Blog Posts

What to do with Worry by Kirsten Ellingsen, PhD, PMH-C

1/13/2023

Worry is the thought component of anxiety. An important part of effectively managing anxiety is recognizing, challenging, and changing unhelpful thoughts and thinking patterns.

Worry can be productive and facilitate planning and problem solving for an upcoming event or figuring out how to prepare for an upcoming challenge. It can be beneficial for academic achievement. It can enhance focus and motivation. For example, if your child is worried about an upcoming test worry can encourage productive studying and enhance performance. It can also motivate action to prepare for potential risk or challenges, such as gathering supplies and an evaluation plan if a predicted hurricane nears. Worry might also help a child think through consequences and be more cautious to moderate risk-taking behavior.

When worry is addressed or facilitates productive action it is a manageable and helpful part of normal life. Everyone worries. Just like we do not want to get rid of all anxiety, we do not want to get rid of all worry. The goal is to recognize and use worry to make safe choices and prepare or plan for necessary responses to challenges.

However, worry is an ineffective method to solve problems if thoughts begin to focus on extremes (e.g., the “what if…” or highly unlikely 1% possible negative outcomes) and become out of balance to real danger or circumstances. When worry is excessive, frequent and/or interferes with enjoying and full functioning in life it can become a significant problem. It is a problem when worry is unrealistic with an exaggerated risk or probability that results in a child not wanting to participate in expected or otherwise enjoyable activities.

What anxiety might look like for children and teens

Frequent reassurance-seeking.
Afraid to separate from parents; fear of being alone.
Complaints about physical symptoms (headaches, stomachaches).
Anger or Oppositional behavior. Increased moodiness or irritability.
More tantrums or meltdowns (particularly toddlers and preschool age children).
Changes in appetite or eating behavior. Trouble falling asleep or regression in sleep.
Trouble falling asleep or regression in sleep.

Steps to Managing Worry
THOUGHTS: Teaching children that they can reduce worry and that worry thoughts are connected to how they feel is the first step to helping them effectively manage worry. Helping children identify worry as thoughts and choose more helpful and realistic thoughts is the goal.

Different types of thoughts can make a person feel more or less anxious. Encourage the Maybe for unknown. Help children become comfortable tolerating uncertainty (and that we cannot know 100% what will happen in any given situation). Learning strategies to increase calming thoughts and relaxation strategies to calm our body can help reduce worry and better manage anxiety.

Challenge Worry: Break it down to understand concerns. Guide child/teen to more balanced or helpful thoughts. Ask “What is the evidence for this/against this”? Question “Are you sure?” “Is that a fact or feeling?” “Am I jumping to conclusions?”.

Help children identify and choose more helpful and realistic second thoughts, so that children realize that they are able to handle worry and feel better by noticing and transforming self-talk, perspective, and the thoughts.

Model healthy coping and express how you manage worries.

Facilitate problem solving and work together to come up with a plan rather than offering a solution or fixing the problem so your child is empowered to address the problem.

ACTIONS: While worry is the thought component of anxiety, there are actions that can help decrease and manage worry.
Physical sensations (our fight or flight response) and emotional reactions are also part of anxiety. Relaxation strategies (diaphragmatic “belly” breathing, progressive muscle relaxation, and guided imagery) can help reduce the physiological symptoms of anxiety. Some suggestions for helping children manage anxious thoughts and worry (particularly when it is problematic) are presented below.
Finally, show compassion and help your child identify and express his or her feelings. Keep the worry in perspective. Validate feelings first. Don’t minimize feelings or dismiss worry Listen. Model calm. Acknowledge concerns and then help them come up with more useful thoughts. Make sure your child gets adequate sleep and re-sets with physical activity every day.

Additional Resources:
Coping Skills for Anxiety www.therapistaid.com/worksheets/coping-skills-anxiety
Worry Less in 3 Steps: kidshealth.org/Nemours/en/kids/worry-less.html

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The Power of Forgiveness and Letting Go By Rachel Funnell, LMFT

1/6/2023

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It’s nearly impossible to go through life without experiencing some form of betrayal, aggression or just plain insensitivity from someone. People can hurt you in so many different ways and forgiving them is not always easy. When we feel betrayed by someone we trust and love, it can be extremely hard to understand why that person hurt us, intentionally or not. However, unresolved conflict, holding on to grudges or ruminating can have a significant effect on your physical and mental health.

Chronic anger puts your body in flight or fight mode, which results in numerous changes to your heart rate, blood pressure and immune response. It can cause depression, anxiety, problems sleeping and concentrating. Studies have found that the act of forgiveness can lower the risk of heart attack, improve cholesterol levels, improve sleep, reduce pain, reduce blood pressure and decrease levels of anxiety, depression and stress.

Depending on the offense, forgiveness can seem nearly impossible. It can be difficult to find compassion for someone who has wronged you. It may even feel like forgiving them is like letting them off the hook. However, forgiveness allows you to let go of the negative emotions and thoughts and be able to move forward, either with or without that person.

Forgiveness is not just saying the words. It’s a choice that is made. It’s a process in which you are actively making a decision to let go of negative feelings whether it’s deserved or not. Depending on the severity of the offense, the process could take weeks, months or even years.

The following steps can help with the process of forgiveness:

Before you can forgive, you have to reflect and process the offense. What happened? How did you react? How did you feel? How has the hurt and anger affected you since it happened?
As hard as this may be, empathize with the person. If you can put yourself in their shoes, you may better understand why they did what they did. This act of empathizing doesn’t excuse the offense or the person but it helps you see them as a human being that made a mistake.
Let go of the expectation that they will or should apologize. If you don’t expect it then you won’t be disappointed.
If able, tell the person that you forgive them. If that is too difficult or not possible, talk about it with someone you trust or write about it in a journal.

Forgiveness is tough at times, however, the more you practice forgiveness the better you’ll be at it. And the research is clear, that forgiveness leads to a happier and healthier life.

https://www.verywellmind.com/the-benefits-of-forgiveness-3144954

https://blog.aamft.org/clinical-topics/page/3/

https://www.hopkinsmedicine.org/health/wellness-and-prevention/forgiveness-your-health-depends-on-it

https://wa-health.kaiserpermanente.org/forgiveness-health-benefits/

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The Mindful Evaluation Process By Dr. Ginger Martin

12/29/2022

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I have been conducting autism evaluations for over fifteen years and have seen every way to do it. I have worked in clinics where time was short and evaluations were rushed, I have worked in settings where detail and the process were valued, and I have even seen some clinics who offer diagnoses via telehealth. In my journey working with this wonderful population, the most meaningful experiences for the child, the family, and myself have been found when the time is taken to truly understand each person’s perspective, concerns, needs, and especially their strengths. I always strive to listen to parents, to honor their concerns, to observe the child and note their most special qualities, to include the providers who work so hard and so closely with the child and family, and to provide feedback that is kind, respectful, thoughtful, and positive. I have told countless families that a diagnosis does not change anything about how wonderful the child is; it simply helps us understand them better and to guide the next steps for support.

Years ago, when I began to cultivate my practice and determined how I wanted to offer the gold standard in autism evaluations, I determined that it cannot be a rushed process and that all people need to be heard. That is why I sit with the child and family for a detailed intake process, asking specific questions, allowing parents to share stories and examples, and paying attention to what they need as a parent during this process. Allowing the child to play, explore the office, interact with their parents and myself, and become comfortable is an essential part of the evaluation as well. It allows me to start to get to know them, observe nuances of their interactions, and start to build rapport. When the child and parent return for the evaluation session, both are more comfortable and relaxed which offers more opportunity to truly see both strengths and weaknesses during the assessment. I enjoy the playful process of the evaluation, a chance to be silly with your child, and to put everyone at ease. I want to see each child at their best and may even ask mom or dad to join us on the floor; often you can get more from your child and I want to see what they are truly capable of! I always include developmental or cognitive testing as well so that I can get a full picture of your child and their needs.

Combined with our intake discussion, parent and teacher forms, and all my observations and assessments I have plenty of information to pour through and compile into a detailed and thorough evaluation report. My goal is to look at all the information with a microscope and then to pull back and look at the big picture and patterns. This allows me to formulate the diagnosis that most truly fits. No one is feeling particularly hopeful when scheduling an autism evaluation for their child and my goal is to put parents’ minds at ease, to allow them to trust my process, and to support them in the journey. The outcome is that most parents leave feedback sessions feeling grateful, relieved, and hopeful about their child’s next steps. We take our time during the feedback meeting, discussing details of the data, offering explanations of my observations, and educating the parent about the diagnosis. Parents are free to ask questions, challenge the data, and to indicate if they feel I truly saw their child. I always provide detailed next steps, a roadmap individualized for your child, and offer continued consultation as needed after the evaluation. My goal is for your child to succeed, for you to know how to best understand and support them, and for everyone to see the gifts each child has to offer.

Dr. Martin is now accepting new clients for evaluations for ages 2-18 at her office in Venice FL for immediate availability. She provides a comprehensive and collaborative evaluation process to assess for autism or other developmental disorders. Contact mbhschedule@gmail.com to inquire about scheduling.

Mindful Behavioral Health
333 S Tamiami Trail, Suite 283
Venice FL 34285

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Mindfulness During the Holiday Season By Krista Morgan, BS

12/22/2022

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As winter approaches, our daily routines are easily influenced by the changing weather and holiday season. Days feel shorter, despite the additional errands and activities we commit ourselves to during this time of year, and sooner than later you may find yourself lost among the chaos of appeasing others before putting your own needs first. If you are struggling to take care of yourself this holiday season, the below tips and resources can help you cope with the triggers you may face and help you kick off the new year on a more purposeful stroke.

Prioritizing Yourself: Setting Boundaries and Establishing New Expectations in Groups
Spending time with family can feel heartwarming and rejuvenating, but if you often find yourself eventually feeling overwhelmed by family dynamics or socially claustrophobic it is important to listen to the signals your body is sending you and have a plan to remove yourself from the situation in order to stabilize your nervous system. You might notice yourself mentally drifting from the present environment, your body temperature rising, your leg shaking or your fingers rapping, your stomach growing painful or nauseous; these are all signs of anxiety rising and your body telling you it is not comfortable with your surroundings.

Acknowledging these physiological manifestations of distress is the first step in being able to effectively self-regulate your body. Once you notice the discomfort, it’s important to reflect on what in your environment is causing you to feel so dysregulated in order to respond appropriately. Below are some ways you might take care of yourself in these situations.

Proactively, if you know what will trigger you:

Create a plan with an accountability partner for how long you will attend an event or what time you will leave
Choose to only attend gatherings with people you feel comfortable spending time with
If traveling, plan your own accommodations so that you have your own space to retreat to
Rehearse responses to personal questions or comments you may not feel comfortable answering in the moment
Be transparent but firm about the boundaries you are setting in order to set expectations for your participation, or absence, as necessary

In-The-Moment, if you notice your stress elevating:

Excuse yourself from the interaction and change your environment by leaving that room or surrounding yourself with different people
- Find your accountability partner whose simple presence may help calm you
- Go for a walk or find fresh air outside
- Spend a few minutes in the bathroom using cold water to wash your hands or your face and sit down if you can
Do some subtle mindful breathing or grounding exercises
- 5 5 5 breathing or 2-4 breathing
- Count your breaths
- Take a drink of water or a bite to eat
- Hold an ice cube in your fist
- Notice what you can physically feel around you

After the Event, to prepare for next time:

Reflect on which stressors affected you and how it made you feel
Determine whether your response in the moment was helpful, harmful, or neutral
Create a plan for how you will respond in-the-moment next time you experience similar stress
Talk through your experience with a trained counselor or therapist

Healthy Routines: Nourishing Your Mind and Body
As schedules are constantly changing to accommodate for hurried errands and festive events, it is easy to get caught up in making sure you accomplish every task without considering your own needs first. This is especially exacerbated by the impact Daylight Savings has on the circadian rhythm our bodies are naturally used to following. Furthermore, being surrounded by others who seem like they are able to handle the stress of this time of year with grace and perfection can negatively impact how successfully you feel like you have managed your own responsibilities. Reference the below reminders to ensure you are supporting yourself before worrying about others during this hectic season.

Eat Well and Hydrate

Schedule meals into your day if you know you will overlook breakfast, lunch, or dinner
Carry snacks and water with you at all times
Respond to your body as it lets you know when it feels hungry or satisfied
Confer with a trained counselor or therapist if you know you struggle with disordered eating or substance use
- Large gatherings, especially during religious observances and Thanksgiving celebrations, are often focused on heavy food dishes and alcoholic beverages. These can be dangerous triggers for those who struggle with what and how much to put into their bodies. Prioritize what supports you need in order to be your healthiest in these situations, even if it means limiting your engagement or practicing exposure, as guided by your mental health professional.

Maintain Regular Routines & Rituals

Try your best to avoid adjusting your sleep patterns too often
Continue practicing self-care rituals, such as a skincare routine and hair styling, as you normally would
If you take any medications or supplements, set reminders if necessary to ensure you do not forget these!

Follow the below resources for more information and guidance on how to approach this holiday season with intention and mindfulness.

https://www.mindful.org/meditation/mindfulness-getting-started/
https://www.psychologytoday.com/us/basics/mindfulness
https://www.nhs.uk/mental-health/self-help/guides-tools-and-activities/
https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20047544
https://www.verywellmind.com/understanding-and-managing-holiday-stress-3145230

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Understanding the Gifted Application Deadlines in Sarasota County for the 2023-2024 School Year By Tara Motzenbecker, NCSP, LMHC

12/16/2022

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Positive Parenting By Jessica Custer, BA

12/2/2022

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Positive Parenting is a lifestyle that focuses on building a positive relationship with your child and setting firm limits with consistent consequences. Through nurturing, protecting, and guiding, you teach your children that they are important to you and that you believe in them. It is about meeting the physical, emotional, and psychological needs of children and providing effective, and expected consequences.

Make 1-on-1 Time a Priority

When starting on your Positive Parenting journey, the very first thing you should do is find time every day to spend focused one-on-one time with each of your kids. You can call this “Special Time”, or whatever label makes sense for your family. The important thing is to label this time, so your kids understand that they are going to get your full, undivided attention for a specified amount of time every day. It should be at least 10 minutes per day, and you should do an activity your child chooses.

Start small. Find just 10 minutes each day (per kid) and focus on engaging with them. It won’t take long for you to see the impact of this very small-time investment. Your kids will behave better and contribute more when they feel a sense of belonging.

This quality time is important for kids of all ages. Sometimes older kids will resist hanging out with their parents because it’s not cool. But find things they enjoy and be persistent. Eventually, you’ll find something that works. Kids will begin to look forward to this time with you and start planning their activities.
If you only implement one of these positive parenting techniques, make sure it’s this one. It’s so powerful that it can change your home’s dynamic.

Give Specific, Labeled Praise for Positive Behavior

Praising your child for their accomplishments and being specific about what you like will lead to higher self-confidence and more positive behavior. Giving general praises like, “Good job!” will not be as effective as, “Good job on getting your chores done on time”. An even better praise would be, “You really worked hard on your homework tonight and you must be so proud of yourself”. This will encourage your child to think about how their own accomplishments make them feel and will motivate them to more positive behavior.

Give Your Kids Power

Let your kids make choices regularly. Giving them the power to choose will give them a sense of belonging and significance. It will also make them feel like they are a valued member of the family. And letting kids dress themselves, choose between the red cup or the blue cup, or decide if they’ll eat spaghetti noodles or penne noodles for dinner will not impact their day at all, but will allow them to feel some control over their day.

Offer choices any time you feel you might experience a little pushback. For young kids, it can be to offer choices at bedtime. It sounds like this, “We need to sleep now, do you want the nightlight on or off? and do you want the door open, or closed?” By making a choice, your child is not only agreeing to the initial statement of ‘We need to sleep now, but also has some choice in the matter. It makes kids feel powerful, but bedtime is not an option. For an older child you might say that it is homework time, but would you rather do it at the kitchen table or in the living room? Or Would you prefer to have a snack before homework, or after homework?

Focus on Routines

Human beings, kids especially, thrive on routine. When you know what comes next there’s very little to think about or be anxious over. For kids, routines build trust and help develop strong relationships with caretakers. When all the basic routines are in place to take care of all their needs, they are free to focus on the ‘work’ of being children (which is learning through play). Develop routines for all the repetitive processes in your life. Start with bedtime, morning get-ready time, and mealtime. Once you have routines in place and follow them consistently, you’ll get much less pushback from your kids, and those key transition times will go smoothly and quickly.

Look Beyond the Misbehavior

The next time you experience mischievous behavior, stop to consider the cause of the behavior. Usually, behavior has a purpose. Ask yourself questions, did we miss our special time today? Could she be hungry? Did he not get enough sleep last night? Was there an unusual, stressful situation that popped up today? More times than not you will realize that there’s an outside factor that’s influencing the situation. When you’re able to recognize that your child is HAVING a hard time, and not just trying to GIVE you a hard time, it’s much easier to handle the situation with love, empathy, and grace. If the purpose of the behavior is attention-seeking, see below for the ignoring technique.

Get Plenty of Sleep

This doesn’t seem like much of a positive parenting skill, but it’s an important topic to cover. Sleep is a grossly under-recognized stressor for kids. There’s ample research indicating that children today are not getting enough sleep. Children must get the right amount of sleep to function and develop properly. You might notice that behavior, attitude, and focus improve drastically once your child is getting the right amount of sleep consistently. A nightly routine can be really helpful in helping kids be ready for sleep.

Implementing “Rest Time” or “Quiet Time” can help ensure young kids get enough rest. This is a 60 to the 90-minute period around mid-day where everyone gets a break. Kids can play quietly, read books, or ‘rest their eyes.

Spend Time Playing as Your Inner Child

Allow your inner child to come out when you’re engaging with your kids, especially during your one-on-one time. This means you might have to get messy with paint, play pretend with monster trucks, or make a mess in the kitchen to make chocolate sprinkle cupcakes. This is how you’ll build strong relationships and develop lasting memories with your kids.

Some parents resist this positive parenting tool because they hate to pretend play. Tea parties and superhero battles aren’t for every parent, but you can find an activity you both enjoy with a little exploration. Let your child be in charge and guide you. Try baking, coloring, or doing puzzles.

Are you still struggling with this one? You’re not alone. Many parents have a hard time finding their inner child. They just want your time, so don’t overthink it.

Use Your Calm Voice

Practice using your calm voice every single day. This is an essential positive parenting skill and it’s surprisingly difficult to master. Many of us have spent our entire lives raising our voices when our blood pressure starts to rise. Developing calming techniques, communicating your feelings and needs in a productive manner, and displaying emotional maturity is key to your success. Let your kids see you using calming techniques like deep breathing, counting, taking a break, and even doing yoga or meditation regularly. Your kids will emulate your behavior. And you will be rewarded with less yelling and more problem-solving from your kids.

Stop Playing Referee

Mediating arguments between your kids is exhausting, especially when you were not there when the conflict began. Stop participating as a referee or peacemaker for your kids. Share your decision with your kids ahead of time and inform them of the consequences should conflict occur.

A great positive parenting strategy is to put the kid ‘all in the same boat, meaning the consequence will apply to ALL parties. For example, if they cannot decide who gets to choose the TV show for their 30 minutes of screen time, then they don’t get screen time at all. It can be helpful to role-play some conflict resolution skills before implementing this ‘all in the same boat’ rule.

Create Effective Consequences

Consequences are a basic principle that kids need to learn. Through this positive parenting tool, you can create related consequences for behaviors you want to discourage, or you can let natural consequences occur and let kids learn lessons from life themselves. The key is that consequences need to be related to misbehavior. They should also be realistic, developmentally appropriate, and revealed in advance of the misbehavior. If you don’t follow these guidelines, the consequence will feel like an unfair punishment, and your little one probably won’t learn from it. It is also important to make your commands direct, and specific. Saying, “Please put away the blocks” will be much more effective than, “Will you please put away the blocks?”.

Here are a couple of examples of effective consequences:

If you do not do what I asked, you will sit in time out.(consistent and expected)
You may not throw your iPad. If you throw your iPad, we will put it away for the rest of the day. (Related Consequence)
I cannot pick you up from school today. If you forget your umbrella, you will probably have to walk home from school in the rain. (Natural Consequence)

Be sure to follow through every time consistently.

Require Contributions from Everyone

Chores are a huge battle for many families. Gather your family and discuss how each person can contribute to the family to achieve common goals. Kids should contribute to the family because they are part of the community. You can use chore charts at the beginning to help everyone remember and give small rewards to reinforce following through.
For example, in my family, we all contribute around mealtime. I often plan and cook the meals, the kids set the table and help with cleanup, and my husband washes dishes. Implement a routine to make these contributions just part of the way your family operates. There are plenty of ways even the littlest of kids can contribute. It will give your kids a huge hit of belonging and significance.

Tips for Success

Start Slow
First, don’t try to implement every Positive Parenting tool and strategy on day one. Start slow. Master one strategy before moving on to another. You’ve probably been parenting differently for months or years. Many positive parenting techniques require you to build new habits. Sustainable change happens over time. Don’t feel pressured to move quickly. Build your positive parenting skills at a pace that is manageable for you.

Recognize Positive Parenting as a Lifestyle
Positive Parenting is not a quick fix to discipline problems you’re currently struggling through. It’s a lifestyle, and it needs to be implemented over time. You won’t get the results you’re looking for if you don’t commit to a long-term lifestyle change.

It’s a Process for the Whole Family
Positive Parenting isn’t just a ‘kid’ strategy. It’s a lifestyle for the entire family. You’ll have to change some of your behaviors. It’s necessary for you to face some of your skill gaps. It requires patience, persistence, and sometimes perseverance.

Stick With It
Don’t throw in the towel without giving it a true chance. You will get out what you put in. Spend time understanding and implementing the tools. Make the effort to change your bad habits. If you push through the struggles, you’ll reap the rewards.

Handle Setbacks with Grace
Every family is different. Each child is unique. Some tools will work better for your family than others. Realize that your Positive Parenting solution will be unique to your family, and face setbacks with grace. When you make mistakes, own up to them, talk about them with your kids, and plan to do better next time. One of the great things about using positive parenting techniques is that they don’t require perfection to make an impact.

Ignore Small, Attention-Getting Misbehavior
When children do small, attention-getting behaviors, like whining, or interrupting, ignoring the behavior is your best strategy. This does not mean letting them get away with it, but actively ignoring, and giving no attention to the behavior and waiting until positive behavior resumes to give attention will reinforce the positive behavior. Be sure to praise the positive behavior as soon as it happens following a behavior you are ignoring. For example, if your child is interrupting, you can ignore the behavior completely, this is not easy- especially at first, and the interrupting may escalate at first, but if you continue to ignore (no eye contact, or responding verbally at all), then as soon as he backs off and starts doing something else, or maybe steps back to wait, you quickly praise the behavior, “Thank you so much for waiting until I was finished, I really like it when you wait your turn”. This will reinforce the positive behavior you are looking for and diminish the annoying behavior. Keep in mind ignoring won’t work if there is another gain that the child is getting from the behavior, like cheating on a game, or stealing a cookie from the cookie jar. Those behaviors will have to be addressed with consequences.

References
CDC. (2021, September 23). Child Development: Middle Childhood (9-11 years old) | CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle2.html

Parent-Child Interaction Therapy - Official Site. (n.d.). PCIT - Official Home. Retrieved November 17, 2022, from https://www.parentchildinteractiontherapy.com

Positive parenting. (n.d.). NSPCC Learning. Retrieved November 17, 2022, from https://learning.nspcc.org.uk/research-resources/leaflets/positive-parenting/

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Supporting Your Teen Through The College Application Process By Izzy Devorkin, NCC, RMHCI

11/28/2022

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November is College Application Month, an exciting and highly stressful time. The college application process can be a chaotic time for the entire family, and there are many ways to support your teen during this time. It’s important to know what steps can be taken to help make this a positive and productive experience for your child.

Educate yourself

As your teen begins the college application process, it’s important that you have an understanding of how the process works. It may feel automatic to compare your child’s college process with your own, but it’s important to remember that the process is constantly changing and evolving, and each individual has their own unique experience. It’s a stressful time not only for your teen, but for you as well. Having a good sense of the process and how you can best support your teen is a key ingredient in relieving that stress.

Taking the time to do your own research is a great way to develop a solid understanding of the process and what to expect. Increasing your knowledge on what your teen is going through allows you to be more actively involved in the process. This article gives a straightforward breakdown of the application process.

Be involved

Involvement is crucial for helping your teen succeed with the college application process. Senior year of high school is a busy time, and having extra support can help decrease feelings of overwhelm. It may be tempting to do things for your teen, such as filling out parts of their applications, but it’s important that you serve as a guide along the way, offering assistance as needed. It may be helpful to have designated set times throughout the week where you and your teen work on all things college together. You want to offer the right amount of support without being overbearing.

Help create a pros and cons list

One of the hardest parts of the college application process is deciding which colleges to apply to. Helping your teen figure out what they want in a college and creating a pros and cons list may be a helpful visual in the decision making process. Categories may include size, location, and price. This also gives you as the parent an opportunity to be transparent on how much financial help, if any, you are able to provide. When deciding what colleges to apply to, it’s helpful to have your teen make a list of ‘safety schools’ that they know they will likely be accepted into, ‘target schools’ that your child fits the criteria for, but may be a bit more challenging to get into, and ‘reach schools’ which have high expectations and low acceptance rate (Gordon, 2021).

Offer to read/edit your teen’s college essay

Writing a college essay is daunting for many teens. It’s an opportunity to talk about themselves and their accomplishments which may be difficult for some students. Assisting your teen in what to include in their essay may be extremely beneficial. If your teen has already started their essay, offering to read it or help make necessary edits can be helpful.

Assist with creating a timeline for deadlines

Deadlines are important to follow when it comes to the college application process. To make sure things are getting done in a timely manner, and to lower household stress, working with your teen to make a timeline with deadlines is a necessary step for productivity. Putting the timeline where both you and your teen can see it will be a helpful daily reminder of what should be prioritized. Hanging the timeline on the fridge is a great visual and will decrease the temptation to constantly give reminders. It may be necessary to have a timeline for each college your child is applying to. Important deadlines may include college essays, letters of recommendation, due date of the college application, financial aid due dates, and scholarship due dates. Timelines can be personalized to the individual student and can be easily created using Excel.

Offer support with financial forms and scholarship resources

Financials are one of the most stressful parts of the college application process. Expenses tend to add up fast between college visits and college application fees. Transparency regarding financials is crucial, and it’s encouraged to have this discussion sooner rather than later. Be transparent with your child on how much financial help, if any, you are able to provide. Offer assistance in filling out financial aid forms and searching for scholarship opportunities. It’s important to create realistic financial expectations so everyone is on the same page and there are no last-minute surprises.

Have confidence in your teen

It's easy to forget how capable a teen is when stress levels are high for everyone in the family. As a parent, you want to see your child succeed. You may feel the need to give constant reminders and want to do things for your child, but it’s important to remember that your teen is capable and the college application process is a great opportunity for them to practice independence. As a parent, you won’t be with them at college making sure they attend every class and complete every assignment, so this is a perfect opportunity to practice having patience and confidence in your child. There are many aspects of the college application process where you can offer valuable help, but things such as requesting transcripts and asking for letters of recommendation will need to be done on their own. This is also why having a timeline as mentioned above is beneficial, your teen is still able to complete things independently, but you can assist them with a visual reminder.

Validate your teen’s feelings

In addition to stress, your teen is likely experiencing a whirlwind of emotions relating to the college application process. This is a great opportunity for you to engage in active listening. Active listening requires paying attention to what is being said, using eye contact and appropriate body language, and truly focusing on what the other person is saying rather than how you plan to respond. Many times your teen may just want you to listen and be present, and offer advice only when sought out. It’s important to validate the feelings of your child and help them understand that it’s typical to feel a roller coaster of emotions during the college application process, and you are here as a support.

It’s important to communicate with your child that it’s okay for them to not be accepted into every college they apply to. Teens already put enough pressure on themselves, the last thing they want is to feel like they disappointed their parents. Just as you would celebrate their acceptances with them, validate their disappointed feelings if they don’t get into a school they applied to.

Check-in yourself

It’s important to recognize that your teen is not the only one going through a large change. As a parent, you are also experiencing a lot of emotions relating to your child beginning the college application process. Although it’s an exciting and important time in your teen’s life, It’s okay to feel all the different emotions that arise. It’s crucial to check-in with yourself and your emotions and do what is necessary to take care of yourself. Find what helps you stay regulated and relaxed, whether it be taking a walk, stretching, deep breathing, or having alone time, it’s important to know what steps to take to keep you feeling your best.

Celebrate

Remember to celebrate your teen’s accomplishments! Whether it’s celebrating the smaller victories along the way, or having a celebration when your child receives acceptance letters, it’s important to recognize their hard work and all the effort that was put in along the way. Remember to pat yourself on the back too, helping a teen through the college application process is no easy task!

Resources:
https://www.verywellfamily.com/how-to-support-your-teen-through-the-college-application-process-4801641

https://grownandflown.com/50-ways-parents-help-teen-with-college-admissions/

https://www.usnews.com/education/best-colleges/articles/college-application-process

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Uncertainty by Kirsten Ellingsen, PhD

11/11/2022

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Uncertainty is unavoidable in daily life. Not being able to tolerate uncertainty is a sure path to increased worry and anxiety. Learning how to better accept and cope with uncertainty is possible with practice. Strategies that can help are outlined below.

What is Intolerance of Uncertainty?
“Uncertainty” has been a frequently used and much felt word the past few years. Parents, children, and teens had to manage many unknowns and often experienced a loss of control related to plans for school, work, health, and safety. Having to tolerate or accept what might happen in the future reached a new meaning for many people.

The concept of Intolerance of Uncertainty or “IU” is receiving more attention as it relates to anxiety. In fact, research has found a strong connection between IU and both anxiety and worry in children and adolescents https://doi.org/10.1016/j.jad.2017.07.035).

Anxiety Canada’s handout How to Tolerate Uncertainty outlines behaviors people do when they have difficulty with uncertainty :

Seeking excessive reassurance from others
List-making
Double checking
Refusing to delegate tasks to others
Procrastination/avoidance
Distraction

How to be more comfortable with “not knowing”

The unknown can be desirable for immediate events like the end to a good book or exciting movie. It can also cause considerable worry and stress when an anticipated outcome could be negative. This can be true for situations we think we have control over and those where we feel that we have absolutely no control. When the possibility of the (highly unlikely) outcome is terrible, it is sometimes difficult to focus on the 99% probability. (This is particularly true if you have experienced a negative life event that is rare). However, because we can very rarely be 100% certain about future events, it is helpful to learn to be okay with some uncertainty, even when a potential outcome would be difficult.

Increasing your ability to tolerate uncertainty can occur the following two ways:

Changing how you think
Changing what you do

Change how you think: Changing how you think about unknown/future possible events is important when thoughts are unhelpful, excessively negative, and unlikely. Cognitive Behavioral Therapy is an approach that helps people understand the connection between thoughts, feelings, and behaviors. Change or modify one to change another. Think different to feel different. Act different to think about yourself or a situation differently.

Catastrophizing is a common “thinking error” or thinking pattern associated with anxiety. This is thinking about or imagining the “worst case scenario” or highly unlikely negative outcome.
One good check is to ask yourself: Do I predict bad things when I’m uncertain?
Try asking and answering these questions to challenge persistent worry:

Anxiety increases when thoughts turn and get stuck on what if? For every What if? come up with three alternative “What else might happen”? reasonable responses.

Is this worry realistic? What is the probability of what I predict happening? Is this feared outcome likely? If so, can I handle it?

Imagine and identify What is the Best, Worst and Most Likely outcome?

Could good things be just as likely to happen as the anticipated bad?

What is in my control?

Worry can be helpful when it prompts us to think about and plan. It can provide motivation to take action to try to make sure behaviors are safe or outcomes we want are more likely to happen (studying for a test we want to pass). “By worrying, we are trying to figure out all the possible ways things could go wrong so we can be more certain of the outcome.” https://www.anxietycanada.com/articles/tool-4-make-uncertainty-your-friend/

Worry can be an effort to try to reduce feeling of uncertainty and make things more predictable.
It is a problem attention to a possible future event or outcome that affects your ability to be present, enjoy or participate in life activities and when there is little control. Identify what you can control and what is outside of your control. If something is in your control, make a plan, and then act on it. When it is not, practice coaching yourself with helpful statement to let go of the worry.

Change what you do. If you change your behaviors around uncertainty this will help change your feelings and thoughts about it.

Act as if you can tolerate uncertainty. See https://www.anxietycanada.com/articles/building-your-tolerance-for-uncertainty-act-as-if/ for an example of ranking by difficulty behaviors that help manage uncertainty and coming up with a progressively more difficult list of activities that require uncertainty to do. This practice or gradually facing uncertainty without the managing behaviors can increases confidence. Think about the outcome, how you felt, what you did to cope if the outcome was not positive.
Ask yourself the following questions: Did things turn out ok even though I was not 100% certain? If things did not turn out ok, what happened? What did I do to cope with the negative outcome? What does this tell me about my ability to cope with negative outcomes in the future?

Practice mindfulness: Focus on what is happening right now. Not avoiding, but intentionally being aware of the present moment, without judgment. This will increase your ability to handle discomfort of unknown and uncertainty. See also How mindfulness can help: https://childmind.org/article/how-mindfulness-can-help-during-covid-19/childmind.org/article/how-mindfulness-can-help-during-covid-19/

As hard as it is, learning to be able to accept some uncertainty in life is important for reducing excessive worry and managing anxiety. It starts with acknowledging this tendency and increasing awareness of what is happening to be able to use the strategies outlined above. If worry or anxiety has become overwhelming and is negatively interfering with your daily life, please reach out to a physician or therapist to find support.

Additional Articles: Returning to a new normal 12 tips for handing uncertainty: https://www.anxietycanada.com/articles/returning-to-a-new-normal-12-tips-for-handling-uncertainty/
How Uncertainty Fuels Anxiety https://www.theatlantic.com/health/archive/2015/03/how-uncertainty-fuels-anxiety/388066/
Coping tips for Uncertain Times: https://health.choc.org/6-coping-tips-for-uncertain-times/

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Selective Mutism: Understanding Treatment Options and Key Terms in PCIT-SM by Kate Gibson, PsyD, ABPP

10/30/2022

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There are different types of therapy offered for treating Selective Mutism. Some are offered by Speech Pathologists and some by mental health practitioners. All use different strategies to work toward the same goal of increasing the child’s ability to speak when anxious. This blog focuses on understanding Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM), the approach offered at our practice and created by Dr. Steven Kurtz.

PCIT-SM is a behavioral treatment approach that uses positive reinforcement to help children increase their brave talking while decreasing the negative reinforcement cycle that is maintaining their anxious avoidance of speaking. Positive reinforcement of brave talking involves rewarding the desired behavior of talking. The negative reinforcement cycle that maintains SM involves children being self-rewarded by avoiding talking because avoiding talking is the quickest way they know to decrease their own anxiety.

Before focusing on brave talking PCIT-SM devotes time to building a relationship between the therapist and the child without prompting for speech. Activities that the child is interested in are completed together. This phase of treatment is called the Child Directed Interaction (CDI). This phase is essential for building comfort in treatment for the child before tackling the challenge of working on their anxiety. CDI is used to help a child warm-up at the start of each session. CDI is usually done in the presence of an adult such as a parent that the child already talks to. CDI is also used as a warm-up when a new person is introduced or another variable is changed. The concept of contamination plays a role throughout PCIT-SM.

Contamination is the phenomenon of a child or teen with SM already having experience not speaking to a person, in a place, or in a situation. Children or teens with SM will be unable to speak with any contaminated subject without intensive practice and support. We avoid contamination by completely avoiding questions and heavily relying on the use of CDI skills from PCIT-SM. We also work to un-contaminate previously contaminated individuals in VDI by thoughtfully fading in people who are contaminated and/or working in places or situations that are contaminated.

When the therapist is ready to have the child work on their brave talking the Verbal Directed Interaction (VDI) phase of treatment is begun. Here are some key terms that will come into play during VDI: fade-ins, rehearsal, shaping, living and exposure lifestyle.

Fade-ins are the process of helping a child with SM talk to a new person. It involves slowly getting a child or teen comfortable speaking in front of and eventually to a new person, scaffolded by gradually moving the person being “faded in” closer to the child to encouraging interaction, and then passing the talking baton from the familiar person to the new person.
Shaping is used to establish a behavior that does not currently get performed. It involves breaking the ultimate goal down into smaller steps to take toward that goal. Shaping is a process of taking small steps starting with a lower difficulty action and gradually increasing the difficulty working progressively toward the ultimate goal. You want to wait until your child has more confidence with the step they are working on before increasing the difficulty. If you take things a step harder and your child is completely unable to do it then you probably need to break the steps down into smaller steps toward their goal. In PCIT-SM the therapist will support you in pacing the shaping steps. We think of it as taking steps up a ladder with each step or rung on the ladder being slightly harder than the last.
Rehearsal means practice! If you want your child with SM to order their own donut, they will need to practice first. If nonverbal greetings are also hard and you want your child to wave at their friend as they walk up to the school building, they will need to practice first. They will likely need to practice many times and in a variety of settings. Practice will happen in session but practice outside of session is essential for progress to generalize to your real life. Do not underestimate the power of practice in getting your child ready to face a new challenge with their brave talking or participating. Rehearsal could mean practicing with you multiple times, it could mean practicing with a bunch of different people, it could mean practicing in a bunch of different places. We call looking for any opportunity to practice “living an exposure lifestyle.” Pretty much anywhere you find people is a chance to practice and live that exposure lifestyle.

There are different intensities of treatment available for children with Selective Mutism. PCIT-SM can be delivered individually or in group. Generally children begin with individual therapy and after making progress may be referred for a weekly SM group. Sometimes children with SM take a good amount of time to warm up, making a traditional hour a week therapy model not the most effective approach. In these cases more intensive individual treatment may be recommended first. Intensive treatment could be a few longer sessions each week for a period of time or could be as much as full days of treatment spanning an entire week either in the office or in your home/school/community. Weekly SM groups are allow children to work on talking with adults and other children in activities that simulate things that happen in a classroom. Groups are a great opportunity to work on higher level goals. Some children also benefit from a more intensive group treatment approach. The SM camp models are known as Intensive Group Behavioral Treatments (IGBTs). Our practice will be offering an SM camp this coming summer 2023 called Mighty Mouth Kids Sarasota based on the MMK model developed by Dr. Steven Kurtz.

Your therapist in PCIT-SM will guide you every step of the way in using the strategies discussed here in and out of session to help your child succeed and will help guide you in the intensity of treatment your child needs to succeed!

The treatment principles and terms in this Blog are drawn from PCIT-SM developed by Dr. Steven Kurtz of Kurtz Psychology Consulting.

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Understanding Oppositional Defiant Disorder (ODD) By Rachel Funnell, LMFT

10/21/2022

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Everyone knows that all children are defiant at times, especially when they are tired, hungry, stressed or upset. They will talk back, refuse to listen, yell, and argue. The truth is that oppositional behavior is a normal part of developmental for two year-olds to three year-olds and early adolescents. Oppositional defiance becomes an issue when it’s consistent and stands out when compared to other children of the same age and developmental level and when it affects the child’s family, social and academic life. So how do you know if your child’s defiant behavior is typical or not? Below are the signs and symptoms you want to look out for.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing Oppositional Defiant Disorder (ODD). The DSM-5 criteria include emotional and behavioral symptoms that last at least six months.

Angry and irritable mood:

Often and easily loses temper
Is frequently touchy and easily annoyed by others
Is often angry and resentful

Argumentative and defiant behavior:

Often argues with adults or people in authority
Often actively defies or refuses to comply with adults' requests or rules
Often deliberately annoys or upsets people
Often blames others for his or her mistakes or misbehavior

Vindictiveness:

Is often spiteful or vindictive
Has shown spiteful or vindictive behavior at least twice in the past six months

These symptoms can occur in just one setting or across multiple settings like home, school and in the community.
ODD can sound like a very scary diagnosis to parents. It can make a parent feel like they aren’t good parents or they did something wrong. Or it can feel like something is wrong with their child. The truth is that there is no known single cause of ODD. However, there are lots of different treatment options for parents and their child.

First, it’s important to get properly diagnosed. A lot of times, the child may have some signs and symptoms of ODD but don’t meet the specific criteria. Also, there are times that the child has another disorder that needs to be treated too, like ADHD, learning disabilities, depression or anxiety disorders. Without knowing the full picture, it will be hard to treat the ODD effectively. If your child doesn’t meet the criteria, the type of treatment might be a little different depending on the areas of need.

Once properly diagnosed, the parent needs to look for specific treatment that treats ODD. Not every type of therapy is effective with ODD. The following are more effective treatment:

Parent Management Training - this helps the parent and others learn how to manage the child’s behaviors. Parent-Child Interaction Therapy (PCIT) is a great type of parent management training that works with kids ages 2-10.
Individual Psychotherapy - this can help the child learn more effective anger management techniques.
Family Psychotherapy - this can improve communication and mutual understanding between the family.
Social Skills training - this increases flexibility and improves social skills to help increase frustration tolerance with peers.
Medication - this can help control some of the more distressing symptoms and treat any coexisting conditions.

In addition to the above, there are several things that the parents and others can do to help the child.

Catch the child being good. Praise the child every time you see them doing a behavior that you want to increase. Be specific about what you like when talking to younger children. That lets the child know what you like and what they need to do next time.
Avoid arguing. A child with ODD will argue if you engage with them. So pick your battles. If you can give options, then do that. Otherwise, pick your battles.
Take a break if you think you’re about to get elevated. This is a great way to model for the child to take a break. Also, allow them to take a break if they want one.
Set limits that are age appropriate and reasonable. Be consistent with the consequences and make sure they can be enforced. No empty threats.
Manage your own stress so that you can stay calm during those challenging moments.

A child with ODD can be challenging but it is treatable. With treatment, the child can have a very successful and fulfilling life.

https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-With-Oppositional-Defiant-Disorder-072.aspx

https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

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Parent and Child Psychological Services PLLC
info@childtherapysrq.com
941.357.4090 (Office)
727.304.3619 (Fax)
4071 Bee Ridge Road, Suite 204
Sarasota, FL 34233

Photos used under Creative Commons from verchmarco, wriggly_toes, verchmarco

What to do with Worry by Kirsten Ellingsen, PhD, PMH-C

The Power of Forgiveness and Letting Go By Rachel Funnell, LMFT

The Mindful Evaluation Process By Dr. Ginger Martin

Mindfulness During the Holiday Season By Krista Morgan, BS

Understanding the Gifted Application Deadlines in Sarasota County for the 2023-2024 School Year By Tara Motzenbecker, NCSP, LMHC

Positive Parenting By Jessica Custer, BA

Supporting Your Teen Through The College Application Process By Izzy Devorkin, NCC, RMHCI

Uncertainty by Kirsten Ellingsen, PhD

Selective Mutism: Understanding Treatment Options and Key Terms in PCIT-SM by Kate Gibson, PsyD, ABPP

Understanding Oppositional Defiant Disorder (ODD) By Rachel Funnell, LMFT

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