Difficult Parents:

AND YOU THOUGHT THE KIDS WERE THE PROBLEM

Lilly Landikusic LMFT, Founder and Director, EMPOWERMENT COUNSELING SERVICES

Talon Greeff CPCI, Director of Residential Care, UTAH YOUTH VILLAGE

Introduction

“The thing that impresses me most about America is the way parents obey their children.”

  -Edward, Duke of Windsor, Look, 5 March 1957

Introduction

• Tools for Use With Parents

• Types of Difficult Parents and Specific Approaches

• Conclusion

Tools for Use With Parents

• Traditional Therapeutic Tools– Effective Assessment– Relationship Building– Build Trust

• Effective Intervention Tools– Pragmatic “real world” Solutions– Role-play Approach– Linking to Services and Resources

• Tools for Tough Times– Effective Confrontation and Teaching– Avoiding Negative or Emotional Baiting– Addressing Emotional Outbursts with

Parents

Traditional Therapeutic Tools

• Effective Assessment

• Relationship Building

• Build Trust

Effective Assessment

• Assess underlying need– Constellation of issues– Find “pain”– Magic question– Common problem thread– Take time (Boy’s Town study)

• Parents pain can be core to problem in children or marriage– Identify underlying issue, secondary

gain • Guilt over abuse, neglect, divorce• Family of origin pattern of conflict• Enabling parental style

Relationship Building

• Parents unable to accept feedback or need to change– Focus on child’s issues– Child presents special needs and challenges– Outside the range of normal child behavior– Use specialized tools to help with child

• Parents will say, “I don’t like my child”– Without relationship, child may act out to punish

parent– Consequences lose effectiveness– Ask for small change i.e. 15 minute activity

weekly with child– Gently move parent from negative to positive

perspective• Empathy statement• Highlight positive child trait or progress

Relationship Building

• Be careful not to assume parents’ emotional state – One of you needs to be in a problem-

solving state– Leads to emotional burnout– Recognize their hopelessness,

frustration, anger or sadness– Physiological indicators: tense

muscles, breathing quickly• Work on parents’ issue first then

referral agency issues• Praise specific, genuine progress

or strengths

Build Trust

• Regular reviews of progress, goals, what is working and what is not

• Ignore baiting, allow venting, address continued combative statements

• Use humor, honesty, openness, support their decision-making by working on one of their issues

• Assess, collect information, wait until they ask for advice before giving it

Effective Intervention Tools

• Pragmatic “real world” Solutions

• Role-play Approach

• Linking to Services and Resources

Pragmatic “real world” Solutions• Give small assignment to identify

willingness to work• Identify the “mover and shaker”

within the family• Remind parents of their own

childhood • Use your own childhood

perspective to help them• Think outside the box “scheduled

meal preparations to TV timeline”• Close sessions with summary,

plans, goals and homework

Pragmatic “real world” Solutions

• Simple changes can lead to dramatic results – 15 minutes per week– Specific description of behavior

• Predict results, solutions need to fit their environment and resources

• Simple, small lasting change better than complicated, super-healthy unachieved goal

Role-play Approach

• Processing information is not an efficient way to teach skills needed for productive changes

• In learning new skills for teachers, Joyce and Showers in 2002 found:– Theory and discussion led to 10% passing a test

on the material, 5% being able to demonstrate the skill and 0% skill use in the classroom

– Adding demonstrations led to 30% passing the test, 20% being able to demonstrate the skill and 0% skill use in the classroom

– Adding practice and feedback to training led to 60% passing the test, 60% being able to demonstrate the skill and 5% skill use in the classroom

– Adding coaching in the classroom led to 95% passing a test on the material, 95% being able to demonstrate the skill and 95% skill use in the classroom

Role-play Approach

“It is one thing to say with the prophet Amos, ‘Let justice roll down like mighty waters,’ and quite another to work out the irrigation system.”

-William Sloane Coffin, Social activist and clergyman

Role-play Approach

• After teaching a skill, strategy or technique:– Discuss specific application, ask for

real world scenario– Role-play: therapist as parent,

parent as their child– Role-play: parent as parent,

therapist as child– Role-play: parent with child,

therapist as coach– Coach: observe parent with child,

provide feedback on implementation and refinement

Linking to Services and Resources• Look at underlying needs: economics, lower

functioning, lack of informal support, employment issues

• Identify patterns which impact family functioning and children’s issues

• Describe disability or mental health issues openly, without embarrassment or emotion – “special needs or vulnerabilities”– By diagnosis

• Help find effective supports that will last after you terminate services and are self-sustaining– Religious– Neighborhood– Family– School– Friends

Tools for Tough Times

• Effective Confrontation and Teaching

• Avoiding Negative or Emotional Baiting

• Addressing Emotional Outbursts with Parents

Effective Confrontation and Teaching• At service initiation, inform them that you will

give feedback to help with change• Balance rapport with solution thinking

– Criticism by suggestion• Empathy/praise• Define situation and parent’s solution• “Have you ever thought about…?”• “Are you willing to try it?”

– Humor through confrontation– Normalizing

• Plan for initiation, mid-intervention and closure– Prepare them for progress and change– Prepare for support– Emotional closure– Support for follow-up– Prepare for “end of service” crisis

Effective Confrontation and Teaching• Work on their agenda and priorities

– Assess and address their “pain”– Refocus on family’s goals– Bridge from developed strengths to referring agency’s

issues• Help identify emotional trigger points within adults

and family– Discuss them with parents– Develop plan to de-sensitize parents and set

boundaries– Teach how to recognize physiological changes before

emotions• Model disengaging for parents

– Avoid hooks by staying focused on issue– Be specific about recommendations and behaviors

avoiding “judgment” words – Use parent rationales– Empathy “I understand you are upset, I am just doing

what I can to help your family”

Avoiding Negative or Emotional Baiting• Specific tool for disengaging

– Waiting – Agreeing – Listening– Re-focusing

• Emphasize the power of remaining disengaged

• Careful! Don’t get sucked into parents’ emotional baiting, especially when it seems reasonable– Transference that fits family system– Use in discussion about family patterns

Addressing Emotional Outbursts with Parents• Use disarming techniques

– Agree/empathize– Wait until they are done speaking– “Did I do something you did not like or agree

with?”– “What would you like to see happen?”

• Assess needs and underlying message, rather than words

• Avoid emotion, stay specific and avoid adjectives when describing situation

• Accept their feedback– Support their emotional needs– Teach them how to meet needs without

emotional outburst– Remain calm because it’s not personal

Types of Difficult Parents and Specific Approaches• Self-Sabotaging/Victim Stance• Permissive• Controlling/Overly Strict• Borderline• Suspicious• Needy• Lower Functioning• Crisis/Drama Lifestyle• Depressed/Apathetic• Disabled• “Munchausen's Syndrome by Proxy”

Self-Sabotaging/Victim Stance

• Give assignments• Follow-up on small tasks• Phone reminders, if necessary• Empathy with confidence

statement• Set boundaries and avoid

enabling• Test: Do they use the tools

provided?• Example: Don’t drive client, help

client find resource

Permissive

• Assess: why they are permissive-disengaged or a best friend?

• Address issues within the home and use family strengths

• Rationales for change “It will help your child succeed”

• You need to say “no”• Conflict and limits develop independence in

adolescents, natural tension• Build in “outs” for discipline like positive

correction• Short but hard consequences• Reward system with no negative consequences

Controlling/Overly Strict

• May have trouble with feedback• Rationales of increased control,

use with rewards• “You may want to go through the

back door on that one”• Consequences often porous or

limited• Criticism by suggestion • Identify and modify “trigger

points”• Emphasize progress• Will you try it?

Borderline

• Regular support for you, staff with others

• Communication with family, referring agency and stake holders critical

• Refocus on written goals and treatment plan

• Documented treatment planning• Be willing to agree the fit isn’t

working

Suspicious

• Work on family’s “pain” or agenda

• When possible, separate yourself from referral source

• Be open with information and confidentiality limits

• They may “test” you, be upfront and clear

Needy

• When preparing to disengage, be deliberate and plan ahead

• Access outside resources and supports

• Add “develop independence” to treatment goals– Informal supports– Religious groups

• If possible, its ok to be a “long-term monitor”

Lower Functioning

• Normalize their situation “you are who you are”

• Creative problem-solving that is concrete

• Focus on skills and strategies, avoid processing

• Role-play is critical and highly effective

• Linking to services such as DSPD, Workforce Services, Deseret Industries

Crisis/Drama Lifestyle

• Listen• De-escalate, calm

client, address tone• Refocus on main

issue, avoid joining in drama

• Develop healthy strategies that encompass the crisis/drama rather than replace it

• Avoid tilting windmills with client

• Short-term goals and homework

Depressed/Apathetic

• Medical referral• Informal supports for long-

term help• Strategies that address

issues in small steps• Link with family members or

community resources for activities and solutions

Disabled

• Address environmental factors

• Don’t be afraid to ask about disability and limitations

• Get comfortable with client’s disability

• Learn about it from a professional or research it

“Munchausen's Syndrome by Proxy”

• Parent wants to be case manager rather than caretaker

• Identify specific issues which are documented to address

• Validate parent and emphasize role as expert in providing care

Conclusion

“The problem with children is that you have to put up with their parents.”

-Charles DeLint, Fantasy and science fiction author

Specific Tools and Techniques to Help Parents:RAD, CONDUCT DISORDER, ANGER AND OTHER

CHALLENGING ISSUES

Lilly Landikusic LMFT, Founder and Director, EMPOWERMENT COUNSELING SERVICES

Talon Greeff CPCI, Director of Residential Care, UTAH YOUTH VILLAGE

Introduction

“Before I got married I had six theories about bringing up children; now I have six children, and no theories. ”

  - John Wilmot, 2nd Earl of Rochester 1647 - 1680 Rake, Soldier, Courtier and

Poet

Introduction

• Overview of Common Tools• Anger/ODD• Conduct Disorder• RAD• ADHD• Self-Harming• Encopresis

Overview of Common Tools

• Create understanding that change will take time and commitment

• Normalize problems-all families have problems

• Avoid power struggles or engaging– Agree, “say OK”– Give options– Be careful not to argue– Focus on “If/then”

Overview of Common Tools

• Disengaging– Waiting – Agreeing – Listening– Ask “What do you want to do?”– Shifting to a positive remark or behavior– Re-focusing

• Teach parents how to use a calm voice tone– Identify triggers– Role-play– Positive, calming self-talk– Use praise or empathy before correction

Role-play Approach

• Processing information is not an efficient way to teach skills needed for productive changes

• In learning new skills for teachers, Joyce and Showers in 2002 found:– Theory and discussion led to 10% passing a test

on the material, 5% being able to demonstrate the skill and 0% skill use in the classroom

– Adding demonstrations led to 30% passing the test, 20% being able to demonstrate the skill and 0% skill use in the classroom

– Adding practice and feedback to training led to 60% passing the test, 60% being able to demonstrate the skill and 5% skill use in the classroom

– Adding coaching in the classroom led to 95% passing a test on the material, 95% being able to demonstrate the skill and 95% skill use in the classroom

Role-play Approach

“It is one thing to say with the prophet Amos, ‘Let justice roll down like mighty waters,’ and quite another to work out the irrigation system.”

-William Sloane Coffin, Social activist and clergyman

Role-play Approach

• After teaching a skill, strategy or technique:– Discuss specific application, ask for

real world scenario– Role-play: therapist as parent,

parent as their child– Role-play: parent as parent,

therapist as child– Role-play: parent with child,

therapist as coach– Coach: observe parent with child,

provide feedback on implementation and refinement

Overview of Common Tools

• Work with parents to identify:– Personal issues/triggers– Thinking errors impacting

parenting– Myths about parenting, marriage,

children and families

• Teach realistic expectations• Picking battles and shaping

behavior

Overview of Common Tools

• Be specific in describing behavior and avoid judging words

• Avoid triggers such as always/never• Emphasize pragmatic solutions vs.

diagnosis or theory• Reframe issues as strengths, such as

the oppositional child who demonstrates ego strength

• Teach parents how to explain choices and when possible, give them

• Allow children time to make a good choice to avoid a power struggle “Take 5 minutes to decide what you are going to do”

Overview of Common Tools

• Help parent structure the home with 7-10 rules• Discuss appropriate consequences and rules• Teach charting and contracting for “point”

solutions• Use positive correction

– Child has earned negative consequence– Provide opportunity for child to engage in

positive behavior to earn up to ½ of consequence back

– Example: Child yells at parent and is grounded for two days. The child could earn one day back for using pleasant voice tone during the next 24 hours.

– Example: Child has to clean the living room for being late from school. The child could only have to vacuum the living room if they do a small worksheet about getting home on time.

Anger/ODD

• Role-play avoiding power struggles• Identify and practice ignoring triggers

and baiting• Emphasize relationship building• Identify antecedents to behavior-

correct before blow-up• Role-play with child taking a time out

or other small consequence• Apply consequence after “flare up”• Use positive correction• Teach parents when to call the police

Conduct Disorder

• Identify necessary structure• Write out clear expectations• Youth need to have accountability

at earliest possible age• Random checks with rewards• Use consistent, non-emotional

consequences• Avoid enabling, fear-based

thinking• Use positive correction to teach

appropriate skill

Reactive Attachment Disorder

• Behavior deteriorates as relationships develop, over time

• The better they know you, the more they fear harm from you as part of their life experience

• Remaining calm and engaged over time critical• 24 hour “restart” helpful in keeping child

engaged by motivation system• Parents should emphasize the child will stay no

matter what• Clear expectations with rewards and

consequences• Relationship building must continue to occur

through crisis times• Respite provided in-home rather than providing

respite outside of the home• Children look for rejection or signals of

rejection

ADHD

• Assess if it is physiological or a function of the family system

• “Did you notice a significant difference after a few days on the medication?”

• Structured, predictable routine• Simple target goals

– Calm, focus– Simple task completion– Calming through frustration– Break down tasks into manageable pieces– Short periods of time on task followed by

activity, return to task

• Be behaviorally specific in expectations

ADHD

• Emphasize getting started• Focusing tools

– Eye contact– Assist in task completion– Let go of perfection– Calm “record player” verbals– Increase waiting skill with praise

• Waiting to leave bed• Waiting to talk• Waiting for reinforcer

Self-Harming

• Emphasis on rewards for positive behavior

• Relationship building• Identify areas that parents can give

youth control• Avoid power struggles• Charting with rewards• Realize self-harming can be anywhere

on body• Adaptive behavior relating to abuse,

anxiety• Eating disorders also fall into this area

Encopresis

• Check with doctor for physiological symptoms

• Anxiety can lead to bedwetting after it has stopped

• Defense mechanism against abuse• Smell may be comforting• Avoid power struggles or emotion

around behavior• Don’t provide negative consequences

for behavior• Adapt environment with plastic

protective covers and bedding• Charting with rewards

Conclusion

“The secret of dealing successfully with a child is not to be its parent.” 

Mell Lazarus, Comic strip author

This training presentation is available for download at:www.utahparenting.org

© 2007 Utah Youth Village.