For the introduction to the ‘Outtakes’ series and to learn why it exists, click here.
Some of this material will likely be in the book, but in a much different (i.e., better) format. Since I am not an expert on child psychology , I went to Dr. John for a more seasoned take on therapy with children. When I asked him about the difficulties on working with children, he gave me a fairly scathing diatribe about parents and their role in child/adolescent pathology. I scribbled out as many notes as I could while he ranted/drank vodka, and I tried to put his voice into something remotely cohesive. His points are better than his jokes. Take a look and my apologies for John in advance if you are a good parent:
“While it is possible to present hundreds of case studies on children, there really is no point, because they all tend to boil down to a few important themes:
1) Parents do not want to be told that they have to do something differently.
Mom: I spank them, I yell at them, I throw things, I give them time-outs, and they still won’t stop fighting with each other. Fix them!
Dr. John: I understand what you’re saying. But hitting and screaming are basically just forms of punishment and, as we’ve gone over multiple (twenty-three) times, punishment does not work in the long run. It’s basically just abuse and traumatizing.
Mom: My parents hit me when I was a kid, and it worked! They’ll listen if I punish them.
Dr. John: So why are you here, then?
2) Parents do not like to utilize reward systems to change behaviors.
Dr. John: Okay, for every day that your child doesn’t hit you in the back of the knee with a stick, you need to reward him.
Dad: What?! That’s just bribery! He should know that you’re not supposed to do that!
Dr. John: (yes, he should, but you didn’t do a very good job of teaching him that, which is why you’re here.) I understand that, but for some reason he doesn’t quite see that. What we are doing is providing him what is called an “extrinsic reward,” such as his favorite food, time with his video games, tokens that he can utilize later to buy something that will allow to feel positive about himself because he’s “earned” it. You pair that with lots of praise for a job well done, which is called an “intrinsic reward.” Over time, we decrease the frequency and value of the extrinsic rewards and increase the intrinsic rewards. That way you’re not really “bribing” him, at least not over the long haul, because your praise and improved relations with him will be the long-term reward for him. This will have wonderful effects on his self-esteem.
Dad: That’s ridiculous! My parents never did that with me, and I never, ever hit them or anyone else. I don’t even yell or have an anger problem, for Christ’s sake!!
3) Parents don’t realize that child therapy is really parent-child therapy.
Any parent who enlists the aid of a competent therapist to cope with some problem their child is experiencing must agree to actively participate in the therapy. That doesn’t mean you have to sit in on every session, week after week, but you do need to meet with the therapist periodically to learn how you can help your child put into practice what has been discussed during the child’s therapy. You cannot deny the role you must play in your child’s development. I’ve had parents whose idea of a meeting was to tell me to “get the little bastard to shape up” in the first session and leave. Then they do nothing more than drop off their child each week and drive away before I have any chance to speak with them. These parents tend to talk to me only when their insurance will not reimburse them in a timely fashion.
4) Parents don’t recognize that certain things can’t be changed.
In my practice I’ve seen many bright children who possessed reasonable amounts of insight toward problems that are solvable: depression, anxiety, relationships, venting about parents, poor grades, post 9/11 fears and more. But for many parents, merely treating these issues doesn’t go far enough. They want the Full Monty and then some:
Dad: Yes, she’s not having sex with the gardener anymore, but she gets straight C’s in school. Do something!!!
This girl is basically developmentally handicapped.
Dr. John: Sir, I understand your concern, but your daughter has an I.Q. of 77, which is well below average. These tests are not perfect by any means, but kids of her age with a score of 77 are actually more likely to get D’s and be held back. She works so hard to get her grades, she’s making the most of a horrible situation. I think that she should be praised.
Dad: I’m sorry, what did you say your name was? Dr. Idiot?
Dr. John: A lot of people mispronounce my name, it’s okay. It’s Dr. _________.
Dad: My wife, mistress, and I have been over this multiple times, and we all agree, as do you as of right now. She…will…go…to…Harvard.
5) Parents don’t understand the term “consistency.”
When parents are given tips on changing a child’s behavior, I tell them that being inconsistent with these tools, is just as bad as not using them at all. I usually use the same example to highlight this:
“If you have a toddler who screams and yells until you give him a lollipop, he learns that this behavior is useful to obtain what he wants. If you withhold the lollipop when he does this, he may actually scream and yell more at first, because he is unclear why his usual method is not working. However, this behavior will not last, which is called “extinction.” Extinction is the goal, but you must understand that it is not likely to be a permanent solution if you are not capable of following through each and every time. In fact, if you eventually give in, especially on a sporadic basis, the child will learn that if he increases his yelling and screaming, he will get what he wants, sooner or later. So, in effect, you are actually making the behavior worse by not consistently following through on our behavioral plan. This is a similar process to what you might see in Las Vegas when you play the slot machines. If you were to not get what you wanted every time you put in your quarter, you would eventually stop playing (extinction). But since the casinos want your money, they will give you want you want every once in a while. And, to make it worse, they give you a reward without any predictable pattern. This, of course, keeps you sitting there at the machine, putting in quarters. A child with a temper problem experiences the same thing, minus the alcohol and dry eyes and hot waitresses and pit bosses. Does this all make sense?”
Of course, every mom and dad nods his or her head vigorously, as if they’ve just been empowered to raise an entire litter of small urchins. Do they ever follow-through? No, they do not:
Parent: I did it like 6 or 7 times in a row, and it worked pretty well, but like you said, it did get a little worse, and I caved in and bought him the truck.
Dr. John: Why did you do that?
Parent: He just got so Goddamn loud in the store. But it’s going to be okay, because I told him ‘this is THE last time young man, do you understand?’ And he nodded! So I think we’ll be okay from here on in.”
6) Some children simply despise their parents.
It’s just a sad fact of life. The days of respecting, caring for and loving your parents simply because of who they are do not necessarily apply in this day and age. Actually, that was probably true even when I was a teenager, but I don’t think I noticed it as much back then. I’ve met more than my fair share of very nice, polite parents with great values who want nothing but the best for their children. However, that doesn’t translate to being well-liked by said children. While some of these parents can often be too much of something in their love (e.g., overly doting, spoiling, too conservative with rules and regulations, overly involved in their children’s schoolwork and friends), they clearly do not deserve such harsh words and hatred from their children. However, time and time again kids come in and tell me that they simply loathe their parents, and it truly seems as if there is nothing the parents can do about it, other than perhaps die. And if this isn’t enough, the sheer hate more often than not translates to behavioral problems, from the more benign comments such as “leave me alone, it’s none of your business how school was today,” to the more unnerving, “I didn’t go to school today. I was at Bed, Bath and Beyond buying this Henckel’s knife to plunge into your heart.”
I’d like to thank John for his time and…candor.
As a warning to parents, if your child’s therapist is like Dr. John (or at least as cantankerous), you may not want to ask about the hardest part of working with your child. Unless, of course, you are prepared for the real answer: you.