Parent-Child ACTChris McCurry, Ph.D.

ABCD, Inc. Seattle, WAcmccurry@abcdseattle.com

Disclosure

The presenter has a pitifully small financial interest in two books in

the bibliography

Objectives Participants will learn how ACT theory and

concepts help clinicians understand typical child development and important parent-child transactions

Case presentations will describe, from an ACT perspective, presenting problems commonly seen in child clinical practice

Research-informed strategies and techniques for improving child and parent functioning will be demonstrated

The Referral Path Children rarely refer themselves

Who owns the problem- The child? One parent or the other? The pediatrician? A teacher? A grandparent?

Relates to values and goals

The Hairball Model of Psychopathology

We need an understanding of

“Me? I thought you were raising them.”

Attachment Between about 6 months and 1

year of age a child will develop certain behaviors in response to the absence of the caregiver or the presence of a threat

These behaviors will coalesce into a predictable pattern marked by general distress, signaling, withdrawal or proximity seeking

Attachment Depending on the caregiver’s response,

a child may reliably obtain relief or not

A child’s “distress behaviors”, shaped by the parenting environment, will be subtle or dramatic, clear or ambiguous

Internal Working Models of how the world operates (safe or threatening, helpful or unhelpful) will develop

“Individuals whose needs for security are not met come to

view the world as comfortless and

unpredictable, and they respond either by shrinking from it or doing battle with

it”

John Bowlby

In Other Words

Avoidanceor

Control

Cognitive Development:Born Fused and Inflexible

Egocentric

Idiosyncratic / Magical

Literal (psychic equivalence)

Rigid

Binary

Fusion (internal and external)

Under stress, they (we) will

regress

A Common Process: The Distress Gambit

A child’s distressed behavior invites (compels) the caregiver to

participate in the distress as a witness, confidante, cheerleader, task master, lifeguard, or most

commonly, as a rescuer

The Distress Agenda

The child’s behaviors are an effort to engage the caregiver in the dance, in order to achieve …

Emotional Avoidance utilizing …

Escape/Avoidance Attempts at Control

Fear is meant to feel bad!!!

MomRescue

“Good”

Cry

“Mom”

Job

Mother

Yell

Spouse

GuiltStressMore

Stress

Danger!!

The Limits of Parent Training

Parent Management Training (skill building) has been shown to be helpful, but parent and child may have reverted to old patterns at follow-up

High stress families are most vulnerable to this erosion positive behavior change

Stress is known to constrict attention and enhance a negative attentional bias

The Parent-Child Ecosystem Parenting is a large and diverse

class of behaviors embedded within a larger ecosystem or “field”

Parenting behavior is influenced by distal, indirect, unhelpful, and (dare I say) unconscious factors- Setting Events

“It’s a magic potion that makes everything you say interesting”

The Reactive Dance1. Child becomes distressed (and regressed)

2. Child, seeking rescue, acts out his distress in dramatic, regressed, or confusing ways

3. Parent becomes distressed (and regressed)

4. Parent seeks escape from this situation

5. The immediate goal for both parent and child becomes escape or control in the present, avoidance in the future

Mutual Parent-Child Experiential Avoidance

Held in place by negative reinforcement, also known

as “the coercion trap”

Tolerance Inconsistent parenting leads to increases in

negative child behavior

Inconsistent parenting is often due to the parent’s behavior falling under the control of distal setting events, typically life stressors

Basic parent “leaning in” and “leaning back” must be under the control of the child’s behavior and what the current situation actually calls for

Team Captains

A Responsive Dance1. Child becomes distressed, regressed

2. Child acts out; seeks contact, communication, rescue

3. Parent is alert to becoming distressed, regressed

4. Parent models distress tolerance

5. Parent acknowledges distress with specific language and connects to cause

6. Parent orients child to the original goal, to a solution, or to appropriate coping strategies

Changing The Dance

1. Increase awareness

2. Shift the focus of attention

3. Take values-driven action

Increasing Awareness

Classic Definitions of Mindfulness

Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally

Bringing one’s complete attention to the present experience on a moment-to-moment basis

More “Active” Definitions of Mindfulness

Mindfulness Exercises Observing the breath Eating Listening Smell Touch Seeing Descriptions v. Judgments Taking your mind for a walk

S.O.B.E.R. Stop Observe Breathe Expand Respond

S.O.R.B.E.T. Stop Observe Relax Breathe Expand Teach

Graybar’s First Law of Human Behavior

“All behavior is a message, and a behavior won’t begin to change until the person

knows the message has been received”

Validation Closes the communication loop:

“message received” Provides accurate and nuanced

emotional vocabulary Replaces ineffective reassurance

in many situations Says nothing of the

“appropriateness” of that thought or feeling at the time

Validation Promotes mentalizing and

undermines fusion and psychic equivalence

Links outer events with private events and the wanna-do’s

Articulates the process; both currently and what’s possible

Validation Strategies

Simple and specific “Ah” statements; “Ah, you’re feeling …” “You’re having one of those ‘I can’t do it’ ideas

now”

Identify expectations; “You thought there would be popsicles” “Ah, you want me to carry you now”

“I wonder” statements

Shifting the Focus of Attention

Shift attention from unhelpful private events to actionable goals

Breathing and orienting to an “affect neutral” stimulus as a “pivotal response”

The Role of Attention

Isabelle

7-year old female

Diagnosed with Separation Anxiety D/O and phobias: the word “Zombie”

Can’t be alone in any room of the house: “Marco Polo”

Lots of avoidance or trying to control situations

Mother, Holly, is the primary “dance partner”

Isabelle and Holly’s Dance The Situation: Any transition or anticipated separation

Setting Events: Holly’s work stress, other children

The Initial Behavior: Resistance and inertia from Isabelle, then focuses on some stimulus that evokes a pantrum

Holly’s reaction: Cajoling, reassuring, then pleading, then yelling/threatening

And then...? Holly may angrily physically guide Isabelle through the transition or Holly may acquiesce to Isabelle’s implicit demands

For Isabelle’s Mother

Child Directed Play

Dictionary.comEnglish Portuguese

Dictionary.comEnglish

“I’m scared”

“It’s not fair”

“I’m a loser”

“I’m a loser”

Portuguese

“Tenho medo”

“Não é justo”

“Eu sou um perdedor”

Swahili

“Mimi nina loser”

Dictionary.com

English German

Sterling

Sterling and Alistair’s Dance The Situation: Getting homework started and completed

Setting Events: Alistair’s own history with school, plus marital stress

Initial behavior: Sterling’s avoidance, arguing that homework is irrelevant to his future

Alistair’s reaction: Argues, debates, throws up hands and leaves

And then…? Sterling’s mother steps in and helps Sterling complete the work step-by-step

Projective Identification or The Hot Potato: “He who

cares least has the most power”

Rule-Governed Behavior “Behavior that is controlled by verbal

specification of contingencies rather than by direct contact with contingencies”

Enormously helpful: “Don’t eat those, they’re poisonous”

And, behavior based on rules tends to be insensitive to feedback from the environment: e.g., buying lottery tickets

“And then it hit me: I’m salivating over a bell”

Defusion Exercises

Naming and cataloging

Emotional vocabulary

Boats on a river

Matt Smith

Common Categories of Private Events

Sterling

“Scorekeeping”

Frustration

Impatience

Worry

Alistair

Impatience

Frustration

Worry

Regret

Emotional Vocabulary Angry

Annoyed

Frustrated

Belligerent

Indignant

Dudgeon

Defusion Exercises

Naming and cataloging

Emotional vocabulary

Boats on a river

Matt Smith

Matt Smith is a big, fat idiot.

OKOK

“Homework is irrelevant and stupid”

OKOK

“It’s not fair”OKOK

“This kid will never learn”

OKOK

Taking Values-Driven Action

Orienting away from avoidance and control of thoughts and feelings and toward the goal

“Oh, yeah. What were we trying to accomplish before all this commentary showed up?”

“When you’re going through Hell, keep going!”

Willingness vs “wantingness”

Commitment

A pledge or promise: obligation

The act of committing, pledging, or engaging oneself

The motivational story we tell ourselves

The choice to limit our choices

Commitment and Acceptance: Two Sides of the Same Coin

Effort, Frustration, Sacrifice,

Thoughtfulness

To Be A Good

Team-mate

Commitment and Acceptance: Two Sides of the Same Coin

Effort, Frustration, Sacrifice,

Thoughtfulness

To Be A Good

Student

Commitment and Acceptance: Two Sides of the Same Coin

Effort, Frustration, Sacrifice,

Thoughtfulness

To Be A Good

Brother

Commitment and Acceptance: Two Sides of the Same Coin

?????

To Be A Good Parent

More Defusion Exercises

Passengers on the bus

Goggles

Fiona 15-year old female Anxiety by Hx- now emerging

depression; low mood, low energy, anhedonia

Starting to “try out” cutting Somatic: stomach aches, migraines Lots of school absences Comprehensive avoidance/paralysis

around school work Few friends

Fiona’s Family

Strategies For Fiona and Parents Facilitated Listening

Contingency and Sensitivity

Tolerance

Chess Board

Choices and Decisions

The Distraction Paradox Valued Living Questionnaire

(behavioral activation and parent-daughter time)

Acceptance

“Be equal to your fate”I Ching

“The Fates lead him who will. Him who won’t, they drag”

Seneca

Strategies For Fiona and Parents Facilitated Listening

Contingency and Sensitivity

Tolerance

Chess Board and losing an important piece

Choices and Decisions

The Distraction Paradox Valued Living Questionnaire (behavioral

activation and parent-daughter time)

Fiona’s VLQ (partial)

Carl Gustav Jung

“Life’s truly important problems cannot be solved, they can only

be outgrown”