A few months ago, I wrote a piece about “good enough” parenting that seemed to strike a chord for many readers. Some challenged the idea that “good enough” could lead to complacency and short-change our children, but most expressed an appreciation for the self-acceptance inherent in that model. This month, at the risk of stirring up even more debate, I want to talk again about an approach to parenting.

After the birth of my son, I realized that if I ever wanted to take a shower again, I was going to have to let him cry it out for a time. This was very hard, but it was an important first step in my parenting journey that led me to embrace the art of benign neglect. It soon became clear to me that I would not physically be able to attend to my child’s every need every moment of the day. He would have to wait sometimes. He would have to entertain himself sometimes. He would have to delay gratification. This wasn’t a conscious parenting choice; it was just our reality. As it turns out, it was a pretty good thing.

Once my post-childbirth head started to clear, I remembered some words of wisdom from one of my favorite grad school professors. She opened the year by making the bold statement, “Our kids don’t suffer enough. They should suffer more. Thank you.” This was my introduction to the woman who led courses in achievement motivation and social and moral development. I was struck, even intrigued, by her words. As I followed her courses, I began to get what she meant. It was not, however, until I became a parent that I truly understood the implications, and challenges, of this concept.

What my professor was talking about was not abject, crushing, demoralizing suffering, but a more tempered form of discomfort and struggle. She was not advocating throwing our kids into the deep end of life and letting them sink or swim. What she was talking about was allowing them to face adversity while they still had a safety net, letting them stumble over little obstacles as practice runs at life’s larger challenges. Noted psychologist Lev Vygotsky talked about the concept of scaffolding—a way of providing appropriate support to children to allow them to stretch beyond their current abilities. As parents practicing the art of benign neglect, that’s what we try to do. If we do everything for our kids, if we smooth out every bump in the road, if we do everything in our power to remove pain, challenge, and discomfort from their young lives, we deny them the opportunity to learn, to grow, and to develop the coping skills they will need as they become independent adults.

When I think about the skills I want my son to develop, I want him to be secure. I want him to be confident in his own abilities. I want him to struggle through things, work them out on his own, ask for help when needed, and bounce back when things go wrong. I want him to be determined and resilient. In order to do all of this, sometimes I need to do nothing. I need to give him the chance to fail. I need to let him fall down, but be there to pick him up. This is what separates benign neglect from just plain neglect. I need to know where he is. I need to know what he is doing. I need to know that I’ve put the sharp knives out of his reach. It means, though, that sometimes I need to not intervene even when I so very much want to.

I see this in action when we are on play dates with friends. No parent wants his or her child to be pushing other kids or to be the kid being pushed around. Those practiced in the art of benign neglect will watch to see how events unfold. Do the kids sort themselves out when they scuffle? Are things escalating? Is anyone in danger of getting seriously hurt? Most of the time, the kids work things out on their own, learning valuable lessons and negotiation skills in the process. Sometimes, adult intervention just makes things worse. Other times, adult intervention is exactly what is needed to prevent full-scale descent into a Lord of the Flies scenario. When well-intentioned parents are ever-present, however, and intervene at the first hint of discord, our kids don’t get to learn how to work things out.

For the parents who are worried that if we don’t intervene our kids will learn poor strategies, hold those concerns for just a moment. Just because we do not intervene doesn’t mean we lose the teachable moment. Sometimes, our kids are more open to learning after an event rather than in the heat of the action. We can talk with them about their interactions. We can hear how they felt about it. We can talk about the consequences of the choices they made. We can teach them new strategies that they can try out next time. We can share wisdom and perspective, talk about our values and the way we want them to treat others, and we can encourage their independent growth. We can encourage them to think about why what they say and do is important, not because “we said so,” but for reasons that feel real to them. In short, we become resources for them and partners in their learning.

Practicing benign neglect as a parent is not about abdicating responsibility, ignoring limits, or letting go of all boundaries. On the contrary. It is about creating clear limits and boundaries, which all children need, yet allowing for enough freedom within those limits for true learning to occur. It is about watching and waiting and being intentional in the ways we intervene. It’s about allowing our children to feel some discomfort, letting them struggle, and helping them work through it. It is about loving them enough to let them experience the world in a way that lets them grow and learn, even when, with every fiber of our being, we want to shield and protect them from the bumps and bruises they will get along the way.

Children learn an enormous amount from their caregivers and parents. They learn through direct contact how to communicate, interact, and perform daily activities. They learn through exposure how to react and emotionally respond to situations. And whether parents are fully aware of this or not, a child’s behavior is in part the result of their parents’ response to it. According to a recent study led by Diana Morelen of the Department of Psychology at the University of Georgia, children and parents have a reciprocal emotional relationship. In other words, the way in which a parent responds to a child’s emotional reaction directly influences the way in which a child emotionally reacts.

The primary aim of Morelen’s study was to determine how reciprocal the child-parent emotional relationship was. Using a sample of 54 participants made up of fathers, mothers, and pre-adolescent children, Morelen examined how supportive emotional parenting (SEP) affected emotion regulation when compared to unsupportive emotional parenting (UEP). Specifically, Morelen wanted to know if SEP increased adaptive emotion regulation (AER) in children and if UEP increased maladaptive emotion regulation (MER). She then wanted to find out if these relationships were bidirectional. Morelen assessed the parents and children as they talked about four different emotions, anxiety, sadness, anger, and happiness.

She discovered that the way in which parents responded to their children’s emotions directly impacted the way in which children emotionally reacted. Morelen’s theory of reciprocity was confirmed when she found that SEP led to AER and AER led to SEP in all four of the discussion conditions. Also, MER predicted more UEP than SEP for fathers and mothers when discussing anger. However, when discussing the more vulnerable emotional states of sadness, mothers responded with SEP more than fathers when children exhibited MER. This finding could be partially explained by the male ideal of power and strength. This, in turn, may lead fathers to identify emotional vulnerability as a weakness. However, Morelen believes this is concerning because there is an abundant amount of research linking UEP to feelings of shame and inadequacy and patterns of emotional suppression, all of which can increase the risk for psychological impairment. Because of this, Morelen hopes interventions aimed at addressing family, child, and parent interactions focus on the emotional response of both mothers and fathers. “Programs could highlight the role that child behavior plays in soliciting parental behavior and coach parents on how to be mindful of the potential (positive or negative) influence of child behavior,” said Morelen.

Reference:
Morelen, Diana, and Cynthia Suveg. A real-time analysis of parent-child emotion discussions: The interaction is reciprocal. Journal of Family Psychology 26.6 (2012): 998-1003. Print.

There is a question that has been asked of me multiple times over the past few months that I would like to answer. The question is: “Should a child’s foster parent(s) be granted access to their child’s psychotherapy notes?” The answer is not as straightforward as it may seem.

The short answer is: “No, a child’s foster parent(s) should not be granted access to their child’s psychotherapy notes.”

First, we must understand what the HIPAA privacy rule is, as it will ultimately answer the question. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, is a federal law which resulted in the establishment of the HIPAA Privacy Rule in December 2000. The HIPAA Privacy Rule is designed to protect information about individuals’ health care treatment. To understand privacy protections in the United States, you must start with this federally established framework and then consult state laws to determine whether there are any additional requirements to observe.

Second, we must understand what the HIPAA Privacy Rule has to say about “individual personal representatives.” An individual personal representative is any person with the authority to receive or access another individual’s protected health information (PHI).

In some cases, adults and emancipated minors have individual personal representatives, such as someone holding “power of attorney” or in a court-appointed adult guardianship or conservatorship. Otherwise, adults and emancipated minors do have uniquely boundaried privacy protections, whereas minors (children under 18 years old, with the exception of children—typically 16 or 17 only—who have been formally “emancipated” from dependency status by a court of law) always have at least one individual personal representative.

Children and adolescents in foster care tend to have many individual personal representatives, including representatives from Child Protective Services, attorneys, designated child-placing agency representatives such as case managers, foster parents acting as medical consenters, and, in some cases, juvenile probation officers. In rare cases, even court-appointed special advocates (CASA) may obtain status as medical consenters through a court and would, then, hold the distinction of an individual personal representative.

In addition, foster kids benefit from an extensive continuum of care including doctors, dentists, psychiatrists, clinical psychologists, school psychologists, school counselors, collaborative treatment team participants such as child-placing agency treatment directors (such as myself), and other consultants (at my agency, we have psychiatric fellows and residents as well as a program manager, intake coordinator, and, in some cases, a higher-level program administrator who all may participate in the ongoing treatment staffing related to a child’s case planning), therapists (individual, sibling, family, group), early childhood interventionists (speech, physical, and occupational therapists), and skills trainers. Each of these treatment providers freely accesses PHI of other providers in the course of treatment, which is necessary and beneficial for collaborative treatment.

Ultimately, these supports are beneficial, but often, along this stream of care, the “minimum necessary requirement,” a best-practices principle generally recognized and affirmed through the HIPAA Privacy Rule, is not sufficiently revered, and foster kids’ private and protected health information may not always be protected in practice with the same degree of diligence that it is in so many other sectors of health care. It is in this current that foster parents often believe that they, too, are entitled to the most private of health care information, their child’s therapy providers’ psychotherapy notes. I know this to be true from my own professional experience.

The third thing that you must understand to answer this question is that psychotherapy notes are given unique privacy protections within the HIPAA Privacy Rule, more so than all other protected health information (PHI), including purely diagnostic or evaluative information, case notes, other treatment services such as developmental therapies (speech, physical, occupational), as well as other treatment summaries or reports. Even reports via email from a therapist summarizing general or overall progress of therapy—or any other generalizing or summarizing report—are not given the same protections as psychotherapy notes themselves (U.S. Department of Health & Human Services [HHS], 45 CFR 164.508, 2006).

There is one final piece of this puzzle: The HIPAA Privacy Rule clarifies that, in certain circumstances, parents are not privileged to act as their minor children’s personal representatives—with respect to certain protected health information—and thus neither control the child’s health care decisions nor the protected health information related to that care:

1. If no existing state statute or binding legal precedent requires a parent’s consent prior to a minor child obtaining psychotherapy treatment, and if the minor child then consents to his or her own psychotherapy treatment without the expressed consent of a parent, then, with respect to the minor child’s participation in that psychotherapy treatment, no parent acts as the child’s personal representative and, thus, the parent(s) will not be provided access to the psychotherapy notes without the child’s written consent.
2. If a court grants or other law authorizes another adult to act as the personal representative for a minor child as it relates to the child’s health care, then the minor child may obtain consent for such psychotherapy treatment from another personal representative, as provided, without consent from a parent. Similarly, in this case, with respect to the minor child’s participation in that psychotherapy treatment, the parent(s) will not be provided access to the psychotherapy notes without the child’s written consent.
3. If a parent provides a written and signed waiver expressly relinquishing his or her own right to participation in a confidential relationship between their minor child and a psychotherapist, then the privacy of the psychotherapy notes—as well as, in some cases, other protected health information—will remain boundaried and protected between the provider and the minor child, and parent access will be restricted unless the minor child provides written consent to the access of these protected records.

Further clarification in the Code of Federal Regulations (CFR) should be noted: “Even in these exceptional circumstances, where the parent is not the ‘personal representative’ of the minor, the Privacy Rule defers to state or other laws that require, permit, or prohibit the covered entity to disclose to a parent, or provide the parent access to, a minor child’s protected health information. Further, in these situations, if state or other law is silent or unclear concerning parental access to the minor’s protected health information, a covered entity has discretion to provide or deny a parent with access to the minor’s health information, if doing so is consistent with state or other applicable law, and provided the decision is made by a licensed health care professional in the exercise of professional judgment”(U.S. Department of Health & Human Services [HHS], 45 CFR 164.502, 2003).

Because foster children do not require the consent of foster parents before they can obtain psychotherapy services—and may obtain consent, if required, by way of other representative adults (such as child welfare caseworkers, child-placing agency case managers, etc.), whether the child independently consents or secures a nonparent consent to participate in such therapy, then, under the HIPAA Privacy Rule, the foster parent(s), for the purposes of this particular health care service, will not be provided distinction under the law as the child’s personal representative, and, thus, will not be provided the right to access documentation from the treatment record.

However, again, it is not that the HIPAA Privacy Rule expressly denies that foster parents have access to their children’s therapy notes, and, in fact, a “covered entity,” or provider (meaning, the child’s therapist) does retain prerogative to provide or deny a parent access with discretion if doing so is consistent with state and other applicable laws. Yet, this should be justified therapeutically.

In most cases, it is difficult to make a case that it is in the best interests of the child, therapeutically, to take away what is typically the only confidential outlet a foster child or teen has within the convoluted and institutional system in which they live and, thus, it is best practice in my state (K. Teutsch, personal communication, January 4, 2013) and in every state to preserve the therapeutic relationship by preserving the boundaries of confidentiality within that relationship and of privacy concerning the psychotherapy notes.

References:

1. K. Teutsch, Division Administrator for Medical Services, Texas Department of Family and Protective Services, personal communication, January 4, 2013.
2. U.S. Department of Health & Human Services – Office for Civil Rights (2006). HIPAA Administrative Simplification: Regulation Text [45 CFR 160, 162, & 164]. Washington, DC: US Government.
3. U.S. Department of Health & Human Services – Office for Civil Rights (2003). OCR HIPAA Privacy: Personal Representatives [45 CFR 164.502(g)]. Washington, DC: US Government.

It is not unusual for people to come to therapy with feelings of confusion about what they want, think, and/or feel. I find that many grew up in families in which one or both parents involved themselves in their children’s lives in ways that interfered with the development of separate, individual thoughts and feelings. Most of these parents were well-intentioned. Their intrusion into their child’s life typically came from a need to protect the child from painful feelings or to assure that the child’s behavior and choices were the “right” ones. As a consequence, these children grew up relying on their parents to define not only what they should feel or how they should behave, but ultimately their identity: who they are as individuals. As adults, these children spend a lot of time in their heads worrying about the choices they make, how they are seen in the world, if they upset their parents by having separate ideas, if they did the right thing, etc. They become confused when the thoughts they have about themselves are different from what they know their parents believe. “What is true and real about me?” becomes the question that these patients bring to therapy.

“Sam” came to see me filled with anxiety. He didn’t know if he should continue in a relationship that was becoming serious. “I think I’m in love with Kara,” he said. “We have a really good time together, and she is very good to me. But then I get confused: Do I really want to spend my life with her? My father thinks she isn’t a good match for me. She’s Italian, and I’m German. I never really thought about things like that, but my father thinks that the cultural differences are too much. He also thinks that Kara’s family is very different than ours and that will be a problem when we have a family.” Sam continued to describe his uncertainty about how he felt and what he should do. I asked him if he thought he would be less unclear about Kara if his father approved. It was striking to me that this question seemed to startle Sam. It hadn’t occurred to him that his father’s opinion about what was good for him had such a profound influence.

Sam agreed to begin therapy, and we began to explore how he thought about himself and how he determined what he wanted and needed. It soon became apparent to both of us that Sam’s father had always played a big role in characterizing who Sam was. Sam recalled that he wanted to take guitar lessons when he was about 10. His parents bought him a guitar, and he liked strumming it and learning to play, but he had trouble with dexterity and was not developing into a very good player. After about six months, his father told him, “You’re not very musical. You should find a different hobby. You should try chess; you would be good at that.” Sam recalled: “Even though I enjoyed playing and fooling around on the guitar, I stopped the lessons. My father started to teach me chess. I did get pretty good at it and joined a chess club in middle school. My father always says with great pride how he knew I would love it because I’m such a rational and logical person, that chess is perfect for me.” Sam paused and thought a minute and said, “It’s funny, I never thought about this before. I think of myself as a logical guy, but then I never know what to make of all the feelings that seem to boil up in me. My parents don’t see me as emotional.” Sam paused again, seemed deep in thought, and then sadly said, “Wow, I guess I hide that part of myself from them. They don’t really like emotions.”

As Sam and I continued to talk, he became increasingly upset as he began to discover that much of what he thought about the kind of person he was mirrored his father’s view of him. He also began to realize that there was a judgmental attitude when his father told him what he thought. For example, his father still believed that Kara was not for him. His father had explained, “You’re not someone who can deal with opinionated people. She is too aggressive for you.” Instead of becoming confused and wondering if his father’s idea was true, Sam began to consider his own experience. He was learning to ask himself what was happening in his internal life and to study what went on externally. He thought about Kara and her opinions and realized that many of her ideas were different from those of his parents. But he also saw that she was flexible and, in fact, he often agreed with her. As he was more able to focus on himself and create some space apart from his father’s influence, he could consider how he felt. He didn’t feel conflict with an opinionated Kara. Rather, he was becoming aware that he disagreed with his father. This was not an awareness that he allowed himself to experience very often. It made him anxious, but now he second-guessed his experience less, and he was beginning to make space for his separate feelings and ideas to emerge.

Sam and I still have work to do. He is working on his relationship with Kara. As he develops the ability to know what he wants and feels, he is more able to express himself to Kara and that relationship is getting stronger. Sam continues to work on individuating from his father. After 30 years of relying on him to define and characterize who Sam is, it takes time to develop confidence in his own thoughts and feelings. There is still anxiety for Sam when he asserts his newly found voice with his father. Sam has recognized that his father’s judgmental tone has made it difficult for him to feel that his own perspectives are valid. His memory of his father telling him, “I’m your father and I know what you like and what is best for you” no longer feels just about his father’s love and concern. Sam is beginning to understand that his father is anxious, too, and that it is his anxiety that drives him to try to control Sam and to believe that he knows what’s right. Hopefully, as Sam’s sense of identity becomes more solid, he will be able to negotiate the relationship with his father so there will be room for multiple thoughts, feelings, and perspectives.

Well-intentioned parents who are critical and controlling may promote their child’s reliance on them to determine and define what is good and acceptable about the child. When a loving parent is so certain that he or she knows what is right for the child and does not consider that the child may have valid, different ideas about what he or she wants, needs, and feels, there is no space and no invitation for the child to develop the ability to express his or her own self with separate ideas, feelings, and needs. Over time, as the child grows to adulthood and is exposed to more ways of thinking about things, there is typically a good deal of confusion about identity, thoughts, and feelings. Unless there is an opportunity to develop a separate sense of self, there will likely be a lot of anxious thinking about what is real but little ability to think for oneself in a self-reflective way.

Housing options for low-income families are limited. Research has shown that disadvantaged communities can contribute to emotional and behavioral challenges for children. But few studies have looked at the quality and kind of housing affects the developmental trajectory of children. Rebekah Levine Coley of the Applied Developmental and Educational Psychology Department at Boston College decided to explore this issue in a recent study. Coley looked at housing contexts including stability, housing quality, renting versus owning, and subsidized housing. She examined how these factors affected well-being in both the children and the parents.

Coley used data from over 2,400 participants ranging in age from 2 to 21 years old. The data was collected over a 6 year period and was used to determine how cognitive, behavioral and emotional well-being was affected by housing. The study revealed that several aspects of housing affected childhood development. Coley said, “Within the four characteristics of housing considered in this research, poor quality housing was the most consistently and strongly predictive of children’s well-being across the span of childhood.” Poor housing quality affected the emotional and behavioral development of the younger participants the most and had a strong negative impact on adolescents’ reading and math skills. Stress from living in poor conditions also contributed to negative outcomes. Coley believes that parental stress from inadequate living resources, as well as stress from neighborhood factors, including crime, violence, and drugs, could culminate to decrease parental emotional availability. Combined with the stress of the child, the result could be decreased coping skills and higher levels of internalizing and externalizing behaviors.

Housing stability was examined and revealed mixed results. For instance, multiple moves led to more externalizing and internalizing. But a move within the prior year led to lower maladaptive coping and better reading skills. This could be the result of moving to a better home or better community. Although Coley didn’t fully examine the details of the stability, these contradictory findings should be explored in future research. Finally, the developmental differences of children who rented versus owned, or who lived in subsidized versus non-subsidized housing, were minimal. The cost to own a home may put a financial burden on families that outweighs the benefits of owning. And aside from the environment in which subsidized housing is located, private versus subsidized renting did not directly affect developmental outcomes. Coley hopes that future research will further examine the impact of the home, in all its contexts, on overall development and well-being in children from all socioeconomic classes.

Reference:
Coley, R. L., Leventhal, T., Lynch, A. D., and Kull, M. (2012). Relations between housing characteristics and the well-being of low-income children and adolescents. Developmental Psychology. Advance online publication. doi: 10.1037/a0031033

Evidence has shown that not only are many children with autism spectrum (ASD) highly intelligent, demonstrating creative and cognitive abilities that far exceed those of their non-ASD peers, but autistic children are also better able to process details than other children. In many tests, autistic children outperform their peers on local processing tasks, or tasks that require identification of parts of a whole. This is especially true when there are clear delineations between the individual segments of a global picture. When there is less distinction, the ASD children tend to perform equal to that of their non-ASD peers. Some researchers believe that this local processing skill is a trait of ASD and accounts for the high levels of artistic talent among children with ASD. But Jennifer E. Drake of the Department of Psychology at Boston College hypothesized that perhaps this local processing strength is a trait of artistic talent and not exclusive to individuals with autism.

To test her theory, Drake enlisted 30 children, half of whom had ASD, for a drawing and visuospatial test. She used the Block Design Task and the Group Embedded Figures Test to determine local processing, and also had the children create still life drawings. She found that the children with more drawing talent had higher levels of local processing abilities, regardless of whether they had ASD or not. Drake also noticed that the tests she administered were more predictive of drawing talent than they were of ASD. In other words, tests that are sometimes used to identify ASD traits in children may actually be indicating artistic abilities and not autistic tendencies.

Drake believes that her findings have significant clinical implications. Many children are assessed for autism at a very young age. It is at this time that strengths first appear as well, including artistic strengths. She believes it is possible that many young children with strong local processing abilities may actually be exhibiting artistic strengths when they take these types of tests. In the absence of global deficits, these children may not be demonstrating true characteristics of autism. “Thus, the superior local processing seen in ASD may be due to the drawing talent so often present in those with ASD,” Drake said. But Drake cautions that any deficits or strengths that are outside of the normal range should not be ignored in young children, especially if the children exhibit other reasons for concern.

Reference:
Drake, J. E. (2012). Is superior local processing in the visuospatial domain a function of drawing talent rather than autism spectrum disorder?  Psychology of Aesthetics, Creativity, and the Arts. Advance online publication. doi: 10.1037/a0030636

Last month, we talked about how figuring out why someone is doing something is key to changing his or her behaviors. We learned that most behaviors are motivated by getting something, getting away from or stopping something, feeling good, or are simply automatic (a reflex, for example).

In order to change behaviors, we must learn about reinforcement, not merely the functions of the behaviors.

Case Example
Imagine this scene, one that is played out in countless grocery stores every day around the world. Picture, if you will, a harried mother trying to get the shopping for the house completed. She is tired and in a rush to get home. With her is her young son. In the checkout line, as Mom tries to load the groceries on the little conveyor belt, her child asks for a candy bar (located conveniently an arm’s reach away, at child eye level). Mom, being a kind and benevolent mom, says, “No, we’re going home and having dinner. You don’t need a candy bar right now.” Her son, being like most children of his age, doesn’t like this state of affairs. In response to the denial of sucrose refreshment, he starts wailing at the top of his lungs, “PLEEAAAASEE! I WANNA CANDY! I WANNA CANDY! I WANNA CANDY!”

Other store patrons stare at the impending debacle. Mom feels embarrassed and more than a little ticked off. She still has to get the groceries home, get them unpacked, and make dinner. Dealing with a tantrum is the last thing she wants to do. At first she tries to calmly explain to her child that dinner will be soon, but the child screams louder. Then she commands him to cease his tantrum. That works about as well as can be expected (not at all). Finally, Mom gives in and buys her little angel the candy bar, at which point he immediately ceases his caterwauling.

Can you name all the reinforcement that occurred in the above example? What do you think will happen next time Mom brings her son to the grocery store?

What Is Reinforcement?
The technical definition of reinforcement is anything that occurs after a behavior that increases the chances of that behavior occurring again. Simply put, when your child does something (a behavior) and you do something immediately afterward, if your child repeats the behavior, whatever you did was a reinforcer.

This idea is key to behavior change. We want to provide rich and powerful reinforcement for the behaviors we wish to see (start behaviors) and avoid reinforcement for the behaviors we do not wish to see (stop behaviors). This interaction is at the heart of everything we wish to accomplish.

Important points:

• Reinforcement occurs only if you see the behavior again. You might feel you are rewarding your child, but if the reward does not result in increased frequency, intensity, or other improvement in the behavior, then the reward is not reinforcing.
• Reinforcement can be anything. It doesn’t have to be pleasant, either. For example, a person who likes fighting might enjoy when he is in a fight and find getting hit or yelled at reinforcing.
• Reinforcement always increases behaviors. Anything that decreases the chances of seeing a behavior is called a punisher.

The bottom line? Reward your kids when they do what you want them to do and they will do those things more. If you simultaneously remove the rewards from the behaviors you want to see less of, you will see less of those behaviors.

Isn’t this just bribery, you may ask? Nope. There are some key differences between bribery and reinforcement. Bribery is typically something (often money) given to someone in advance of behavior. It is generally given to get a person to do something unethical or illegal. Reinforcement always occurs after a behavior, and we are not using it to get our children to do anything unethical or illegal (hopefully!).

You might also ask: Why should I be rewarding my kid for doing what he is supposed to do? Shouldn’t he just do it? In a perfect world, yes, your child would do what he or she is supposed to do. However, in the real world, children are compelled by the “drive-your-parents-nuts accord” to not always follow directions. If we, as parents, want to keep our sanity, it behooves us to use all the tools at our disposal to encourage and reward our children, and ultimately to teach them what to do and when to do it.

Types of Reinforcement

• Positive: This is the most common type. It is something that is added to the situation (money, candy, praise). Basically, if you give your child something because he did something good, that’s positive reinforcement. In the case example, the mother positively reinforced her child’s checkout-line tantrum behavior by buying him the candy.
• Negative: This not punishment. (That decreases behaviors.) It is the removal of something. In the case example, the child negatively reinforced his mother’s candy-buying behavior by ceasing his tantrum when she gave in and bought it.

Classes of Reinforcers

• Primary: These are typically those things that all people need—food, air, companionship, etc.—and are often tied to basic survival. These are good because almost everybody will respond to them. However, they suffer from the “too-much-of-a-good-thing” effect, also known as satiety. When you’ve had enough of something, it loses its reinforcing qualities.
• Secondary: These are learned reinforcers. Typically paired in some way with primary reinforcement, these can be anything. Money is perhaps one of the most prevalent secondary reinforcers in the world. It always amazes me what people will do for colored bits of paper.

Putting This Information to Use

Follow these simple steps:

1. Ask yourself: Is this a start behavior or a stop behavior? (Do you want to see this more or less?)
2. Ask yourself: What is the function of the behavior?
3. For stop behaviors, the answer to question No. 3 will tell you what you need to decrease or eliminate from the situation to make the behavior go away. Do that.
4. For start behaviors, the answer to question No. 3 will tell you what you need to do to get the person to do the behavior more (or better).

As with all things simple, there is a lot more to look at, but it ultimately comes down to these four points. (We will discuss more about reinforcement and how to set it up and deliver it in future articles.)

What’s the Best Reinforcer?
The best reinforcer is the one that works in a given situation. However, my preference is praise. I will cover praise in more detail in a future article, but here is why I like it as a reinforcer: Just about everybody responds to praise. The more you praise someone, the more he or she likes you. The more he or she likes you, the more he or she will respond to you. Praise is free. It takes up no space. People rarely get tired of it. It pairs well with every other kind of reinforcer (thus making the praise and the other reinforcer more effective). In your experiments with reinforcement, try adding a little praise to your efforts and see how it enhances things.

I hope this information helps make your day-to-day challenges less challenging. Please comment below, ask questions, or make suggestions. Let me know about creative ways you have found to reinforce your children (or anyone else, for that matter). Hang in there, parents!

When parents view their child’s “problematic” behavior, attitudes, or troubles as a reflection of them, it can be a terrible blow to the ego. For parents with positive self-feelings, anger, hurt, and disappointment can occur when they don’t see themselves reflected in their children. (“My child should be just like me.”) For parents who do not feel very good about themselves, seeing a child as being “just like me” can feel devastating. Parents who lack self-esteem often feel like their child’s problems are their fault. Their inability to differentiate themselves from their children can also result in guilt and painful feelings of responsibility that are often overstated and inaccurate. Many parents who struggle with the idea that their child is a reflection of them (for better and worse) have not separated from their children. These parents tend to feel some responsibility for their child’s situation. Most often they believe that, either in their early behavior with their children or in their biological contribution (or both), they have profoundly affected their child’s life and character.

“Peter” came to his therapy session in a rage about “Adam,” his 25-year-old son. He had just come from his son’s apartment and was disgusted about the dirt and disarray he encountered: “What is the matter with that kid? He’s such a slob. There is stuff everywhere. It feels so chaotic! I have the same feeling when I think about how he gets drunk with his friends on the weekend. He’s a mess!”

When I asked Peter what made him so angry about this, he began to express remorse about being so enraged. Choking up, he said, “I guess I’m really hurt. I feel like Adam is being disrespectful to me. He knows I hate his messes and his drinking behavior. I feel like he’s on a terrible path of disorganization and disaster. I keep asking myself, ‘How did he turn out this way?’ ”

I asked Peter what he thought about why Adam was like this. “I don’t really know,” Peter said. “But I honestly believe it’s my fault. You know I was a terrible workaholic during Adam’s first 10 years. I neglected him when he was growing up. Then I think, if I was a workaholic, will he be an alcoholic? I know I made him this way. I’m a mess of a father.” Peter was tortured by his painful feelings and disappointment that his son hadn’t turned into the ideal adult that Peter wished he could be.

Over time, as we explored Peter’s feelings, it became apparent that he put all the responsibility for the person Adam was at age 25 on himself. He found it very difficult to see Adam as a separate individual with his own reasons for behaving the way he did. Slowly, Peter was able to consider that his influence hadn’t only been negative and that he wasn’t the only influence on Adam’s development. Adam’s mother was nurturing; Adam had many friends growing up. Peter could even recall some teachers who were influential in Adam’s life. He acknowledged, for example, that a high school teacher had encouraged Adam to stay with his music, and Peter admitted that Adam was a successful musician.

“I guess I haven’t focused enough on Adam’s successes, just on the ways I see him as a failure and blame myself,” Peter said. “Sometimes I still think that maybe Adam is punishing me when he messes up in ways he knows I hate. I guess I really have to admit that it isn’t all about me. Adam is a different person from me. It’s just hard to be OK with that. But I do want to get there. I know that would be best for our relationship.”

Peter is slowly beginning to separate from Adam and experience Adam’s successes and failures as more about Adam than him. He is also beginning to take Adam’s character and behavior less personally. Giving up the idea that “it was all my fault” makes space for Peter to see Adam as a separate individual.

“Rose,” another client, began to talk about her 10-year-old daughter, “Jessica,” in our therapy sessions.  Rose was obsessed with worry that Jessica, who had learning disabilities, would never have a successful life. She said with some sadness: “Her brain is damaged. How will she ever be OK?”

“What do you mean, ‘Her brain is damaged’?” I asked.

“You know that we had her tested and she has so much trouble focusing and organizing her thoughts,” she responded.

“Yes, I know she has some learning disabilities, but seeing her as ‘a person with a damaged brain’ seems a rather extreme way of defining your daughter,” I said.

“I sort of know what you’re saying is true,” she said. “But you know I had learning disabilities as a kid. No one identified them; no one did anything about it. I still struggle at work and in my life in general with being focused and organized. I get so depressed and anxious when I forget things or don’t get stuff done like I promise my husband or my boss. I know my brain is messed up, and Jessica is just like me. Why would I think her fate is going to be any different?”

Rose had a very strong belief that biology was determining her future as well as her daughter’s. She was reluctant to consider that her daughter’s life could take a different path from hers. She had a difficult time thinking about Jessica as a separate person with her own unique characteristics. I reminded her that she and her husband had been addressing Jessica’s learning problems and getting help for her. I also pointed out that this was very different from her own experience growing up. I emphasized that there are many influences other than biology that influence a person’s development. I also asked Rose to tell me anything she could think of about Jessica’s accomplishments. We both listened to the list Rose came up with: “Great piano player, really good artist, hula-hoop champion, kind person, good swimmer, and I guess other stuff, too.” Rose reluctantly acknowledged, “Yes, I suppose her brain works OK in some ways.”

Rose and I spent a lot of time talking not only about Jessica, but also about Rose’s negative sense of self. It was harder for her to take seriously that she has her own accomplishments. It was even more difficult to consider that Jessica was like her in some ways and not others. (Rose is a terrible artist and swimmer!) Our work has centered on Rose’s struggle to experience herself in positive ways and on seeing Jessica as a separate, differentiated individual. We have also been talking about how painful it is to see your child have areas of deficit, and even worse when you feel you are the cause. Helping Rose to talk about her impaired sense of self and its development has allowed her to make distinctions between her own experience and Jessica’s. I have tried to help Rose consider that while there could be some biology at work in regard to Jessica’s learning disabilities, so much more than being “just like me” is involved in what makes Jessica who she is.

We are familiar with parents feeling great pride in how they played a role in their children’s successes. But when parents boast incessantly about their children’s accomplishments to the extent it doesn’t feel like typical parental pleasure, we typically consider them to be narcissistic. For Peter and Rose, their great dismay in what they perceived as their children’s deficits, problems, and failures was also narcissistic.

The term narcissism comes from the Greek myth of Narcissus, in which Narcissus falls in love with his own reflection in a pool. The notion of reflection is pertinent to the experiences of Peter and Rose. Rather than experiencing narcissistic pleasure, these distraught parents experienced a narcissistic wound. They couldn’t tolerate the pain of looking into the pool (i.e., at their child who also represents the parent) and seeing something that is not “beautiful” reflected back. When they looked at their children, they saw a reflection of themselves. It was intolerable that the reflection they saw was “a mess” or had a “damaged brain.” It was not “beautiful.”

These parents are responding narcissistically, and they have not differentiated themselves from their children. One has to wonder how parents, who view their children as reflections of themselves, may have influenced their child’s separation/individuation process. As parents become more aware that their beliefs that their children are or are supposed to be “just like them” are assumptions, they will be in a better position to examine those beliefs. As a result, parents will experience less pain, and their children will be helped to develop into separate, unique individuals.

Some people become emotionally overwhelmed when they see or hold a small baby. They develop a longing to have a baby, even when they may already have children. In popular culture, this phenomenon is known as “baby fever.” This type of event can happen to virtually anyone. However, it seems to affect only certain people, while others appear to be immune. The curious nature of “baby fever” was of interest to Gary L. Brase at the Department of Psychology at Kansas State University, so he decided to conduct a series of studies to determine if there were biological causes for the phenomenon and why it occurs.

Brase recruited 853 nonstudent young adults and 337 college students and measured their desire for a baby, if this desire differed by gender, and how it related to sexual desire, emotions, and experience with other children. After an exhaustive examination, Brase found evidence for the existence of “baby fever.” “Three factors strongly and consistently underlie desire for a baby: Positive Exposure, Negative Exposure, and Tradeoffs,” Brase wrote. One contributing factor that led to “baby fever” was positive experience with children. Individuals who had bad experiences with children were less likely to develop “baby fever” than those who had only good experiences. Trade-offs also played a major role. Participants who were comfortable with trading time, intimacy, financial resources, and energy for a baby were at increased risk of “baby fever” when compared to those who were less willing to trade those commodities.

Although Brase discovered that the desire for a baby was present in men and women alike, it was more evident in the women. He also noted that desire for sex was quite different than the desire for a baby for both sexes. Despite the fact sex leads to babies, the reproductive/sexual desire is independent from the desire to nurture and parent. The results of this study clearly show that “baby fever” is a unique occurrence unrelated to sexual motivation and cultural expectations, but future research should look further at the psychological origins.

Reference:
Brase, Gary L., and Sandra L. Brase. Emotional regulation of fertility decision making: What is the nature and structure of “baby fever”? Emotion 12.5 (2012): 1141-154. Print.

One of the reasons many children do not tell anyone about being sexually abused is because they fear that their loved ones will not believe them. Often, their abuser is a friend or family member, and although children may know that what occurred is wrong, they may be confused and worried that their caregivers will think they have misconstrued the behavior. Children who feel neglected or maltreated by caregivers may feel reluctant to disclose abuse, and many abusers threaten children, creating more reasons for nondisclosure. However, when children do reveal abuse, getting them to explain the abuse in a way sufficient to lead to prosecution can be challenging.

Various methods of interrogation are used on child-abuse victims, including open-ended questions, yes/no questions, “What happened?” questions, and “How did that make you feel?” questions. For the most part, open-ended questions and “what” questions tend to provide the least amount of detail. Children often are unable to articulate the details of their abuse. And while “how” questions that prompt children to reveal their physical reactions and feelings allow them to detail their personal experience in great detail, this is the most rarely used form of interrogation. To explore which method would provide the most accurate recollection of abuse and elicit emotional responses that could demonstrate credibility to jurors, judges, and therapists, Thomas D. Lyon of the Department of Psychology at the University of Southern California recently examined transcripts from more than 100 child-abuse cases.

Lyon discovered that when children were asked closed-ended questions such as yes/no, their responses were narrow and they exhibited little emotion. Similarly, when they were asked “What happened?” they were hesitant to reveal details and appeared emotionally undisturbed. But when children were asked how the abuse made them feel and what their physical reactions were, the responses were extremely vivid and consistent. They demonstrated emotional responses and used words such as angry, sad, afraid, confused, “sick to my stomach,” and dirty. They manifested facial and physical reactions that allowed those interviewing them to see the damage of the abuse in ways that the children could not articulate when prompted with direct questioning. “Children can be surprisingly articulate about their reactions to sexual abuse, despite their apparent lack of affect in describing the abuse itself,” Lyon said. He hopes that these findings will motivate interviewers, prosecutors, and mental health professionals to evaluate physical and emotional reactions of abuse as a means to gather details from child sexual abuse victims.

Reference:
Lyon, Thomas D., Nicholas Scurich, Karen Choi, Sally Handmaker, and Rebecca Blank. ‘How did you feel?’: Increasing child sexual abuse witnesses’ production of evaluative information. Law and Human Behavior 36.5 (2012): 448-57. Print.

What was once considered a rarity—step-siblings, step-parents, and step-in-laws—has become more common than not. When couples marry, there is a very good chance that one of them brings an extended family that branches by halves and steps. And if that couple winds up divorcing, the tree splinters even further. Because there is no biological bond that obligates a step-family member to stay in contact with other steps, the rules of engagement can be confusing and tense. In a recent article, marriage experts explain how to navigate the rocky road of step-relationships after divorce.

Take, for example, the case of an ex-wife who spent decades raising her step-children. Should she continue the relationship with these nonbiological children, even though she has no legal claim to them? Mary T. Kelly, a marriage therapist from Colorado, notes that often step-children can be a contributing factor to divorce. Many blended-family parents disagree over how to raise his, hers, and their children. Tension that exists between step-children and step-parents seems like normal childhood rebellion, but in many cases may actually run deeper.

Paul Hokemeyer, a New York therapist, says couples and children need to determine if they want those relationships to continue after divorce. Many children may not be permitted to make contact with their ex-step-parents while they are minors, but can make the choice whether to have a relationship with that significant person when they reach adulthood. Even step-grandparents get caught in the mix when step-families divorce. Grandparents who become attached to step-grandchildren, only to have them taken away, may not be willing to invest as much into future step-family members.

One Massachusetts psychologist, Patricia Papemow, recommends that clients try to initiate contact through letters rather than personal visits or phone calls. It is important for step-children to be allowed to have time to process the shift in the relationship on their own terms. Letting them know a step-parent is there through cards and letters is a noninvasive and subtle way to continue contact and keep the door open for future communication. Regardless of how an individual chooses to stay in contact with their step-children, Hokemeyer insists that they review their motives so that all parties will be receptive. “Make sure that you are acting out of genuine love and concern for the other person, and not out of anger and attempts to manipulate,” Hokemeyer says. Following these tips could help step-exes maintain important family ties in a world of ever-changing family dynamics.

Reference:
Gootman, Elissa. When branches tangle in a stepfamily tree. (n.d.): n. pag. The New York Times. 3 Oct. 2012. Web. 8 Oct. 2012. http://www.nytimes.com/2012/10/04/fashion/-step-family-trees-with-tangled-branches.html?pagewanted=all&_r=0

Marriages aren’t like fine wines. They are not harvested in vineyards and they do not always get better with age. However, many marriages far exceed any expiration date. According to a recent article by Matt Richtel, Pulitzer Prize-winning writer and columnist, modern marriages—which divorce at rates upward of 50%—may benefit from an exit strategy after, say, five, 10, or 20 years. Richtel said that many marriage contracts already exist. Prenuptial agreements are rampant among the wealthy, some couples who live together make paperless commitments to each other, and many celebrities and politicians have legalized business/marriage agreements. In fact, the idea of contractual marriage has been picked up in Mexico, where lawmakers recently introduced the idea of renewable marriages. Good idea or bad, the law didn’t pass.

But should it have? Should the institution of marriage be updated to keep pace with other cultural advances in areas such as medicine and technology? This was the question that Richtel asked several marriage therapists, psychologists, and divorce attorneys. The responses were varied. Author and professor Pepper Schwartz commented that marriage has been getting picked apart for decades and needs to be fully examined. Today’s marriages have less connection to religion and family, which creates a weaker support system, and modern technology encourages people to expect instant gratification from marriage. Schwartz said something like a 20-year marriage contract is an option, and that nuptial contracts including dowries and financial arrangements are not new.

Dr. Robert E. Emery, a professor of psychology at the University of Virginia, says the problem with marriage is the expectation of longevity that it comes with. Children of divorced parents bear the immediate emotional devastation of losing one parent, or having their family rhythm disrupted. If the possibility of divorce was anticipated, and marriages were not supposed to last past a certain point, it would be more culturally acceptable and emotionally tolerable. Emery says the best way to approach marriage is to understand that it is not a union filled with unlimited sex with someone who is beyond perfect, but rather an investment of every available resource that can reap emotional, sexual, and physical rewards. “There are good reasons to be romantic about marriage,” Emery said. “The big benefit of marriage is precisely the commitment over the long term.”

Reference:
Richtel, Matt. Till death, or 20 years, do us part. (n.d.): n. pag. The New York Times. 28 Sept. 2012. Web. 1 Oct. 2012. http://www.nytimes.com/2012/09/30/fashion/marriage-seen-through-a-contract-lens.html?pagewanted=all&_r=0