It is not uncommon for adults to consider seeking therapy long before they schedule their first therapy session due to a variety of anxieties and concerns. Common concerns include embarrassment and shame in regards to needing help, anxieties about being judged, fear of not finding a good match in a therapist, and uncertainty as to how any resulting changes will impact their life. Children and youth have many of the same concerns when their parents encourage them to participate in therapy.

If you believe that your child would benefit from therapy, you will need to consider how best to approach the subject to increase the likelihood that your child will not only agree to attend the therapy session, but to also participate once they arrive. The following are some key strategies to consider.

Set the Stage

Start by explaining how therapy works. For younger children, you may want to explain that therapy is a place where people can talk about anything they want, including worries and other feelings, without getting in trouble. Emphasize that sessions are fun, with opportunities to play games, and that the person they are meeting with is nice. This description will distinguish therapy from medical appointments. For teens, you will want to emphasize that therapy is a resource, allowing for private conversations with an adult other than yourself.

Watch Your Language

Be mindful not to use language that is judgmental or blaming, and do not imply that you view your child as needing to be “fixed”. Younger children can interpret appointments with professionals as implying that they are in trouble or have been “bad”, and teens interpretations can be self-critical. Instead of focusing on difficulties or deficits in your conversation, focus on the opportunities and potential for growth.

Understand and Validate Your Child’s Concerns

If your child has objections to therapy, clarify what the objections are and then validate the related emotions. If your child feels you understand them they will be more likely to comply with your wishes.

Give It Time

Don’t get discouraged if your child objects to attending therapy initially. For children, simply giving them a few days warning of an appointment may be sufficient to allow them time to express any questions or concerns. Teens may require more time. Continue to revisit the topic when it feels natural, particularly when they are specifically asking for suggestions as to how to improve their circumstances.

Negotiate

If you believe your child’s objections to therapy are primarily due to anxiety and misperceptions, suggest that they at least try therapy by attending a few sessions. You may need to reinforce your child’s bravery to try therapy at first through praise and/or any other reinforcement you would commonly use in your home (e.g. getting a treat after the session). Any therapist who works with children and youth will have had experience addressing common anxieties about treatment and will have strategies to improve engagement once your child arrives at the first session.

Reduce Shaming

Once your child has agreed to attend therapy, be mindful of your communications with your child’s therapist. If you wish to express your concerns about your child, it may be helpful to communicate this information when your child is not in the room, either at the beginning of a session or prior to a session by email or phone.

Alternatives

If you have attempted each of the suggestions above, and your child refuses to attend therapy, you do have some alternatives. In many cases, parent therapy can be equally as effective as child therapy. Such sessions typically include coaching on how to respond to your child’s behaviors in a manner that supports growth and development. A therapist can also work with you to identify ideal times and ways in which to revisit the topic of therapy and ways to refine the strategies listed above for your child.

What’s Wrong with Talking to My Child about their Weight?

Focusing on weight, rather than general health behaviors, reinforces the “thin ideal”. It has the potential to shame your child, and may lead to body dissatisfaction. Body dissatisfaction may cause your child to avoid social opportunities and physical activity due to shame about their body and fitness level. Research has found that comments about a child’s weight predict dieting, binge eating, eating disorders, obesity, depression, and low self-esteem.

How Can I Encourage Healthy Lifestyle Behaviors without Emphasizing Weight or Body Shape?

• Model body positivity; never make comments about weight or the shape of anyone’s body, including your own, your child’s or anyone else’s. Do not let others criticize your own, your child’s or anyone else’s body.
• Don’t encourage your child to diet, and do not diet with them. Dieting has actually been associated with weight gain in both children and adults. Dieting actually causes long-term weight gain.
• Get rid of your scales and foods labelled as “diet” specific foods.
• Be sure to emphasize that a person’s value and worth is not based on their appearance; success and likeability are not dependent on your appearance.
• Teach your child that perfection is not possible; trying to be perfect will inevitably make you feel like a failure. Instead, encourage experimentation, and give your children permission to fail, promoting learning and growth.
• Encourage your child to have compassion for others (accepting others despite faults, tolerating others’ imperfections), and encourage them to treat themselves the same way.
• Encourage physical activity by scheduling family outings or regular walks or hikes, sign them up for sports, and find fun activities your child enjoys. Limit screen time.
• Be sure there is plenty of healthy food options in the home, and do not purchase snack foods that your child tends to overeat.
• Provide nutritious meals and snacks. Loosely following a glycemic index based meal plan will ensure health and nutritional needs are met, and will also reduce hunger (e.g. Provide a protein, a fat and a carbohydrate at every meal and snack. Carbohydrates include fruit, vegetables and/or grains).
• Encourage your child to trust their internal cues of hunger and fullness, and allow them to eat when hungry.
• Eat as a family and involve your child in food preparation.
• If your child complains about their weight, tell them you love them no matter what, and they have a lot to offer the world. Add that if they want your support you are willing to help them be more active and eat healthy, but that you won’t focus on weight.

Something to Consider

While weight is an indicator of health, there are much better indicators of health, such as nutrition, amount and type of physical activity, a balance between structured and unstructured time, and opportunities for social engagement. The medical profession continues to use weight as a general marker of health because it is easy to measure. It is much more difficult, and less accurate, to ask you about a wide range of health behaviors each time you or your child come in for an appointment. However, as a parent, you have much more information about your child’s health behaviors. When considering your child’s health, you should be looking at a wide array of indicators, rather than focusing on weight.

Anorexia Nervosa is the refusal to eat sufficient food to maintain health, and a fear of weight gain. Bulimia Nervosa is also characterized by a fear of weight gain and an overemphasis on the importance of weight and shape, but is also associated with periods of perceived loss of control with eating and engagement in behaviors meant to compensate for eating (e.g. vomiting, use of laxatives, and over exercise). In each case, the person is consumed with thinking about food and not eating. These disorders usually begin around the time of puberty, with most youth being diagnosed by health care providers around 15 years of age.

What Causes Eating Disorders?

There are still health care providers out there who may come across as blaming and judgmental of parents, but current research is clear that eating disorders are not the parent’s fault. In fact, there does not seem to be one clear cause of an eating disorder: the current literature suggests that eating disorders develop as the result of I) personality traits of either obsessiveness and perfectionism and/or emotional dysregulation and impulsivity (biological or genetic factors), combined with II) a desire for thinness or value placed on diet, healthy eating, or thinness (importance of body related ideals). To summarize, it is believed that there are people who are genetically or biologically at risk of developing an eating disorder, who, if they value and pursue thinness, will be at greater risk of developing an eating disorder. Bullying about weight and appearance is the most common form of bullying.

Pursuit of thinness is believed to be the result of a variety of influences. Our culture’s “thin ideal”, and more recent “fit ideal” has been argued to be a large contributor to the pervasiveness of body dissatisfaction. Over half of women are unhappy with their bodies and appearance. Rates of body dissatisfaction in boys and men have been increasing in recent years, perhaps as a result of the recent media emphasis of the masculine fit ideal. Our relationships with others also influence our beliefs about the importance of weight and appearance. Among youth, bullying and “fat talk” is particularly concerning, as children conclude from these messages that thinness or attractiveness will result in happiness, worth, and likeability. It is of note that over half of individuals diagnosed with an eating disorder report having been teased or bullied about weight as a child.
Eating disorders affect all sorts of families. They are not a choice, they are a serious mental health disorder associated with illogical thinking and immense suffering.

What are the Signs of an Eating Disorder?

Although the above factors are common for a wide range of children, less than three percent will develop an eating disorder. The first outward sign of an eating disorder is dieting, followed by gradually more drastic reductions in nutritional intake. Other signs include:

• Calorie counting
• Eliminating food groups (e.g. meat, dairy, grains)
• Unusual food behaviors such as micro-eating (cutting things in small pieces) or using large amounts of condiments (mustard, hot sauce)
• Weight loss or failure to continue growing
• Using only the same cutlery or dishware
• Feeling cold, particularly in the hands and feet
• Lack of menstruation
• Hair loss
• Interest in cooking or baking, but not eating what they have made
• Obsessive or compulsive exercise, and anxiety or guilt if they miss part of their routine

Over half of individuals struggling with an eating disorder also have an anxiety disorder or struggle with depression.

Treatment of an Eating Disorder

If you think your child has an eating disorder, consult your child’s physician or pediatrician. Both anorexia and bulimia affect the heart, either by starvation or electrolyte abnormalities, which can be fatal. If the physician diagnoses an eating disorder, request a referral to a specialized pediatric eating disorder treatment program. The first line of treatment for an eating disorder in childhood is Family Based Treatment for an Eating Disorder. This treatment approach will provide you as parents with the supports needed to “re-feed” your child. If this approach is not successful, hospitalization may be considered.

Treatment first focuses on normalization of eating and activity level, as, the sooner you make these changes the more likely your child will recover from the eating disorder. Once the behaviors are improved, psychological interventions will be introduced to address the overemphasis on weight and shape, as well as self-worth.

The good news: children and youth who receive treatment for their eating disorder early, while still in their parent’s care, recover more quickly from their eating disorder than those whose treatment does not occur until they are adults. It is believed that this is due to the fact that weight restoration, which can be done more quickly when people are younger, allows the person to face their fears of a healthy body weight more quickly, reducing the number of years the disorder can be entrenched.

In every close relationship, there is potential for differing perspectives and high emotions from time to time. This includes the parent-child relationship. You and your child are bound to disagree from time to time, and your child is bound to have moments of intense negative emotion. How you handle both of these situations has a significant impact on the type of conversations you will have with your child, now and in the future. A key parenting strategy to subdue conflict and/or intense emotions is validation.

What is Validation?

Validation is an interpersonal skill that can lead to an acceptance of differing opinions and reduce the suffering of your child; it is expressing to your child that you can see things from their perspective, even when you may not agree with it. Validation is not agreement, but rather a demonstration of acceptance and understanding of your child’s perspective and emotions.

Why is Validation Important?

Validation will lower the intensity of the emotions your child is experiencing. Lowering emotional intensity increases the likelihood they will continue to engage in the conversation. What is fabulous about lowering the emotional intensity of the conversation is that when we are less distressed our conversations are more realistic and accurate. In other words, the more you validate your child, the more likely you will understand their perspective, which makes it easier to validate them. Validation also communicates to your child that you understand them, and that their experiences make sense, which strengthens your relationship and promotes emotional well-being.

How Do I Validate My Child?

If you are having a particularly difficult time understanding your child’s perspective, try to find a “kernel of truth” in what they are saying, and acknowledge it. Even if you don’t agree with your child’s behaviour, you can validate the feeling that led to that behaviour. For example, after finding your child up late at night still texting to their friends you might say something like, “I understand that your friends are great at reassuring you and making you feel happy.” If your initial validation is sufficient to reduce your child’s defensiveness, you can move on to expressing your concerns or opinions. However, if your child continues to respond with emotional intensity, you will need to continue with validation. If your child is highly emotionally reactive or struggling with mental health difficulties, you may need to wait to express your concerns until a later and quieter time. Parents often mistakenly feel that they must correct or levy a consequence the moment a misbehaviour is observed, and doing so is not always wise or required.

The steps to take in order to validate your child include: 1) actively listen to them, 2) be careful not to communicate invalidation, particularly nonverbally, 3) try to determine which words best reflect your child’s emotions, 4) communicate this emotion without judgement, 5) be tolerant of their reactions and behaviours, and 6) continue to convey that you are taking their perspective seriously.

What is Invalidation?

Invalidation is any comment or gesture that communicates to your child that their emotions, thoughts or behaviours do not make sense or are uninteresting. Being dismissive and uninterested are forms of invalidation. Be careful not to express invalidation, particularly when you are feeling frustrated or tired.

Free Workshop on Managing Stress and Improving Your Relationships

Hosted by New Leaf Psychology Centre

February 10, 2015
6:15pm – 8:30pm

Milton Public Library
1010 Main Street East
Milton, Ontario

6:15  –    Welcome and Refreshments

6:30  –    Stress Management

Presented by Dr. Alena Strauss

You will learn what stress is and how if effects you. Emphasis will be given to stress management strategies.

7:10  –    Living Mindfully

Presented by Beheshta Jaghori

You will learn what mindful living is and how you can integrate it into your daily life in order to reduce stress and

improve your quality of life.

7:50  –    Improving Communication with Loved Ones

Presented by Dr. Sherry Van Blyderveen

You will better understand why couples have difficulties communicating with one another despite the fact that

they can communicate well with everyone else in their lives. Strategies to improve communication in

relationships with loved ones will be discussed. 

To register call Milton Public Library at 905-875-2665 ext 3263 or email [email protected]

Caring for a Family Member with Physical or Mental Health Difficulties

20% of Canadians are struggling with mental health difficulties, for a total of 1.5 million children and
4.5 million adults. 13% of Canadian’s (3.8 million) are struggling with physical disabilities,
and among those over the age of 75 the rate is 43%.

The role of caregiver, whether it is of an aging parent, a family member with a physical disability or a child with mental health difficulties, can at times be overwhelming. The time, energy and finances required to care for a loved one, and the emotions associated with being a caregiver, sometimes lead to caregiver burnout, a state of physical, mental and emotional exhaustion. Exhausted caregivers describe feeling stressed, anxious and depressed, and they report symptoms similar to those seen with depression. For example, they report irritability, loss of interest in activities they used to enjoy, social withdrawal, poor appetite, sleep difficulties, and feelings of hopelessness. In a state of burnout, a previously positive and loving caregiver may become negative and uncaring. Caregivers also often experience guilt, anger and self-doubt. Strategies to address the feelings associated with caregiver burnout are detailed below.

Guilt

We all want the best for our loved ones, and this can result in caregivers setting high standards for the care of their family members. In setting high standards for the care of their loved one, caregivers may set unrealistic expectations of themselves and may assume exclusive responsibility for the care of their loved one. When caregivers do not meet the high standards they set for themselves, it is not surprising that they then become self-critical. For example, a parent of a suicidal teen might tell herself “I should have checked on my daughter more often throughout the night”. A child of an ailing parent might tell himself “I cannot put my mom in a nursing home, I should be able to make it work at home”. Not being able to live up to self-imposed unrealistic expectations, and the resulting belief that they are not doing a good enough job of caregiving, results in feelings of guilt and shame.

In order to reduce feelings of guilt it is important to set realistic goals for yourself, accept your own limitations, and allow others to assume some responsibility for the care of your loved one. When you start to feel guilty, ask yourself whether you are being realistic or idealistic.

Anger

Many caregivers become frustrated by a lack of money, resources, and skills to effectively plan, manage, and organize their loved one’s care. They also can become angry that their loved one is suffering. Anger can be directed at their loved one, themselves, other family members, healthcare professionals, and/or a higher power. It is important to understand that anger is a normal human emotion that we experience in response to feeling a lack of control with our situation.

In order to reduce feelings of anger it is important to accept what you cannot change about the current situation, and use the energy associated with anger to change the things you can. Remember that even when you do not have control over the situation or outcomes, you are in control of your own behavior and can choose how you will cope.

Self-Doubt

Caregivers commonly question whether they are doing the right thing for their loved one, and they may become confused when they are given differing opinions from a variety of sources. Self-doubt can become exacerbated when caregivers judge their caregiving approach based on the response of their loved one, whose symptoms may vary or progressively worsen.

In order to reduce self-doubt, it is important for caregivers to educate themselves about their loved one’s illness and the treatments or care available. Remember that your loved one’s response to your care is based on a multitude of factors, including the illness your loved one is struggling with. Be realistic about your loved ones illness, their symptoms are not a reflection of your caregiving.

Self-Care Strategies

The primary strategy to prevent or treat caregiver burnout is self-care. Finding the time for self-care is often a challenge, and even when time is taken, caregivers often feel guilty for not using that time to help their loved one. However, it is important to remember that self-care is necessary to be the best caregiver you are capable of being. Self-care requires making time for breaks, and using that time for fun, socializing and rest. This may require another family member, caregiver or organization providing you with some respite (e.g. in home care, short stays in nursing homes or group homes). Self-care includes eating well, exercising, getting adequate sleep, and taking care of one’s own medical needs. Seeking support from others is also necessary for self-care. Sharing your feelings with those within your support network (e.g. friends, family, religious community), a counsellor, or another caregiver in a similar situation (e.g. support group) can be a great way to release stress and get helpful advice.

Written by Dr. Sherry Van Blyderveen
Clinical & Counselling Psychologist
____________________________________________________________________________________________________________

References:
Spencer Scott, P. (2014). The seven deadly emotions of caregiving. http://www.caring.com/articles/7-deadly-emotions-of-caregiving
WebMD (2014). Heart disease and caregiver burnout. http://webmd.com/heart-disease/heart-disease-recognizing-caregiver-burnout
Canadian Mental Health Association (2012). http://alberta.cmha.ca/mental_health/statistics/#.U-5nN_IdWn8

After giving birth, experts say that a well-balanced diet and proper nutrition is even more important than during your pregnancy. The food choices you make will greatly influence the quality of your breast milk, and how quickly your body will rebound from the pregnancy.

You will want to include a high amount of complex carbohydrates, including:

– Whole Grains, such as brown rice, and rye or whole wheat bread,
– Fruits, such as apples, berries, peaches, and melons, and
– Vegetables, such as broccoli, squash, and bell peppers.

You should also ensure that you are obtaining the proper levels of calcium, protein, iron, and fat. Aim for three to five servings of fat per day and calcium-rich food.

Here are some additional nutrition tips:

– Increase your fluid intake by drinking at least one glass of water before you breastfeed, and aim for 3 Litres of fluids daily
– When choosing seafood options, opt for items that are higher in omega-3 fats, such as salmon, herring, trout, and pollock, and avoid items high in mercury such as shark, white tuna, and swordfish.
– Avoid alcohol, as it takes 2-3 hours to completely exit the breast milk stream.

Eating a wide variety of foods will also change the flavor of your breast milk. This will help introduce your baby to different tastes, which can help develop their palette at an early age.

 Written by Ingrid Toombs
Registered Dietitian