wise-minded parenting: teaching essential skills to ... · 02-06-2015 · (casey, galvan et al....

Webinar: Wise‐Minded Parenting: Teaching Essential Skills to Parents of Teens

June 2, 2015 | Laura Kastner, PhD

©Laura Kastner, Ph.D | Distributed by Behavioral Tech, LLC ▪For educational use only. Do not copy or distribute without permission.Linehan Institute | Behavioral Tech, LLC I 4746 11th Avenue NE I Suite 102 I Seattle, WA 98105 | Tel (206) 675-8588 I Fax 1-(206) 675-8590 I www.behavioraltech.org

Behavioral Tech, LLC is a wholly owned subsidiary of the Linehan Institute, a nonprofit organization.

1

©Laura Kastner, PhD | Distributed by Behavioral Tech, LLC 5

Wise-Minded Parenting:Teaching Essential Skills to Parents

of Teens

Laura S. Kastner, Ph.D.

Clinical Professor

Department of Psychology

Department of Psychiatry and Behavioral Sciences

University of Washington


Learning Objectives• Identify the social, emotional and cognitive developmental changes

among adolescents which increase the likelihood of parent-child conflict and the need for both parents and teens to learn emotional-regulation skills.

• Learn the merits of authoritative parenting, behavioral management, and strategies for averting power struggles with teens.

• Recognize typical family system problems and the importance of systemic analysis for understanding what contributes to teen problems.





2


Goals of this webinar• Provide information that might be helpful in parent

counseling or family treatment (not necessarily DBT)

• Assist parents in understanding their teens so that they might make fewer negative attributions

• Encourage therapists to connect and collaboratewith parents if they see adolescents in individual treatment


Adolescent development–period of risk and opportunity

• Rapid physical growth

• Increased risk-taking and sensation-seeking

• Increased romantic and sexual interests

• Experimentation with alcohol and other substances

• Onset of psychiatric disorders

Sports, fitness, health

Trying new goals (travel, service, leadership, work)

Learning about skills needed for successful relationships

Learning gut instincts for safety and decision-making

Learning to be responsible; self management

Puberty and biologic maturation Building competencies





3


Social Development

• Desire to be with friends

• Peer conformity drives

• Joining and belonging

• Identity development

Social skills

Acceptance /social conformity

Social connectedness=health

Building values from exploration and commitment

• Social skills


Cognitive development

Capable of: But…

• Abstract reasoning

• Symbolic thought

• Creative problem solving

• Hypothetical analysis

• Erratic application

• Magical thinking

• Imaginary audience

• Myth of immunity

• Overestimation of rewards

All raging hormones? A mystery…until…





4


Prefrontal cortex functions:PlanningReasoningWeighing costs/benefits/risksIMPULSE CONTROL Limbic system reacts to:

RewardsThreats


Synapses at birth, 6 yrs and 14 yrs,Public Library Association





5



Re-modeling process of the prefrontal cortex

• “Pruning” takes place in prefrontal cortex ~ 13 years

• Gray matter decreases and white matter increases

• Neural connections created by learning & experience

• “The neurons that fire together, wire together”(“Use it or lose it”)

• Greater moodiness, emotional reactivity and risk-takingfor most teens





6


Teen Brain Nascar Metaphor• Big engine—maturing bodies,

independence-striving

• Poor Driver—immature PFC and judgment

• Faulty Break system—immature inhibitory mechanisms in PFC

• High octane fuel—hormones


Teen moodiness, reactivity, & risk-takingon a crude normal curve





7


(Casey, Galvan et al. (2008) “Braking and Accelerating in Adolescent Brain”. Developmental Review .

15 yrs


Emotional Drives- Fast Lane Neural Pathways

Reward-centered habits

• The dopamine pathway-pursuit of immediate gratification, “wanting” and “go-get-it”.

• Features of addiction: compulsive reward-seeking, dependence, withdrawal and craving.

Threat-based mental habits

• Stress can increase impulsivity and negative emotions; a sense of “no control” increases threat.

• Anxiety exaggerates fear of danger, fear conditioning.

• Chronic anger creates persistent resentment about injustices

• Depression is associated with distorted cognitions re: past, present and future





8



Reward-centered habits

Dopamine pathway – immediate gratification; trigger

Go get it!



Amygdalahijack

Threat-based pathwaysAmygdala trigger: perceived threat, “reptilian” fight/flight system





9


Neuroendocrine system changes: hormone production & the brain

• Testosterone in boys can increase by 1000% by the end of puberty, and 20 X more than girls of same age.

• The amygdala has massive amounts of receptors for testosterone, resulting in novelty seeking, territoriality and exploration for stimulation.

• Hormones have impact on neurotransmitters, moods and symptoms: norepinephrine (energizer); dopamine (pleasure); and serotonin (mood stabilization, relaxation, confidence)

• Changes in circadian rhythms alter alert-fatigue signals, affecting memory and biorhythms.


Sensitivity of brain to substances

• Alcohol stimulates the release of dopamine during the “sensitive period” of adolescence, decreasing its natural production.

• Heavy alcohol use interferes with memory and glutamate functioning.

• Nicotine stimulates dopamine supply and affects other neurotransmitters, allowing rapid addiction.

• Dopamine “squirts” result from computer games, stimulating media, gambling and other high arousal pursuits.





10


Developmental-neurobiological patterns

• Hormone releases, in conjunction with brain changes, have implications for the internalizing disorders for girls and the externalizing disorders of boys

• Intense romantic attraction stimulates neural firing pattern in the limbic system that looks similar to the dopamine spike of cocaine.

• Facial emotions are interpreted by the amygdala in teens and distorted (e.g. fear and anxiety can be perceived as anger and hostility)


Yurgelon-Todd, U. Pittsburgh





11


What are the biggest hot button issues for parents during the tween/ teen years? (non DSM)

(14 chapters of Getting to Calm)• Rudeness, sassiness and the morphing into a teen

• Risk-taking, defiance, rule breaking

• Lying and dishonesty

• Parent polarization (when parents don’t agree)

• Entitlement, spoiled behaviors

• Distancing and discord about identity issues

• Parent-child conflict

• Peer problems

• Over-Plugged into media and electronics

• Teen romance

• Sex

• Disappointing grades or academic performance

• Substance use

• Stressed-out families and kids


Wise-Minded Parenting:7 Essentials for Raising Successful Tweens and Teens

Content: (7 chapters)Secure AttachmentSelf ControlAcademic SuccessSocial ThrivingEmotional FlourishingStrong CharacterPhysical Health

Parenting curriculum within chapters :Wise-Minded parenting conceptsDBT dialectic of changeAuthoritative parenting styleEmotion coaching/Mindful parentingNeuroscience of emotions and teen brain changesBehavioral principlesPositive parenting basics





12


DBT wise-minded parenting principles

Your child is doing the best he can at this moment in time.

Parents who accept this truth can move the child along toward change in the future.

Your child needs to do better, try harder, and be more motivated to change.

That will more likely to result from your skillful handling of his extreme emotions and behavior.

Your child wants to make things better.

Children naturally seek approval from their parents and are happier when they master challenges.


DBT wise-minded parenting principles

Your child must learn new behaviors and take responsibility for coping in difficult situations.

And she will, as she matures and you skillfully work with her.

Family members should take things in a well-meaning way and not assume the worst.

Negative reactions are normal, but they’re not usually helpful.

There is no absolute truth.

Arguing over the truth with your child is invalidating, usually pointless, and often escalates conflict.





13


Wise-Mind = Emotions + Cognitions

EEmotion

MindReason

MindWiseMindWise Mind


Emotion Mind• evolved for survival

• faster and more powerful than the thinking brain

• requires quieting for the executive functioning processes of prefrontal cortex to work optimally

Potential problems:

• Dysregulation

• harm to relationships

• distrust

• alienation





14


Reason Mind• Prefrontal executive functioning

• Analysis

• Crucial for problem-solving

Potential problems:

• "I'm right, you're wrong" trap

• logic wars from “one truth” triggers power struggles

• lack of understanding/empathy of other

• alienating others and failure in connecting

• ineffectiveness/invalidation


Authoritative Parenting

Psychological Autonomy- Respect for independent thoughts and

feelings- Collaborative- Not intrusive

AuthoritarianPermissive

Neglect/IndulgentDiana Baumrind; Lawrence Steinberg,Authoritative Parenting, APA





15


Authoritative parenting

WarmthSecure AttachmentUnconditional acceptance

Firm AuthorityPositive ParentingBehavioral Management

PsychologicalAutonomy

Emotion CoachingMindful Parenting


Secure Attachment(warmth)

Unconditional acceptance

Maintaining a mostly positive relationship (5+: 1 ratio?)

Reliable support

Acceptance of negative emotions

Connection when distressed

Genuine interest in the teen (opinions, selfhood)

DBT PRINCIPLES





16


Unconditional Acceptance(warmth/secure attachment)

change acceptance

DBT Principles

Your child is doing the best hecan given his emotional state

And he needsto do better


Acceptance(con’t)

Your child is a mixed bag like everyone else

And will benefit from yourskillful handling of emotions and behaviors

Your child wants to make things better





17


Firm Authority• Boundaries, structured home-life

• Skillful behavioral management (for a review of EB parenting programs, see www.blueprintsprograms.com)

• Non-violent discipline (behavioral consequences, avoidance of harsh punishments)


Positive Parenting

Positive interactions,talking, listening, fun,involvement, empathy

Praise, rewards,encouragement

Limits, rules, routines

Ignore, distract, redirect

ConsequencesTriple P, The Incredible Years, Raising Healthy Children (SDRG), PCIT, etc.

Time outs(youngerChildren

Loss of rewards

Grounding

Loss of Privileges

Extra chores





18


Behavioral Management Skills• Routines that structure compliance with rules and

expectations which are clear

• Attention for positive behavior

• Emotional regulation

• Ignoring low-level negative behaviors

• Use of natural and logical consequences

• Targeting behaviors for change (rewards)

• Enlisting teen in change agenda

• Following through without negative talk/lectures


Common parental slip-ups

• Not acknowledging good behaviors

• Attending to undesirable behaviors

• Making threats and escalating anger and demands

• Not exiting from unproductive exchanges

• Believing they should have the last word

• Thinking, “I can’t let him get away with this”, which keeps them engaged

• Talking too much—with lectures, negativity, escalating to negative engagements (reinforcement).





19


Staying out of power struggles

1. State your expectation

2. Don’t fall for “the bait” of resistive protests.

3. Re-state expectation (without power-coercive comments)

4. Extricate kindly and accept negative feelings

(Proactively, parents should have a policy of giving consequences for noncompliance, so that threats are not necessary)


Psychological Autonomy

• Focus on managing behavior, not controlling the teen’s thoughts and feelings

• Avoidance of “psychological intrusiveness”

• Acceptance of negative emotions; they are seen as opportunity for connecting and coaching

• Tapping the strengths of “emotion coaching”





20


“Emotion Coaching”• Parents are aware of and care about their own feelings

and those of their children

• They demonstrate empathy and encourage appropriate emotional expression and emotional regulation

• They problem solve by collaborative problem solving

• They accept negative emotions; whereas dismissive parents see their role as getting their children to change their feelings or have them go away.

Katz, L.F., & Hunter, E.D. (2007). Maternal meta-emotion philosophy and adolescent depressivesymptomatology. Social Development, 16, 343-360.


Staying out of power struggles(Susan, 15 yo, threatens to go to unsupervised party

despite parental objections)

Mom: You better not go or you’ll be grounded.

Susan: I hate you. You suck as a mother. You never let me do anything.

Mom: How dare you talk to me this way! You are heartless. You aren’t going to the party and give me that cell phone!

Susan: Screw it! I’m going! You can’t control me! (Susan runs out)

Mom: George, why are you making me do everything!





21


Avoiding power struggles

Use the Wise-Minded Parenting Filter

1. Calm Emotion Mind (mindful calming)(My child is doing the best she can given her emotional state,

temperament and developmental stage)

2. Filter out being right (Reason Mind)

(I might be right but am I effective?)

3. Determine realistic goals

(“The only person I can control is myself)

4. Be ready to lead with empathy and validation

5. Respond skillfully to her emotional needs, not the “content issue”

6. Postpone discipline and consequence talk until out of crisis


Mom using wise-minded parenting

Susan: This sucks. Everyone is going! You have to let me go!

Mom: We’re sticking with our rules, Susan. I’m sorry that you are so angry about it. I get it. You see us standing in the way of your having a great time tonight.

Susan: Fine. If you “get it”, then let me go! You’re making me crazy! I hate you! You don’t care that you’re ruining my life!

Mom: I’d like to help you figure out something else that might work tonight. We probably need to cool down first though.

Susan: I want to go to the party! I’m going whether you give your permission or not! I’m serious!

Mom: Look, I understand how disappointed you are. You feel like you’re missing something really fun. Think a little about whether going tonight is worth it , in the long run. (pause) I’m going to make us some tea.

+

+





22


Solution for flooding:Mindfulness


t s

Peers

Family

Teen

School

CULTURE

Neighborhood

Clinical problems





23


Why a family system perspective?How do you know what tx is indicated without evaluating family? (Individuals give biased reports)

Seeing child exclusively alone in therapy:

• you could lose rapport with the parents;

• you could miss the chance to help parents through psycho-education

• you could miss the chance to impact the most important attachment unit for the child

• If the system is maintaining the problem, helping the family change may a crucial factor in effective intervention

Research support (Family Intervention Science, Liddle, Bray, Levant & Santisteban, 2006)


What does it mean to say a family is a system?

A family is greater than the sum of its parts.

• As members of a family system every member is interconnected.

• Think about a mobile. When one piece moves, the whole mobile moves. Movement of one affect the whole system.





24


It’s drug abuse

It’sbullying It’s

maritaldysfunction

It’sconductdisorder

It’sparent hysteria

It’sEmotionaldysregulation


Other research that supports a systemic/parent skill focus

• Authoritative parenting predicts higher grades, better adjustment and higher behavioral competence (Baumrind, Steinberg)

• Monitoring and non-coercive management-key concepts from Oregon Social Learning Center (Patterson, Forgatch, Dishion, Reid)

• Secure attachment-predictive of long term adjustment and successful transition to adulthood (Main)

• “Context” is thought to play a key role in the development of psychopathology and risk-taking in teens (Cicchetti)

• Research on parental psychological intrusiveness emphasizes the importance of behavioral control as opposed to the control over teens’ feelings, verbal expressions, identity choices (Barber)

• Multisystemic therapy for conduct disordered youth (Henggler et al)





25


_

i

momIP

stepdad

stepbro

Mom is afraid of dad’s“fatigue with parenting”losing a 2nd marriage, protective of dau

Step dad is furious withthe wear and tear on mom and cost of Ashley’s tx. since “it isn’t working.”

Mom’s biodaughter (15),in DBT group

Dad’s son has ADHD andstruggles with school

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ __ _ __ _ _ _ _ __ __ __ __ _ _ _


Teen lives in family system

• Parents’ psychological

problems

• Economic strife

• Marital discord

• Low social support

• Parent polarization

• Parent-child alliances (good cop – bad cop)

• Triangulation of marital issues

• Divorce or step-family problems

• Black sheep –scapegoat

• Poor parent-child temperament match

Context issues System issues





26


Family system analysis

• Assessment!

• What contributes to the problem?

• Family systems treatment is not necessarily “family therapy”

• Treatment may include a variety of interventions, but a working alliance with parents is essential

• It takes a village…


Family System Goals

• Behavioral tolerance (avoid nagging, understanding the harms of criticizing and complaining, stop trying to change the other person)

• Marital and sibling subsystem functioning improvement.

• Use of the "split screen" , “Imaginary You Tube", “Turn in your own homework“

• Focusing on connection, understanding the other's behavior from adaptive perspectives and empathy

• Improved behavioral management skills and increasing positive experiences together





27


Family Strengths• Parent/marital self care

• Economic stability

• Social support

• Lack of psychopathology in parents

• Priority on family time and involvement

• Acceptance of child’s temperament

• Modeling of emotional and social competence and character strengths

• Self-regulation skills

• Realistic expectations about normal developmental changes

• Behavioral management

• Authoritative parenting

• Firm Boundaries

• Flexibility & stability

• Closeness/autonomy

• Resilience

• Systems thinking- no blame

• Problem-solving skills

• Engaging teen in positive activities


Physical Health1.Exercise

2.Nutrition

3.Time in nature

4.Sleep

5.Technology management

6.Sexual health practices

7.Limiting health risks and substance use

8.Stress management

9.Religious or spiritual involvement

10.Recreation outlets and leisure activities





28


Wise-Minded Parenting Mantras

• My love messages really matter, even if my teen can't resist expressing disgust or irritation.

• Don't just do something, stand there!

• Getting to calm is more important than getting my way.

• Accepting negative emotions is good parenting.

• Avoid modeling behavior that you don't want to see in your teen.


More Wise-Minded parenting mantras

• I will not cave when faced with high emotions.

• I need to believe the good things I hear about my child.

• Be aware--emotions are contagious.

• My goal is to demonstrate emotional intelligence, not to control my teen's reactions.





29


Adjuncts• BA

• MBSR/MBCT

• CBT

• ACT

• IPT

• PMT

• DBT adds

• RO-DBT

• FBT

• FST

• MFT

• FAP

• And others!


Thank you for attending!www.behavioraltech.org

63

Linehan Institute – Behavioral Tech | 4746 11th Ave NE Suite 102 | Seattle, WA 98105 | Phone 206.675.8588 | [email protected] Behavioral Tech, LLC is a wholly owned subsidiary of the Linehan Institute, a nonprofit organization.

Continuing Education Credit Information Wise-Minded Parenting: Teaching Essential Skills to Parents of Teens

Live Webinar | June 2, 2015

Only participants with 100 % attendance will receive credit.

Behavioral Tech cannot offer partial credit. Please remember to sign in and sign out to document your attendance. Continuing Education documentation will be emailed to you 4-6 weeks after the event.

This offering meets the requirements for the following hours by discipline. Licensing and continuing education requirements vary by state. Please contact your state's regulatory authority to verify if this course meets your licensing or continuing education requirements. Inquiries regarding CE for other disciplines not listed may be directed to Behavioral Tech at 206-675-8589 or via email to [email protected]. Alcohol and Drug Abuse Counselors: Behavioral Tech, LLC is approved by the NAADAC – the Association for Addiction Professionals, Provider #77431. This activity is approved for 1.5 contact hours. Behavioral Tech will email you a letter documenting your attendance upon successful completion of the activity. Mental Health Counselors: Behavioral Tech is a NBCC-Approved Continuing Education Provider (ACEP™) and may offer NBCC-approved clock hours for events that meet NBCC requirements. The ACEP solely is responsible for all aspects of the program. Behavioral Tech has allocated 1.5 clock hours for this activity and will email you a letter documenting your attendance upon successful completion of the activity. Nurses: Behavioral Tech, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Behavioral Tech designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits TM. Nurses should only claim credit commensurate with the extent of their participation in the activity. Continuing Medical Education is accepted by the ANCC for nursing certification renewal. Psychiatrists: Behavioral Tech, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Behavioral Tech designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. Psychologists: Behavioral Tech, LLC is approved by the American Psychological Association to offer continuing education for psychologists. Behavioral Tech maintains responsibility for the program and its content. Behavioral Tech has allocated 1.5 hours of CE within APA guidelines. Behavioral Tech will email you a letter documenting your attendance after successful completion of the program. Social Workers: Behavioral Tech is approved by the NASW Washington State Chapter, Provider Number 1975-166, to offer continuing education for Certified Social Workers, Marriage & Family Counselors, and Mental Health Counselors. Behavioral Tech has allocated 1.5 CE hours for this activity and will email a certificate of attendance upon 100% completion of this activity.

mailto:[email protected]

Linehan Institute – Behavioral Tech | 4746 11th Ave NE Suite 102 | Seattle, WA 98105 | Phone 206.675.8588 | [email protected] Behavioral Tech, LLC is a wholly owned subsidiary of the Linehan Institute, a nonprofit organization.

Information about the Instructor Laura Kastner, PhD received her doctorate in Psychology from University of Virginia and completed her postdoctoral internship at University of Washington. Currently a clinical professor in the department of psychology and the department of psychiatry and behavioral sciences at U.W., Dr. Kastner has also taught in pediatrics, adolescent medicine, and the medical school. The topics of her academic publications include adolescent sexuality, chronic illness, eating disorders, adolescent development, behavioral pediatrics and medical education. Dr. Kastner sees children, adolescents, couples and families in her clinical practice. She is a frequent speaker at conferences, workshops and forums on adolescent development and family relationships. She has been interviewed for numerous articles about adolescence in national and local media. She is the co-author of four books entitled “The Seven Year Stretch: How the Family Works Together to Grow Through Adolescence (Boston: Houghton Mifflin, l997), “The Launching Years: Strategies for parenting from senior year to college life; (Random House’s Three Rivers Press, 2002), Getting to Calm: Strategies for parenting tweens and teens" (ParentMap, 2009) and Wise-Minded Parenting: 7 Essentials for raising tweens + teens (ParentMap, 2013). Her next book, entitled “Calming the Early Years” is written for parents of 3 to 7 year olds and is due out in April, 2015. *Faculty Disclosure Statement: Laura Kastner, PhD receives royalties for books she co-authored on DBT and Parenting. Dr. Kastner is a contracted speaker with Behavioral Tech, LLC and receives compensation for her training activities.

Behavioral Tech Policies Regarding Faculty Disclosure and Disclaimers Conflict of interest definition: A conflict of interest may be considered to exist if a continuing education course faculty is affiliated with, or has any significant financial interest, in any organization(s) that may have a direct interest in the subject matter of the presentation or may be co-sponsoring or offering financial support to the course. Situations involving a potential conflict of interest are not inherently bad or wrong, but in accordance with standards for continuing medical education we would like you to be aware of the affiliation/financial interest of your instructors. Faculty Disclaimer: When an unlabelled use of a commercial product, or an investigative use not yet approved for any purpose is discussed during an educational activity, we shall require the speaker to disclose that the product is not labeled for the use under discussion or that the product is still investigative. Notice of requirements for successful completion: Participants must attend 100% of the training to receive a certificate of successful completion. This includes signing in and out each day of the event. Commercial support or sponsorship: There is no commercial company support for this CME/CE event. Noncommercial Sponsor Support: There is no noncommercial sponsor support for this CME/CE activity. Non-Endorsement of Products: Behavioral Tech approval status refers only to continuing education activities and does not imply that there is real or implied endorsement of any product, service, or company referred to in this activity nor of any company subsidizing costs related to the activity. Off-Label Product Use: This CME/CE activity does not include any unannounced information about off-label use of a product for a purpose other than that for which it was approved by the Food and Drug Administration (FDA).

wise-minded parenting: teaching essential skills to ... · 02-06-2015 · (casey, galvan et al....

Documents