help4yourfamily

Create the family you want to have

Chronological Age vs. Developmental Age

written by Kate Oliver, LCSW-C

Having a blog on WordPress is so nice in that I got a nice little report for the end of 2012 letting me know which of my posts has gotten the most attention, etc. By far the most popular post was this one! So, in the spirit of sharing and refreshing for the New Year, I thought I would update and repost this blog, since it was one of my earlier ones and may have been missed by some of the folks who are newer to my blog. I keep my comments open and would love to hear if people are getting what they are looking for from this post even if it has been a while since I originally posted. Enjoy!

Chronological age vs. Developmental Age

When figuring out how to best meet the needs of our children, it is important to understand their developmental age.  For many children this can be the same age as the chronological age, the age we typically think of when we talk about our children, however, if you have a child that, among other possibilities:

  • has a history of trauma or neglect,
  • was adopted at an older age (18 months or more),
  • has a developmental disability,
  • has experienced the death or loss of a primary caregiver,
  • has experienced a major change in family structure,
  • or has a parent with a serious illness or addiction,

you may have a child that has a “stuck” part of their development. If you have a child like this, typically you might notice that there are times when he or she acts much younger than you would expect for their chronological age.  What makes this confusing is that your child may be able to do things that are appropriate for their chronological age.  For example, you may have a child that works at or even above grade level in reading and/or math, but in some emotional areas they may be developmentally younger than their chronological age.

Let’s look at an example everyone can relate to, think for a moment about a time when you have been triggered into a younger developmental age, say, when you go to your parent’s house for the weekend.  Even as an adult, you may find that you act differently toward them or your siblings than you would in your day-to-day life.  You may feel younger, angrier, more docile or more or less confrontational.  What that signifies is that there is a part of you that has not left or resolved some of the struggles from your own childhood.  Most of us have something like this. Our children are no different.

Some important questions about an area where your child seems stuck in a younger developmental age are:

1. Is my child capable of meeting the demands of this developmental stage? Developmental delays, learning issues, issues related to physical abilities and early childhood exposure can all add to a child’s difficulty in meeting a developmental milestone.

2. Has my child ever been properly taught how to meet this developmental milestone? For example, if you have a daughter you adopted from foster care at age 5, she may not ever have been properly potty trained and taught to clean herself appropriately after using the bathroom. It may be that while we expect that to be a skill children learn between ages two and four, your daughter may require instruction now, as she has not received it before.

3. Did something prevent my child from being able to learn this skill at the appropriate time? Perhaps you had a child with medical issues, a traumatic situation or something else. At the time when other children were learning to make friends and play nicely with other children, your child was busy managing an internal or external stressor that demanded all of their attention they would otherwise have been able to focus on meeting a developmental milestone.

4. Does your child have a traumatic trigger that remains unresolved which prevents them from moving through a developmental stage? I see children who have experienced trauma. Many of them have memories associated with trauma that prevent them from focusing on a task. Children (and adults) with unresolved trauma have what we call triggers, which remind them of the traumatic incident. Depending on what happened, a trigger could be a bathroom, a car, candy, really anything that reminds them of the trauma. What this means for parents with children who have experienced trauma is that the simple act of making a snack for your child could result in a child acting much younger until the traumatic triggers have been identified and resolved so that the apple you cut is just an apple again, instead of a reminder of a difficult past.

Why is it important to know where your child might have a developmental lag or stuck place?  Knowing that there are areas where your child is developmentally behind their chronological age allows you to make decisions about how to handle their  behavior appropriately.

What to do about a child acting developmentally younger:

After considering the reasons behind the developmental delay, it is easier to figure out how to address the issue. Sometimes it may just be a matter of time, or finding appropriate school or therapeutic support to allow a child’s brain to develop. For children who are delayed due to an external factor, in addition to school and therapeutic support, consider attempting to change your response to match their emotional/developmental age for the issue you are addressing.  What would you do for a two-year old who needs to brush her teeth?  Would you tell her to go brush her teeth and expect that she was going to easily and happy get right over to the toothbrush and begin throughly cleaning her teeth after applying just the right amount of toothpaste to the toothbrush?  Of course not!  Ideally, you would go with them (even if they are grumbling), you might remind them of why tooth-brushing is so important (if you have a child adopted at an older age, please remember it may be that no one ever taught them the importance), you would make brushing fun by singing a silly song to say how long you need to brush your teeth.

I know many parents reading this might be saying that your 12-year-old, who acts like a 2-year-old at brushing time is not going to stand for you hovering over her while she is brushing her teeth, and you are not going to talk to her like you would talk to a two-year old.  You are right, I am not recommending that you use the tone you would for a two-year old because you might get the death stare or worse, escalate a tense situation.  No, I am saying to use what you would do with a two-year old as a guideline for figuring out something with your child that is developmentally two during tooth-brushing time but is residing in a 12-year-old body.  To me that would look something like, playfully having a contest to see who can get just the right amount of toothpaste on the toothbrush or offering to get your child started by putting the toothpaste on the toothbrush, then saying a silly poem or singing a silly 12-year-old song, or reading a page out of a joke book to your child while they brush their teeth so they can get an idea of how long to brush.  Only read or sing when they are brushing, stop if they stop and start when they start again, and stay playful. Yes, they may look at you like you are crazy, but are they brushing while they are doing it?

Spc. Elizabeth Jarry shows an Iraqi girl prope...

Yes, I can hear protesting parents, now saying that you do not want to put toothpaste on your 12 year old’s toothbrush because they are old enough to do it themselves!  I know they are chronologically old enough, however, we are talking about something that they experience at a developmentally younger age.  And, here’s the good news, if you speak to your child’s developmental age for a while, their needs for that developmental stage get met, and they move on to the next stage of development for that issue.

For more parenting tips that don’t take a ton of time but do improve the happiness level in your home please see my previous posts:

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January 5, 2013 Posted by | attachment, child development, discipline, help for parents | , , , , , , , | 10 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

When your inner critic hurts your relationship with your children

Written by Kate Oliver, LCSW-C

We all have an inner critic.  Some of us have several.  You know, that voice in your head that just feels like it is part of you?  It’s the one that tells you that you did it wrong again, you are not working hard enough to fix your child’s problem, and reminds you of all the times you tried and failed to get items knocked off your “to do” list.  If you are not fully familiar with your inner critic, the next time you are upset about something, take a moment to listen to your thought process.  What are the thoughts floating through your head at that moment?  Our inner critic can be harsh…and sneaky.  We don’t even know it’s there, it feels so much a part of us.

I’ve heard our inner critic (or critics) referred to as “the committee.”

Committee

Committee (Photo credit: Editor B)

I love this because it is so true.  Think about the act of going to the grocery store and passing through the cookie aisle.  The committee gets activated!  You hear one part of your committee saying, “Get the cookies you like, you deserve it!”  Another part of your committee chimes in, “Yeah, your butt loves those cookies so much it will hold onto them all the way through summer.”  Then the internal negotiator pipes up, “Maybe there is a new, healthy cookie out that you could try.  Or, if you get the individual packs, you won’t eat the whole thing in two days and you can enjoy your cookies over the next few days, a little at a time.”  Of course then the critic chimes in, “Fat chance…get it?  Fat chance?  Haha.”  And so on.  Even after making a temporary decision to leave the aisle, or put the cookies into the cart, your mind wanders back as you continue through the store, either feeling like you should take the cookies out of the cart, or wondering if you will pass by other cookies and if you will be able to pass them over too.  Is it just me?  I don’t think so, maybe for you it’s not cookies, maybe it’s picking the right birthday card for a friend, or what job to take, the email you are sending to a friend, etc.

When the committee gets involved, we can all empathize with the wish someone stated to me once when he said he wanted to put them on a bus and send them away for the weekend.  Since that is not possible, what is the alternative?  I have one that may surprise you.  Think about loving them.  That’s right, envelop each part of your committee with love and thank it for working so hard on your behalf.  Right now I imagine there are quite a few people reading this who will argue that there is a part of them that is just plain wrong, that it is a part they would like to eliminate completely and that the focus should be on eliminating the “bad” parts.  If you are saying that, here is my question to you…how is that working for you?  I’m guessing that has not been so successful or you would not still be reading this post.   I might suggest that telling them to go away hasn’t been working so well so far.

If you want to try something new, take a moment to reflect on what it is each member of your committee is trying to say to you.  Try to listen to one at a time.  Are they trying to convey important information about your health, safety, or emotional well-being?  Is your committee chiming in about ways to keep yourself or your family safe?  Is it reminding you of something you need to know right now?  I promise you that even the most seemingly destructive parts of you are trying to help you in some way.   When you figure out the message, imagine yourself giving that part of you a hug and thanking it for it’s input, like you would a friend that just told you something that was really hard to say.  Make sure it knows you got the message and that you will take it into consideration.  Often times these parts of us, our committee, can be like any other team meeting where, if people feel like their important message is not being heard they just repeat it over and over again, saying it louder and louder, until people finally take notice.  Your committee may be doing this now.

Remember, listening to your committee does not mean that you will do exactly what they say, but, just like your children, if you take time to really listen to them, and they feel heard, they are more likely to listen when you tell them no, feel good when you agree, and feel less and less like they need to yell to be heard.

If it is confusing when I say to listen to your committee then listen to yourself, since your committee is part of you, that is understandable.  What I mean is, your committee members are all aspects of who you are.  At your core is you.  The you who knows what you really need, the you who is connected to all the love you feel for yourself and others, the you that does not need to judge anyone else, and is the same you that is connected to a higher, spiritual purpose.  Some people call it their higher self.  We all have this, it is the part that tells us we can do this, forgives us our imperfections, and that finds creative ways to solve any issues.  Take a few moments each day to connect with your committee, then to connect with your core, or higher self.  If you worry about fitting this into your daily routine, remember, thinking is free and can be done anywhere.  Even people with young children can take a few minutes a day to sit when the kids are in bed or are eerily quiet in the next room to check in with their inner dialogue.  The process of getting to know yourself and find peace within does not happen in one day, rather, it happens in increments over time.  It takes a lifetime, which is okay, because you have that long to do it.

A word of caution, your committee may try to tell you that doing this is too difficult and to stop or you won’t like what happens next!  Should you hear that warning from your committee, I would urge you to find a therapist to help you navigate the murky waters of your inner workings.  Over time you will find that the process of getting to know yourself can be like finding a long, lost friend that you have been missing desperately for a long time.

Doing this exercise is especially important for parents because, I hate to tell you, our inner dialogue shows to our children whether we like it or not and becomes their inner dialogue.  The best thing we can do for them is to clean up our inner space and be infinitely loving to ourselves so that our children may follow our example.

There are guides for this type of work as well. Self-Therapy: A Step-By-Step Guide to Creating Wholeness and Healing Your Inner Child Using IFS, A New, Cutting-Edge Psychotherapy, 2nd Edition by Jay Earley (Jan 27, 2012) is one such book.  It is available on Amazon and if you click on the Amazon widget link at the top right of this screen you can find out more about it.  Please read my disclaimer page.

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May 9, 2012 Posted by | help for parents, parent support/ self improvement | , , , , , , , , | 6 Comments

Monday is parenting affirmation day at Help 4 Your Family!

From now on, Monday is going to be parent affirmation day at Help 4 Your Family.  Sometimes I  will share affirmations I have created and used, other times I will quote affirmations from teachers I have come to trust.

For this Monday, May 7, 2012 your parenting affirmation is:

My children give me constant opportunities to learn and grow.

Now, you know this one makes you smile, even when you are tired. I would suggest that, to make this part of your self-talk, you repeat it many times throughout the day.  Say it to yourself in the mirror, and mention it to your friends in conversations.

If you have a parenting affirmation that you would like to share, please feel free to let me know.  Maybe you will see it some other Monday 🙂

All the best to your family,

Kate

May 7, 2012 Posted by | affirmations | , , , , , , , | 9 Comments

I’ve been tagged and I’m dedicating this post to assholes

Asshole 7"

Asshole 7″ (Photo credit: Wikipedia)

Well, I’ve been tagged by Rebecca from Mom meets Blog.  What does that mean?  It’s some kind of game in the blogosphere, and I’m a child therapist so I know games are good. Here are the rules of this game:

  • Answer the question the “tagger” listed for you in their post
  • Create 11 new questions for the people you tag to answer
  • Choose 11 people to tag and link to them in the post
  • Let each blogger know that you have tagged them

Rebecca was kind enough to allow me to choose a question.  I figured since she listed me as the fifth blog she tagged, I would answer question number 5.  It’s a good one.  “Was there a teacher who had a particularly strong influence in your life?”  Why, yes, quite a few as a matter of fact.

I recently took a meditation class where the teacher, Claudia, explained about people with a name she pronounced ( ash-o-les).  When she said it, I thought she was talking about her wise, spiritual teachers.  The actual spelling of this word is assholes.  In fact though, Claudia said that assholes have been some of her best teachers.  Well, the same is true for me!  They are, indeed some of our best teachers if we allow them to be.  In figuring out how to live life with, around, and in spite of, assholes, we learn so much about ourselves, including our weakness, strength, resilience and even courage.  I have had several teachers in my life who, I have to say, sometimes I thought were real assholes (and sometimes they really were).  I won’t name them here- they don’t really need it.  Most of them were wounded and were assholes because they carried the belief that whatever they were doing was self-protective.

Now, on to another great teacher for me who is most definately not an asshole.  Well, not to me anyway.  My mom thought he was a real asshole for a long time.  She’s long since worked it out, but who can blame her?  After all, she and my dad divorced back in the early 80’s after he came out of the closet.  The non-asshole is, you guessed it, my father.  Stay with me, I’m going to bring this right back to the beginning.  My father is one of my greatest teachers because, among other things, he decided to be true to himself.  Back in the 80’s, being gay was not considered to be too awesome.  In fact, things were pretty hush, hush.  My dad’s coming out caused quite a ruckus.  He lost his marriage (and almost his children), and he came close to losing the private practice (he is a physician) that he started when his partners nearly voted him out.  He has told me, in the many conversations we have had since about this time in his life, that he felt he no longer had a choice once he came to the late understanding that he is gay.  In coming out, my father modeled for me how to stick with the strength of my convictions even though sometimes people are going to think you are an asshole.

I offer this to you, readers, as a lesson as well.  Sometimes in life, we need to be okay with other people thinking we are assholes.  It can save lives, literally.  We can also learn that sometimes, when we think someone is being an asshole, they are just trying in the best way they know how, to protect themselves, or even save their own lives- even if it does not look that way from the outside.  The people who think you are an asshole sometimes could be your kids, your parents, your boss or co-workers.  They could all think you are an asshole when you don’t do what they want you to do.  The trick is to figure out if you are doing what you are doing for the greater good and whether this is actually self-protection (or protecting your children) or not.  I’m so glad my dad was able to weather that storm.  His decision to be true to himself gave me so many gifts.  I am also grateful and for all the other lessons he has taught me- like, that being honest is really the best policy, and how to maintain long-term, healthy relationships (he and his husband have been together for more than 30 years).  Thanks Dad.

Now, on to the next part of the game…tagging others.

  1. Gorillaparenting
  2. Queen of Familosity
  3. Anger Management Chicago
  4. 400 days til 40
  5. Mommyman
  6. Science of Mom
  7. One Inch of Grace
  8. Let Life In Practices
  9. Boundaries of the Soul
  10. Unhappy Mommy
  11. Danielle’s Story

There are so many great blogs to choose from! If I didn’t choose yours, or you don’t have a blog, feel free to just answer one of the following questions below.  I pose the same questions (pick one or more) to the chosen blogs.

  1. What is advice you would give to new parents?
  2. How is your life different now than you imagined it would be ten years ago?
  3. Have you ever had a good lesson that came in strange wrapping paper?
  4. What is something you said you would never do that you now do routinely?
  5. What books are you reading and what do you think about them?
  6. What path did you take to do the job you are doing now?
  7. If you could change something about your life, what would it be?
  8. What is the best thing that has happened to you in the past year?
  9. What do you think will be different about your life in ten years?
  10. What is your favorite blog post ever, and why (you can include your own)?
  11. What is something about you people might not guess from your blog?

May 2, 2012 Posted by | blog awards and recognition | , , , , , , | 8 Comments

getting insurance to finance specialized therapy

No matter how you feel about the whole health insurance debate in the United States, I think most of us can agree that dealing with insurance companies can be confusing and frustrating.  It can almost seem like the insurance companies have their own special language and code words.  If you have a child in need of specialized therapy, or you are in need of therapy yourself, going through your insurance can seem really daunting and to add to the difficulty,  many specialists no longer deal with insurance.  My hope is that this post will help you navigate the way US insurance companies work so that you can get services paid for (even if they are out-of-network).

Do not let your insurance’s first response, where they say they are not funding an out of network provider, or they say they will but will only pay 20%, throw you off.  You still have options, they just aren’t going to tell you what they are.  Let’s start with a quick primer on insurance “lingo” you need to know:

in-network providers– are providers covered by your insurance company.  If you are going to an in-network provider your insurance company has an agreement with your provider so that they are likely to pay most of the bill except for your regular co-pay.

out-of-network providers– are providers your insurance company does not have an agreement with.  If you are calling your insurance company and they say the provider you are calling about is out-of-network, you will want to ask if you have out-of-network benefits on your plan.  If they say no- do not panic- you have options!

usual customary rate (UCR)- is the rate your insurance customarily agrees to pay for a given service.  When your insurance says they will pay 70% of the UCR that means they will pay 70% of what they normally agree to for that service- which is often different from what the specialist charges.  If your insurance says they cover a percentage of the UCR, ask them what the UCR is for the service you are getting.  If they say $80 and they cover 70% of the UCR, that means they will reimburse you or the therapist $56 and you would be responsible for the remainder of the UCR if you are seeing an in-network provider, or the remainder of the provider’s fee for out of network providers.

Now that you know these terms. give your insurance a call and see what they have to say about the provider you want to see.  Remember to also ask if you have a deductible and how much of your deductible has been covered.  Other insurances have a rate that changes, for example, they pay 20% for sessions 1-5, 40% for session 6-30 and 70% for sessions 31 and above.  Don’t worry, I’ll summarize at the end so you can get all the questions together.

So, what do you do if your insurance company tells you your chosen specialist is not covered? 

Gather the information that makes your provider special.  Do they have special skills and training to help your child that other providers do not have?  My clients that call would tell their insurance I have specialized training in trauma, attachment and adoption- if they are bringing their children for one or all of those reasons- pick only the issues that pertain to you and your child.  Ask your insurance if they have anyone in-network that provides that same level of expertise.  Your insurance is required to find someone with comparable skills within a reasonable distance of your home who has the specialized skills you require.  If they do not, they are required to offer to pay their UCR to your specialist.  If you have a willing specialist, with just a short conversation with your insurance, they can negotiate a rate for services.  I have done this several times now.

To summarize, the questions for your insurance are:

1.  Is (name of the provider) in-network for my plan?

2.  Do I need authorization?- asking the question starts the process if you need it.

3.  If my provider is out-of-network, do you have an in-network provider with the same skills and availability within reasonable distance from my house?

4.  If you do not have anyone in-network, could you offer the provider a single case agreement?

5.  What is my deductible?

6.  What is the reimbursement for this service?

7.  If they mention UCR, what is the UCR?

Remember, if they say they have an in-network provider with the same skills as your specialist, make sure to follow up and call that specialist to make sure they are taking clients because if they are not, you can call the insurance back to report and they need to find someone else or offer a single case agreement.

In case you understand better with a flow chart, I have included one of those below as well.  If you have further questions or would like clarification, please ask in a comment.  This stuff is confusing and someone else probably has the same question!

insurance questions flow chart

April 27, 2012 Posted by | health insurance, thinking about therapy? | , , , , , , , , | 1 Comment

Qualities of good programs to prevent child abuse

PEARL HARBOR (April 23, 2010) Mara MacDonald, ...

PEARL HARBOR (April 23, 2010) Mara MacDonald, from the Navy New Parent Support Home Visitation Program, leads a group of new mothers and their babies in an infant massage class. The program is administered by the Navy Region Hawaii Fleet & Family Support Center and assists new parents and expecting parents with home visits, information on parenting, referrals, support groups and nurturing skills. (U.S. Navy photo by Mass Communication Specialist 1st Class Jason Swink/Released) (Photo credit: Wikipedia)

In my final post (for now) about programs to prevent child abuse, I thought I would highlight some qualities of programs I have seen that effectively work to prevent child abuse. As a reminder, my original start to this series of posts was a question posed on another blog about how we can prevent child abuse and child deaths.

1.  The first quality any program providing aid to people who could use parenting help is compassion/ empathy.  I know this may seem like a no-brainer, but some programs I have seen seem to leave this element out.  No one wants to go to a program to hear how awful they are, thus confirming their internal fear that they are, in fact, awful.  A compassionate program understands that all parents experience fear, that we are all doing the best we can, and that none of us have children thinking we are looking forward to messing them up as much as possible.  Acknowledging this over and over is an important part of any program seeking to help parents.

2.  Normalizing getting help is an incredibly important part of any program seeing to end child abuse.  Highlighting the diversity of parents, race, class, and gender, who seek help is also incredibly helpful.  This is, in my opinion, best achieved by having mentors that have completed the same or a similar program and are a representation of the general client population of the program.  For example, if this is a program aimed toward parents experiencing postpartum depression, you would want a parent mentor or group leader who has experienced this and is regularly available to participants.

3.  Good programs focus on the importance of parents in a child’s life.  For regular followers of my posts, you know I had to mention attachment :).  But seriously, the cornerstone of a good program that prevents child abuse absolutely needs to highlight the impact parents have on their children.  I think people sometimes think it is a given that parents know how important they are to their children, but for people struggling with parenting- perhaps people whose parents were not ideal either- I find that many of these parents feel disempowered to make change in their child’s life.  A good program reminds a parent of just how important they are.

4.  The final quality I would like to highlight is that a good program helps people to build a supportive community.  Good programs build communities so that if the program is ever unavailable, the learning and growing continues among the members of the community.

Some good programs I know of in my area are:

The Healthy Families program where parents are met in the hospital by someone from the program and are given support if they request it.  Support can include getting help with access to services or forming a group of other new parents in the community.  While there are healthy families programs all over the country, you can find the one near me here: http://www.hopkinsmedicine.org/howard_county_general_hospital/services/mothers_and_babies/healthy_families/index.html

The National Family Resiliency Center (NFRC) is a center for families experiencing a family transition and for parents where there is any need for co-parenting agreements.  NFRC has been a national leader in helping court systems to recognize that when parents separate it is important to keep in mind the best interests of the child.  They provide individual, couples, group counseling for parents and children, reunification and collaborative divorce services as well as very good classes for parents and children who are experiencing the transition process.  Additionally, NFRC helps parents who would like to have co-parent agreements and low-conflict divorce.  One way they do this is with an on-line program, www.familyconnex.org to help parents make decisions that are in the best interests of the children.  Here is the link to NFRC’s website: www.nfrchelp.org

The Infants and Toddlers program, which is part of the educational system but may go by different names in other states, identifies infants who may have developmental delays and helps parents by offering resources for children birth-5 years with the combination of services they might need to get them school ready.  You can find them here: http://marylandpublicschools.org/MSDE/divisions/earlyinterv/infant_toddlers/about/message.htm

There are many more, but these programs I mentioned in particular, although they target different populations, offer the combination of qualities important for a program aiming to prevent child abuse.  While they might not even directly target child abuse, they are organizations that can recognize and report possible abuse, and that may help to prevent it in the first place though education and service.

What do you think?  Do you know of any good programs that have been effective in your area in preventing abuse?  I would love to hear about them.  Also, did I miss any qualities of effective programs to help parents?

April 20, 2012 Posted by | help for parents, social services | , , , , , , , , , | Leave a comment

Trash Your Behavior Charts!

Kids (film)

Kids (film) (Photo credit: Wikipedia)

I have a pet peeve as both a parent and as a clinician about behavior charts.  You know, those charts where kids get stickers for doing things they are supposed to be doing anyway, and then they get a treat or prize for doing it enough times?  I am aware this opinion may be upsetting to some clinicians and especially school professionals where behavior charts are relied upon so heavily.  As a parent, I just think they are annoying and hard to follow for me.  As a clinician, I believe they set up a tit for tat system in a family where everyone starts measuring who did what when.  For my parents with children with attachment disorder they are especially frustrating because by the time a child has earned the prize, you might feel as though you are so angry about all the work it took for you to get them to do the chore/ desired behavior that you don’t really feel like giving them anything.  Sometimes kids make you sorry you gave the prize after the fact by deciding now that they earned the prize they don’t need to do anything for a while.  What a pain.

I have a much better alternative to traditional behavior charts.  It’s the only one that works and it requires little effort from you!  This will take all of two minutes of your life.  Here’s how it works:

  1.  Take a piece of paper and write down one or two (I would only do a couple at a time because it’s easier to keep track of) things your child does that bug the heck out of you i.e. lying, “forgetting” to do their chores, sassing back.  Pick something that is realistic for their developmental level.
  2. Think of a few prizes you might like to earn that involve self-care: a massage, getting a cup of tea with a friend, take a long bath, etc.
  3. Let your child know that you are now giving yourself a behavior chart.  When you are able to successfully handle this behavior from your child in a manner you feel is appropriate (without you yelling, whining, engaging in a back and forth battle), you get a point!  Decide how many points you need to earn to get a prize.   Tell your child that when they engage in that behavior from now on you (not they) will earn a point.
  4. When they do engage in the behavior, calmly remark on what an opportunity this is for you to earn points so you can take care of yourself.  It’s important for parents to take care of themselves when kids are giving them a hard time.  You can wonder aloud how long it’s going to take to get your prize.
  5. This is the most important step.  Follow through!  When you earn your points, do the thing you said you would do to take care of yourself, even if you don’t feel like it.  Remember you picked things you like to do so perhaps they can help you now.

I have successfully used this “behavior chart” with many parents now and I have used it myself.  It works like a charm.  I used it with my own daughters who kept coming in at night to have me take them back to bed when they had their normal cycle of lighter sleep.  I modified it so that if one kid came in, she earned her sister a point!  Guess who sleeps without interruption for weeks at a time?  This lady, right here does! J  It’s really a win-win either way since even if you don’t get the desired behavior right away (and you will because kids get annoyed at the idea of earning you a prize) you at least get some self-care.

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April 5, 2012 Posted by | attachment, discipline, help for parents | , , , , , , , , , , , , , , , | 7 Comments

What is attachment disorder?

Mother and Child watching each other

Mother and Child watching each other (Photo credit: Wikipedia)

One of the areas I specialize in is working with children with attachment disorders.  If that term is new to you, please allow me to explain.  Attachment is the relationship a child forms with their early caregivers that shapes how we form connections to other people throughout our lives.  We are all born relying completely upon adults to meet our needs.  I am no animal expert, however, I believe humans are one of the few species that cannot feed ourselves soon after birth.  For basic nourishment and caretaking, we rely heavily upon adult caretakers for a relatively long period of time.

As infants, while we are relying on our caretakers, we are also building the neurotransmitter systems in our brains.  When babies look into the eyes of their parents, literally thousands of neurons per second get activated and the building of this neuron wiring sets up the building block of our attachment system or structure.  When you think of it this way, it is simple: if baby gets her needs met “enough,” she develops what we would call a secure attachment, if baby does not get her needs met “enough” she develops what we would call an “insecure” attachment.  By the way, “enough” has been studied and it means that we meet our babies/ children’s needs 30% of the time (or preferably more).  That does not mean that 7 out of 10 times are gimme’s!  Think about when a baby is crying.  You try to figure out what is wrong…diaper?  No.  Hungry?  No.  Rocking and singing?  Bingo!  You just got it wrong twice and right the third time.  The trick to this is to keep trying to label and meet a child’s needs and to help them learn to label and name their needs to make it easier for you as they grow.  But I digress…

Securely attached children tend to think more along the lines of:

  • The world is a safe place.
  • I am loving and loveable.
  • I get my needs met.
  • Adults are reliable.
  • If I have a problem, I can usually fix it or get someone to help me.
  • My choices make a difference.

Children with insecure attachments tend to think more along the lines of:

  • I need to get my own needs met.
  • I am bad.
  • When I trust people I usually get hurt.
  • My choices don’t make any difference.
  • I need to fix my own problems.
  • People are not trustworthy.

In the classification of insecurely attached children there are two categories.  I see these categories as insecurely attached with a structure (anxious or avoidant) and insecurely attached without structure (disorganized) .  Why the distinction?  Because if you have a child who tends toward anxious/avoidant, you are more likely to be able to predict behaviors and their response to different challenges.  However, with a disorganized structure, because the child has no system for tackling issues in place at all, it is incredibly difficult to predict what the child will do in a given situation.

To find out more about attachment disorder please visit the website I participate with www.attachmentdisordermaryland.com.  There you will find a wealth of information on this topic.

Stay tuned for future posts on attachment as well!

March 31, 2012 Posted by | attachment disorder | , , , , , , , , , | 10 Comments

Finding the right counselor/therapist for you and your family

So..you decided that you want to find a therapist for you or your child.  How in the world are you supposed to know how to do that?  What an intimidating thing to do, and, like any other doctor you see, who you pick can have a strong influence on your outcomes.  While your first instinct might be to go through your insurance to find a provider, this is actually not the path I would suggest for the majority of people (even if money is an issue).

My first suggestion is that you identify the reason you are seeking a therapist.  Is it for marital issues?  Are you looking for a social skills group for your child who has a diagnosis of ADHD?  Have you had a history of trauma and are you seeking to heal from it?  If you know anyone who has had similar experiences and you are close enough to them to ask, check with them if they have found a good mental health provider.  Even if you do not want to see their provider because that might feel weird, if their person is good, you can call them and ask for referrals. Similarly, do not be afraid to ask a mental health provider that you know personally about referrals as long as you trust their opinion.  While someone you know personally can not see you for ethical reasons, they may know of a referral for your specific issue.  If you do not have a resource like this, look up local groups in your area that specialize in the issue for which you are seeking treatment. They may have some providers they commonly refer to.   School counselors also typically have referral resources.  If you are attending a college or university, you may also be able to see a therapist on campus.

On a side note, if you are not clear on the specifics of who you are looking for, think of mental health professionals being like other health providers.  There are specialists and general practitioners.  If you are unsure, go to a general practitioner.  If you work for a large company, there may be an Employee Assistance Program (EAP) provider who will see you for a few sessions and steer you in the right direction (with the understanding that then your work has a record you saw someone), or there are many good, general mental health practitioners out there that you can find using your personal network.  If you find a good one and they identify that you need a specialist, they may refer you out for more specialized treatment.

Now that you have identified possibilities, it’s time to make some calls.  I would encourage you not to be put off by someone if you can not find them on-line, you may find that in my profession, there are not as many technologically savvy people out there so there are tons of wonderful professionals who may not have a website- or even email!  Call the professional directly.  Try to speak with them on the phone to get an idea of availability and whether they specialize in the area for which you are seeking help.  Ask about what insurance they take, if any.  Those lists you find on line from your insurance company can be hopelessly out of date so always ask.

Pay attention to how you feel when you are speaking to the provider on the phone.  Do you feel they listened to you?  Do they have availability to see you at times that work for you?  If you are uncertain, do not be afraid to say that.

Now is the time to check with your insurance.  If the provider you want is in-network for your insurance, great- skip this paragraph!  If not, call your insurance and see what your out-of-network benefits are.  For instructions on how to do this, you can look under the insurance button on my practice website: www.ahealingplaceincolumbia.com.  Do not give up if you do not have out-of-network benefits and your selected provider does not take your insurance.  Call your insurance, ask them to find someone in-network who works with the specialty you are looking for.  If they can not locate someone in-network with the specialty you need and who has openings to see you- they must offer you an option to reimburse the person of your choice.  There is a law that says insurance companies cannot deny you coverage simply because they do not have an in-network provider that provides that specialty.

If all else fails, ask your chosen provider if they are willing to give you a sliding scale for payment up front- you would be surprised how many providers are willing to negotiate.  Finding someone that you work well with and trust, while it may cost more up front, you will also probably get better quicker so you do the math- say you go to see someone 10 times for $75/ week sliding scale vs. seeing someone who takes your insurance with a $40 copay but since they don’t specialize, let’s estimate it takes twice as many sessions- 20 for you to feel better.  That’s a total of $750 for the first treatment and $800 for the second (plus the extra time in your life you spent in treatment).  When you look at it that way, it’s a no-brain-er.  And, don’t forget, if you have a health spending account through your work, mental health care is covered and reimburseable.

Next it’s time to go ahead and meet with the person you feel comfortable with on the phone and remember- you are a consumer!  As a consumer, you have the right to decide where and from whom you are going to get treatment.  If you go in and see someone and they just are not it- try someone else.  Not all therapists are a good fit for every person.  However, if you find you have gone to meet five different people in search of the right person, you might want to think about whether your expectations are realistic and give the one you found the most helpful another try.

I will be the last person to tell you that all therapists are good, or even the same.  Look for my future post on different kinds of therapists to learn about just how different we can be.  No matter who you see, what is found consistantly in studies about mental health is that it is the relationship between the therapist and the client that is more important than the choice of intervention when we look at whether therapy has been successful.  You have a right to getting what you want from treatment.

Look for future blogs to address red flags when looking for a therapist and when it might be time to move on.  Since I specialize in attachment disorders, I will also be posting about finding an attachment focused therapist.

March 30, 2012 Posted by | thinking about therapy? | , , , , , , , , , | 7 Comments

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