Parenting Parallels to Therapy

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As a parent I have noticed there are a number of different camps in parenthood literature: ones that espouse behavioural modification shaping (i.e. cry it out in terms of sleep) and others who espouse attachment/ child-led philosophies that tend to emphasize the child’s innate ability to know what they need and face natural consequences. As a parents I have found wisdom in both of these camps.

Similarly in working as a therapist I have found competing theories in working with clients with what psychiatrists often call “behavioural issues”, or “personality disorders”.

These are clients who for whatever reason (often poor attachment growing up, but not always) employ coping mechanisms that keep them stuck in a negative emotional state over the long-haul and often involve intensive contact with the psychiatric system. Some approaches demand a very rigorous and structured approach, and others espouse a focus on the creation of re-creating an attachment relationship over many years in therapy.

In working with these clients, you are often presented with dilemmas familiar to being a parent to a child who has temper tantrums, misbehaves at school, or directs anger inwards at themselves. How do I respond to problematic behaviour and strong emotions in a way that shows love and respect ? How do I respond so that I do not inadvertently make the problem worse rather than better ?

However, unlike parents, I do not have the same amount of time, nor even trust with such clients; I might see my client one hour per week, rather than working with them 24 hours a day. In addition, the clinical situations I face require decisions that force me to balance the risks between encouraging positive change in the long-term, and short-term safety risks (i.e. suicide). I am usually the most recent therapist of a long list of helpers and caregivers that have tried to help them and have given up, left for other reasons, or passed them on to another care provider.

I am by no means an expert in helping these complex clients, but I do care about them and would aim to work therapeutically for their benefit and recovery.In my effort to try and be a contributing force for good in the my work I hope to actively process reflections from various books on this blog, beginning with “Doing Dialectical Therapy” by Kelly Koerner (2012).

Never Insight Alone: DBT Therapy

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In Doing Dialectical Behavior Therapy, Koerner (2012) asserts states that “You’d never consider insight alone to be enough to change your golf swing or paint with oils.  Yet we often think that insight alone is somehow enough to change the complicated, highly habitual maladaptive behaviors of regulating emotion.”  

 What this means essentially is that understanding that what you’re doing is not working is not enough to change what your doing; you need to be taught and practice a lot. 

Similarly, telling someone what to do without actively assisting them to act out new skills can set someone up for failure.  However, even the act of learning a new skill needs to be handled with care to provide validation for their efforts and inherent value, especially when techniques to handle emotional pain aren’t performed perfectly the first swing. To do this you not only need to have the right information but deliver it in a wise way, like an excellent coach. 

Growing up, many of you played team sports; more often than not the coach would be a parent volunteer.  However as most of us know, there were good coaches, there were bad coaches and there were excellent coaches.

I had an excellent soccer coach throughout my childhood.  A tall lanky British born man with a distinct accent; he had nicknames for all of us.  He was no softy, but always explained his rationale “If I’m yelling at you on the field, it’s not because I don’t like you or am mad, it’s that I need to you to hear and respond quickly”.  This explanation helped poor sensitive spirits like myself.  He had a way of honing on your particular talents and garnering enough encouragement to keep trying at something that you’d failed at 100 times. For example, he knew I had a knack for heading the ball, and always stationed me near the net at corner kicks, despite playing left defence.  It was because of his coaching I eventually did score that way in a provincial championship game.   I can’t say that I didn’t shed quite a few tears on the soccer field trying to learn how to punt, but I kept persevering.  He had high expectations and outlined what it would take to improve, but never used high-handed verbal threats.  I thrived under his excellent coaching which was solution-based corrective feedback , with firm constant validation. 

This is what our clients need to move forward; excellent coaches, trained in their craft, knowledgeable about how they can move forward, providing corrective feedback in a validating way.  Looking back, I think the key to the success of my childhood coach was that he knew everybody as a person, our nicknames signified our value and belonging.  His connecting with each person, not just the stars made the biggest difference.

I’ve found similarly with some of my clients, I work as a coach, sIowly working out alternate strategies that work for them, without the use of deeper emotional processing therapy. For example I worked with a client who engaged in self-ham activity and suicidal urges, which was always precipitated by binge-drinking.  I went through this creative problem solving and testing out with him until he eventually felt confident in his chosen strategy and even if he relapsed into old ways was able to provide self-talk to himself realizing it was just a “slip” and continue on.  Yet throughout this process, I always encouraged him to see that he did have choices in how to deal with the problem, but they held different consequences.  This process has taken almost a year, long slow work with setbacks and small steps forward. Important work in the playing field of life.