Wednesday, May 18, 2011

Explosive Tantrums - 10 year old Michael



This is an e-mail from a mother of one of my clients, an 10 year-old boy prone to frequent explosive tantrums.
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Hi Dr. Childress,

Since yesterday there have been countless times (already about a dozen times today) that I've had to remind myself not to focus on behavior but to focus on Michael’s inner experience. I get it!  However, practically, I’m having trouble with how to respond.

An example: we were all doing chores to get the house cleaned up. I had Jonathon put away kitchen towels (with protest, but ok, he's 3), Mary unloaded the dishwasher, but then went on to do much more (I heaped on praise), but Michael flat out refused.  He sat on the kitchen chair, rocking back and forth, saying, "I caaaaaan't. I caaaaaan't. I just want to play my gaaaaaameees."

I said, over-exagerated, "aw, Michael, sure you can. We all don't like chores, but we still have to do them."  His behavior then escalated. He "fell" down to the floor, rolling back and forth sayihg "I caaan't, I caaaan't, I'm not going to, I'm not going to.  You can't make me. You can't make me." And all of this being mixed with fake laughing and fake giggling, you know, the really annoying fake loud laugh and giggle meant to annoy.  And this annoying behavior sent me into a fit of wanting to lay in and scream at him for being so rude and obstinate and defiant.

I didn't punish him and his chores did not get done (well they did...Mary did his for him) and he's now upstairs playing his video games.

I feel like he "won", he got away with bad behavior, he didn't help with chores, he's upstairs playing his video game, and I did nothing to focus in on his needs.

What should I have done? This is really, really tough and makes me feel like a horrible, ill-equipped mother, being totally truthful.

Help :-)
Sarah
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Here is my response:
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Hi Sarah

I’m going to offer commentary during your description of the therapeutic opportunity.

An example: we were all doing chores to get the house cleaned up.

Commentary:  Three children one mom.  The ratio of relationship to child is stretched thin.  In a well-regulated family this could go okay.  But in a family of high relationship needs this is likely going to be too thin.  So already I’m expecting some trouble.

One thing you may want to consider in the future is to “scaffold” Michael doing his chores one-on-one, while the other kids do other stuff, so that your complete focus can be on Michael.  If it was just about task completion, you might as well do the tasks yourself, but the goal is to scaffold Michael in doing the task.  Gradually, over time you’ll begin to reduce the extent of scaffolding support you provide to Michael.

Your initial intent:  An intent-to-task. This is understandable, the goal is the household chores.  But the relationship needs of a child are likely going to request an intent-to-be-with (perhaps emerging through an intent-to-understand).

When the child communicates a challenge to the parent’s intent-to-task (if we are trying to respond therapeutically) we need to shift to an intent-to-understand / intent-to-be-with that re-establishes relationship, that organizes the child’s inner experience (through our “eyes-of-the-other” recognition/definition of this inner experience), and that fosters increased development of sophistication in communication (from protest behavior to emotional signaling initially, then to increased verbal communication as the process progresses over repeated cycles).

I had Jonathon put away kitchen towels (with protest, but ok, he's 3),

Jonathon is spot-on the age of attachment system activation.  He presents with high protest, but in a gentle way, but he nevertheless demands attention.  This draws parental focus (love) away from Michael (and Mary – I worry about Mary).  Michael can’t compete with Jonathon on developmental immaturity (at 3 years old, Jonathon has him beat hands down), so Michael may develop “symptoms” of incompetence to compete with Jonathon.

Mary unloaded the dishwasher, but then went on to do much more

Sweetie.  Mary appears to be trying to carve out her own niche of parental bonding through being the angel.  Jonathon has immature-baby wrapped up, Michael has a problem child version of immature-baby… so what’s left for Mary… wonderful angel.  Michael needs to develop into more angel and Mary needs to develop into more problem child… come-on children, let’s share…

(I heaped on praise),

Deservedly so.  Praise is often used as “reinforcement,” based on studies training lab rats.  Doesn’t work with children.  Human children are immensely complex and social.  I’d recommend doing the same thing but changing how you think about it to… “I heaped on lots of loving.”  Praise is for what we do (intent-to-task), love is for who we are (intent-to-be-with).  Humans are social animals, make it personal.  She wasn’t well-behaved, or responsible… she was nice to you.  It’s personal.  “Thank you so much sweetie, I really appreciate your help.” <big hug and smooch>

but Michael flat out refused.

Protest behavior.  Therapeutic opportunity.  Shut down your intent-to-task and shift to intent-to-understand in order to bring organization to his inner experience and to begin the process of facilitating a longer-term increase in communicative level.  Use the task to organize the focus of your intent-to-understand, but shut down your internal press toward task completion in order to give increased time to Michael’s relationship needs (i.e., an intent-to-be-with).

Approach Michael with a positive emotional tone and an intent-to-understand his perspective from his point of view.  Your tone can include a mild challenge to his protest behavior (i.e., a gentle intent-to-change; making your response a “complex communication” of nurturance and challenge), but any intent-to-change should be only the slightest hint and should be dwarfed by a nurturing positive emotional tone and the intent-to-understand (we’ll turn up the volume on the intent-to-change later in the communication dialogue).

“Michael?  What’s going on, sweetie.  I need your help in getting some things done.” <make it personal… I need your help>.

He sat on the kitchen chair, rocking back and forth, saying, "I caaaaaan't. I caaaaaan't. I just want to play my gaaaaaameees."

Stay with his experience.  Help him organize the meaning of his experience.  Let’s explore what this is really all about.  We’re about to embark on a voyage of discovery.  Is he afraid he’ll be unsuccessful and that he’ll lose your loving?  Are his brain systems currently captivated by the happy of the game and he’s experiencing intense disappointment at having to stop happy and do un-fun?  Does he simply want your loving or your special attention apart from Jonathon and Mary, does he need to be special to you?

Depending on your read of his current emotional state, you may want to feed some positive happy emotion into him by offering an affectionate gesture.  In this case, I might offer a soft rub-rub to his upper back or shoulder, all the while maintaining a calm, nurturing tone of concern for his communicated distress (i.e., his emotional signaling).

I said, over-exaggerated, "aw, Michael, sure you can. We all don't like chores, but we still have to do them." 

Ouch. This  response is a denial of his experience and it represents an intent-to-change / intent-to-task, which ultimately communicates that he’s an object, you care about what he does, not who he is.  This will hurt more and will likely provoke further deterioration in his emotional functioning.

Stay with his experience for a few more relationship beats (called “relational moves”).  You can offer this intent-to-change and prompt to task, but do it toward the end of the communication-relationship sequence.  At the early phases, the therapeutic goal is to help him understand the meaning of his inner experience and to provide him with relationship support for his distress.  Three relationship beats on an intent-to-understand his experience from his perspective.

"I caaaaaan't. I caaaaaan't. I just want to play my gaaaaaameees."

“Really?”  <our surprise communicates a gentle challenge that his reality is odd – this is enough of a denial of his experience.  We then need to repair even this ever-so-mild a breech in our psychological connection with him (called the “intersubjective field”) by entering his world from his point of view.

“You’re having a lot of fun playing that game, aren’t you.”  Which one are you playing?” <joining with his experience – providing our “eyes-of-the-other” to his inner experience – followed by a question to foster increased communication.  Taking the time to ask a question related to his activity also communicates that we’re not in a hurry, i.e., an intent-to-be-with on our part.>

<smile – rub-rub – feeding affection/positive emotion into his emotional system – which will help relax his emotional locking up> “I know, you really like playing those games, don’t you?”  <psychological bonding with his experience, synchronizing our nervous system to his through our mutual mirror neuron networks, which may help him maintain the organization of his nervous system when we transition our nervous system back to an intent-to-task – because his nervous system will be in a supportive synchrony with ours.

So far, we’ve offered Michael two beats of an intent-to-understand with a dose of positive emotion; and the gift of time we give to him in doing this communicates an intent-to-be-with.  Now let’s shift to another gentle breech – make it personal – and continue a positive emotional tone.

“but sweetie, I need your help to get some stuff done.”

"I caaaaaan't. I caaaaaan't.” <I’ll just pretend he continues this kind of response. However, often times the child will become cooperative as we engage in relationship supportive dialogue.>

Repair the breech in the psychological connection (breech-and-repair sequences).

<Continuing with a soft nurturing tone> “Oh honey, you’re really having a hard time with this, aren’t you.” <bringing our “eyes-of-the-other” to his inner experience while also communicating a nurturing response to his distress; i.e., when you’re in pain come to me for loving.>

“What makes you think you can’t do it?”  <intent-to-understand – this has to be an honest intent-to-understand.  The false intent-to-understand seeks the child’s response so that we can then invalidate the child’s experience and convince the child to do what we want.  The key is our response to the child’s response.  Do we maintain an intent-to-understand (i.e., and authentic intent-to-understand the child’s experience from the child’s point of view), or do we shift to an intent-to-change by invalidating the child’s reasons?> 

"I caaaaaan't. I caaaaaan't.”

“So, you’re just having a hard time getting yourself to leave the games.  You know what I think, I think you’re just having so much fun playing your games that you find it hard to stop doing something that’s so much fun, especially if you have to do something un-fun.  Is that it?”  <continued intent-to-understand by defining his inner experience for him – offering him our best guess as to his inner experience.>

"I caaaaaan't. I caaaaaan't.”

<rub-rub>  “Hmm.  So what can we do about this?”  <the goal is to develop a mutual intent>  “Hey, I have an idea, how about you help me do two things, I’ll give you a big hug, and then you can go back to your games.  Will that work for you?”  <will that work for you is my favorite phrase in developing a mutual intention.>

"I caaaaaan't. I caaaaaan't.”

“Really, you can’t help me?”  <a slightly more adult, slightly less nurturing tone.  Mild social guilt induction – make it personal.  “Really” communicates an expectation of cooperation, “you can’t help me” makes it personal and applies “moral suasion” (a mild sense of guilt arising from feelings of social responsibility – moral: right and wrong; suasion: like persuasion – moral suasion: persuading based on issues of social right and wrong.)>

"I caaaaaan't. I caaaaaan't.”

<adopting a more adult tone – but not angry>  “But you know what sweetie, I need your help, so you need to put the game down now and come join me in the kitchen.”  <a calm and confident communication of adult authority – adult tone of voice – authority but not angry – but we’re definitely moving the situation forward.>

"I caaaaaan't. I caaaaaan't.”

<sharper tone>  “Michael, listen.  I need your help.  Jonathon is helping, Mary is helping.  I love you.  But, if you’re not going to help me you’re going to have a punishment for disobedience.”  <calm and direct adult tone – major breech – seeking to activate the dominance-submission networks of the authority system.>

Can be followed by an immediate repair of the breech, “Come here, sweetie, give me a hug”  <smile, soften the tone into nurturing again (breech-and-repair sequences) encourage cooperation – hopefully he’ll move forward into cooperation at this point>

If he doesn’t move into cooperation at this point, then proceed with punishment.  Anger? Send him to room?  Take away his game?  Its up to you, they’re all pretty much equivalent. He’ll cry and tantrum.  That’s the way of things.  Return to complete your task.  Calm and confident adult authority.

When the punishment is over and you’re in a more even place, maybe later in the evening, review the sequence of events with Michael, offering a nurturing positive tone and an intent-to-understand, bringing your “eyes-of-the-other” to the sequence of his experience.

His behavior then escalated. He "fell" down to the floor, rolling back and forth sayihg "I caaan't, I caaaan't, I'm not going to, I'm not going to. YOu can't make me. You can't make me."

If it gets to this point, repair the breech as above.  He’s more important than chores.

But ultimately, we’re going to move forward and he either needs to cooperate and help, or bad things will happen (i.e., a punishment).  But we’re going to add a therapeutic phase ahead of the authority-punishment phase.

And all of this being mixed with fake laughing and fake giggling, you know, the really annoying fake loud laugh and giggle meant to annoy.

Anxiety.  Not really positive emotion.  Anxiety because you’re going to get angry. 

I suspect he’s afraid that he’s not going to be able to do the task because he’s locking up emotionally-behaviorally already, and you’re going to become angry and everything is going to deteriorate.  And he’s right, that’s exactly what happened.  He needs help getting through the current lock-up and his fear that his current lock-up is going to lead to angry and a deterioration in your relationship.

And this annoying behavior sent me into fit of wanting to lay in and scream at him for being so rude and obstinate and defiant.

Understandable.  Do your best in the early going to offer a positive emotional tone, an intent-to-understand his experience from his perspective, and the gift-of-time (an intent-to-be-with), this is the therapeutic period.  But once you’ve done this, it’s time to move on.  Make it personal – mild social guilt induction (moral suasion), intent-to-task; intent-to-change (activating the dominance-submission networks of the authority system; punish-induce suffering, he cries and tantrums and we wait for it to resolve. Offer love at the end, a final dose of mild frowny face for the tantrum, love again and move forward.

I didn't punish him and his chores did not get done (well they did...Mary did his for him) and he's now upstairs playing his video games.

Okay.  That’s fine.  I’d go and talk to him in a parent-adult firm-stern disappointed tone (tinge of anger but not overt – just stern).

“Michael, I’m really upset that you didn’t help me.  Mary had to do your chores, and that’s just not right.  Do you think it’s right that Mary should do your chores while you play your games?  I don’t.” 

“Do you think you should be punished for making Mary do your chores? --- I’m going to have to think about it.  But at the very least, I want you to apologize to Mary and thank her for doing your chores.  If you do that, I may decide not to punish you.”  <social guilt induction –right and wrong – we do things because we love people, not to avoid punishment.>

Punishment is personal.  You annoy me so I annoy you.  He was mean to you by not helping, he was mean to Mary by making her do his chores.  Seemingly merits suffering if you want.  He’ll cry.  Your message to him: then don’t annoy the big gorilla.

Mary deserves a big hug-n-snuggle and a treat.  Arrange a mother-daughter time when grandmother is watching the boys to go get a frozen yogurt or some treat with her (my daughter would choose a Starbuck’s drink).

One thing I did with my kids is to wave my hand in the air in a sprinkling motion while I said “Brownie Points.”  Brownie Points weren’t really anything specific, it just meant that for a kid who had been earning a fair amount of Brownie Points I would be more likely to change a “no” to a “yes” when they asked for something.  It’s not a formal reward, it’s a social acknowledgement of appreciation.  Sometimes my kids would bring this up when asking for something, “dad, can we go get a smoothie” --- “no, not today” --- “I’ve been earning a lot of Brownie Points.” --- “Yea…. You’re right.   Okay”

I feel like he "won", he got away with bad behavior, he didn't help with chores, he's upstairs playing his video game, and I did nothing to focus in on his needs.

We want to move away from win and lose, and it’s not bad behavior.  His brain systems got scrambled and we weren’t able to help him unscramble them.  In terms of power, we have all the power.  We can do all sorts of things to make him miserable, take away his TV and games, yell at him, fail him in school, put him in jail, reject him, fire him from work, all sorts of bad things can happen for the kids who are disobedient of adult authority.  Believe me, these kids are not happy campers.  They’re miserable.  We have all the power.

He was mean and un-loving.  Ouch.  That’s not right.  You love him, why does he treat you and Mary so mean?  That’s not right… that’s the long-term coercive press of our social communication that we’re going to use with him.  When he is captivated by fun and has difficulty getting unstuck to do un-fun, we want him to activate his love for us to help un-stick himself from the fun, and to help overcome his aversion to un-fun.

We need him to cooperate because he loves us, because it makes him happy to make us happy, because we love him and he wants to maintain our love (we want to establish and use our psychological connection; i.e., the synchrony of our brain systems can support the organized functioning of his brain systems).  And, if he needs a little bump from the dominance-submission networks of the authority system to help him over that final hurdle, we can help him with that.  Don’t annoy the big gorilla because the big gorilla will make you suffer.

But first, we want to provide Michael with a therapeutic response to help him define the meaning of his inner experience (through our approach with a positive emotional tone and our intent-to-understand his experience from his perspective – our “eyes-of-the-other brought to his inner experience – the formation of a psychological connection) and the therapeutic opportunity to communicate this inner experience to others in an ever more elaborated and sophisticated ways.

It’s a three-step process

1)   Approach with an intent-to-understand – at least three relationship beats

2)   Orient him to the social context of other people’s needs, and external rules, limitations, and restrictions

3)   Negotiate a mutual intention – not necessarily what you want – not necessarily what he wants – but what you can BOTH agree on

Once we move through this process (we can cycle several times through steps one and two – but we shouldn’t spend too long with step three – offer one, maybe two potential solutions… then move forward), if a mutual intention cannot be developed, then we’re the big gorilla, we’re the adults, it’s up to us to decide what needs to happen and to then make it happen.  If this involves a punishment for annoying us, then so be it.  But the punishment is not for “bad behavior” (people have a right to have a different opinion or different wants-needs-desires), the punishment is personal – you annoyed me, so I’m going to annoy you. 

It’s simply about power, and that’s fine.  I have the power (I’m the big gorilla) and you need to do what I say or I’m going to use that power to make you suffer (punishment).  That social communication of hierarchy status should activate the dominance-submission networks of the child’s brain, which will then turn off the child’s personal motivational press and allow the child to adopt our motivational agenda.  If it doesn’t, deliver a punishment (anger, removal of something pleasurable, lecturing, restricting freedom – time out/room restriction, whatever…)

In this way we build three brain networks with Michael,
1)   self-awareness
2)   other-awareness
3)   social cooperation and negotiation to get his needs met within a socially organized context of other people’s needs

By sequencing these steps, we also build (we build what we use) the transition networks between these three systems, so that over the course of time (months and years) we will build, through use-dependent processes, Michael’s ability to become aware of (and communicate in language) his inner experience --- then transition --- to his looking around to take in the needs of others and any relevant rules and restrictions that affect his needs and desires --- then transition --- to developing a way to get his needs and desires met within the context of the social needs of others and the rules and restrictions of the setting.

We build what we use.  So, right now, we want to “scaffold” Michael’s use of these processes.  Behavior is the outward symptom, but behavior is not the focus of intervention.

What should I have done?

Right now, I’d suggest having a cup of hot cocoa (or glass of wine) and a nice hot bubble bath.

This is really, really tough and makes me feel like a horrible, ill-equipped mother, being totally truthful.

Children are designed by nature to be annoying… children are supposed to annoy us… and they can be pretty good at it, can’t they.  Deep breathe and smile.

Sometimes it helps to go into our children’s bedroom when their asleep and watch them sleeping.  They look so angelic that all our frustrations just seem to lift away.

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