Almost any imperfect happening can be looked back on with a smile later if we have the right attitude, so why not allow yourself to be present, go with the flow, and, when it gets to the point where you have a chance to sit back and enjoy your hard work and planning, do it?

This week, I want to remind you that as you find yourself planning to create just the “right” memories, remember also, that there comes a point at which you can stop and just enjoy the ride as well. Show your children that when you plan well, you also get to laugh hard, have fun, and be present in the moment. Any worries you have about work, money or anything else can wait a moment while you allow yourself and your children to enjoy a family meal, take a drive to see the Christmas lights, or enjoy a special holiday show.

This week’s affirmation is:

I enjoy being present with my children as we enjoy each moment together. I remember that it is often the imperfect moments that we end up treasuring the most.

By the way, 15 minutes before my ceremony, the sky cleared and we ended up having our ceremony outside anyway. It turns out whether I worried or not, the day was destined to work out just fine.

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December 3, 2012 Posted by | affirmations, help for parents, parent support/ self improvement | , , , , , , , | 4 Comments

Parent Affirmation Monday- Curious- 11/12/12

Written by, Kate Oliver, MSW, LCSW-C

Curious children gather around photographer To...

Curious children gather around photographer Toni Frissell, looking at her camera (Photo credit: Wikipedia)

This weeks affirmation for parents focuses on the “c” in Daniel Hughes concept of PLACE Parenting, the attitude of curiosity. Curiosity in parenting is absolutely essential and often overlooked. By being curious, we can avoid a lot of misunderstandings with our children that are based on our own quick assumptions that we always know what they are thinking. I see so many issues in my office which arise that could have been avoided from the beginning had parents used a parenting strategy that incorporated curiosity. Being curious is especially important for my readers who have children with attachment disturbance as those children often see and understand the world quite differently than we adults expect them to.

When I suggest that parents get curious, what I mean is that when children are angry or upset, rather than assume that we know what they are angry or upset about, get curious. I remember a time when my nephew, who was five, was at my house playing with my girls. The play got a bit rough and I ended up fussing at him. He is not used to me fussing at him, and when I looked at him, I was surprised. While I anticipated he would be upset, or seem repentant, what I saw was him to see him glaring at me, chin down, eyes up, fists clenched, shoulders hunched, and breathing through his gritted teeth. My instant response was that he was angry with me for correcting him, but, rather than assuming, I got curious. I took a breath and using a light tone, (think Mr. Rogers) I asked him if there was something he was upset about. He replied that he was very angry. Rather than assuming he was angry with me, which would have been easy, since I was the one he was glaring and blinking rapidly at, I asked who he was angry with. His response surprised me again. He blurted out, “I’m angry with myself!” and burst into tears.

Imagine the difference in response from believing that your child is angry with you, to understanding that your child is angry with himself. Doesn’t the knowledge change the response? When we take an attitude of genuine curiosity with our children, the result is that we deepen our understanding of them, and our relationship with them.

Often, I have parents ask me to give them words to use with children. Here are some phrases that work well when coming from a curious place.

  • I’m not sure I understand where you are coming from, can you help me?
  • I’m curious about what has you upset?
  • I’m wondering what you think just happened?
  • What do you think about that?
  • How do you feel about that?
  • What do you think is going to happen next?
  • I wonder what you think I said that?

Please remember that the tone of curiosity is as important, if not more important than the words. After all the words, “What were you thinking?” can be said in many different ways. The tone of genuinely wanting to know where a child is coming from is essential in using this technique. I am sure if you begin to explore this your children will surprise you with their responses. I would love to hear about it if they do. Also remember, that we are incorporating the other parts of the PLACE attitude, like “accepting,” so that whatever your child’s response is, you accept that that is what they were thinking, rather than trying to talk them out of it. Here is response and a question you can ask with curiosity if your child says something that you have difficulty accepting. “It makes sense you are feeling that way if that is what you think happened. Is it possible, it could have been something else?” Make sure you give a moment between the acceptance and the question.

I am curious to find out how this goes for you. Really! Please feel free to share your findings from your own adventures in curiosity this week in the comments below, or via email: helpforyourfamily@gmail.com. This week’s affirmation is:

I no longer jump to conclusions. I am curious about all areas of my child’s emotional and physical well-being.

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November 12, 2012 Posted by | affirmations, attachment disorder, discipline, help for parents, Parenting | , , , , , , , , , | 8 Comments

Parent Affirmation Monday- Accepting- 11/5/2012

An icon illustrating a parent and child

An icon illustrating a parent and child (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

The third aspect of the PLACE parenting attitude, which I have been highlighting in our weekly affirmations is accepting. This element of PLACE parenting refers to the idea of accepting all feelings that your child has. This is important for all children but especially for traumatized or attachment disordered children. When used as part of parenting, it also significantly reduces the number of fruitless discussions we have with our children about whether they should feel that way or not. All parents get caught in these battles, often with good intentions, however the result is still the same in that children end up feeling as though they are not being validated. It goes like this:

Child: I hate my picture.

Parent: What do you mean? That picture looks great! I love it. I really like the colors you used.

Child: I hate it. It’s awful! (buries head down)

While arguing with a child about how great their picture is (and, let’s be honest, sometimes there is room for improvement), understandable because we want our children to feel good about themselves, there is an alternative. Here is what acceptance looks like:

Child: I hate my picture.

Parent: What is it that you don’t like about it?

Child: All of it. I don’t like the way it turned out. I think it’s horrible.

Parent (empathic): It’s tough when pictures don’t work out the way you want them to.

While there is nothing wrong with encouraging your child to take a second look at a picture to help them see the parts that can be good, often this is best done and most accepted by children after their feelings have been listened to. Just think about the last argument you had with a significant other to see if you felt the issue was resolved without them seeing your side of things, whether they agreed or not. Over time, what happens with children who feel as though they are constantly being talked out of their own feelings, and begin to question whether the things they think are true or not. Fast forward to adulthood and you see adults in relationships that in their hearts they know are not good or healthy but which they continue to maintain, etc. because not listening to their inner voices has become routine. Additionally, by accepting that you child is questioning whether perhaps they could improve their picture, you are encouraging them to try harder to be satisfied for themselves. This encourages internal motivation to do and be better, rather than encourages complacency.

All this is what makes the acceptance of a child’s feelings so, so important. And, just to make you feel better, here is the second part of the conversation that you get to have after acceptance:

Parent: I wonder if there are any parts of the picture you do like.

Child: Only the color I used.

Parent: Hey, that’s what I was thinking I liked. That is a good color. What do you think you want to do next?

This conversation can go in many different directions from here, but all of them are good, right?

Here is our affirmation for this week:

I accept all feelings that I or the people I love have. All feelings are valid.

I would love to start a conversation about some of the feelings we parents find it harder to accept about how to get to the point of acceptance.  Please feel free to share any struggles or achievements you have had with this issue.

Below, I have also linked to a post I read last week, “The Great Invalidator,” which speaks to the word “but” and the ways in which it invalidates a child’s feelings and thought processes, another article about acceptance, written in a different way.

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November 5, 2012 Posted by | affirmations, child development, discipline, help for parents | , , , , , , , | 5 Comments

Parent Affirmation Monday- 10/29/2012- Love

English: In the End ...

English: In the End … (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

This week we are focusing on the second of the parenting characteristics detailed in the PLACE attitude, loving. While it may seem simple to say we must always strive to parent with love, as parents we know that can be hard at times. I find the matter to be simplified if I focus on the true intent behind my interactions with my children, without being side-tracked by the other details.

Take chores as an example, yes, I do want my children to help with the dishes but what is behind that desire? Sometimes the desire we are most connected to when we ask is the desire not to do the dishes ourselves, but we also know that there are times we ask our children to do a chore that we could easily do in less time, with less effort for the child, and less effort for us. So why bother to ask children to do chores at all? Of course we do it because we want them to grow up to be contributing members of society and to any relationship with others. Why do we care about that? Because we love them and want our children to be happy and proud of themselves as they grow into adults. Boiled down to its most essential qualities, our direction toward our children comes, for most parents, from a place of love because we care about them and their happiness.

There are ways to phrase requests or instructions that help our children to know that we are coming from a place of love. One of these ways I detailed in my post, End the Hassle! Tell Kids What They Deserve, in which I describe how to tell kids they deserve a clean room, safety, a healthy body, less stress about school (i.e.- do your homework), etc. Some other statements that put love first with your children:

I love you too much to argue with you about this.

I love you more than I care about what you accidentally broke/spilled/ruined.

I don’t want you to feel any worse than you are going to feel about talking to me this way, let’s both cool off in a separate room…

I love you.

You are special to me.

I was thinking about you today.

I think you get the picture. This weeks affirmation is:

I am loving and loveable and I honor my love for my children by showing them with my words and actions.

Remember, the more you say the affirmation, the truer it becomes for you. If you find yourself slipping, remind yourself that is how you used to talk to your kids before you figured out this way of talking. Forgive yourself, because you probably learned how to talk to yourself and your children the other way from your parents, who learned it from their parents, and so on. Congratulate yourself on trying something new. Good luck!

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October 29, 2012 Posted by | affirmations, help for parents, parent support/ self improvement, Parenting | , , , , , , , | 3 Comments

Scary Movies

This week, I was honored to be invited to write a guest post for Leah DeCesare over at Mother’s Circle about how to know when children are ready for scary movies. Here is the link: For a Happy Halloween- Save the Scary Movies. Enjoy!

October 25, 2012 Posted by | help for parents, keeping children safe | Leave a comment

Parent Affirmation Monday- playful- 10/22/2012

Silly Furry Saturday!

Silly Furry Saturday! (Photo credit: Buntekuh)

Written by, Kate Oliver, MSW, LCSW-C

Last week, I wrote about the PLACE Parenting attitude, as taught by Dr. Dan Hughes. For the next few weeks, I want to focus on each of the different parts of the PLACE attitude.

Our first attribute of this attitude is playful. I have to admit that as a parent, this is actually the most difficult part for me, which is actually pretty funny considering I started my career as a therapist as a “play therapist.” However, while my husband is pretty good at finding a silly answer to my children when they are grumbling about something, I’m too busy trying to figure out how to “fix” what I think is going wrong. Well, last week, I had a little breakthrough and I thought I might share it with you to show you what I mean about being playful.

My oldest daughter likes shopping for clothes almost as much as she liked getting a root canal last year. Actually, I heard less grumbling during the root canal. I’ve bought enough clothes that have disappeared into her drawers never to be seen again, or just to be outright rejected to know that I’m not spending money on clothes she has not picked. As a result, she and I have had a building issue about clothes shopping such that I myself have imagined the welcome relief of giving a cat a bath rather than taking her shopping. Long story short, what we were doing was not working despite my trying to process each interaction that went poorly when it came to clothes shopping. Recently, I decided to get playful.

If you haven’t heard of the gangnam style of dancing, you might want to check it out on Youtube (the dance starts around 30 seconds in). Let me give a brief descriptor: the gangnam dance is a sort of galloping style where sometimes you put one hand over your head like you are going to rope cattle at a rodeo. I downloaded the song on itunes and put it on my cell phone. Before leaving to go get winter pants with my darling eldest, I pulled her aside and said to her that I wanted things to go well. I put my arm around her and smiled while I told her that I had a plan for what to do if she got snippy or sassy with me. I proceeded to turn on the song and, to her horror, starting dancing/galloping around the living room. We both laughed pretty hard, but I ended by suggesting that if she found it so funny, she might like to see it in public as well.

And so it happened. Right there in JCPenny’s, going up the escalator my normally sweet, but now snarly girl said something  about me being fat- I’ve already forgotten what it was but it wasn’t nice. I took a breath, asked her in a serious tone if she knew what I had to do now, then, again, to her horror, I turned on that song. Right. There. In. JCPenny. (So sorry if you were there and happened to see that! It was necessary.) We both ended up laughing- I probably laughed hardest. And, we moved on. I didn’t hiss at her in the dressing room to get back at her. I didn’t feel the need to “make her pay” further. She apologized, sincerely almost as soon as the words came out of her mouth, but you know I still had to dance anyway.

When you can, if you can, be playful with your children. Find a way to make them, or at least yourself, smile. Show them how to rise above a nasty comment with a laugh and a grin. Show them how we, as adults, are able to stop taking ourselves so darn seriously all the time! With that being said, here is the affirmation this week:

I find ways to be funny and playful with my children. I welcome moments of unexpected silliness.

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October 22, 2012 Posted by | affirmations, help for parents, parent support/ self improvement, Parenting | , , , , , , , | 5 Comments

PLACE Parenting for Children with Attachment Disturbance

A mother holds up her child.

A mother holds up her child. (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

When you have a child with any sort of attachment disturbance, you also have a child that is very good at making you feel like you don’t know what you are doing.  In one training I went to on attachment disturbance, the presenter, Art Becker-Weidman said one of the parents he worked with described it something like this:  ‘It’s like you as the parent are the control station for a radio station, then the kids come up and play with all the buttons until they find one that gets the response they are looking for.  When they find that button that gets them what they want, they just keep flipping the switch over and over again.’  I have used this description with the parents that come through my own practice and find it resonates deeply with them as well.  What to do when you have a child that is constantly pushing your buttons and finding creative ways to make you feel like you don’t have a clue what you are doing?

Daniel Hughes and Art Becker-Weidman are working to popularize a parenting attitude that really can work wonders if parents are able to maintain it when they have an attachment disordered child (or any child for that matter).  It is called the PLACE mentality, it stands for: Playful, Loving, Accepting, Curious, Empathic.  I find that while the words are familiar it can be easy to misinterpret the meanings of those words in this particular context so let’s look at each word to see what we are talking about when it comes to parenting children using the PLACE mentality.

Playful–  The most common misinterpretation of this quality is that parents believe I want them to throw a parade in their child’s honor every time they do something desirable to the parent.  What I mean by playful is just finding an approach that has a less authoritarian tone.  Instead of telling kids where to go to find their glasses, encourage them to play a little game with you where they have to look at your face for them to give you a hint where the glasses are.  When they look into your face and lie, come up with a playful response “That’s a good one.  I’ve always known you were creative.  Tell me another!”  Often being playful can help everyone tone it down a notch.  If you have a child with a history of abuse or neglect, it can also keep them from getting triggered into believing that they are in huge trouble and helps prevent them from going into fight or flight mode so that you have some chance of them hearing some of the words you are saying.  A way to really get playful is to learn from a parent that really gets this stuff.  Christine Moers is a mom raising adopted children with attachment issues.  She posts vlogs on youtube to help other parents (and to keep herself sane).  Her video blog:  http://www.youtube.com/watch?v=HDAALaVG27k&feature=fvwrel is a wonderful example of how to discipline in a playful way.   I would recommend you look at her videos when you need help staying sane.

Loving– When I think of saying things in a loving way to children, what really helps me to stay in that place is remembering my purpose for saying the words in the first place. Yes, ultimately I may be asking my child to do a task because I want it done. But the bigger picture reason for asking children to do a task is to teach them so that they know how to do it, to give them a system for tackling problems, to get them into the routine of caring for themselves and planning how to fit everything into a schedule, or something else like that. In the end, our job as parents is to make it so that our children no longer need us in order to make it through the day. When we remember that we are asking our children to do something because we love them and want them to be happy, healthy adults, we can state requests in a more loving way. By remembering this, I believe the primary change is our tone of voice, which makes a world of difference to children with attachment disturbance.

Accepting– One trap I see so many parents walk into is the argument with their child(ren) about whether their child is having a reasonable feeling or not.  Both the child and parent find this is a way to feel crazy pretty quickly and I would like to present an alternative…acceptance.  Here is how it goes, maybe it sounds familiar:

Child comes down to breakfast dressed in a completely inappropriate outfit for school

Parent (being curious):  Wow, is there something going on at school today?  That’s an interesting outfit.

Child: I knew you wouldn’t let me wear it!  You never let me wear anything I want!  You’re such a witch!  You want me to be the ugliest girl in school!

Parent (accepting):  That made you mad.  I can see how you would be mad if you thought I wanted you to be the ugliest girl in school.

It’s that simple- do not engage in an argument about whether you want her to be the ugliest girl in school!  If that is her belief in that moment, accept that her feeling is appropriate for the interpretation.

Curious– In my office, I often frame this curiosity as being a “feelings detective.”  I tell kids I ask lots of questions because I am a very curious person and sometimes it takes me a while to understand things.  Get curious about your children.  In the above example, rather than arguing about who wants whom to look ugly, you might get curious about it.  “I wonder what made you think I wanted you to look ugly when I asked about your outfit.”  Another way to help with getting kids to understand you are curious (not judgmental) is to say something along the lines of, “I’m curious what got you so mad because I don’t want you to feel that way again. ”  When they tell you what got them mad, again make sure you avoid arguing about whether that is really what happened (accepting) and then …empathize.

Empathy– Empathy looks like this,” If I thought someone felt that way about me/ said that to me/said that about me I can see how you would feel mad/sad/ scared too.”  That’s all empathy is being able to see something from the viewpoint of another person.  Empathy does not involve any discussion about whether someone is right or wrong for feeling the way they are feeling.

So, why does this work?  It works because our children with attachment disturbance find the things we need to do most often, educate, speak with authority, and parenting, to name a few, to be triggers to them of things that remind them of times they were hurt or  neglected.  When kids do not learn the typical role of parents early on, they easily misinterpret the actions of parents.  Using the PLACE mentality is one way of reducing the number of triggers for your child, not to mention that it just makes parenting more fun.  I use it with my own securely attached children as well.  Of course, this is a very quick overview of the PLACE mentality.  It is important that if you feel you are in a position with your child(ren) where you need to utilize the PLACE attitude more and could use support in doing so, that you see a therapist that has an attachment informed practice.

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October 18, 2012 Posted by | attachment, attachment disorder, help for parents, parent support/ self improvement | , , , , , , , , , , , , | 12 Comments

10 Tips for Guiding Children Through Difficult or Unique Life Circumstances

Writer Lesley Lathrop (left), an adoptee, at r...

Writer Lesley Lathrop (left), an adoptee, at reunion (Photo credit: Wikipedia)

written by, Kate Oliver, MSW, LCSW-C

Most families have gone through, or will go through some type of unique life circumstances at some point. Some families seem to have nothing but unique life circumstances! Whether your child is adopted, was born via a surrogate, has an absent parent, has a parent with a life-threatening illness or drug addiction, an ill or unique sibling, or something else, it is important for them to have a narrative (story) to explain their experiences.

While it may seem commonplace to us, as adults, we can forget that children do not have the knowledge we do about certain life experiences, and, in case you have not noticed, they can be pretty self-centered folks. What happens when those two characteristics combine are some pretty interesting situations, like the mother who brought her daughter to me because she had been acting rotten to her sister in a way that was completely out of character for her. Upon further exploration, I came to learn that this child’s younger sister had recently been diagnosed with ADHD and my client (9 years-old) thought she might catch ADHD. She was irritated with her sister for getting it and bringing it into the house. If you think about it, it makes sense. My client saw her sister taking medicine, just like you have to when you are sick, and had most likely been told it was because her sister had ADHD. Why would a 9 year-old believe that ADHD is any different than the flu? Similarly, a child with say a drug or alcohol addicted parent will come up with a compelling story about the why’s of the way things are and, typically, it has to do with them doing something wrong or being bad.

To avoid misunderstandings for children when there are difficult and/or unique life circumstances, it is important to give them a good narrative to explain what has happened. To guide you in this endeavor, here are some tips for you as you create your narrative:

1. Tell the truth. While it may feel easier to tell kids that mommy is sick and she is going to get all better, if you don’t really know she is going to get better, don’t include that in what you say. Just like if you were taking your child to the doctor to get a shot, you would not want to tell them it’s not going to hurt at all (then you would be a liar), you want to say, “It’s going to pinch for a minute but then you will be fine.” If your child cannot trust you to tell them the truth, who can they trust?

2. Know the developmental age of your child. You want to make sure you are speaking at their developmental level or you will just sound like the adults from a Charlie Brown cartoon. Think of the words that you use and whether they are words your child will understand.

3. Keep your story as simple and to the point as possible. I am thinking of one mom in particular who wanted to explain to her daughter about being adopted from China. She found an opportunity while her child was playing to use dolls, and one of her son’s toy planes. The mom said to her daughter, “One day a lady had you in her tummy. She couldn’t take care of you so you went to live at the orphanage with other kids in China. Mommy and Daddy wanted to have a daughter. We went to China in the plane to find a daughter. We met you and we were so happy! We brought you home on the plane to live with us forever.” The little girl re-told the story, and asked her mom to retell the story many, many times. As she has gotten older, her mother has added more details at her daughters request however, starting this as a simple story, and telling it at a time when her daughter was open and attentive to hearing it was key.

4. Tell the story when it is a good time for your child. You know your child. Some kids listen best in the car. Some only listen when they have asked the question rather than you bringing up the subject. Others want to talk at bedtime or in the morning when they are fresh. Pick a time that works for your child.

5. Watch your tone of voice! Think matter-of-fact, not gloom and doom when you are talking to your child. They will take their cues about how to feel about this story from you, and if your tone suggests it is a horrible story or circumstance, then that is what they will believe about it.

6. Avoid harsh, shaming words for any of the people in the story. To be more specific, I have heard adoptive parents describe a birth parent as a “druggie” and a “loser.” Keep in mind that the people in this narrative may be very important to your child, and they may identify strongly with them. So, for example, in this instance rather than saying “druggie and loser” you might say, “Your birth mom was addicted to drugs when you were young and she made a lot of poor choices because of that.”

7. Include any evidence that points to it not being the child’s fault that people are sick, parents got divorced, they were adopted, abused, etc. and be sure to include any evidence that shows they are loved and lovable. Examples of this could be, “When parents have an addiction, it is never a child’s fault. Usually, it is a problem they had since before their child was born.” or, “Even though your birth mom was not able to take care of it’s clear she loved you because she wanted you to have the best opportunity to have a good life.”

8. Check in with your child after you have told them the story to see what they heard. Many times children will nod along then, when you ask them if they understand, they will say yes. I would encourage you to gently ask something like, “Can you tell me what you just heard me say?” For some kids you will need to tell them they are not required to say your words back verbatim, they only need to give you a summary (like a quick report at school) of what you just said. This is an important thing to do for two reasons: 1. Sometimes kids didn’t get what you said, or interpreted what you said differently than you thought. You can only correct this if you know it happened. 2. Sometimes as we ask children what we just said, we can realize that we just used a ton of words and we may need to edit this story for simplicity.

9. Keep the lines of communication open with your child after you have introduced the narrative to them. The kinds of issues I am talking about in the post typically are issues that last a lifetime and as such will need to be revisited multiple times throughout a child’s life and, while they will start simple when a child is young, they will grow in complexity as a child ages.

10. If there is something a child can do to help be clear about that, however, be careful that your child does not then take on that duty as a life or death responsibility. For example, telling a child who has a mother who has cancer that it one way she can help mom is to make sure she is helping around the house makes perfect sense. Remember, however, that children, even adolescents can have some of what we call magical thinking, and, whereas you and I get that not doing your chores will not make mom sicker, should mom get sicker, you are going to want to make sure your daughter knows it is not because she stopped doing the dishes and sassed her mother last week.

What are some circumstances you have had to explain to your children? How did it go?

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September 27, 2012 Posted by | child development, help for parents, Parenting | 5 Comments

How Pregnancy and Postpartum are Affected by Eating Disorders

During my vacation, Leah DeCesare from Mother’s Circle has been kind enough to write a guest post about an important topic.  Enjoy!

How Pregnancy and Postpartum are Affected by Eating Disorders

by Leah Decesare,

Over the course of a single spring, I worked with three women struggling with postpartum anxiety. During our time together, I learned that they all had a history of eating disorders.  This connection motivated me to research and talk to women about how eating disorders affected their pregnancy and postpartum experience. [Names have been changed.]

Eating Disorders as Related to Childbearing

The two most common eating disorders (EDs) are anorexia nervosa (AN) and bulimia nervosa (BN), estimated to affect 5 – 10 million females in the United States. Approximately 4.5% – 9% of women of childbearing age have a past or active eating disorder.  AN is characterized by extreme calorie restriction, obsessive dieting and loss of periods.  Symptoms of BN include repeated episodes of binge eating followed by purging, fasting, excessive exercise and abusing laxatives, diuretics and enemas.  Both experience extreme fear of weight gain and distorted perception of body image.

Women struggling with EDs often exhibit perfectionism, obsessive behavior, extreme sensitivity, seriousness, anxiousness, self-consciousness, impulsivity, a feeling of being out of control, negative self image and a high level of self-blame.  There is a strong correlation among perfectionism, anxiety and eating disorders.

While there are some contradictory study results, EDs have been linked to maternal and fetal risks including excessive vomiting during pregnancy, cesarean section, postpartum depression/anxiety, anemia, hypertension, pre-eclampsia, miscarriage, intrauterine death, preterm delivery, breech presentation, low Apgar scores, low birth weight, fetal growth restriction, small-for-gestational-age infants and slow weight gain.

Research also indicates a significantly greater incidence of anxiety and depressive disorders in women with EDs than in the general population. Shame and guilt about their illness can cause secretiveness, denial of a problem or reluctance to disclose symptoms to providers.

Eating Disorders and Pregnancy

Studies indicate that many women with EDs have a temporary remission during pregnancy which changes in the third trimester and the first three to six months postpartum, when symptoms often reemerge more severely than before pregnancy.

Women suffering with EDs fear losing control of eating and weight, causing damage to their baby and worry about being unable to cope. They often have unrealistic, idealized expectations of motherhood.

Postpartum Adjustment in Women with Eating Disorders

Studies show the majority of mothers with EDs have less favorable maternal adjustments and that attachment can be impaired.

Jennifer said that she felt bonded with her baby at the hospital, but “as soon as I realized that she was going to be a burden and that my life wasn’t going to be the way it was and how much it was going to change, I couldn’t connect with her.  I don’t remember when that changed.  I have regrets about how I spent the first couple of months.”

Heather, another mother afflicted with disordered eating and anxiety, described her experience of new motherhood saying, “I didn’t expect it to be such an assault on our marriage, an assault on everything that you know.”

With greater adjustment difficulty, the incidence of postpartum moods disorders rises.

Infant and Child Feeding in Women with Eating Disorders

Some studies indicated that women with EDs were less likely to breastfeed fearing changes in body shape, yet greater awareness that breastfeeding quickens weight loss can prompt women to breastfeed. Many women with EDs report low desire to breastfeed and many have difficulties when they try.  Weaning is a cautionary time as they are vulnerable to binge eating and starvation.

Regarding feeding, Heather lamented, “I have to be concerned with what she’s eating and what I’m eating.  When I’m really anxious, my hunger cues go away or I ignore them.”  Jennifer commented, “I cannot totally separate it, when I’m feeding Sally, I’m over-worried about giving her a variety.”

When Sally was five months old, a doctor commented about her being chunky, which created angst and Jennifer started to reduce the number of daily bottles. Research found that 50% of mothers with EDs report being concerned their child will become overweight.

What Can Help?

How are you feeling as your body is changing with pregnancy?   Do you have a history of anxiety, depression, or eating disorders?   Do you have an exercise routine?  Are you able to sleep/eat when the baby is sleeping?

Simply being aware can help a family, or Mom, seek needed extra support.

At risk Moms should prepare prenatally. Find a lactation consultant if you plan to breastfeed, join a new mom’s group, hire a birth and/or postpartum doula to help you transition confidently to motherhood. Jennifer said her new mom’s group “was very helpful. It was so nice hearing other moms feeling the same way I did.  It was something to look forward to.”

Learn and practice techniques to relieve stress. Be aware of the signs of postpartum mood disorders and talk with a counselor before birth.  Use the Edinburgh Postpartum Depression Scale to self-screen. Seek out nutrition and exercise education and support.

It is especially important for Moms with a history of, or active, ED to have realistic expectations and to make the baby as real as possible early in pregnancy.   Take time through reading, classes, and talking to new parents, to expose the reality of life with a newborn.

Other effective strategies include cognitive behavioral therapy (CBT), medications, relaxation, meditation, yoga, and fish oil.  Seek opportunities to explore worries and triggers for unhealthy behaviors and actively enlist a multidisciplinary support system.

Low spousal support is a risk factor in postpartum relapse of EDs.  A Mom with an ED must set  positive and healthy goals and strategize paths to achieve them; reaching goals can help nurture a sense of control and confidence in her ability to be a mother.

At prenatal checks, a Mom may decide whether she’d like to know her weight, if she prefers not to know, she should request to be weighed with her back turned.

She says she would have benefited from a direct approach of having someone prepare food, take the baby and have her sit to eat three times a day. “I felt pressure to eat, pressure to nourish someone else, I was too anxious to even swallow.”

Jennifer also said that having someone make food for her and caring for the baby while she ate helped her and she ate more at those times.

Mothers with EDs may need assistance improving their ability to recognize and respond to their child’s cues. It’s a Mom’s job to serve a variety of healthy options and it’s their child’s job to decide what and how much they will eat.

Breastfeeding difficulties often accompany EDs and it may be helpful for a Mom to have “permission” to stop nursing.  Heather told me, “I did not like breastfeeding and the stress of being on the clock and being the only person to feed her, but I needed the assurance that it was okay not to breastfeed and that I would still be a good mom.”

Conclusion

The history or presence of an eating disorder in expectant and new mothers can create a multitude of issues that hinder the confident and strong basis of a new family.

Support is vital.  Practical and emotional support, reassurance and praise for learning to be a capable parent are critical elements that benefit any new Mom, but are imperative for a new Mom with an ED or history of an ED.

References

Astrachan-Fletcher E, Veldhuis C, Lively N, Fowler C, and Marcks B. 2008. The Reciprocal Effects of Eating Disorders and the Postpartum Period: A Review of the Literature and Recommendations for Clinical Care. Journal of Women’s Health. 17(2):227-239.

Bansil P et al. 2008. Eating Disorders among Delivery Hospitalizations: Prevalence and Outcomes. Journal of Women’s Health. 17(9):1523-1528.

Cantrell C, Kelley T, and McDermott T. 2009. Midwifery Management of the Woman With an Eating Disorder in the Antepartum Period. Journal of Midwifery & Women’s Health. 54(6):503-508.

Koubaa S, Hallstrom T, and Linden Hirschberg A. 2008. International Journal of Eating Disorders. 41(5):405-410.

Leddy M, Jones C, Morgan M, Schulkin J. 2009. Eating Disorders and Obstetric-Gynecologic Care. Journal of Women’s Health. 18(9):1395-1400.

Martoz-Ordonez C. 2005. Pregnancy in women with eating disorders: a review. British Journal of Midwifery 13 (7):446-448.

Mazzeo S et al. 2006. Associations among Postpartum Depression, Eating Disorders, and Perfectionism in a Population-Based Sample of Adult Women. International Journal of Eating Disorders 39(3):202-211.

Stein A, and Fairburn C. 1996. Eating Habits and Attitudes in the Postpartum Period. Psychosomatic Medicine. 58:321-325.

Swinbourne, Jessica M. and Touyz, Stephen W. 2007. The Co-Morbidity of Eating

Disorders and Anxiety Disorders: A Review. European Eating Disorders Review

15, 253–274.

Bio:

Leah DeCesare has been working with childbearing women and their families since 2002. Leah writes about perspectives on parenting from pregnancy through teens at www.motherscircle.net. In 2008, she co-founded Doulas of Rhode Island to provide support among doulas in the state and to educate the community about doulas.  She serves on the DONA International Board as Northeast Regional Director and is a certified birth and postpartum doula, certified childbirth and postnatal educator and Certified Lactation Counselor. She is married and the mother of three children.

August 30, 2012 Posted by | help for parents, parent support/ self improvement | 5 Comments

The Art of Breathing

Written by, Kate Oliver, MSW, LCSW-C

Meditating on Airport Mesa Vortex - Sedona

Meditating on Airport Mesa Vortex – Sedona (Photo credit: Al_HikesAZ)

Based on a question I had from my parent affirmation about breathing last week, and because I teach people the mechanics of breathing several times a week, I decided to take a moment to really break this breathing thing down for everyone. Breathing is the first step in getting connected to our bodies and what our body is telling us.  Before you think that you already know how to breathe, take a moment to ask yourself whether there were any times in the last week where you noticed you had been hungry and meaning to eat for several hours but did not get around to it. Or, alternately, did you find yourself mindlessly eating away at your child’s leftovers as you were doing the dishes? Maybe you realized you needed to go to the bathroom and just did not give yourself the time to take a quick break. If you did any of those, that indicates is that you, like most everyone else, have learned the art of neglecting your body. You or your child may have especially mastered this art if either of you has a history of abuse or neglect.  In order to survive ongoing childhood trauma, people tend to cope by overriding their body’s system for communicating in order to survive the abuse. Anyone with a history of neglect, never learned to listen to their body in the first place. After all, babies learn to continue voicing discomfort because when they do someone responds with caring and, typically, an explanation. It usually sounds like, “Awww, what’s the matter? Are you hungry? Is your diaper wet?” Even before we understand this, we get the message that what we feel matters and that listening to our bodies is important. The attachment disturbed children I see have unlearned this lesson to the point that most of them have an issue with bed or daytime wetting, or soiling. They have learned to take on the neglect that was dealt to them in early childhood. The first step to getting reconnected to your body is paying attention to your breath.

Even if you do not have a history of trauma or neglect, I would argue that the vast majority of us have seen the art of listening to our bodies become devalued over the course of our lives. We are encouraged to “push through” pain, to “get over” discomfort, and to wait or delay gratification. These values all have their place. I’m certain Olympic athletes, world leaders, and good parents are required to do all of these things to one degree or another. Still, taking time to check in with the body that supports your ability to selectively push through, delay gratification, etc. is only fair, and in that spirit, I would like to teach you the art of breathing, which you may have forgotten since infancy.

In a recent training I went to with Pat Ogden, a well-known expert in somatic (body) psychotherapy, she said that our bodies predict what our brains think is going to happen next. Think about that for a moment. What does a child standing like this think is going to happen next?

Sad child

Sad child (Photo credit: Lejon2008)

How about these children?

Children near Pawana Dam

Children near Pawana Dam (Photo credit: santosh.wadghule)

Our breath predicts what we think is going to happen next as well.  In fact, it gives our body a message about preparing for the next step.  To get connected to your breathing, take a moment, without trying to change anything, to pay attention to your breathing. Which part of your body moves when you breathe? Is it your chest? Your shoulders? Your tummy? Your ribs? Most of the traumatized children I see are breathing from their shoulders. Whether or not you were breathing from your shoulders, take a moment to try it. How does it feel? When I say breathing from your shoulders, I mean that when you take the breath in, your shoulders rise. Some might also say it is breathing into your chest. You feel your chest expand, and your shoulders rise. Try that for a moment and see what emotions come up.

Now try this. When you breathe in, think about breathing all the way to your belly. In fact, put one or both hands on your belly. When you breathe in, think of filling your belly with air, like a balloon. When you breathe out, think of letting the air out of the balloon. This may feel awkward and take a moment if you are not used to it. Breathe in, fill the balloon. Breathe out, let the air out of the balloon. You may also feel your ribs expand a bit when you breathe this way. How do you feel now?

Why does the way you breathe matter? Just as the way you hold your body predicts the future, so does the way you breathe. When people breathe from their shoulders, it sends a signal to your body much closer to a fight/flight or freeze reaction. Think of how you would take in a breath just before a car hits your car, or how you breathe when you just went for a strenuous run. You breathe to your chest or shoulders. Your body is working hard to protect you at those times. Now think of how you breathe just before you are going to drift off to sleep. Or, if you have one handy, watch a relaxed baby. You will notice the breaths are belly/ rib cage breaths as opposed to shoulder/chest breaths. This signals to your body that you are calm, and that there is nothing to fear.

English: A sleeping male baby with his arm ext...

English: A sleeping male baby with his arm extended (Photo credit: Wikipedia)

The first step to training your body into understanding that it is not under siege is paying attention to your breath. I teach my clients to do it. I encourage you to do it. I encourage you to teach your children to do it if you see they are struggling. I find simply noticing that a child needs to try a new way of breathing can help to ease anxiety. I introduce it by saying something like, “Can we try something?”or “I’m curious about something. Can we do an experiment?” Then I ask them to play around with their breathing, the same way I asked you to. It often changes the feelings in the room from tense to more relaxed. If the mood goes back to tense, I simply notice it out loud, “Wow, look, as soon as we started talking about that your breathing went back to the old way. What happened?” It gives me the opportunity to help a child or adult explore the feelings that go with the breathing and to teach a way to disconnect from the old intensity of the emotion that goes along with whatever they are remembering or anticipating.

Have you tried this exercise? How has it worked for you?

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August 15, 2012 Posted by | help for parents, parent support/ self improvement | , , , , , , , | 9 Comments

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