3. Our Happy, and Not So Happy, Customers
Make It Relevant: Bring to Mind One of Yours
3
4. Goals for Today
• Increase your confidence in
working with those clients
you find most challenging
• Encourage your reflective
observation and thinking
• Give you practical
tools to use
4
5. 1. Quick Review of Motivational
Interviewing
2. Relationships Inform Progress, or
Lack of
3. Key Principles from Infant Mental
Health
4. Your Questions 5
10. Things you wanted to know…
• What can I do with parents of overweight children
who are concerned their children don’t eat
enough?
• What can I do with parents who will prepare
whatever their child wants just so they will “eat
something”?
10
17. Relationship Matters*: the parent-
child relationship impacts child’s:
• Growth
• Brain Development
• Sensory Regulation
• Motivation
• Self-Help Skills
• Social Skills
*from Julie Wood, MA, LMHC
“The Feeding Relationship”
17
18. Relationship Matters*: the parent-
child relationship affects parent’s:
• Capacity to use nutrition information
• Ability to implement changes
• Responsiveness to child
• Motivation
• Emotional state (which child reads!)
18
19. 19
Case Scenario
3 young children throwing food
• Chaotic, stressful mealtimes
• Yelling, spraying children with water
• Mom has tried everything – overwhelmed
parents
• Dietician has tried
everything too!
20. Red Flags:
When do I need consultation from a
mental health professional?
• Impaired/insecure attachment (parent and
child are not attuned)
• Temperament mismatch that parent struggles
with or does not acknowledge
• You just know: “this family is just too much!”
20
24. Simple IMH Definition
• Infant mental health means healthy social and
emotional development in babies and young
children, birth to 5 years.
• All professionals working with this population
can build capacity for experiencing, regulating
and expressing feelings; building close
relationships, and exploring the environment
to learn.
24
25. Getting to “Green”*
• Green is defined as a “ready to learn” state:
alert enough, calm enough, and interested
enough. This needs to be our first goal!
• We can (sometimes) move clients to green by
offering calm, empathetic, encouraging,
confident presence.
• Sometimes we need other tools (OT, mental
health, etc.)
*Concept from Connie Lillias, Ph.D, MFT, RN
25
26. How You Can Do It
Practical Tools of IMH include*:
• Considering the caregiver’s experience,
feelings, and needs
• Considering the child’s experience, feelings,
and needs
• Reflecting on your own experience, feelings,
and needs
• Remembering all behavior is communication
*Concepts from Promoting First Relationships curriculum
26
28. More Ideas
• Notice the positive interactions and comment:
“When you paused and hugged her, her whole body
relaxed! That prepares her body for eating.”
• Always wonder, never assume. “I wonder what it’s
like for you when Samir won’t open his mouth.”
• Allow caregivers to pause and think
28
29. Case Scenario
27-month-old twins with
poor growth
• No sleep (or other) schedule
• TV always on
• Sippy cups with water
• Parents overwhelmed;
unable to follow through
with adding calories or
other changes 29
31. The Need for Time to Reflect
Reflection means stepping back from the
immediate, intense experience of hands-on work
and taking the time to wonder what the experience
really means. What does it tell us about the
family? About ourselves? Through reflection, we
can examine our thoughts and feelings about the
experience and identify the interventions that best
meet the family’s goals for self-sufficiency, growth
and development.
-Zero to Three
31
32. Offering hope is more important
than we realize
There likely was no graduate-level class on inspiring
hope in your clients! 32
33. Summary
• Motivational Interviewing: RULE
• It is relationships that inform progress or lack
of progress
• IMH Principle: “Get to Green” first
• It is NOT all up to YOU. Be a part of a team,
and team with your client families.
33
37. Contact Information and Resources
• Deb Weiner, LICSW, dfitchitt@yahoo.com;
425 299-0504
• Adverse Childhood Experiences Study
www.acestudy.org
• Reflective Supervision
www.zerotothree.org
• Self Care (aka Survival Care)
traumastewardship.com
37
Editor's Notes
Ok, so I’m guilty of this myself. As human beings, most of us can really only focus on one thing at a time. That said, our modern cultural milieu is usually expecting we can do many: listen, type an email, check texts, etc. To the extent possible, I challenge you to stop, slow down, and pay attention. My sense is that webinars are very difficult, as those of you connected online are not viewing me, the person/presenter, but rather ONLY my PowerPoint. Yikes, that’s a bit daunting.
Think of a family/child/parent you are working with where you’d like to make a better connection with the family and/or see some better progress. Throughout the webinar, we will take a few 1-2 minute silent periods during which you can jot down thoughts, reflections, and ideas about the family you’re considering today.
Reality is that some families are harder to work with than others: because of complexity, because of grief responses, and sometimes because the parent and/or child pushes YOUR buttons.
As you go through the webinar, think about how the tools we discuss might apply to that client. I’ll allow a couple of 1 minute silences for folks to jot down ideas. By the end of our time together, I’d like for you to have 1 or 2 ideas to try with that client/family.
In challenging moments, we may think “oh my goodness, this parent needs counseling/mental health professional.” I encourage you in those moments to ask yourself one/more of the following questions: What am I feeling right now? What might it be like to be this mom? What might it be like to be this child? OR…
Why did I say “xyz”? What could this parent’s behavior mean? What could this child’s behavior mean?
Empathy: acceptance facilitates change, skillful reflective listening is key. Ambivalence is normal. Really seeing a person, or a parent-child dyad, takes time. Sometimes you don’t have the time, and acknowledging the limitations of your role can be critical to accomplishing what you CAN. Expressing empathy demonstrates acceptance and is the cornerstone to building rapport. Acceptance actually is important in facilitating change.
Developing discrepancy: finding your in… what do you and the parent/child share as a concern? Are they concerned about what you see as the main problem? If not, what do they see as concern? How might it relate to your concern? Can you “meet them where they’re at?” SW 101. Is there information/education you need to provide to support parent/child’s awareness of consequences? Remember to let client present the reasons/arguments for change.
Avoiding argumentation is just a reminder that arguing is counterproductive, leads to defensiveness, etc. That said, if we do find ourselves having falling into this all-too-human trap, it is an opportunity to deepen our working relationship with a client by owning our having overstepped. Could be as simple as saying, you know, I think when we talked last week, I was really pushing my own agenda and trying to get you agree that we need to… (schedule surgery consult for G tube, have your son getting more tastes of foods every day, etc.) Being human and providing authentic communication goes a long way to building the rapport that facilitates change.
Roll with resistance: we acknowledge the resistance we hear, much like we try to acknowledge a person’s feelings, rather than actively trying to change them (we hope!) This requires your ability to be present with difficult feeling, choices, situations… not easy!
Supporting self-efficacy: we’re helping client to see that he/she/they have the power and ability to make the changes desired/needed. We let them generate the solutions – they know themselves, their child, their world best.
Empathy: acceptance facilitates change, skillful reflective listening is key. Ambivalence is normal. Really seeing a person, or a parent-child dyad, takes time. Sometimes you don’t have the time, and acknowledging the limitations of your role can be critical to accomplishing what you CAN. Expressing empathy demonstrates acceptance and is the cornerstone to building rapport. Acceptance actually is important in facilitating change.
Developing discrepancy: finding your in… what do you and the parent/child share as a concern? Are they concerned about what you see as the main problem? If not, what do they see as concern? How might it relate to your concern? Can you “meet them where they’re at?” SW 101. Is there information/education you need to provide to support parent/child’s awareness of consequences? Remember to let client present the reasons/arguments for change.
Avoiding argumentation is just a reminder that arguing is counterproductive, leads to defensiveness, etc. That said, if we do find ourselves having falling into this all-too-human trap, it is an opportunity to deepen our working relationship with a client by owning our having overstepped. Could be as simple as saying, you know, I think when we talked last week, I was really pushing my own agenda and trying to get you agree that we need to… (schedule surgery consult for G tube, have your son getting more tastes of foods every day, etc.) Being human and providing authentic communication goes a long way to building the rapport that facilitates change.
Roll with resistance: we acknowledge the resistance we hear, much like we try to acknowledge a person’s feelings, rather than actively trying to change them (we hope!) This requires your ability to be present with difficult feeling, choices, situations… not easy!
Supporting self-efficacy: we’re helping client to see that he/she/they have the power and ability to make the changes desired/needed. We let them generate the solutions – they know themselves, their child, their world best.
Resist giving them direction.
Understand the client’s movitation/values/pressures.
Listen with empathy.
Empower them—they come up with the solutions, they own their progress.
TAKE a 1-2 MINUTE break to write down one aspect or idea of MI that you could use at next home visit or session with the family/child you’re reflecting on today.
Give you 1-minute to think about a motivational interviewing approach, or specific question, you can use with a client in the coming week. Note it down somewhere where you will see it immediately before you meet the client.
What are some MI principles you could use to address these two common situations? Take a 2 minutes and jot down your ideas.
Explore parent’s concern: what is enough? How do they know when child’s had enough? If they don’t know, how might they imagine knowing? What wondering questions might they ask?
Ask parent what do they imagine happening if they did not make/offer child’s preferred food? Consider amounts… what about presenting very small portions (If concern is about wasting food?) What if they simply provided meal or snack that included one preferred food and two new/non-preferred and allowed child to choose?
Let’s talk briefly about your relationship with the family… sometimes they really want you to tell them exactly what to do… then, you need to help them see what their importance as being the expert on their child. Sometimes we need to just meet that expectation; but often, it is important to really ensure they believe that we know them/their child accurately in order to be in a position to support/assist them in making health behavior changes.
You’re making it very hard for me to be the professional I’d imagined I’d be… YOUR relationship with parent is CRITICAL. The process of how we treat one another does impact how others treat others.
Briefly touch on psychosocial history, ACES, home environment, special needs. Then move to next slide
Attachment styles: secure, avoidant, anxious/ambivalent, or disorganized – briefly describe secure; and then include example of avoidant and anxious and impact on feeding relationship.
Temperaments: Easy, Slow to Warm, Difficult, Intense
Psychosocial Hx:
Home environment: safe and stable? Chronic / toxic stress levels?
Special needs: delays, syndromes, disorders, etc.
*from Julie Wood, MA, LMHC “The Feeding Relationship”
Take 1-minute to jot down one specific idea or question you can ask a client in the coming week that helps you better understand the parent child relationship…
Examples:
We have to take care of our own needs in order to be present for our families. Just as they are unable to work on higher level needs before the basic ones are met, same is true for us…
Always wonder, never assume
I’m going to shift into part 2, thinking about the relationships involved in your work.
