Parent-Child ACT Chris McCurry, Ph.D . ABCD, Inc. Seattle, WA cmccurry@abcdseattle

1. A Practical Guide Parent-Child ACTChris McCurry, Ph.D.ABCD, Inc. Seattle, WAcmccurry@abcdseattle.com

2. Disclosure The presenter has a pitifully small financial interest in two books in the bibliography

3. 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

4. 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

5. Tools & Happiness

7. The Hairball Model of Psychopathology

9. We need an understanding of “the common processes involved in how anxiety-related problems develop and are maintained” Eifertand Forsyth, 2005, p. 4

10. Early Childhood Development and Parent-Child Transactions

11. “Me? I thought you were raising them.”

12. 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

13. 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

14. “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

15. In Other Words Avoidance or Control

16. Cognitive Development:Born Fused and Inflexible Egocentric Idiosyncratic / Magical Literal (psychic equivalence) Rigid Binary Fusion (internal and external)

19. Under stress, they (we) will regress

20. 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

21. 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

24. Fear is meant to feel bad!!!

26. Mom Cry Rescue “Good”

29. “Mom” Job Yell Guilt Stress More Stress Mother Danger!! Spouse

30. 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

31. 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

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

34. The Reactive Dance Child becomes distressed (and regressed) Child, seeking rescue, acts out his distress in dramatic, regressed, or confusing ways Parent becomes distressed (and regressed) Parent seeks escape from this situation The immediate goal for both parent and childbecomes escape or control in the present, avoidance in the future

35. Mutual Parent-Child Experiential Avoidance Held in place by negative reinforcement, also known as “the coercion trap”

36. 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

37. Tubes

39. Team Captains

40. A Responsive Dance Child becomes distressed, regressed Child acts out; seeks contact, communication, rescue Parent is alert to becoming distressed, regressed Parent models distress tolerance Parent acknowledges distress with specific language and connects to cause Parent orients child to the original goal, to a solution, or to appropriate coping strategies

41. Changing The Dance Increase awareness Shift the focus of attention Take values-driven action

42. Increasing Awareness

43. 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

44. More “Active” Definitions of Mindfulness • “Stepping back from unproductive ways of coping . . . in order to see more clearly how best to respond”- Jean Dumas • “An open, probabilistic state of mind… finding differences among things thought similar and similarities among things thought different” -Ellen Langer

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

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

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

48. 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”

49. 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

50. 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