Parenting Corner

 

 

Parenting is an ever-unfolding process.  No one can do it perfectly without slip-ups, errors, or lapses in judgment.  If you meet someone who professes to know exactly what to do, I would advise you to nod your head and get away as quickly as possible!  Perhaps you are like me; whenever I read a parenting article that has the latest  “you should never,” I have the perverse wish to run into the author at the grocery store, with their children, dirty and grubby, and secretly watch as they buy the sugary snacks that they have written should be off limits. Parenting is a tough, messy, imperfect, “twenty-four hour a day” job, and we parents are painfully human, which guarantees that we are bound to make mistakes with great regularity.  So how do we attempt to get it right more often than not?  My suggestion this month is to know yourself. 

 

When I was working as a counselor in the school system, there was a little boy, Alex, who would miss the bus many times because he did not want to get dressed for school.  This was causing problems academically, socially, and at home.  His parents needed to get to work and did not have time to drive him every morning.  Meanwhile, he was missing the early morning school work.  One very frustrating morning, Alex’s father stormed into my office and said, “I can’t handle it any more!  This kid won’t get dressed. We talk to him, yell at him, give him punishments…. nothing is working!  Why is he doing this?” As I was giving his desperate plea thought, I noticed that Alex’s dad was barefoot!

 

I use this story because it is a glaring example of a typically very subtle problem.  Our children have spent their entire life doing little more than studying us.  From their first precious days on earth, we are their mirrors and their guides.  Within days, long before they even possess language, they have mastered behavioral gestures that promise to thrill, melt, and commandeer us into action. Children are gifted at reading their parents.  Those traits, habits, and behaviors that we think that we have hidden from the majority of the world are plain as day to our kids. And, as we are their guides from birth into adulthood, they mimic us. 

 

Now, it typically is not as easy to see as half-dressed Alex and his barefoot dad.  For many of us, we might need a spouse, friend, parent, or therapist to help us see the patterns we have in place.  But, once you take time to really think about the behavior and from where it might be coming, solutions arise.  Families are experts at one another and insight helps to enlighten those murky, inexplicable situations from which we all suffer. 

 

Knowing yourself will help you know your child.  Talk to them about what you see in both yourself and within them.  Listen to what they have to offer.  In my experience, children often have the answers to many of the challenging familial situations that we all face.  Together you might be able to create some positive change for the entire family. 

 

Elizabeth Stabinski, MS MFT is a

Marriage and Family Therapist, registered intern in full time private practice at Weston PsychCare.  She is passionate about her work with parents and families.  Feel free to contact her  with any questions or concerns.

 

Mindful Eating

Mindful eating means being in touch with all your senses while eating and, more importantly, it means being aware of your body’s needs. Mindful eating means being satisfied with the food you eat even after eating small quantities. Mindless eating means eating out of boredom, sadness, anger, frustration or any other emotion. You ate mindlessly if you ate too fast and realized you ate too much once you already finished your meal. Mindless eating is the main cause of overeating, which leads to weight gain. Use the following tips to help you achieve mindful eating.

Mindful Eating Tips

· Ask yourself “How hungry am I?” Use the hunger- fullness scale (0-Starving and 10-Uncomfortably full)

· Eat when you are at 2-3 on the hunger-fullness scale (hungry, but not starving) and stop when you are at 7-8 (satisfied, but not stuffed).

· You are “satisfied” when you ate enough to carry you through the next 2 ½-3 hours without need for another meal/snack.

· Put your fork down when you finish eating and wait at least 10 minutes to check whether you want to keep eating or you are satisfied.

· Eat slowly. Take around 30 minutes to finish a meal.

· Taste each bite you take in, particularly the first few bites.

· Do not eat in front of the computer or TV. These will keep you from being aware of the taste and the amount of food.

· Question whether your bites of food are too big. If so, take smaller bites than usual.

· Be aware of what you are eating and try to eat what your body wants. If your body is asking for a hamburger it is probably because your body needs protein.

· Learn to leave food on your plate if you are full. Don’t hesitate to ask for a Doggy Bag.

· Do not eat sweets when you are starving. If you do, you will likely eat quickly and too much and not fully taste them.

· Follow your cravings by taking time to eat them: taste them and, most importantly, enjoy them. For example, if you are craving chocolate have a small square of chocolate and eat it slowly, really savor it. If you still want more start the process again but always be aware of you body’s cues.

Jessica Gallego, RD, LD,  is a bilingual Spanish-English licensed nutritionist and has been a registered dietitian since 2000. She received her Nutritionist/Dietitian degree at the Universidad Central de Venezuela and her Masters in Clinical Nutrition at New York University.

Mrs. Gallego works as a nutritionist at the Renfrew Center, one of the leading residential eating disorder facilities in the country, where she continues to gain extensive experience in nutrition counseling and group therapy. Mrs. Gallego has a special interest in helping those suffering with eating disorders improve their behaviors and conquer their food fears.

Additionally, Mrs. Gallego is certified in weight management and is extremely knowledgeable in treating overweight and obese patients. During her work at different hospitals including Saint Vincent’s Hospital in Manhattan and Centro Medico de Caracas, Mrs. Gallego has counseled patients suffering from various nutrition related diseases such as obesity, cardiovascular disease, and diabetes. She is truly passionate about helping people improve their health and well being by providing nutrition education and promoting lifestyle changes using a non-diet approach.

Selective Mutism: The Puzzling Sound of Silence

 

S. Elizabeth Kortlander, Ph.D., Licensed Psychologist

 

How is it that a child who is full of life– animated, loud, and often precocious intellectually–can suddenly shut down in certain settings, stop any vocalizations, become “stone faced”, and even have difficulty navigating physically through her world?  A child with selective mutism can actually display such an on/off switch.  While this loss of speech may be puzzling, it is actually a loud proclamation of the intense anxiety a child with selective mutism is feeling at any particular moment.

            Selective mutism is a perplexing social anxiety disorder in which children “lose” their voice in situations that are perceived as threatening.  Thus while children with selective mutism may be perfectly comfortable with immediate family members, they may not speak in the presence of friends, extended family members, and/or neighbors.  Typically school offers a particularly challenging environment with inhibited speech exhibited either across the entire school setting or in certain situations.   Teachers and other adult “authority” figures may be especially anxiety provoking.  Along with the primary symptom of inhibited speech, children with selective mutism  often have difficulty initiating activities, especially in unstructured social time such as the play ground.  Transitions and any unexpected change in routine or personnel may also cause the child to shut down, not only verbally but behaviorally as well.  At its severest, a child with selective mutism may actually have to be physically prompted or guided to continue or start a new activity. 

            Of all the anxiety disorders, selective mutism is one of the easiest to gage in terms of the degree of anxiety or discomfort that a child is feeling at any one time.  For instance, while a child may not verbalize at a normal volume, he may at times whisper into a trusted person’s ear or even out loud.  Likewise, eye contact and a willingness to interact via gesturing or other physical signs increase as the child becomes relatively more comfortable.  The key word is relatively, since for a child to actually start talking with a developmentally appropriate voice in a previously threatening environment may require their moving slowly up through a hierarchy of discomfort.

            Successfully treating Selective Mutism involves a variety of interventions across a range of environments.  The goal is to help the child learn that the people and settings that feel scary are actually safe.  To address school issues, parents, teachers, and mental health professionals must work as a team.  The first step is education.  On the part of the mental health provider he should observe the child in the school setting (before meeting him), note the subtle cues of comfort and discomfort that the child gives in different settings, consult with the school personnel about their observations, and draw up a structured plan for helping the child to make progress.   Parents should also be educated about the disorder and its treatment.  Quite often by the time a child sees a mental health professional, the parents have tried a number of things, such as punishment for not speaking and reinforcers for speaking.  While well intended, these strategies have the unintended effect of pressuring the child to speak, which is one of the most potent ways to induce anxiety and further shut down verbalizations.   Other professionals such as speech pathologists, to rule out any other contributing factors to verbal inhibition, may also be called upon.  The mental health provider, parents, and school personnel should meet and collaborate with a plan. Simple interventions such as getting the child to school early so the parent can help transition the child into the classroom, avoiding too much eye contact when speaking to the child, and shaping questions to allow for yes/no or other brief answers may also help.  Identifying who the child feels comfortable with in the class, and even arranging play dates outside the school setting are all often part of the overall plan.  The essential component of treatment is patience which will allow for awareness and appropriate reinforcement for any steps forward.  Developmentally appropriate cognitive behavioral therapy is also useful to help the child deal with her anxiety and gain coping skills.  Parent education and guidance on how to best help their child is also critical.   Intervening at the earliest possible time is key, since selective mutism may become increasingly difficult to treat as the child matures and moves through school.  Likewise the social, academic, and emotional ramifications of being unable to communicate become increasingly debilitating with age. 

            The good news is that information about the disorder and effective treatment is growing.  With appropriate interventions and patience, selectively mute children can break their silence, and let the world know of all the talents they have to offer.

 

For more information on selective mutism please visit www.selectivemutism.org.

 

If you would like any further information on the topic of selective mutism, please contact her via her webpage at http://www.westonpsychcare.com/s-elizabeth-kortlander.html

 

 

Weston PsychBlog

Please feel free to make our blog a rich and diverse wealth of information.  We encourage you to submit questions on the website on any topics in which you might be interested.  We are very excited about this new year and look forward to being of assistance to our vibrant community.

Seth Grobman, Psy.D.

Director Weston PsychCare, P.A.

Weight Control and Your Child: Conceding the Battle to Win the War

In this day and age in which the media has exposed the epidemic of childhood obesity and associated diabetes, it is impossible for parents to not be more attuned to this issue with their children.  For better and worse, we have access to data, research and information like never before.  This is clearly the case in the area of food, nutrition and physiology.  No doubt, understanding the implications of how we feed our bodies and how we move our bodies is invaluable information.  What can often be a difficult task is translating this information into utilizable material that our children can understand. 

 As parents, we must be persistently aware of, not just the information we deliver, but HOW we deliver it.  Sometimes being accurate is not enough to help children benefit.  Sometimes accurate information can be useless, if not harmful, when delivered ineffectively.  In trying to educate children about food, weight, nutrition and healthy eating, we must be sensitive to the subtle nuances in our delivery.  We, as parents and caretakers, must be aware of how we deliver potentially embarrassing or shameful material to children. 

 Phillip says to his mother, “Amanda told me that I’m fat.  I want to lose some weight.  How much should I lose?”  “Well,” said her mom, “Dr. Speilman said on your last check up that you could stand to lose five pounds.  Why don’t we start there?”  Phillip agrees and queitly walks away.  Conversation over?  Hardly.  For all practical purposes, Phillip’s mother likely feels like this was a good opportunity for her to address his pediatrician’s concern.  She probably feels relieved that someone else did her the service of alleviating her of hurting her son’s feelings.  What she failed to realize is that she delivered the confirming “blow” to Phillip’s self esteem.  In discussing matters of this nature, it is essential to realize the subtle impacts you may have.  In matters of this nature, it is more fruitful to address the biological and medical aspects of this discussion and to STEER CLEAR OF NUMBER OF POUNDS! For example, you might address blood elevelations such as cholesterol or pulse as the impetus for change, or simply the concept of supporting the development of a healthy heart that will “take care of you,” or “keep your body strong for the rest of your life.”  By externalizing the issue, you reduce the sensitive issue of self-esteem or physical acceptance.  Further, you engage your child in a process about which your child can be more curious and motivated.

Therapy Group Offerings and Descriptions

How Does Group Therapy Work? 

Groups may vary widely in purpose and style.  On one end of the continuum, a group can be psychoeducational in nature.  The group leader maintains a “didactic” or educator position, imparting information to the group members.  The information provided generates discussion between the members.  The leader has an important role in structuring the learning experience.  Therapists who work under this model may suggest activities inside or outside the group (homework) in order to help develop these skills, i.e. communication, social, problem resolution skills, etc.  These groups rely heavily upon the use of intellectual, rational understanding, and the conscious wish of the member to make changes based upon ‘decision’ and drawing on the ‘will power’ to fight against old habits in order to practice new behaviors.  The identification that members feel towards one another is a powerful force to sustain motivation and to support each other in times when obstacles to the goal present themselves.  These groups are usually constituted by people who have a common goal or issue, and the work circumscribes to a specific goal.

On the other end of the continuum, the focus is upon ‘group process.’  In these groups, people from potentially different walks of life with unique struggles or issues come together.  These groups parallel natural social environments. Each member comes with a different agenda and the wish to resolve some issue that pains him or her.  What people talk about, and the interactions that occur between the members, happens spontaneously.  How people relate to others, their thoughts, feelings and actions, over time, tell an their “story.”    The member reveals him or herself, letting others “know” them, and they gain a new awareness of self.  It is through the group’s natural interactions, as in life itself, that people attempt to get their emotional needs met.  In the process, they are able to discover the internal obstacles to getting what they say it is they want.  In these process groups, the therapist has a very different role.  His or her role is to facilitate progressive communication between group members; the role is of a more passive nature. 

Below is a description of the groups being offered at Weston PsychCare, P.A.

 Social Skills Groups for Children and Adolescents 

Three groups are designed to strengthen the social skills of children (8-11 years), teens (12-15 years), and young adults (16-19 years) as we discuss issues that are common amongst their age group.  Childhood is a fundamental stage of life and its influence easily extends into adult life.  Providing your child at an early age with skills that will (a) improve communication skills, (b) reduce tantrum behaviors, (c) minimizing impulsive and aggressive behaviors, (d) strengthen self esteem, (e) manage anxiety related to school and (f) encourage appropriate peer interactions is essential for a successful adulthood.  These skills will also be addressed in the adolescent group, along with more verbal processing which will allow the expression and management of emotions regarding issues typical of the teenage years (e.g. family conflicts, peer pressure, at-risk behaviors, and decision-making).  Adolescence is a transitional stage that involves psychological transformations.  The group will provide them with a space to address matters in a setting with their peers.

 Emotional Eating 

This is an ongoing group oriented toward adults who suffer from being overweight due to emotional eating habits.  Boredom, sadness and anger are among the emotions associated with “hungerless” eating.  The group assists members in learning how to eat “mindfully,” using biological hunger and fullness cues.  The group will work on developing alternate coping skills and ways to self-soothe.  Additionally, the group will offer nutrition education on grocery shopping, healthy eating habits, adequate food portions and label reading.  Eating mindfully and incorporating nutritional knowledge into healthy eating patters will help the group member to reach a recommended body weight and live a healthy life.

 Teen Relational Aggression 

This group is oriented towards adolescents who have experienced relational aggression, either in the role of the aggressor or victim.  Members will explore and come to understand the underlying motivations, behaviors and feelings associated with ongoing problems in social situations.  The group will aim to increase insight into the cycle of victimization and to develop efficacy in dealing with difficult peer relationships.  Issues of power, envy, jealousy, exclusion, anger, etc. will be addressed. 

 Parenting Skills 

This six session group is oriented towards parents of children of any age.  The group focuses on exploring and becoming aware of the unconscious motivations that shape the parenting relationship each member develops with his/her child.  Within the context of developmental theories and normal age expectations, the group works together in finding ways to resolve problematic behaviors in the child, parent or the relationship.  This group is conducted in a two-fold manner; reflecting on the deeper individual’s parenting philosophy, and the development of concrete skills and strategies to face the daily challenges of uncovering the true potential of your child and the parenting emotional experience.  Separate English and Spanish speaking groups will be held.

 Relational Issues 

This ongoing group is oriented towards adults motivated to learn about themselves in relationship to others.  Most of us feel most challenged when feelings of intimacy or aggression are aroused.  These feelings most often present themselves in the context of sustained relationships such as ongoing groups.  Group therapy is an ideal method for recognizing individual repetitions that interfere with successful and enjoyable relationships.  Through reenactments that occur in the moment with therapist and other group members, it is possible to identify patterns of behaviors or emotional states that disrupt relationships.  When dark meanings and unconscious motivations rise to awareness, they can be taken into account, and can be influenced or changed.  This revelation can result in a wider range of choices, increased sense of freedom and a richer, more adaptable repertoire of behaviors and feelings.  This group applies to marital, parental, work or social relationships.  It is held separately in both English and Spanish.

 Recovery from Disordered Eating 

This group is organized around assisting and supporting the individual already committed to her treatment and recovery.  This open-ended group is a means of supporting the work being done in individual psychotherapy.  Those who are struggling with symptoms of anorexia nervosa or bulimia nervosa are invited to discuss and examine their struggles and efforts in recovery.  Issues addressed in this group include conflicts with self-esteem, boy image, family dynamics, and interpersonal relationships.  Examining the function and purpose of one’s symptoms is also open for discussion as is methods of symptom management and alleviation.

Considering Medication in Your Treatment

Therapists are often asked by their clients what they think about medication either as an alternative to psychological treatment or as an adjunct.  It should be noted that therapists are not licensed physicians and cannot ethically or legally offer medical advice.  Despite this fact, clients and therapists do, in fact, discuss medication as part of a client’s (potential) treatment.  While therapists may have differing philosophical views or beliefs about the benefits of medication, most would agree that such a decision needs to be made on a case-by-case basis.  Among the factors you and your therapist might consider include:

1. Your Medical History:  It is imperative that you thoroughly discuss with your clinician your medical and medication history as certain psychiatric medications can interact with your current medication regimen.

2. Your Drug and/or Alcohol Use: Likewise, a thorough discussion of your usage patters affects the appropriateness for psychopharmacologic treatment.  For example, excessive use of alcohol can easily negate the benefits of an antidepressant, not to mention cause an increase in medical side effects.

 3.  Your Family History of Psychiatric Medication:  It is helpful to know if members of your family have benefitted from certain medications as you might find similar medications and regimens beneficial as well.

4.  Your motivation:  Believe it or not, excessive skepticism or resistance to medication in and of itself can render it useless.  Human will and motivation are biologically strong qualities and can interfere with the potential value of psychiatric medications.

5.  Your Patience:  The decision to begin a medication regimen requires patience and commitment.  In most cases such as a depressive disorder, the benefits of medication may not be realized for upwards of two to three months.  You must decide if you can wait to achieve the full value of the medication.

6-Your Treating Physician:  While psychiatrists are clearly the most well-trained healthcare professionals to evaluate and treat medically based psychiatric symptoms and disorders, other healthcare professionals are becoming better informed and trained in treating certain “uncomplicated” conditions.  Primary care physicians such as internists, family practitioners, pediatricians, gynecologists and neurologists often prescribe psychiatric medications.  The benefits of using these practitioners range from the ease of access, reduced stigma and medical “one stop shopping (my doctor already knows me well).”  These doctors best serve you by consulting with your therapist and acting as a “multidisciplinary team.”

 We all know that in this day and age, being an educated consumer is an essential.  So to, should the “consumer” of mental health services be well-informed.  Do not hesitate to inquire and discuss any and all of your medication concerns with your therapist. 

While we do not have psychiatrists as part of our practice at Weston PsychCare, we do share office space with three incredibly talented and compassionate, board certified, psychiatrists who are an unending wealth of valuable assistance to our clients and therapists alike.

Drs. Noel Cabrera and Lynn Hernandez are board certified child and adolescent psychiatrists, and Dr. Thania Quesada is a board certified psychiatrist specializing in the treatment of adults.  If you would like to set up a consultation with one of them, feel free to call them at (954) 385-0055.

Announcing THERAPY GROUPS forming

As we eagerly await our practice relocation, we are in the process of offering and forming therapy groups. We see that there is a strong need in our community for groups and our therapists are excited to expand the practice to offer these services. Among the groups offered are:

* Social Skills Groups for Children and Adolescents
* Relational Aggression Group
* Parenting Group
* Relational Issues for Adults
* Eating Disorders Support Group
* Couples “Wellness” Group
* Nutrional Counseling/Educational Group

Please note that these groups are not intended to replace traditional psychological treatment. Rather, they are more “educational” in nature and are geared towards improving skills for more satisfying daily lifestyle. These groups are not covered by insurance as insurance companies require a psychiatric diagnosis for reimbursement. Feel free to leave any questions at our site and we will respond promptly.

Fantastic Website For Parents

A dear friend and psychologist has developed probably the most comprehensive website on any and all news pertaining to childrens’ needs. The beauty of this site is that she presents the most up-to-date research in a thorough, easily-understood manner. If you are interested, please visit Dr. Debbie Glasser’s website: http://www.newsforparents.org/ . I hope you find it to be helpful.

Seth Grobman, Psy.D.
Licensed Psychologist
Director Weston PsychCare, P.A.

Sexualization of Girls

Everyso often, I will post an entry with an interesting link or reference that will promote self-education. The topic of sexualization of girls is of particular interest to me as it pertains to my extensive experience in the area of eating disorders. There is a wealth of research indicating that girls with eating disorders are excessively preoccupied with their presentation, self-control and level of social acceptance. It is tragic, but true, that society has subtlely embedded in the minds of young girls that they should begin an early age to think about, not only their attractiveness, but worse, their sexual desireability. It is appalling what has been normalized by our culture. Who would have thought that the “Barbie Doll” would be outdone by the “Bratz Doll” figure: a doll and character whose body is severely emaciated in appearance, accentuated by an oversized head and overemphasized lips and eyes? We have, in my opinion, a responsibility to our girls on an individual, familial and societal level to be activists lest we perpetuate a cultural myth that girls are no longer sexually “off limits” or unable to integrate explicit material. I invite your thoughts and opinions via our website mailbox. I encourage you to visit the following link: http://www.apa.org/pi/wpo/sexualizationrep.pdf

Seth Grobman, Psy.D.
Licensed Psychologist
Director Weston PsychCare, P.A.