Insane Medicine, Chapter 9: The Worried Parent (Part 2)

Editor’s Note: Over the past few months, Mad in America’s Parent Resources section has been publishing selected chapters of Sami Tamimi’s new book, Insane Medicine. Dr. Timimi is a consultant in child and adolescent psychiatry at the UK’s Lincolnshire Partnership NHS Foundation Trust. His past works include the books Naughty Boys: Anti-Social Behaviour, ADHD and the Role of Culture, and A Straight Talking Introduction to Children’s Mental Health Problems, among others.

Following is Chapter 9, Part 2. All chapters are archived here. 

Enriching emotional energies

Once you get your head round the concept of emotional flow in relationships, you can think more about how to get more desirable emotional flow happening more often and less desirable ones happening less often. This way of constructing focusses less on behaviour and more on emotional flow and the relational dance.

I believe this helps build more enduring and nourishing relationships and allows for a different way of looking at children’s behaviours through the lens of their emotions (and yours, as the parent), rather than just behaviour in isolation.

Here are a few ideas that can help with noticing and creating emotional flow for desired relational dances:

• Describe what your child is doing, when they are doing something you like, as if you’re talking to a blind person. Whether you do this in your mind or out loud, it will help transmit emotional energy toward your child, enriching the qualities and behaviours you want to see in them, and it will demonstrate to them that you’re connected and emotionally engaged at this time. Instead of saying something like, “Well done, that’s a nice picture,” you could describe what you see in greater detail, such as “I see you’ve drawn a house with three windows and you’ve coloured the grass green. That looks like a person standing on that grass. I love how carefully you’ve coloured in the red roof on the house.” Ask yourself if there are ways you can use this idea regularly for behaviours you would like to see when you see small examples of them.
• We often teach children values and qualities when we see them showing a lack of these. Thus, “Don’t be disrespectful” is more commonly said than “I like the way you are being respectful.” Can you find simple, everyday examples of things your child is doing to which you can add a value or quality statement? Maybe look back at the portfolio of desired qualities you want in your child. You could make a list of things you want to look out for, like listening, showing empathy, being respectful, being independent, so that when you see even the tiniest example of any one of them you can comment on what they’re demonstrating. You can use phrases that begin with “I appreciate” or “I like” or “I’m pleased to see” and so on as an introduction to saying what quality or value they have demonstrated. You can describe, and then add a value statement, such as “I can see that you were listening really nicely to what your big sister was telling you. I’m pleased to see how deferential you were to her.” Don’t be afraid to use big words or words they won’t understand (you can do a google search for synonyms) as it may start a conversation about what that word means, giving even more opportunity for emotion flow.
• When we have to deal with challenging behaviours, it’s common to find ourselves having all our energies taken up with trying to manage the difficult situation we face. Once those situations have eased off, even if for a little while, it’s not uncommon to experience a sense of relief and so get on with all the things that you weren’t able to do while you were managing the difficult situation. What this means is that the emotional energy flows to your child when the undesired behaviours are taking place and stops when the desired behaviours happen. Can you reverse this? Can you withdraw emotional energy when the things you don’t want to happen are happening and manage the situation with as little emotional interaction as you can? Can you focus your emotional energy into proactively identifying those calmer, better-behaved moments and provide the emotion flow in these moments?
• Can you put together these three ideas to enhance emotional flow toward more desired behaviours in some way? Firstly, to describe situations and things your child is doing as if talking to a blind person. Secondly, add a value or quality word about what your child is demonstrating. Thirdly, notice those times when your child isn’t breaking the rules and focus your emotional energy on these times. Don’t be surprised if your child rejects your attempt to strengthen the positive energy flow. If this hasn’t been part of their “script” and what they expect in their “dance” with you, they may initially reject such a change or at least remain suspicious that you are “up to something”! Don’t let that put you off.

Starving undesired emotional flows

Have a think about rules. Do you and your child have a clear understanding of what the rules are at home? If you are enforcing a rule, can you be certain that your child knows what this rule is? Are you clear about what rules you have and expect your child to follow? If you think you or your child may not be clear on rules, how might you make the rules clear to you and your child?

How do you make requests to your child? Are you sometimes asking questions instead of instructions in an attempt to be fair? Requests that are put as a question give great scope for engaging in undesired emotion flow. For example, do you say “Could you please tidy up your room?” or, “Are you going to get up?” when you really mean “I need you to tidy your room in the next hour” and “I want you to get out of bed now”?

Ambiguous requests give plenty of opportunity for a child to decide whether they wish to go along with your requests given they have been asked a question. If what was intended was a request, then think carefully about whether you have conveyed what you wish with clarity.

Generally speaking, rules that are clear, including “no” rules, are much easier to follow than rules that have fuzzy boundaries. Many so-called “positive rules” have unclear boundaries. Rules like “be respectful” are difficult for a child or indeed the adult to figure out when they are following or breaking that rule. However, rules that start with a “no,” such as, “no hitting,” “no throwing things,” are often easier to understand and therefore follow.

Disobedience can be a major source of stress and frustration for parents. Because of this, parents’ emotions will be pushed toward high emotional energy flow from you to your child. When this happens, we often start using “infinity” words. Infinity words communicate a high level of emotional intensity during which we think in infinite terms. For example, when someone is in love, they may say something like, “I will love you forever” rather than “I love you now, but by Thursday I’m not really sure how I’ll feel!”

Similarly, we can betray high emotional intensity toward undesired behaviours when we say things like, “you never listen” or “you’re always late” or “Without fail you play up when we go to the supermarket,” and so on. If you hear yourself using an infinity word or phrase, it may be a warning that you are in a state of high emotional intensity. In such states, our biology pushes our body to action; to doing something rather than thinking before we act. Be warned: Using infinity words is a sign that there is high-energy emotion flow coming out from you toward your child.

What does all this potentially mean for consequences? Parents will have particular consequences for different children. What engages and motivates young people will be different for different personalities. For one child, withdrawal of the XBox for an hour might be a more undesirable consequence, but for the next person not being allowed to go out with friends that evening is an undesirable consequence, but not XBox privileges, and so on. What follows is a way of thinking about the process and energy dynamics of consequences and not the particular consequences you might use, as these will be unique for each child.

• Let’s use a football (soccer if you’re North American) referee as our “model” for when we take up the role of rule and consequence implementation. In a game of football, there are rules, but they still need interpreting and it is the job of the referee to enforce those rules as fairly as possible. Referees get very little praise for the job of enforcing consequences. Players from the team that has had a consequence (such as a free kick) given against them, often protest about the unfairness of the referee’s decisions. The job of enforcing rules and consequences is usually a thankless task, drawing little praise and much protest. Yet without a referee, a game of football would be chaotic—so it’s a thankless task that has to be done.
• What makes a good referee? Those of us who enjoy watching a good game of football appreciate referees who are good at letting the game flow without regular interruptions. One of the most important tasks of a referee is that of knowing when not to intervene and thus allowing the game to flow.
• Once an intervention from the referee is necessary and they have made the decision to give, for example, a free kick, then that particular consequence is announced and has to be served and the game can’t go on until it’s delivered. The consequence (in this case a free kick) is delivered by the referee with minimum fuss. Often, players surround the referee arguing about the unfairness of the consequence. However, beyond a very short explanation of the reason for awarding a free kick, the referee does not engage in any extended conversation, argument, or debate about whether it was a free kick or not. A good referee, if they are not entirely sure about whether they have made the correct decision, may discuss their decision with an assistant (if one is available) before deciding what the correct consequence is. However, once the decision is made, the consequence has to be served.
• Once the consequence has been served, it’s then over and done with, and the referee is back to focusing on keeping the game flowing. You do not see good referees running down the tunnel at half-time continuing to tell off a player about what they did or didn’t do during the game. They don’t do long lectures or explanations, either on the pitch or off. There is very little emotional energy flow when delivering and enforcing consequences and little discussion about it afterward.
• As far as the actual consequences are concerned, they are all delivered in the moment, here and now. Consequences are rarely delayed. Referees do not say, “OK I’ll make sure you have the free kick in the next game.” Delayed consequences give plenty of time for negotiating your way out and so often have little impact in the here and now.
• A good referee doesn’t worry about whether a player is learning from their mistakes. They will just implement the consequence with minimal emotional flow and get on with it.

You should by now understand the analogy I am putting forward. You can use the model of being a referee and adapt it to your own environment/family and with your own children when you have the task of applying rules and consequences in your setting. Remember, consequences are more important for showing that you have noticed and are intervening, and so do not need to be for a long time. Short (such as a few minutes) and immediate often works better than long and delayed.

Emotional reset

One of the biggest obstacles to becoming more sensitive to the nature of emotional flow in our relationships is that it’s about emotions. Emotions are not about logic or reasoning. Dealing with the intensity of our emotions—particularly as you can find yourself in situations where, in this model, you are going against what instinctively you feel you should be doing—can be quite draining.

One concept that can be useful is the idea of finding your own “reset” button. This is an imaginary button that, when we push it, works on our emotions, bringing them from a state of high intensity down to a lower one. How do we achieve coming out of high emotional states to return to a calmer emotional place? When we are highly “worked up” emotionally and our children are inviting us to engage with undesired behaviours, how do we “back out” emotionally? If we expect our children to get from being in a high emotional state back to a calmer one, shouldn’t we first demonstrate that we can do this?

Have a think about things you already do that can act like a “reset” button. These can be things that work in the “heat of the moment” as well as outside of the heat of the moment. We all have ways that work to help us relax or calm down. You may also want to learn new strategies by talking to family and friends and finding out what works for them.

What on your list could work in that immediate, here and now, heat of the moment? How might you access these? What might you need to practice to improve your ability to access your “fast” reset button?

What on your list are your “slow” reset strategies, ideas that help you calm down away from the heat of the moment?

How about a “refuelling” or “recharging the battery” plan? Dealing with an intense child is draining of emotional energy. How might you get your energy levels back up again? How might you create more refuelling opportunities? Who might be able to help you and in what way?

Raising children is always a task that requires a social support network around you, from just having someone to talk to right up to the direct physical help others can provide. We shouldn’t be too harsh on ourselves as parents. It’s such a difficult task with so many social- judgemental attitudes at the best of times, let alone when we have an intense child.

Encourage ongoing rhythm change

If some of these ideas prove to be helpful, you will often find that the “script” I mentioned earlier (the “S” in Emotion WARS) will keep pulling you back to your earlier undesirable “normal” without your realising it. To help you get through this you might:

• Keep a keen eye and ear for any example, however large or small, of something different happening in your family and get very curious about that.
• Be proud of any of your own positive achievements. Get “excited” by anything different that has happened.
• Be aware of setbacks. They always happen. The main danger with setbacks is how we feel about it and not the setback itself. When a setback happens, we may start to feel that we are back at square one, and what was the point of even trying. We start to feel hopeless that change can be sustained. We may feel that we are no longer empowered and no longer able to believe we can continue to keep change going. We can then start to believe that our child needs some special therapy or diagnosis. In reality, it’s likely to be just the “script” returning. Try not to let this cloud your sense of achievement with any, even minor, change you were able to make before the script returned.
• Ask yourself how you managed to do things differently. How surprised are you that you managed to do that and how did that make you feel?
• It’s likely, if you have managed to shift some of the relational dance, that you had to deal with going against what you felt like doing—going against your instincts. How did you manage that? What did you learn about yourself and your relationships as a result? What new things did you learn about your child?
• What new skills do you feel you had begun to develop? How might you further develop those skills?

Once you have managed to shift the relational dance for a while, you will start to get on with your new life and the focus on the new ways of “dancing” will start to recede. This will be fine, and hopefully you have got far enough forward to establish a new “script,” a new family relational dance.

However, this isn’t always the case, and the old dance may be lurking, ready to reclaim centre stage. How might you help protect your future against this and be able to deal with a return of the old dance without feeling unnecessarily overwhelmed or stressed by it? To prepare for that, consider the following three questions:

• When the next setback happens (and it will), what one idea do you want to come to mind immediately that will help you get past the inevitable return of feelings of hopelessness?
• If tomorrow you met a parent that had a child exactly like yours and they were in exactly the same situation you were in before you started making changes, what specific advice would you give them?
• If you were to make an imaginary or real emotional flow “First Aid” box, what imaginary or real objects would you put in it and why?

Kids’ Skills

Kids’ Skills is an approach to helping children overcome emotional and behavioural problems that was developed in the ‘90s in Finland by a team of psychotherapists and special early education teachers led by psychiatrist and psychotherapist Ben Furman. I see it as having a complimentary set of ideas to those of RAP, as this too moves the focus away from the child’s behaviour and trying to get rid of the problem toward a way of imagining that has ingredients aimed at building helpful relationships (see here for further information).

A key idea is that you don’t focus on children’s problems, but on skills that children need to learn to overcome their problems. This shift in focus from problems to skills can improve the likelihood of collaboration between children, their parents, and the wider social network surrounding the child. All children are continuously learning new skills as they grow and develop. For any specific child, some skills will be mastered by them more quickly and easily than others. The idea in this approach is to understand what skills the child may benefit from learning that will help them overcome situations they have yet to master.

An important shift in perspective is that of converting children’s problems into skills for them to learn. As with RAP, it’s relatively easy to get what this is about at a rational/intellectual level, but easier said than done at the emotional level.

The basic idea is to describe situations in which the unwanted behaviours of the child occur to get an idea about what situations are challenging for them. Once you know what situations are difficult, you go on to ask how, as a concerned adult, you would want the child to learn to handle those situations in the future.

Parents and other carers talking about situations that are difficult for their child to handle helps them to develop ideas of how they would want the child to learn to deal with those situations in the future, and that, in turn, leads to ideas of what skill the child would benefit from learning.

Next, you turn “negatives” into “positives.” This means imagining what you want the child to do rather than what you don’t want the child to do. For example, instead of wanting the child to learn how to “stop yelling at me” (i.e. learn not do something), you would want them to learn the skill of “accepting the decisions we make,” or whatever is relevant to the specific situation that often gives rise to the concerns the parents have.

Once you have a skill in mind, think about how many of the child’s supporters in their social network (parents, teachers, grandparents, friends, friends’ parents, etc.) could join you and the child in helping them develop that skill. The idea is to be creative. Can your supporters’ group, with your child, come up with some simple rituals, things for them to practice? You could give the skill a name, imagine it as friend, draw a picture of it, and so on. Then you need a way to celebrate achievements along the way to developing the skill. Think of rituals that kids love, to show how well they’re doing, like versions of “show and tell” or getting a certificate and so on.

You can adapt these ideas to older children and adolescents. Many adolescents act as if they “hate” you and don’t care about what you say or think, but this is often just an understandable defence against feeling that the important adults in their life don’t care about them, don’t like them, or see them as a burden. Deep down, they crave positive recognition and genuine pride in their accomplishments.

As with RAP, you can think in terms of how to improve desired emotional flow. Instead of naming a skill and expecting the adolescent to collaborate (as opposed to labelling you as patronising!), just think of what skill you want them to learn and then look for minute examples where they show that and acknowledge it when you see it. For example, if you want your adolescent to learn the skill of “being respectful,” just notice small examples regularly, as in “I really appreciated how respectful you were to your sister today when you both watched telly earlier.” Train yourself to notice these small examples rather than the examples where you feel they are being “disrespectful.”

Other simple things to try

Ideas that might prove helpful are as numerous as there are people and families wanting help. The specifics of each case differ, meaning that finding helpful concepts will similarly differ depending on the family. The following ideas may also prove helpful for some:

Diet and nutrition: Try eliminating potential irritants (such as artificial additives), adding a daily multivitamin and mineral supplement and an EPA-rich essential fatty acid. Improve the balance of the diet if necessary by removing excess sugars and dairy products.

Fresh air and exercise: Enable your children to get plenty of opportunities for exercise (particularly outdoors), including chances for unstructured and unsupervised active play.

Regular positive family time: Find opportunities to do things together as a family on a regular basis. Like all relationships, we have to continue “working” on our relationships with our children (day after day, week after week, month after month, and year after year after year after …).

Communication and understanding: Talk to each other, but more importantly listen to each other (not the same thing). Try to understand your child’s point of view and help them understand yours. Create regular opportunities for you to communicate, listen, and try to understand what’s on each of your minds.

The following “pitfalls” are also worth keeping in mind:

Giving up too quickly: With some interventions, unwanted behaviours can get worse before they start to improve, resulting in parents giving up on the strategy prematurely.

Becoming hopeless following a setback: Setbacks are an inevitable part of any process. Hopelessness can creep in and with it a sense of failure and a loss of confidence in the ability to bring about lasting change. When the inevitable setback occurs, remember it’s very common and not something you need to get stressed about.

Unrealistic expectations: If we have unrealistic expectations of our children, then we will feel disappointed with them no matter what changes. What are your expectations with regards to their emotions, their behaviour, their academic ability?

Inconsistency: Children are often clever enough to spot opportunities that arise from inconsistencies in order to further their own desires; for example, by playing one parent off another.

Unresolved difficulties between parents: This is where issues such as inconsistency can become a potentially serious obstacle to progress. In a situation where the parental couple have separated, it’s vital for parents to put any continuing animosity toward one another to one side and keep the child out of any of their arguments. Separated parents will still need to communicate with each other when making decisions about their child.

Unresolved issues from parents’ own childhood: For example, if a parent had an unhappy relationship with their own parents, resulting in them feeling hate or fear toward that parent, they may act with their own children in a way that is designed to avoid this happening to them, resulting in trouble enforcing boundaries with their own children for fear that their children will come to hate them too. Children need parents to be able to bear their hate without the parent “crumbling.”

The anger-guilt-reparation cycle: In this “drama,” a parent becomes infuriated with the child’s behaviour, imposes some sort of punishment (anger), they then calm down and feel that their punishment was unduly harsh (guilt), as a result they try to repair some of the damage they feel they have done and so may give some sort of treat or comfort to their child (reparation). The child may learn that any consequences imposed may be withdrawn and, indeed, may be followed by some sort of reward. The parent then feels the child has “taken them for a ride,” becomes angry again, and off we go.

Creation of a “safe zone”: We are exposed to constant messages telling us how dangerous the outside world is, particularly for children. The subsequent desire to protect our children from the perceived dangers of the world may hamper children’s capacity to develop the independence skills they may need to cope in later life.

Fear of change: This can be a change for any member of the family (see above about family “scripts”). Change usually causes a certain amount of anxiety and fear of the unknown, not just for the individual but also for other family members.

Lack of support: As the old African saying reminds us, “It takes a village to raise a child.” Raising children demands a lot from parents both physically and mentally and, given the pressures they face, they need trusted partners, friends, and other family members to provide emotional and practical support.

Lack of time: Another feature of modern life is how busy and time-stretched we are. With so many things to do and such little time to do them we may feel stressed, and this often impacts on children, the time we spend with them, and the quality of the time we spend with them.

Reference Sources

Chess, S., Thomas, A. (1997) Temperament: Theory and practice. Brunner/Mazel.

Glasser, H., Easley, J. (2007) Transforming the Difficult Child: The Nurtured Heart Approach. Worth Publishing.

Timimi, S. (2009) A Straight Talking Introduction to Children’s Mental Health Problems. PCCS Books.

Timimi, S. (2017) Non-diagnostic based approaches to helping children who could be labelled ADHD and their families. International Journal of Qualitative Studies on Health and Well-being, 12, sup1.