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Parent and Child Psychological Services PLLC 
941.357.4090 (Office)/ 727.304.3619 (Fax)
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What were you thinking?  By Kirsten Ellingsen, Ph.D.

10/27/2019

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What we think and say to ourselves can profoundly affect how we feel.  This is a central component of Cognitive Behavioral Therapy (CBT), a therapeutic approach that focuses on the connection between our thoughts, feelings, and behaviors.  It includes noticing and examining thoughts to identify and challenge unhelpful, negative, or inaccurate thoughts and thought patterns. 
 
Teaching children and teenagers that their thoughts and self-talk can make them feel better or worse and providing strategies to increase helpful thinking will increase coping during difficult situations and improve mood.  This is an effective way to build confidence and resiliency.
 
While everyone has negative thoughts, when children have frequent patterns of negative thinking or self-critical statements it is important to understand the underlying reasons and to support more helpful thinking (and self-talk). The following article (https://childmind.org/article/how-to-help-kids-who-are-too-hard-on-themselves/) helps outline reasons to consider for why a child might be engaging in negative self-talk (e.g., globalized thinking, perfectionism, attention seeking).
 
Increasing helpful thoughts and self-talk
 
The Child Mind Institute also recommends that parents can help children who frequently use negative self-talk by: 1) listening and validating 2) offering a realistic approach (not just “positive thinking” but realistic and balanced) 3) Putting statements in context 4) Model realistic and helpful / positive self talk and 4) “correct the record” such that if you make a critical statement about yourself you turn it into a teachable moment.
 
In addition, parents can use the following to increase helpful thinking and self-talk:
  1. Step 1 Teach young children about thoughts or “self talk”.  Start with teaching that “thoughts are what we say to ourselves” or “thoughts are the words we say to ourselves without speaking out loud”. Tell children that they have many thoughts each hour of the day and these thoughts can change.
  2. Step 2 Help children recognize self-talk and share thoughts. Talk about the difference between thoughts and feelings; label statements and give examples. Often, we are unaware of what we are thinking, and it can take time to learn to identify our specific thoughts. Point to characters in books or movies and ask the child what the person might be thinking. People can have different thoughts about the same thing.
  3. Step 3 Teach children that what you think affects how you feel. For example, recognizing anxious self-talk leads to anxious feelings, which then increases anxious behaviors. Provide alternative perspectives and offer balanced thoughts while talking about how these types of thoughts can produce different emotions.
  4. Step 4  Encourage children to change their thoughts or self talk from unhelpful to helpful.  Provide examples of helpful and unhelpful thoughts. Let children know that unhelpful thoughts make you feel more worried, sad, nervous or angry. Helpful thoughts increase calm, confident, brave, happy feelings.
  • Play a game by tossing a ball back and forth with your child taking turns transforming unhelpful thoughts to helpful thoughts.
  • Add “yet” to “I can’t” statements.
  • Remind a child to say encouraging words to him or herself or ask what might you say to a friend who made the same negative or critical comment
  • Help children come up with helpful phrases, such as “I can handle it”,  “it is going to be ok” “  “I can do this” “ I can take some deep breaths and calm myself down”
 
Finally, it is important to try to understand the reason for the negative self-talk or comments. Listen to your children, explore thoughts, and help identify feelings behind critical or negative comments. (For younger children provide statements that represent the feeling behind negative statements such as, I am frustrated because…I feel bad about…. I am worried about). Empathize with your child.  Let your child know that it is ok to feel angry, frustrated, sad, worried… but we have choices in how we act on those feelings. Provide support and try not to minimize a child’s feelings or experience. Dismissive statements will not help understand underlying reasons for the comments or build positive connections.  Engage your child in discussions with respect and compassion.  Be aware of how you talk about and label your child- what you say, even joking, can influence self-concept and limit comments that might be perceived as criticism (see the Gottman Institute for information about the importance of a 5 to 1 ratio of positive to negative comments in relationships).  Also, be aware of the messages children are hearing from television and movies as well as social media. Model healthy self-talk. Realize that what you say to your child that might feel like criticism. Make an effort to praise the positive and give attention to what your child is doing well (Keep in mind the 5 to 1 ratio of positive to negative comments for healthy relationships www.gottman.com).

If negative self-talk is persistent and pervasive or impacts functioning it might be time to get additional support.
 
RESOURCES and REFERENCES
https://www.anxietycanada.com/sites/default/files/Healthy_Thinking_for_Younger_Children.pdf
https://www.gottman.com/blog/parent-child-wants-talk/
https://childmind.org/article/how-to-help-kids-who-are-too-hard-on-themselves/
For a description of CBT see:
​https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

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It’s Not Just Hand Washing… So What Is OCD Anyway? By Kate Gibson, PsyD, ABPP

10/14/2019

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In Recognition of OCD Awareness Week October 13-19, 2019 I am providing some education about OCD.

When people hear “OCD” they often think of someone who washes their hands over and over, or someone who needs things neat and organized. These can certainly be part of OCD for some people, but OCD can take many forms that may be very different from this and often much more complex and debilitating.

OCD stands for Obsessive-Compulsive Disorder. As indicated in its name OCD is made up of two kinds of symptoms: Obsessions and Compulsions.

Obsessions are thoughts that get stuck repeating in someone’s head that they try to get rid of. These thoughts are intrusive and persistent, and they cause distress. Obsessions often make the person worry that something bad will happen or make them think something feels wrong. Obsessions can have to do with any topic, not just the ones people who don’t know much about OCD more commonly think of, such as germs or counting.

Compulsions are repetitive acts that people do to help themselves feel better. These might be single actions, complex routines and rituals the person feels the need to do, or even things they do in their head. Checking, counting, saying certain things, and trying to make things perfect are examples of compulsions. Children often heavily involve their parents in their compulsions, needing their parent to say certain things or do certain things in a very specific way in order to feel okay. People with OCD believe the compulsions are the only way to reduce their distress or to stop their fear from coming true.

To be diagnosed with OCD according to the DSM-5 you must experience either obsessions, compulsions, or both. The symptoms must be time-consuming, or cause significant distress or impairment in functioning.

OCD is very impairing for the person experiencing it. OCD can consume a tremendous amount of time and energy (often hours a day), leaving the person depleted. It can distract from and/or interfere with getting places on time, finishing tasks, learning in the classroom, being mentally or physically present with family and friends, and participating in extracurricular activities.

Many kids and teens with OCD with whom I have worked express frustration with people who say things like “I’m so OCD” when that person likes things clean or neat. This type of statement can feel very invalidating for someone struggling with OCD. Comments like this make it harder for that person with OCD to consider talking about what they are going through with others. Imagine being so uncomfortable that you can do nothing else until you touch a door knob 4 times with your left index finger, then say “now the day will be okay” two times, then doing it over and over again because you’re not sure if you touched the door knob the right number of times, and believing that if you do not get it right then something terrible will happen to your mother that day. Imagine how hard it would be to get ready for school in the morning. That is just a glimpse of what OCD is like, which is a far cry from just liking things neat. People without OCD can be supportive by being mindful of the language they use since you may not know if the person next you is struggling with OCD.

There is help out there, and OCD can be treated. OCD is most often treated using a form of Cognitive Behavioral Therapy called Exposure and Response Prevention (ERP). ERP teaches people to gradually face their OCD without engaging in the obsessions and compulsions. This is very tough to do on your own, but can be easier with the help of a trained mental health professional. OCD is like a brain trick making people think bad things will happen if certain things are not thought or done, and ERP helps you take back charge over your thinking, feelings, and actions. In order for ERP to be effective it takes time, dedication and practice in and outside of the therapy sessions. Friends and family can help by being sources of support, and by not participating in the OCD rituals.

Even with ERP treatment sometimes progress can be slow. Some people find it helpful to also see a psychiatrist for medication to assist with tackling their OCD. Make sure the psychiatrist you choose has experience treating people with OCD.

OCD Awareness Week October 13-19, 2019
This year for OCD Awareness Week the International OCD Foundation (IOCDF) is inviting people to participate in an awareness raising campaign involving anyone, whether they OCD or not, posting videos of themselves facing their fears (#OCDweek #Faceyourfear) to show solidarity and build understanding of how challenging it can be to face your fears. Details about events happening for OCD Awareness Week can be found at https://iocdf.org/programs/ocdweek/.

Websites with additional resources:
International OCD Foundation: https://iocdf.org/
Anxiety and Depression Association of America: https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd
Association for Behavioral and Cognitive Therapies:
http://www.abct.org/Information/?m=mInformation&fa=fs_OBSESSIVE_COMPULSIVE
 

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Helping Kids Handle Flu Shot Anxiety By Tara Motzenbecker, MS, NCSP

10/10/2019

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lu season is upon us, which means that many parents are opting to vaccinate their children against the flu. A lot of children are fearful of shots and it can be a traumatizing experience to get one, which leads to more anxiety for the next shot and so on…..Fortunately, there are several ways that parents can help reduce the anxiety about shots so the child can have a more positive experience.

First, sit down and have a conversation with your child about it.  Hear them out about all of their fears, concerns, experiences and feelings.  It is always important to validate their feelings by saying something like “It sounds like you’re worried it’s going to hurt”. When they feel heard and understood, they will be much more open to what you have to say next. A thought to keep in mind: Have you ever been stressed about something that was alleviated because someone said, “Don’t worry about it”?  I’m guessing the answer is no, and it’ll be the same for our children too. Their worries are real, and parents must acknowledge that if they are going to be open to what you say next. Once they have shared all of their worries and feelings about it and you have validated them, you can explain the purpose of the shot, in an age appropriate way. For a four year old, this may be something like “we get shots to keep our bodies safe from germs” and for a ten year old, “we deal with a moment of discomfort so that we can prevent a week of feeling horrible”. 

Next, let them know there are many different tricks for feeling better about the shot. You can go over the list of calming strategies below with them and they can decide which ones they’d like to use leading up to the shot and which ones for the actual time of the shot. Giving them all of the information and letting them choose which ones to try gives them the control they may need. Sometimes just going over these options with the child lets them feel in control of the situation and that alone reduces the anxiety. (For the sake of brevity, I am leaving out the science behind these, but upon request, I would be happy to share exactly how and why these strategies work.)

  • Deep Muscle Relaxation: tighten up all your muscles and hold for one minute.  Slowly relax the muscles and everything feels calm. This is especially helpful because the more the muscle is relaxed, the less discomfort there will be from the shot. 
  • Take deep belly breaths.  A belly breath is slowly breathing in the nose until the belly puffs out, then exhaling out of the mouth slowly until all the air is out. You can practice these with bubbles.  The slower and longer you exhale out, the bigger the bubbles will be.   
  • Bring something that has a preferred and calming scent such as play-doh or an essential oil.
  • Count something in the room such as how many tiles are on the floor or ceiling. 
  • Bring earbuds and listen to music or an audio book.
  • Bring a favorite comfort object or a special new toy to hold.
  • Magic Moustache: press the side of your forefinger against your upper lip and press your thumb under your chin. (Your hand forms a “C” shape.)
  • The parent can tap or squeeze alternating shoulders to calm the child’s system. Think of patting a baby’s back but quickly alternate between left and right sides of the body.
  • Engage the child in a guided meditation in the car on the way to the appointment. There are many apps and online recordings to use. 
  • Create a list with the child of past times the child was very worried about something but the situation turned out just fine. 
  • Think of a very special and happy moment.  Visualize that during the appointment. The child can also draw a picture of this happy moment and bring it to the appointment. 
  • Have a fun plan following the appointment to look forward to. Let the child choose this ahead of time. 
  • The child can draw a picture of how they are using the chosen strategies. 
  • Does the child have any other ideas? They may come up with something even better!

Finally, play it out.  This can be a role play for an older child and using toys for a younger child.  You can guide the first time around to show them what it would be like and what you will do right after the shot. Then, allow the child to lead the play. The child may want to “give the shot” to a stuffed animal or to a parent multiple times before the appointment. Children process and learn through play, so this will give them the opportunity to work through what their amazing brains are needing. 

Always leave opportunity for the child to ask questions and do your best to be honest in an age appropriate way.  

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Co-parenting after a divorce or separation By Rachel Funnell, LMFT

10/3/2019

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Co-parenting after a separation is not easy and tends to take a lot of hard work especially if you have a contentious ex-partner. The key to successful co-parenting is to separate the personal relationship with your ex from the co-parenting relationship. A good way to look at this is that you are starting a completely new relationship with your ex. A relationship that is based around the kids and not the relationship you once had with them. The needs of the kids need to be the priority and you must set your feelings aside. By doing this, you are showing your kids that they are more important than any of the reasons why your relationship didn’t work with the other parent. It will help your kids feel secure, have consistency, understand how to problem solve, model how one can put aside differences for a greater good, and help them be more mentally and emotionally healthier. 
    So how does one successfully co-parent? Below are some tips to help guide you in this new transition. 

  • Set aside your anger, hurt and resentment.
Your emotions need to take a back burner to the needs of your kids. This is not to say that you can’t feel hurt or angry but rather they do not need to see these emotions from you regarding the other parent. What’s best for them, is to see you working with the other parent for their best interests. 
In order to manage your own feelings, talk with friends, a mental health profession or support groups. When your feelings flare up, think of your kids or look at pictures of them to help remind you that you are looking out for their best interest. 

  • Don’t put your kids in the middle. 
    Resolve to keep your issues with your ex away from your children. Don’t use them as a messenger and never say negative things about your ex in front of them. Remember that your ex, is their parent and they love the other parent despite how they treat them or you. You putting down the other parent makes it seem like they are doing something wrong for loving them. 

  • Improve your communication with the other parent. 
    This can be especially challenging, if your ex is not a good communicator or struggles with putting their hurt and anger aside. But make it a goal to conduct yourself in a mature way. 
    When communicating with the ex, keep in mind that you want to go about it in the most non-conflicting manner. It does not have to be in person. It can be via email, phone or text. Set a business like tone, make requests, listen, commit to meeting or talking consistently, keep conversations kid focused and try to solve stress quickly so it doesn’t build up. 

  • Co-parent as a team.
    Being consistent in both houses is very beneficial for the children. This is not to say that there will be differences and the children will need to learn some flexibility. However, rules, discipline and schedule need to be the most consistent items.  
    Make important decisions together. This will include medical, educational and kid related financial decisions. There may be times when the other parent is able to afford something that you can’t. Again, don’t focus on how you can’t provide that for your child but rather that your child is able to experience it or have it. 
    Disagreements are bound to happen so set to work on resolving them. Remember to be respectful when talking with your ex, be flexible with schedules, fill the other parent in on information from school or other activities the children do. Keep in mind that even if you both are struggling to agree on a certain topic, it’s still important to keep talking. If needed, get a third party professional to help with facilitating the conversations. 

  • Make transitions and visitations easier for the children. 
    Transition back and forth from different houses can be difficult for kids. To help make it easier, make sure to remind them about the transition or visitation, pack in advance and include any special items they may want, and if possible, try to drop off instead of pick up your child. This helps to keep the child from thinking that you are “taking” them away from their other parent. 
    When your child returns to your house, keep things low key to allow your child to get adjusted back to your house. Allow them to have some space if they need it. You can also have a special routine for when they return if they need it. This could be a special meal, game, movie or activity. 

Again, co-parenting is not easy but it’s what’s best for your children. It will take some time to get your feelings under control but the sooner the better it is for your child. No matter what, don’t give up trying to make it work. 


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    Parent and Child Psychological Services is a private practice serving children and families in the Sarasota, Florida area. The practice is owned and operated by Dr. Gibson, a Licensed Psychologist who is Board Certified in Clinical Child and Adolescent Psychology. ​

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Parent and Child Psychological Services PLLC 
info@childtherapysrq.com
941.357.4090 (Office)
727.304.3619 (Fax)                                                                                                                                                               
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