BLOG - Olivia's Place

Book review: ‘Narrative Therapy in Wonderland: Connecting with Children’s Imaginative Know-How’ by David Marsten, David Epston, and Laurie Markham

Olivia's Place Comments Off , ,
Dr. Sophie Westwood, Clinical Psychologist, LIH Olivia's Place Shanghai

Dr. Sophie Westwood, Clinical Psychologist, LIH Olivia’s Place Shanghai

Narrative therapy is an approach that I regularly consider and apply in my clinical work with children, young people, their families, others involved in their education and community, and adults. I was first introduced to this approach during my clinical training at the University of Surrey in the UK, and it was my experiences working in Shanghai that led me to want to get to know it a little better. Working as a British clinical psychologist in downtown Shanghai with clients from the international and local community was a new experience for me and a fresh way of thinking about culture. I too, had attempted to integrate into a different culture and apply my British ways of working (and living) which provided a melting pot of emotions with confusion, curiosity, amusement, wonder, disappointment, relief, sadness, stress, fatigue to name but a few. After nearly two years of working in Shanghai and a growing interest in a therapy approach that takes a long hard look at the influences of relationships and culture, I took the plunge and travelled ‘down under’ to Melbourne last November to complete the week-long Module 1 Narrative Therapy training course. I was surprised to be the only clinical psychologist present but delighted to be in the company of the other attendees who mostly worked with people experiencing all sorts of difficult situations rendering them vulnerable to mental health difficulties. Our shared aim was to try to help them to move forward in their lives in a meaningful way.

Narrative Therapy in WonderlandMy journey with narrative therapy is in its early stages and from my current perspective, the essence of it involves identifying the stories of our lives that we give the most attention to, and exploring what other stories may have been forgotten, dismissed, or are yet undiscovered. It’s the onion metaphor of first peeling back the delicate skin followed by the thick sticky outer layers to expose those that are perfectly snug and hidden that comes to mind. One of the central ideas of narrative therapy is that we are all make meaning of ourselves, others, our lives, and the landscapes we inhabit through the way that we share and create stories, or narratives. For example, a young child that startles easily and prefers to hide behind their Baba’s legs when they meet someone new might be described as ‘shy’ or ‘nervous’ and this becomes a story about them. From this story alone, we might assume that this child is prone to anxiety, has an ‘anxious temperament’ and might have difficulty making friends when they start school. However, when we introduce greater detail to that story and other stories become entwined too, such as startling easily but only when big dogs are around and hiding behind Baba’s legs when his male colleagues come over for dinner but then giving everyone big smiles after a few minutes or so, there is room for alternative or different meanings. This meaning-making process is heavily shaped by our social worlds and we learn much about ourselves through the ‘eyes’ of others (Bakhtin, 1986). During narrative therapy work, a watchful eye is kept on the influencers of stories and how powerful they can be. For example, it might be helpful to explore what it means to be ‘normal’ in any given family, culture, community, or society. Acknowledging this power dynamic and deciding whether the expectations related to certain narratives are something that we might need to live up to, can free up energy, thoughts, and ideas for different and valued directions in life.

The book, ‘Narrative Therapy in Wonderland,’ truly continued to inspire my interest and enthusiasm for the application of this approach in my work. A few years ago, I had called a young person to tell them more about a therapy group to which they had been invited. When I asked them* if they had any questions, the only pertinent question on the tip of their tongue was ‘will it be fun?’ I believe one of the aims of this book is to answer that question and help those working with younger people (and those fully grown too I wonder?!) to consider why fun is an essential ingredient of helpful therapy. Each chapter is littered with case examples of how ‘fun’ can show up in a variety of ways. For example, following a child into whichever ‘wonderland’ their imagination currently occupies is an adventure that can never be planned and is sure to surprise. It is a humbling experience to be invited into a world where fantasy writes the script and a playground of opportunity presents itself with see-saws and roundabouts rooted firmly in reality. My role is to support the young person and important others to navigate a route or generate a map, whereby together we can find a way to ‘shrink a problem down,’ or ‘stand up to’ it to prevent it from bothering the young person. I have witnessed the birth of incredible ideas to do just this from young people that no textbook or therapy manual could have ever directly prescribed. That is, of course, not to say that those textbooks or therapy manuals aren’t helpful too, and I am often grateful for their guidance in clinical work. The beauty of being trained to apply psychological theory is that alongside the person or people with whom I am working, we can decide collaboratively, which is the best fit for them. I am often drawn to a narrative therapy approach because it is very much led by the client and the knowledge, skills, abilities, talents, and qualities they have of what could work best for them, and not forgetting the valued involvement of those around them.

Something else that I hope to introduce into my clinical practice from Marston, Epston, and Larkham’s writing is the ‘wonderfulness interview.’ During our first meeting, it can be tempting for all of us in the therapy room to devote all of our attention to the problem and the story of how it might have developed, what is preventing it from going away, and the ways in which it is negatively influencing or affecting a person’s life. This is important information to hear but given that narrative therapy aims to find out what is not yet known, forgotten, or dismissed, it’s worthwhile listening to a different sort of story or stories too. By asking questions about what is ‘wonderful’ about the young person affected by a particular problem, we start to learn about other stories in their lives that speak to who they are, what they value, and wish, dream and hope for. Certain skills, abilities, qualities, or knowledge might be known and can be particularly handy in calling upon in service of freeing up the hold that the problem has on a person’s life. You’ll notice that problems in this article have been written about in a certain way: it is ‘the’ problem, as opposed to ‘the child’s’ problem.’ This is an important distinction in narrative therapy because it posits that ‘the person is not the problem, the problem is the problem’ (White, 1984; 2007. For younger people, this means that they receive the message ‘I am a good and worthwhile person who is currently doing my best to deal with a tough problem that’s causing lots of trouble for me and other people.’ This can be a big relief for some young people (and parents) to hear when they have not been particularly keen on coming along to the first session in the first place!

So, as I sat on the phone talking with this particular young person about their potential attendance at the therapy group I answered, ‘yes, it will be fun.’ As my experience has developed, and as I continue to engage in a career that will always be about learning, I now feel I could answer that young person with greater conviction. I keep wanting to learn more about this particular therapy approach because it provides a helpful set of ideas for working with families and helping them to ‘team up’ against a problem or difficulty in an empowering and respectful way. The book reviewed in this article is an excellent addition to any psychological practitioner’s library and a captivating read.

If you are a fully grown (but maybe not self-defined as ‘grown up’!) adult, a lovely introduction to the world of narrative therapy has been written by David Denborough and it is called ‘Re-telling the stories of our lives.’ I recommend this for anyone interested in making a change.

 

References:

Bakhtin, M. M. (1986). Speech Genres and Other Late Essays. Austin: University of Texas.

Denborough, D. (2014). Re-telling the stories of our lives. Everyday narrative therapy to draw inspiration and transform experience. New York: Norton.

Marsten, D., Epston D., & Markham, L. (2016). Narrative Therapy in Wonderland: Connecting with Children’s Imaginative Know-How. W. W. Norton & Company, Inc: New York

White, M. (1984). Pseudo-encopresis: From avalanche to victory, from vicious to virtuous cycles. Family Systems Medicine, 2(2), 150-160.

White, M. (2007). Maps of Narrative Practice. New York: Norton.

*’They’ is the author’s preferred pronoun to signify gender neutrality (as opposed to the use of ‘him/her’).


LIH Olivia’s Place Beijing Opens Learning Center

Olivia's Place Comments Off

This September, LIH Olivia’s Place Beijing will open its doors to a new center that will provide a unique educational setting for children with learning and developmental difficulties. Some children are unable to access mainstream education in Beijing because of their special educational needs. This may be because of large class sizes in their current school, a lack of learning support, or simply the challenge of differentiating or adapting curriculum to an appropriate degree.

The Learning Center is able to offer highly individualized programs to children who experience barriers to learning. Our aim is to offer a high-quality learning experience to children unable to access mainstream education either temporarily or in the long term. We believe that every child is unique and deserves the opportunity to grow as learner.

The Learning Center will be open from 9:00 am to 4:00 pm daily, Monday to Friday, and will follow a semester system. It will cater to children between 3 -8 years of age. Children will benefit from:

  • Speech, occupational, and physical therapy delivered during the week according to need. Therapy can be pull out, push in, or via small groups.
  • Access to Applied Behavior Analysis (ABA) on a daily basis
  • Small group ratios, with a maximum of eight children to two teachers
  • Flexible attendance options, including half time and full time
  • Support for reintegration into mainstream education as appropriate Extended early childhood curriculum and individual target setting
  • Bilingual English/Chinese setting

 

For more information please contact Chery Zhou at cherry.zhou@lih-oliviasplace.com


My Week at the LIH Olivia’s Place Learning Center

Olivia's Place Comments Off ,
Joy Ashford, LIH Olivia's Place Shanghai Summer Intern

Joy Ashford, LIH Olivia’s Place Shanghai Summer Intern

Hi, I’m Joy. I am currently living in Shanghai and working as a marketing intern for LIH Olivia’s Place. I am from Philadelphia, United States, where I help lead a monthly sports program for kids with disabilities. I have seen the difference positive and professional care can make for kids with disabilities back home, and I wanted to be part of spreading that here in China. I fell in love with Shanghai when I visited last year, and I came to LIH Olivia’s Place hoping that I can further their mission and improve the lives of kids with disabilities in one of the best cities in the world.
In June, I had the privilege of working at the LIH Olivia’s Place Learning Center, which provides an inclusive learning environment. LIH Olivia’s Place are actively changing the face of health care in China with their amazing international staff and revolutionary individualized, interdisciplinary, and family-centered approach. It was such an exciting opportunity to spend time learning from them.

When I met the Learning Center staff for the first time, I quickly saw that happiness and positivity underlay everything that they did. You can see it in the toys that line the walls, in the brightly colored student artwork displayed proudly in the front walkway, and in the smiles on the kids’ faces as you walk through the door. Each student has their own individual challenges, whether it be learning, behavior, social skills, or a combination – but none of them have a problem with happiness.

It seemed very apparent to me after my first day at the school that the Learning Center was exactly what a bug-eyed Shanghai newcomer like me needed. I hardly had time to miss home before I was bombarded with eager hugs, with enthusiastic kids teaching me how to do the hokey-pokey, with yoga sessions where I realized just how inflexible I was (and how incredibly flexible kids are!), and with “authentic” Chinese cooking classes, with a side of far more laughs (and a little flour in the face) than I could find anywhere else.

These smiles, of course, did not always come easily. As the students raced through their busy schedule, I could see in every interaction the committed care and attention of each staff member, and the difference it made in each individual child’s development.

One child, they told me, had come into the clinic seemingly always overwhelmed, crying, covering her face, crawling into the corner, and often unable to articulate how she felt. Now I watched her giggling as she stirred a cake mix for us all to enjoy, or gave her classmate an excited “big clap!” when he was willing to put his toys away.

Another child had difficulties with behavior, and had struggled to learn anything in school because of her trouble communicating with and following her teachers. I watched Ms. Akshata’s careful, intentional way of giving the girl directions – counting to 10 to give her time to process, rewarding positive behavior with encouragement, and providing a “break” for her to calm down when she still struggled to accept or understand. I learned to see every “yes” as a sign of hard work, on both their parts. However, by this time, the girl had learned to say a lot more than “yes.” With an understanding teacher, a child that had entered the classroom speaking only a few words of Mandarin was now bilingual, far ahead of her peers in both Mandarin and English.

The Learning Center consistently demonstrates that having “special needs” is not synonymous with comprehensive weakness. Their teachers excel at seeing the special strengths that set each student apart, alongside with each challenge that needs to be worked with. As they themselves would tell you, that holistic approach is their tried-and-true key to success. Sometimes, the best prescription for any developmental difficulty isn’t a medication, but a firm hand, a nod of encouragement, or a “big clap!” when the student gets something right. Letting the students learn and develop at their own pace, the Learning Center’s teachers’ willingness to adjust to each child seems to be their key to success – along, of course, with their ever-present smiles.


LIH Healthcare Pediatric Specialists Present at Children’s Healthcare Forum

Olivia's Place Comments Off , , , , , ,

The “Forum on Current Topics in Caring for Children -Nutrition, Development & Parenting” was held at Shenzhen Bao An Maternity and Children’s Hospital on 14 May. Many well-known professors and international and local supervising physicians were invited to this forum, the theme of children’s health care issues. Dr. Susan Cadzow, Director of Developmental-Behavioral Pediatrics for LIH Healthcare and Kristi Troutman, Occupational Therapist and Clinical Manager of LIH Olivia’s Place Shenzhen, both presented at the event.

Baoan 1Dr.Susan Cadzow is an Australian-registered pediatrician and also a Fellow of the Royal Australasian College of Physicians. She has previously worked at Shanghai United Family Hospital and Royal Children’s Hospital, Brisbane. She is now the Director of Developmental Behavioral Pediatrics at LIH Healthcare.
First, Dr. Cadzow explained what a multi-disciplinary team model is and why it is necessary in the diagnosis of autism. Due to complexity in diagnosis of autism and the similarity of symptoms to many other conditions, precise diagnosis requires the engagement of a team which may include a child’s doctor andoccupational therapy, physical therapy, psychological consultation, speech-language therapy, Learning support, and behavioral therapy.
Next, Dr. Cadzow explained in detail the goal of diagnostic assessment. At the end of the presentation, she expressed that she is looking forward to the further development in specialized services for treatment of autism for children and multi-disciplinary assessment team to enable early diagnosis and early intervention in China, as well as further understanding of practitioners on genetic conditions.

Kristi Troutman, LIH Olivia's Place Clinical Manager, presenting on "Occupational Therapy and Developmental-Behavioral Disorders"

Kristi Troutman, LIH Olivia’s Place Clinical Manager, presenting on “Occupational Therapy and Developmental-Behavioral Disorders”

Kristi Troutman, OTR/L, Clinical Manager at LIH Olivia’s Place Shenzhen, has more than 25 years of occupational therapy experience; she has worked with children with a variety of diagnoses, including autism, ADHD, cerebral palsy, visual impairment, Angleman Syndrome, Noonan Syndrome, selective mutism, and developmental delay.

In her speech, she explained the concept and types of pediatric occupational therapy, and advocated the idea that “Family engagement is Essential in OT”- children, peers, family members, and adults work together on occupational activities such as feeding and eating, caregiver-child interaction in play, dressing, grooming, and personal hygiene. This joint effort is very important to infants, toddlers, children, and their families.

She put emphasis on the significance of occupational therapy, exemplified by how occupational therapy activities are designed to fit for the needs of every single child’s development. Her speech won applause from the audience from time to time, and was received very warmly. In the end, Ms. Troutman explained that the goal of treatment should be varied in terms of each individual, taking consideration of education at home and school, and also highlighted that treatment should be home-centered as appropriate.


LIH Healthcare Expert Invited to Lecture at 2017 ABA Annual Meeting

Olivia's Place Comments Off , , , , , , , ,

ABA 1Recently, the 2017 annual meeting of the Applied Behavior Analysis Specialized Committee of the China Association of Rehabilitation of Disabled Persons was held in Hangzhou, a city with pleasant scenery, attracting nearly 200 professionals throughout the country. Dr. Fengyi Kuo, LIH Healthcare Occupational Therapy Lead and Indiana State University Adjunct Faculty, was invited to give a lecture at this meeting.

With the topic of “Applied Behavior Analysis and Rehabilitation of Autism,” thematic lectures and workshops were thoughtfully arranged to promote the application of Applied Behavior Analysis in therapeutic interventions and education of children with autism and other disorders.

Dr. Kuo has deepened research multidisciplinary therapeutic approaches for children with autism. In this meeting, she introduced how family-centered early intervention and therapy is provided for children with autism in America by using data and vivid case studies. In one case, she especially mentioned a natural history museum where children can learn about various kinds of creatures and animals. In consideration of the needs of children with autism, the museum made special arrangement in terms of lighting, sounds, activity interactions, and many other aspects. Now, the museum has become one of the most popular places for children with autism.

Experts and committee members from across the country shared knowledge in autism and other topics in the meeting. Professor Guo Yanqing, vice president of Peking University Sixth Hospital and chairman of the Applied Behavior Analysis Specialized Committee introduced easy to understand approaches and also appealed to attendees for systematic planning and treatment throughout of lives of children with autism instead of only focusing on their current needs. Dr. Liu Jing, director of the Pediatric Psychological Health Center of Peking University Sixth Hospital, gave a lecture entitled Identification and Management of Comorbidities of Autism Spectrum Disorder. A report on How to Provide Social Interaction Training for Autistic Children at Home by Dr. Li Xue from Peking University Sixth Hospital also attracted a lot of feedback from attendees. Ms. Ke Shuhui, BCBA from Taiwan, shared experience on how to build a case-based ABA consultation system and especially mentioned the supervision role of teaching leads in this consultation system.

This academic meeting promoted the development and progress of the field of applied behavior analysis in China and encouraged academic communication and sharing among international and domestic experts. Pediatric therapy in China, including treatment for children with autism, still has a long way to go. LIH Healthcare will continue to endeavor to help children with autism and their families.


Clinical Training a Focus in May and June

Olivia's Place Comments Off , , , , , , , , , , , , , , , , , , , , , , ,

China-US Pediatric Rehabilitation Forum
Over a hundred general and developmental-behavioral pediatricians, pediatric therapists, and pediatric researchers attended a China-US Pediatric Rehabilitation Forum on May 11 and 12 at Kunming LIH SkyCity Training Center. Attendees engaged in dialogue, formal training, and demonstration and clinical observation to improve the quality of pediatric rehabilitation services in Yunnan province.

LIH Healthcare invited Dr. Chuck Dietzen, Pediatric Rehabilitation Medicine, Riley Children’s Hospital, Indiana University School of Medicine; Dr. Francisco Angulo Parker, a well-known pediatric rehabilitation medicine doctor; Dr. Fengyi Kuo, Clinical Manager at Kunming LIH SkyCity Hospital and LIH Healthcare Occupational Therapy Lead; Dr. Ao Lijuan of Kunming Medical University, Vice President of Rehabilitation College; and Ms. Liu Yun, Director of Kunming Children’s Hospital, Rehabilitation Department.

Presenters and attendees discussed together on children’s rehabilitation, weight management in children, children with brain damage, spasm management for children with cerebral palsy, and prosthetics. Advanced techniques and skills were demonstrated through case study, demonstration, and clinical observation.

GDS-C Training Participants in Beijing

GDS-C Training Participants in Beijing

Griffiths Certification Training
Certification training for the Griffiths Developmental Scales-Chinese (GDS-C) was held on 17 May at Kunming LIH SkyCity Hospital and on 24 May at LIH Olivia’s Place Beijing. Over 40 pediatric professionals were certified through this 3-day intensive training, which followed strict ARICD standards.

The training addresses not only theory but also practical skills. In order to be certified, each trainee is asked to test a child under supervision. Training for the Griffiths assessments (GDS-C, GDMS-2) is standardized across countries, which is one of the reasons that the Griffiths assessments have become known as a gold standard in developmental assessment.

Dr. Denise Challis with the GDS-C.

Dr. Denise Challis with the GDS-C.

As the key instructor, Dr. Challis, the former president of ARICD, highly praised this training, and is confident in further development of Griffiths assessments in China. She stated that LIH Healthcare is a reliable partner with an understanding of the depth of the training program and rich clinical experience; making it uniquely qualified as the exclusive distributor the of the Griffiths assessments in Greater China.

Griffiths training will be offered again in the latter half of 2017 across multiple cities in China, including Shanghai and Shenzhen. For more information, please contact Jingyi Wu, LIH Healthcare Training Specialist, jingyi.wu@lih-healthcare.com.

Distinguished presenters at the Chronic Pain Management Summit

Distinguished presenters at the Chronic Pain Management Summit

Chronic Pain Management and Rehabilitation Summit
On 3-4 June, leading Chinese American rehabilitation experts, the present chief of the American Association of Chinese Rehabilitation Physicians (AACRP), Dr. Hong Wu; and Dr. Gloria Liu, clinical assistant professor at Duke University, and Dr. Ao Lijun of Kunming Medical University visited Kunming LIH SkyCity Hospital for a Chronic Pain Management and Rehabilitation Summit. The event covered various topics including evidence-based management of chronic low back pain and current guidelines, application of type A botulinum toxin in clinical management of neuropathic pain, and cervical and thoracic pain management. In addition to discussions, case study, demonstration and practice workshops, special international outpatient services were delivered to the local Kunming community.

 

Workshop on Spasm Management for Children with CP
Professor Heakyung Kim from the Rehabilitation Medicine and Pediatrics department of Columbia University Medical Center and Dr. Ao Lijuan, the vice president of Kunming Medical University, Rehabilitation College, were invited to present a workshop event including presentation and clinical demonstration on the the topic of spasm management for children with cerebral palsy, including botulism toxin injection. The training was held on 11 June at Kunming LIH SkyCity Hospital. In addition, Dr. Kim provided consultation to patients in the hospital’s outpatient service on 12-13.


Student Contributor Book Review: Jarvis Clutch – Social Spy

Olivia's Place Comments Off , , , , ,

Jarvis Clutch graphic

The following book review was written by a student contributor, aged 13. The review is published as submitted to preserve the perspective and ability of the contributor.

Overview
This book is written by Dr. Mel Levine, a pediatrician and author and Jarvis Clutch, a middle school student. Jarvis is a kid who documents and analyzes social behaviors of other students around his middle school with Dr. Levine, for a period of time. He documents behaviors such as: social categories, peer pressure, social cognition, and fitting in.

Social Categories
There are 5 social categories in every school. The 5 categories are…
1. Popular – Respected by large amounts of students and have good reputations.
2. Fairly Likable – Generally well liked, mostly nice, not everyone knows them.
3. Controversial – Popular with some students, unpopular with others, usually part of a group of kids not accepted by other groups.
4. Mostly Hidden – Nobody knows them well at all, they seem to be invisible a majority of the time.
5. Rejected – Usually feel miserable, They are often excluded from other activities with peers.
Fitting In
In order to change your social category or fit into a certain category, you need to get along with other students. Fitting in with other students consists of talking right, acting right, and seeming right.

Seeming Right includes looking right and acting right. Your appearance can play a big roll in your social status. How you move your body can make a big social difference. You could be too close or too far from a person. Some people don’t like their peers being hyperactive. Seeming cool affects your social image. How might you seem cool to people? Looking as if something doesn’t bother you, walking and talking smoothly, you’re accepted by at least one group. All of the preceding were things that people interpret as cool.

Talking Right is another part of fitting in, it can shape the way people see you. Your tone can change the meaning of the things you say. Along with the tone is word choice. Someone who uses positive, kind words has a better chance of being accepted, rather than someone who uses mean, insulting words. People who can regulate their tone and use appropriate language are usually good at carrying out conversations. Skilled conversations require you to listen, wait, and then respond to whatever the person may have said. Conversation is a good skill to have because you will utilize it very often.

Acting Right, is a critical part of your social cognition, the most important part in my opinion. Many of your peers will judge you by your actions. It is also a way of being socially accepted.

Avoiding aggression is very important to your image. Peers can be aggressive because: they may be too competitive, they may be insensitive to others feelings, or they could have a bad aggressive habit.

Social reacting is the way someone addresses or reacts to a problem. For example, Ben had his pencil broken by Jim, an older student. Ben could respond by: A. Telling a teacher, B. Throwing a temper tantrum, or C. Asking the Jim for another pencil. Two of these three options would be socially acceptable because the right things to do would be to either tell a teacher or ask the student for one of their pencils. Throwing a temper tantrum over a small matter would be disruptive to the other student’s learning.

After a conflict has occurred, conflict repair should come into play. Conflict repair is when the parties involved in the incident figure out how to make things right with each other. Conflict repair for the situation with Ben and Jim would include Jim apologizing to Ben and offering to replace his broken pencil.

Collaboration powers and holds any group project together. No matter what kind of project or job your group needs to complete, collaboration will always dictate whether or not the project gets done well. The key to collaborating with peers is agreement. When everyone can agree with each other the project will move forward much smoother.

Competitive behaviors are very common in schools. Everyone is trying to be better than everyone else in some area or subject. There is nothing wrong about being competitive but the main issue with this behavior is the way it can break friendships apart and become unhealthy. Some people become so competitive with each other they are willing to go to extremes (unhealthy decisions) just to win. These competitions put strain on relationships causing them to fall apart and sometimes become “rival”.

Being the best person you can be socially can be tough. Self monitoring can help you help yourself. Self monitoring is watching how you speak and act so you can improve your behaviors later. By doing so you will get better at socializing. To understand how you can self monitor, it is better to talk to a counselor, therapist, psychiatrist, or psychologist about what you think you are struggling with and they can tell you what you should look out for when you are interacting with the community.
Conclusion
I thought this book had a lot of information in it that made sense to me. It was well written and I was able to learn about different social categories that I never knew existed. I never really focus on social groups when I’m at school because I wasn’t that interested in who was in them or what they did. This book has helped me understand some previous challenges that I’ve had with peers at other schools. It also helped me understand why people have reacted to my behaviors in the past.

 


Mental Health: Steps Toward Prevention

Olivia's Place Comments Off ,
Beth Rutkowski, PsyD, Clinical Psychologist & Psychology Team Lead, Shanghai

Beth Rutkowski, PsyD, Clinical Psychologist & Psychology Team Lead, Shanghai

It is common for people to bring their child for psychotherapy when they believe that something is wrong. If they find their child is suddenly overwhelmed, their mood has taken a turn for the worse, or difficult circumstances have arisen. Often times people will bring their daughter or son to see a psychologist as a last resort or when they feel they are out of other resources. The child may meet the criteria for a diagnosis of anxiety, depression, or post-traumatic stress disorder by the time that they walk through the door.

However, parents don’t tend to think about these types of disorders as preventable. It is common for parent to immunize their children in case they are exposed to mumps or measles. From a young age, we teach healthy eating and the importance of exercise to protect again diabetes and obesity. We don’t often talk about steps to take to prevent the development of a mood disorder.

Studies have found a variety of circumstances that both increase or decrease the likelihood of developing a mental health condition. “Risk factors” are linked with an increased probability of onset, greater severity, and longer duration of major health problems. “Protective factors” modify, improve or alter a person’s response to challenging environmental circumstances, in order to make the development of a mental illness less likely. Protective factors can be both social/environmental and individual.

As parents, we can attempt to maximize our children’s exposure to protective factors and minimize risk factors in their surroundings. Risk factors on a social level include access to drugs and alcohol, isolation, peer rejection, poverty or racial discrimination. Notably, one major environmental risk factor is displacement, which is a circumstance for many expatriate children. Therefore, the need to maximize other protective factors is even more important.

Social protective factors include empowerment, positive interpersonal interactions,
social participation, social support, and community networks. Help your child make connections within the community where you live. Take them to meet the neighbors and schedule play dates with other children. Encourage them to attend after-school activities and join groups and clubs. Allow them to make decisions, such as choosing the color of their room or where the family goes for dinner. Ensure that the majority of your interactions with them are cheerful and optimistic, both to increase their exposure to positive circumstances and to model that attitude.

Individual risk factors are also important for parents to be aware of as well. These include difficulties in school, such as academic failure, learning disorders, and poor study habits, and attention deficits. Physical concerns such as insomnia, chronic illness, and pain are risk factors as are challenges with communication skills and sensory integration. Individuals who come from families with substance use and conflict are also more likely to develop mental illnesses. So what can we do to help our children if they are dealing with any of these circumstances?

Parents can help their children develop protective factors within themselves. These include emotional resilience, positive thinking, problem-solving skills, stress management skills and feelings of mastery.

Combat learned helplessness by teaching arguments against a pessimistic outlook. People who develop mental health concerns often view the world according to the “three P’s”. When something goes wrong, they look at the situation as personal (something is wrong with me), pervasive (my entire life is going poorly), and permanent (what I’m experiencing will never get any better.) Help children view their difficulties as involving the world around them and other people as well. Have them identify the other good things in their lives when times get rough, and remind them that things will always change.

Encourage children to develop coping skills before difficult circumstances arise. These can include relaxation techniques such as visualizing a calming setting and deep breathing. They can also be taught ways to deal with strong emotions, such as expressing themselves through writing or drawing. When your child does go through a negative experience, help them think about lessons that they can take from it. Ask how it might make them stronger, who they found was a good source of support, and what they might do differently in the future- without making them feel guilty.

Help children feel proud of the things that make them special and unique. Allow them to participate in activities and teams where they can experience success. Teach your child to take care of their physical health to maintain mental health as well. These involve eating a balanced and healthy diet, exercising regularly and getting enough sleep.

It is important to realize that it is never possible to ensure your child does not face a mental health disorder. Do not put too much pressure on yourself to be perfect, and do not blame yourself if they are diagnosed. If such a situation does arise, continue supporting them in the ways identified above, to minimize the impact on their lives now and in the future.


Shanghai Psychology Team Trains on Emotion-Focused Therapy

Olivia's Place Comments Off , , ,

Dr. Leslie Greenburg recently visited Shanghai and conducted a series of trainings on Emotion-Focused Therapy (EFT). Dr. Greenburg co-founded the therapeutic approach of EFT, which is an evidence-based psychological treatment. Dr. Greenberg is presently a professor in the department of psychology at York University, where he is also director of the university’s Psychotherapy Research Center.

Three LIH Olivia’s Place Shanghai Psychology Team members – Dr. Sophie Westwood, Dr. Beth Rutkowski, and Ms. Veronica McKibben – attended his one-day workshop on Working with Shame with EFT. Ms. McKibben attended a further two weeks of training in order to develop in depth understanding and skills within the practice of Emotion-Focused Therapy.

The therapeutic techniques of EFT are based on the belief that emotions direct in the way people interact with the world. They guide our actions. They inform us of the things that we want. They help people grow and develop attachments.

The therapy focuses on regulating emotions in order to facilitate a change in behavior. Within a therapy session, an individual is assisted through the process of gaining awareness of their emotions. The therapeutic setting also allows people to experience emotions in a place that is safe and that may be challenging or even frightening to explore without support.

With training, therapists are able to help individuals identify primary and secondary emotions. An example of secondary emotion is when a person expresses anger, though she is actually masking sadness. People are then able to learn to understand, manage, and transform maladaptive emotions. This allows them the opportunity to access and utilize healthy, adaptive emotions, such as grieving the loss of a loved one or developing compassion towards a person who hurt them.

The psychological community of Shanghai was very fortunate to have the opportunity to learn these techniques from Dr. Leslie Greenburg. They will assist the LIH Olivia’s Place psychology team in their work with adolescents, families, and adults.


The Empowered Preschooler Series at Wellington Bilingual

Olivia's Place Comments Off , , ,
Lead Learning & Behavior Specialist, Shanghai

Lead Learning & Behavior Specialist, Shanghai

During the month of April, Jamie Fanelli, Lead Learning and Behavior Specialist at LIH Olivia’s Place, delivered a three-part parenting workshop at Wellington College Bilingual to an enthusiastic group of parents and caregivers. The workshop, entitled “The Empowered Preschooler Series,” introduced learning principles that are key to understanding child behavior and provided strategies based on these principles. The parents and caregivers gained better insight on “why their child keeps behaving in that way” and were given ideas for addressing negative behaviors using positive methods.

During the initial workshop, “ABC’s of Behavior & Beyond: Connecting Learning, Behavior and Positive Parenting,” the parents were educated about a new way of looking at behavior. Ms. Fanelli introduced the basic principles that govern how children learn and discussed how these principles shape child behavior. The parents learned that the building blocks of behavior include antecedents, what comes right before or ‘triggers’ the behavior, and consequences, what occurs immediately following the behavior. The parents discussed their child’s problem behaviors with one another and learned how altering the triggers and consequences can change the behavior over time. They discussed how prevention should often be their first goal and learned how to identify and anticipate the triggers to their child’s problem behavior. Ms. Fanelli outlined some prevention strategies, including:

• Establishing clear expectations and consequences
• Giving their child more choices
• Redirecting their child’s attention to another activity
• Breaking down difficult tasks
• Helping their child prepare for transitions using time warnings and/or visual schedules

Ms. Fanelli and the parents then discussed the different types of consequences, or ways to respond to the behavior. Ms. Fanelli emphasized that traditional discipline around the world focuses on punishment; however, research has indicated that it’s far more effective to focus on reinforcement. In contrast, parents also learned that sometimes no attention is better than negative attention as attention from an adult is powerful and can sometimes increase the problem behavior. Ms. Fanelli suggested parents try ignoring inappropriate attention-seeking behavior, especially when a child is whining or pouting. Behavior management systems, such as reward charts, were also discussed and examples were illustrated. Ms. Fanelli emphasized that rewards should be linked to specific behaviors and always delivered consistently.

Ms. Fanelli then discussed the differences between positive reinforcement and bribery. She stressed that bribing children with the promise of a reward while they are misbehaving is ineffective and counterproductive. The parents and caregivers then actively participated by turning bad behaviors ‘upside down’ by looking at behaviors in a new light. They learned that almost every bad behavior they are tempted to punish could be turned into a positive behavior they can positively reinforce. For example, parents could positively reinforce their child when he puts away a toy as opposed to only reprimanding him when he doesn’t clean up. The parents learned specific ways to teach positive behaviors, including:

• Explaining the desired behavior to the child
• Modeling it
• Practicing it
• Positively reinforcing it.

The parents and caregivers returned on the second day to learn about “A New Way to Say No” and promote positive behavior in children. The workshop reviewed the building blocks of behavior and focused on using the power of positive reinforcement to improve children’s behavior. Ms. Fanelli emphasized that positive reinforcement is one of the most effective tools a parent can utilize and can be delivered in many different forms, such as praise, given a reward or access to a favorite activity. The parents learned the most effective ways to use praise and encouragement, such as:

• Be specific and tell their child exactly what they like
• Keep the praise simple
• Avoid combining encouragement with criticism
• Be very generous with it
• Use the magic ratio of 5:1—praise 5 more times than they criticize or correct

The parents left the workshop empowered and ready to try some new ways of using positive reinforcement that they discussed.

The third and final workshop, “Tame the Terrible Tantrums: Understanding and Responding to Challenging Behaviors,” outlined effective parenting strategies to use when responding to problem behaviors. The parents put on their detective hats and learned more about understanding why the behavior occurs in the first place: the child is trying to communicate something, such as ‘I want you to pay attention to me’ or “I don’t want to stop and clean up.” Ms. Fanelli reviewed and emphasized the effectiveness of positive reinforcement as well as the problems with physical punishment. She discussed that physical punishment, such as spanking, models aggression and often portrays the parent as the ‘bad guy’ rather than focusing on the bad decision the child made. Children often respond to physical punishment by hiding and do not always change their problem behavior. Extensive research shows physical punishment is harmful, counterproductive and linked to antisocial behavior and mental health problems. Ms. Fanelli outlined alternative strategies, including using logical consequences and time-outs.

Logical consequences are negative consequences for problem behavior that the parent decides upon and are logically connected to the behavior. For example, if a child throws a toy at his friend, the parents take the toy away. Ms. Fanelli emphasized that children are not born with an ability to make decisions and accept the consequences and therefore need lots of practice and encouragement to learn how to take responsibility for their actions. Ms. Fanelli encouraged parents to begin by targeting one to three problem behaviors and explicitly teaching the child the rules through modeling, role-playing, using photos, and providing consistent feedback and encouragement. She also emphasized to use positive commands by telling their child what to do instead of what not to do. For example, a parent may tell their child to kick the ball into the net instead of telling them to stop kicking the ball at me. Ms. Fanelli and the parents then discussed using ‘time outs’ as a way to increase the child’s compliance and decrease problem behaviors. During the ‘time out,’ the child would be taken to a quiet area free of toys and given minimal attention. ‘Time outs’ are widely recommended as they are effective, nonviolent and give everyone time to cool down.

The workshop concluded with a discussion about ways to improve children’s emotional regulation skills. Developing strong emotional regulation helps the child control his own behavior, develop empathy for others, follow directions and focus. Ms. Fanelli recommended that parents encourage children to:

• Label their and others’ emotions,
• Help the child identify the triggers that lead to the emotions
• Help the child identify the physical reactions, such as tightened muscles or difficulty concentrating, that happen afterward.

Throughout the workshops, the parents and caregivers shared their own experiences and asked several great questions about their child’s problem behaviors. At the completion of the workshop, they left with a toolbox of strategies and resources to better respond to challenging behaviors and promote positive behaviors.

For more information or to schedule The Empowered Preschooler o similar workshops for parents at your school, please contact Penny Fan by email or at 86 21 5404 0058/59.

To schedule an appointment with Jamie Fanelli, Shanghai Lead Learning & Behavior Support Specialist, please contact intakesh@lih-oliviasplace.com or call 86 21 5404 0058/59.


1 2 3 4 5 6 7 8 9 10 ... 20 21   Next »
Top