Back in the day, the rule from the American Psychological Association was that psychotherapy was only conducted in person. Clinical licensure was restricted to the practitioner’s state of residence. Insurance companies would only reimburse for in-person psychotherapy.
The recent pandemic with the worldwide infectious spread of the coronavirus, COVID-19, changed all that. It’s hard enough to keep up with modern cybertechnology, let alone with changing regulations in the field.
So, our goal, as practicing clinicians, is to provide the best clinical care, in the least restrictive environment, with concern for the health and safety of all involved. What exactly does that mean?
First, the gold standard of clinical care continues to be face-to-face psychotherapy. However, with masking, social distancing, and handwashing guidelines, patients coming to your office to see you may not only be challenging. It also might be lethal.
Where all parties are vaccinated and the pandemic circumstances are abating, there is less risk to in-person psychotherapy. With this level of clinical care, both patient and clinician get the most input for effective clinical care. Verbal, as well as nonverbal communication is maximized. Emotional nuances and “tells” are picked up. Comfort, acknowledgement, even relief from treatment is tangible.
Second, zoom calls carry most of the benefits of in-person clinical care. If you can get past the question of whether or not the other on the line is wearing pants, the interaction is there to make for good treatment. What’s also there is a host of possible distractions. The space for zoom calls, especially from your patient’s point of view, is not dedicated. Other people in the family could walk through the backdrop of your screen time with your patient. There could be distractions at critical moments in your clinical care. It will take both patience and structuring for zoom teletherapy to be efficient and effective.
Third, regular telephone calls would be a way of checking in on patients. While this kind of teletherapy can be useful in certain circumstances, the limitations are evident. Of course, without zoom, clinicians are limited to only verbal feedback. Visual and nonverbal components of the intervention are absent. Where patients do not have zoom capacity, this is a fallback option. Additionally, there is ample room for distraction during the call. Either clinician or patient could be multi-tasking without the other knowing. Finally, the call on cell phones could be made from anywhere. The variables are boundless, with negative impact on therapeutic outcome.
Finally, therapeutic intervention could be through social media, or, old school, through letters and journaling. Again, this form of teletherapy gives the patient access to the clinician’s expertise. However, exchanges are not necessarily private and confidential, despite any available safeguards. Texting, emailing, tweeting all risk exposure and breaking confidence. Paper and pen letters back and forth, or patient sending daily journal entries to their clinician for comment and feedback would be less likely to be intercepted than social media options. Also, none of the social media, or old school, options have the benefit of multisensory input into the therapeutic exchange.
Of these four options for clinical intervention, use in-person psychotherapy where ever possible. You get the most input from your patient and you have the most opportunities for strategic interventions. Use zoom telephone calls where time and circumstances preclude in-person psychotherapy. Help your patient develop the most dedicated context for the call and be aware of potential distractions. Focus of the verbal/nonverbal/physical/visual date available and make the most of the exchange.
Standard phone calls, social media exchanges, and journaling are treatment options that might be best used as clinical care is winding down and patients are close to discontinuing clinical care. To some extent, these options put you in the position of being your patient’s professional best friend or confidante, rather than their doctor.
There’s an old adage that says, “Anything worth doing is worth doing well.” Add to this adage the benefit of practicing a new skill consistently over time, and you get effective active listening.
Mary had just read my book, Teachable Moments: Building Blocks of Christian Parenting. She even convinced her husband, Andy, to take the parenting class with her where this was the resource book. Eight year old Amy, their oldest daughter, was their “test subject” in practicing the parenting tool of active listening.
“Mommy, I don’t get this times table stuff. Can you help me?” she asked one night while doing her homework. Mary put up her book and went to Amy’s bedroom.
“What don’t you get, dear?” she asked. “Everything. Math is dumb,” Amy threw her homework down and sprawled across her bed, covering her head under her pillow.
Mary sat on Amy’s bed beside her distraught daughter and concluded, “Well, that’s not going to get your homework done. Let’s try again.”
Amy groused, “Leave me alone,” as she recovered her head with her pillow.
Mary sighed and paused. She reached over to gently rub Amy’s back and spoke softly, “Well, sweetheart, I guess I just blew that, huh?” Amy uncovered her head from the pillow and turned on her elbow, looking puzzled at her mom’s comment.
Mary cradled her daughter’s cheek with her palm. “You know, darling, your dad and I are taking this class to help us try to better be there for you guys.” She paused and continued, “I think I just blew a chance to active listen your feelings. Can I try again?”
Amy nodded and folded herself into her mom’s arms. Mary thought for a moment and said, “You’re really frustrated that the times table is hard to understand, aren’t you?”
“Yeah, and it’s not fair,” Amy pouted.
“You’re not sure how to go about trying to get it right?”
“No, it’s too hard.”
“Okay, I have some thoughts that might help you get it right. Do you want to hear them?”
Amy eagerly agreed and the two of them tackled the homework together, with Mary guiding her daughter’s efforts.
My dad used to always tell me, if at first you don’t succeed, try, and try again. Good counsel, especially for your efforts to active listen your children. Kids are very forgiving if you are sincere with your efforts, and if you include them in the process.
After Amy successfully finished her times table homework with mom’s guidance, Mary asked, “So, how did I do with active listening your feelings? You know, my bossing you around just pulled you further away from me. When I active listened, was it more helpful to you?”
It’s okay doing this debriefing after a conversation with your child. Their feedback will help you in your skill-building. If it doesn’t go well the first time, back up, take a breath, and try again. You are learning something new, so practice, and give it time. In doing so, you are providing a teachable moment for both you and your child.
For parents and children, transitioning from summer to a new school year has always come with its challenges. But a global pandemic has a way of introducing even more challenges. That’s why it’s now more important than ever to adequately prepare your household for the upcoming school year. Hopefully, these tips and resources can help you do just that:
Cleaning the Home
Maintaining a clean living environment will benefit everyone in the household.
Periodically, declutter each area of your home; this can do wonders for reducing your stress levels.
If your child will be doing online learning, part-time or full-time, it’s essential to help them prepare for the process.
Ensure you have reliable digital security set up on the devices your family uses.
If your child will be attending school, make sure you start to transition them into their new routine at least a week before the beginning of the school year.
Establish a firm bedtime and wake time.
Finally, if the stress starts to become overwhelming, just take a moment to breathe. Balance “me-time” with “child-time.” Build fun activities into school work, take short breaks, reward effort and success. These preparations will form the foundation for a great school year, in spite of changes and precautions because of the pandemic.
Josh Moore <email@example.com> asked me to post this excellent article he crafted. Parenting newborns is hard enough. Use these smartphone apps to simplify.
For moms and dads, technology is a gamechanger. Exhausting nights and trying to recall your last feeding or diaper change, knowing why your baby is crying all the time, and setting up appropriate schedules all got easier with the advent of these apps. Read on for our favorite tech-at-your-fingertips solutions for today’s parenting dilemmas.
What to Expect
As many as 73 percent of parents say that parenting is by far the biggest challenge they’ve faced, and still, 91 percent say it’s their greatest joy according to Zero to Three’s study. This leaves you with one question: What to expect? This applies not only to pregnancy and childbirth but through those toddler years too so that you know what to expect along every step of the way.
The What to Expect app is a pregnancy tracker that gives you updates on your baby’s development, as well as lets you connect with other moms who have the same or similar due dates. Once your little bundle arrives, you have instant access to info and resources through those first weeks, months, and into the toddler stage.
The Peanut app has been touted as Tinder for moms, as it enables moms to swipe left and right to match with like-minded mothers nearby. You can then chat, ask questions, bond over similar mom wins and struggles, and maybe meet up for a much-needed caffeine boost or a play date. Sure, you could post on social media asking questions or voicing concerns, but new moms don’t need advice.
“They need support. They need reality. They need "Me, too!" and "You're not alone!" the Huffington Post explains, and Peanut gives you just that. Parents are so often judged, and it makes navigating this new journey that much more difficult. By having fellow moms in your corner, you can rest assured that you get the support you need in a positive, safe, and productive environment.
We all can benefit from a schedule, and the truth is, babies can too. They tend to follow one naturally when it comes to sleeping, eating, and using the bathroom. However, your little one has no clue what time it is, so it won’t be set in stone. The best way to establish a schedule is by noting “baby’s existing cues, taking into account the loose routine he’s already keeping, making it work with your day-to-day and establishing it a little more definitively,” The Bump explains.
Rather than jot it down, Glow Baby makes it easy to instantly log feedings, diaper changes, sleeping, and even track developmental milestones such as eating solid foods, sitting up, rolling over, walking, etc.
Speaking of keeping track of baby, breastfeeding moms know how easy it is to lose track of feedings, especially during those nighttime sessions when you’re still half asleep. Milk Maid lets you track pumping sessions, record bags/bottles by date so that you can use up older milk first, as well as view your current milk inventory by location such as home, work, daycare, or even a grandparent’s house. You can use the left/right feature to track each side separately, as well as use the built-in timer if your current pump doesn’t have one.
On a final note, since we rely so heavily on our phones these days, there are a couple of things to keep in mind. Keep your phone well-protected against drops and spills with an appropriate case, make sure you’ve got plenty of data or look to prepaid mobile plans so that you don’t add overage charges to your list of concerns, and add a phone charger to your diaper bag so you’re ready if you run out of juice.
Parenting is a joy, but it certainly isn’t always easy. It’s even easier to feel overwhelmed and unsure, but there are tools out there to help you stay calm and relaxed so you can enjoy this time that passes by so quickly. Just remember, there’s an app for that!
One of the ways I have helped couples and families to navigate their relationships is to describe a Plexiglas pyramid they can see to visualize how they can interact meaningfully with people in their lives. The pyramid is transparent, so we can see all of the interactions going on. It has levels that identify the importance of the people in our lives. It has a bright, shining Son above the pyramid that illuminates each of the relationships depicted in the pyramid.
So, the starting point in understanding your Plexiglas pyramid is the bright, shining Son above it. You are standing at the apex of the pyramid. Your spiritual connection to God, how you relate to the Son, generates the quality of the other relationships in your life. In the Bible, Matthew 22:39, Jesus identifies what I call “The Codependent’s Commandment,” which is to “love one another as you love yourself.” As you stand on the apex of the pyramid, you are loving yourself by embracing the axiom, “What would Jesus do?”
The next level down in the pyramid is the coupleness you share with your spouse. When you are in sync, sharing thoughts and feelings, respecting each other’s perspective and opinions, jointly problem-solving, then you have the most to offer each other and your children.
Your children occupy the third tier of your pyramid. As each of you make time to be with each and all of your children, active listening their needs and feelings, helping them learn life lessons, and embracing teachable moments, they will thrive.
Beyond the third tier are your relationships with extended family, friends and coworkers, acquaintances, and strangers, each tier expanding the base to form the pyramid.
Healthy families and relationships work the pyramid from the top down. As you are in sync with God, you have the most to offer your spouse. Similarly, as you and your spouse are in sync, you each have the most to offer your children. As your family is in sync, your extended family thrives, as do your coworkers, acquaintances, and strangers.
In contrast, as you are out of sync with God, all other relationships suffer. I like to share with folks that, when you feel distant from God, you know which one moved ;) Taking care of yourself, in mind, body, and spirit, gives you the most available energy to take care of others. Don’t take care of your own needs and feelings, and you can only engage in conditional loving of others. That is, I will do this for you, but you owe me. I won’t even tell you that you owe me. Just pay up. Take care of yourself and you can give unconditionally to others, what’s called agape love. I have this for you. Have a great day.
Being aware of your own Plexiglas Pyramid of Relationships give you opportunity for self-care, which can generate agape other-care, and provide ample teachable moments.
Sometimes the problems your child may be having are obvious. When she is tearful, yelling & screaming, stomping her feet. Yep. That’s pretty obvious that something’s bothering her. More often, though, the signals are not so obvious. So, what triggers your “spidey senses”? When do you “just know” that something’s up with her?
In terms of all of our communication, there is an interplay between verbal cues and non-verbal cues. So, what your child doesn’t say can sometimes be even more important than what she says.
Eight year old Lacey seems unusually quiet. She just came in from playing outside with her friends. You had called her in for dinner. She goes to wash up without being told and then comes to the table. She says “grace” in a sing-song fashion and digs into her food afterward. Your spidey senses are on alert.
“So, Sweetheart,” you ask, “How was school today?”
“Fine,” Lacey responds between mouthfuls.
You give her a few more specific questions to which she responds with little information, mostly one-word responses. You look across the table at her father and you share a nod of agreement. You take a breath and say, “Lacey, what’s going on, baby? You seem a little off.” A single tear falls from Lacey’s cheek.
As parents, we are attuned to our children’s usual pitter patter of behavior. When your child deviates from her norm, that may be your first clue that something’s up. So, if your child is usually upbeat and chatty, and she turns silent or sullen, because that’s different for her, it may be a clue that something’s up. If she usually goes along to get along, but this time she is mouthy and uncooperative, another possible clue.
Also, non-verbal communication can be very telling. As a therapist, I would look for BMIRs (pronounced “beamers). This is an acronym that stands for Behavioral Manifestation of an Internal Response. For example, silence could mean “I don’t want to talk about it.” An eye roll could convey “Really? Give me a break.” A cold stare could mean “don’t go there.”
Interaction that is different for your child, and her nonverbal BMIRs are tools you can use to tell when your child is having a problem. After making your observations and inviting her to talk about things, if she resists, give her space. “Okay, honey. This all must be hard for you right now, but I respect your space. Just know that, when you are ready to talk, I’m here to listen.” When she is ready, use your active listening to draw out her feelings and then encourage her problem-solving after you see her emotional fever go down. In these ways, you are really there for her.
You, or your child, is jacked up. It’s all just too much. The walls seem like they are closing in. Nobody understands. What to do? Well, for starters, just breathe. Taking one, two, or three meaningful, deep breaths helps you put what just happened into context, lowers your heart rate, and prompts you to give priority to your stress management.
Fourteen year old Mandy stomps in the front door after school. She tosses her jacket and book bag on the floor and sighs deeply. Her mom comes down the stairs to greet her usually perky teen, sensing distress.
“Hey Sweetheart,” mom cautiously greets her, “How was your day?”
Mandy glares at her, boring a hole through her. Then she melts into tears. Mom moves toward her daughter to wrap her arms around her.
“It’s…it’s…just…all too much,”
“What is, darling,” mom hugs her tightly.
“All of it. I don’t know. School, tests, boys, my so-called friends. I just can’t do it all. When will it stop, Mama?”
Mandy is clearly on stress overload.
There are two kinds of stress. Distress gets all the press. It’s when you feel weighed down by perceived bad stuff. The other, lesser known kin to distress is eustress. “Eu” is the Greek prefix for “good,” so eustress happens when confronted with good things in your life. Having a birthday, getting married, having children, getting student-of-the-week, kicking the winning soccer goal. All of these things are good, but stressful in the preparation, persistence, and outcome.
For children and teens, common distressful events include studying hard for a test and still getting a bad grade, being picked on at recess, being unfriended, the “cool” kids talking behind your back, being rejected in dating, feeling out of place or not good enough in general.
Thankfully, for Mandy, her mom sensed Mandy’s distress, checked in with her verbally, gave her space to respond, and then active listened her feelings without judgement, criticism, or problem-solving. All of this gave Mandy the opportunity to clear her head and figure out how to recover. Mom’s reactive stance and support helped Mandy calm down and feel less overwhelmed.
Because stress happens, all the time and to all of us, it is equally important to be proactive. This is a case of the basics. As parents, both model for, and encourage your children to, eat well, sleep well, and maintain physical conditioning. In school, elementary recess and middle/high school P.E. classes form a foundation for physical release and conditioning. Encourage your children in groups, clubs, and sports, also for stress release. Fun, engaging stuff is always stress releasing. Now, inclusion and competition bear their own distresses sometimes, but the stress release function outweighs the potential for distress in these activities.
When you encourage your child to “go outside and play,” you are promoting their positive stress release. When you say, “Let’s go outside and play,” you are both modelling stress management and enhancing relational bonding. Being proactive in your stress management can lead to teachable moments with your children. And remember, just…breathe.
Suppose your child comes to you with an issue. You know, something’s bugging him about things not going for him how he would like. Of course you see his emotional fever rising as he talks to you about the circumstances, and you appropriately active listen his feelings to help him bring the fever down. He seems ready to do something about what’s bothering him. Now what?
The questions are, do you help him address what’s bothering him? How do you help? More importantly, whose fight is it? How can you turn his bother into a learning experience, a teachable moment? The answer is, it depends.
Eight year old Joey got off his school bus after a long day. Mom saw from the kitchen window that his shoulders were slumped and his pace was slow. Usually, Joey had bounded off the bus and run through the back door. “Oh boy!” mom thought as she wiped her hands on the dish towel, “What’s going on here?” She greeted her little boy, got him some milk and cookies and the settled in at the kitchen table. Mom waited.
“It’s not fair,” Joey began, words spilling out, “I just kicked the ball really hard when I was up, like you’re supposed to in kickball at recess.”
His mom nodded and reached out to touch his arm as he continued.
“It’s not my fault that my ball hit Bobby in the face and he fell down.” Mom active listened and Joey continued, “They Bobby got up and rushed at me, yelling and wanting to fight me. I didn’t know what to do, so I hit him back. Then everybody just got around us and yelled ‘fight, fight, fight’ until the teacher broke it up.”
Mom hugged her son tightly and Joey teared up. “What was I supposed to do, Mama?”
Mom has some choices here for her response. She could scold Joey for fighting (judging, criticizing…not good). She could answer her question directly and give him very good solutions (solving his problem…also not good.) She could ask his permission to share some ideas and join him in problem-solving (Bingo!!)
Whose fight is it? It’s Joey’s. Mom’s path to helping out and making this a teachable moment is to active listen, ask permission to offer some thoughts, and then support Joey in formulating a solution.
Now, in these circumstances, age and developmental stage matters. For younger children, ages birth to 6, you take care of their needs, explaining why you are doing what you are doing. From ages 7 to 12, you collaborate and encourage your child to follow through on your discussed plan, indicating that, if he doesn’t, you will step in. From age 13 and beyond, your teen/young adult takes the lead with your encouragement and assurance that you’ve “got his back.” Getting feedback from him along the way helps you be available to consult with him.
How do you help? By being there emotionally and physically for your child come what may. Whose problem is it? Always your child’s problem. How much you help depends on your child’s age and developmental stage. How do you move what’s happening toward being a teachable moment? By collaborating, jointly problem-solving, and giving your child feedback about how he’s handling the situation and how what’s happening fits in to the broader picture of his character and responsibility. Hopefully, in return, you will get a heart-felt “Thanks, Mom.”
One of my favorite old timey baseball players is Yogi Berra, catcher for the New York Yankees and later manager of the hapless Mets. He was colorful and said some goofy things. After a team rally where the Mets won, he commented to the press, “Ya know? It ain’t over ‘til it’s over.” That’s a Yogi’ism that is classic, with meaning far beyond baseball.
How about parenting? When raising your children “in the ways of the Lord, so that, when they grow old, He will not depart from them,” (Proverbs 22:6), is your task ever over? Now, healthy parenting is a lifelong process of letting go and letting God, and your style of parenting changes over the years, but it ain’t ever over.
Occasionally, my now grown and gone son invites me to play golf with him. I consider this a rare opportunity to talk about “stuff” with him, impart the meagre wisdom of my years and experience. There’s a lot of time to talk while riding in the golf cart between shots. Sometimes it’s nothing. Sometimes it’s golden. I cherish every moment. If I were “off duty” or dismissive as his parent now, how would we continue to build and revise our relationship as we grow older. Our adult children certainly have their own lives now. So, how can we continue to fit into them, be helpful, encourage, and reinforce all that’s good about who they are becoming?
In the last chapter of my book, Teachable Moments: Building Blocks of Christian Parenting, I define the Principle of Responsible Freedom, where we give our emerging adult teens who still live at home as much freedom as they demonstrate responsibility for. We build in accountability and supervision, to encourage success with their freedom, We pull back on the freedom when they demonstrate irresponsibility. This guarantees a healthy progression toward launching our children into their own version of adulthood. Our style of parenting changes as they grow.
At birth and until about school-aged, our style of parenting is Hands-On. As they get more curious and their social boundaries are extended with school, our style shifts to Directive Parenting. When their brains develop the capacity for abstract thinking, about age 12, we shift again to Advice-Based Parenting. When they leave the nest, from age 18-30, we shift again to Consultative Parenting. This stage is where we adopt the attitude of hearing them out and commenting, “Ya know, I have some thoughts about what you are going through. Do you want to hear them? Getting their permission gives you the power and emotional connection to impart your wisdom. It’s then their choice to take it or not.
Your teen/young adult’s pathway to adulthood is likened to a NASA space launch. As parents, we are in mission control. We monitor their progress, give them necessary readouts and feedback about their progress. Our teen/young adult is in the space capsule, flying the craft and making mid-course corrections to reach their target. We can’t do life for them, but we can be with them in a supportive, consultative capacity.
When we launch our teen into adulthood, we may give a sigh of relief and believe that our mission is accomplished, but our parenting, while always changing, is never over ‘til it’s over.
Did you know a common, universal truth? It applies to all of us, and double for parents. Here it is. Indispensability is a curse. That’s it. When you try to be all things to all people, especially to your children, it is not only impossible. You are also depriving them of a learning opportunity, to see how well they can stretch their capabilities.
“Moooom,” Derek hollered from the laundry room. “Come here,” he demanded. “I can’t doooo this,” He threw his school shirt back into the churning waters of the filling washing machine.
Allison heard the commotion way across the house, as she was straightening up Emma’s bedroom. Her 5 year old daughter played with her doll house close by. Derek’s mom sighed and whispered to herself, “What now?” She then scurried to the laundry room, where Derek was near total meltdown. Wanting to avoid an inevitable catastrophe, Allison gently tugged her son aside, “Here. Let me do that.”
Wow! I’m worn out just writing this story. Imagine what Allison is feeling. No one, not you, not me, certainly not Allison, can be all things to all people. You can’t pour yourself out without refilling the well. Trying to be all things to all people is a quick trip to impulsive anger, high blood pressure, and an early grave.
First things first. By doing for her children, Allison both overloads herself and deprives them from learning responsibility for themselves. Rather than doing his laundry for her teenager, Allison could have started with active listening, to help him calm down. When he became able to listen, she would then ask his permission to show him what to do. The lesson follows, as Allison watches to be sure Derek gets it right. She then has opportunity to praise her son for a job well done.
Second, even at 5 years old, how is Emma getting off the hook for her chores? With youngsters, explain your direction and help them get started. As she gets it, back away and let her do more of the straightening, followed by your praise both for her accepting responsibility for how her room looks and for getting the job well done. For both children, to avoid the “I forgot how’s” write down the steps in completing the chore and post it where the chore occurs, keeping a copy for yourself.
Finally, what about mom? In Matthew 22:39, Jesus calls us to “love one another as you love yourself.” I describe this as your source of self-care. If you give to others without making time for yourself, then your giving leads to conditional love. That is, “I did this for you. Now you owe me.” If you give to others while making time for yourself, then you show agape, or unconditional love. “I’m doing this because I want to. Have a nice day.”
Examples of renewing self-care include exercising, personal devotional time, journaling, taking coffee breaks between functional activities, and such. These self-care measures require you to set boundaries with your spouse and children, use family meetings to equitably divide up household chores, and know that you are your best version of parent when you are the best version of yourself. Since indispensability is a curse, the ability to lovingly say “no” to the mutual benefit of all family members is the cure. Changing habits is always a struggle at first. Stick to your guns and share the load. What a fountain of great teachable moments for all of you.