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Interview with High Schoolers

Several bright and insightful St. Charles High School students recently visited Plum Tree. They’re finishing Psychology courses and had great questions for a clinical psychologist. Here’s what they wanted to know:

1. How many years of experience have you had in being a therapist?

About 10 years.

2. What are your areas of expertise?

Psychological Assessment, IQ Testing, Attention-Deficit/Hyperactivity Disorder (ADHD), and Suicidal/Self-Injury Behaviors

3. How would you describe your treatment style?

Solutions-focused, collaborative, evidence-based, and genuine.

4. What type of therapeutic strategies do you think work most effectively?

• For ADHD: Coaching strategies, where the focus is on developing organization, improving attention, managing restlessness, improving time-management, and establishing priorities
• For Self-injury/Suicide: Dialectical Behavior Therapy (DBT)
• For children’s mental illness: play therapy, behavioral parenting, and cognitive-behavioral therapy

5. Do you think our society overemphasizes happiness?

No, but society isn’t clear about how to achieve happiness. Particularly teens are bombarded by social media emphasizing fame, fortune, and beauty. In fact, none of these are linked directly to happiness.

6. What made you want to be a psychologist?

I enjoy a challenge. No science seems as complicated and nuanced as that of human thoughts, feelings, and behaviors.

7. Why did you pick to work with children and adolescents?

I’ve always “spoke their language.” This population of people is easily misunderstood. There’s nothing so fulfilling as being the interpreter between a child and his/her caregivers, teachers, and other important adults.

8. How do you decide which approach is best for the patient?

I weigh a combination of patient (or parent) goals, treatment history, symptomology, research, and clinical experience.

6. What has to happen during a session for therapy to be successful?

The patient should feel validated and also supported to change.

7. What are the measurable criteria you use to assess how well treatment is working?

It varies per person. Every patient has a treatment plan with measurable goals and timelines. I also conduct intermittent screenings with psychological tests to monitor progress. Of course, patient (and parent) feedback is an important part of assessing the effects of treatment.

8. Do you believe the effects of labeling are true? In the way that when a patient is diagnosed with a certain disorder they act in that labeled way and also the people around them treat them differently according to their diagnosis?

A diagnosis is not a judgment; it’s a fact. Just as there are criteria and scientific evidence to medical diagnoses (e.g., diabetes, colds, cancer) mental illnesses have criteria and scientific evidence. So, just as it’s appropriate and effective to label someone with flu symptoms as having the flu, it’s appropriate and effective to label someone with anxiety symptoms as having anxiety.

Diagnoses (or, labels) are tied to evidence-based treatments, scientific literature, and clinical outcomes. So, when a patient is accurately diagnosed, then treatment pathways become clear. It also allows for different treatment providers to speak the same language about what issues/treatment goals are.

Overwhelmingly, patients can be relieved by learning about their diagnoses. They may have felt “different” all along. The knowledge that there is a name, a treatment, and a community of people with similar issues can be—in itself—an effective therapeutic experience.

Of course, there’s still a lot of public stigma around mental illness. People who have it can be embarrassed or feel inept. Since the idea of mental illness can make others uneasy, patients may experience some ostracizing. Public education is needed.

9. In your opinion, what is the most common diagnosis? Has that changed in the last several years, if so, how?

Trending shows that—for pediatric populations—Bipolar Disorder and Autism Spectrum Disorders, are on the rise. ADHD has been on the rise for at least a decade now, too.

10. Do you think that therapy is the best choice for all who may need it?

Yes.

 

Oh, Behave!

Once upon a time, a scientist named B.F. Skinner was playing with rats and pigeons. He had this idea, that all behavior had to do with consequences. Wait! This story gets better. Mr. Skinner invented a fancy box for the animals. The box had levers, lights, loudspeakers, food–the works. The box’s floor was an electrical grid. After a series of experiments, the animals did what Mr. Skinner wanted them to do (like press the levers) when they were rewarded. If the animals did something wrong, the poor little guys got electricuted. The animals learned, over time, to do the “right” thing and to avoid doing the “wrong” thing. And everyone lived…happily?…ever after.

Well, Mr. Skinner did anyway. His work is famous in psychology. He showed us that rats, pigeons, and people are motivated by consequences. Our behavior is shaped by our environment. When a behavior is rewarded, we do it more. When a behavior is punished, we do it less. Mr. Skinner shrugged off Freud’s ideas about mysterious, inner drives and urges. Behavior is as simple as A-B-C: Antecedent, Behavior, Consequence.

Understanding Skinner’s work can save you hundreds of dollars in child therapy. If you want your kid to behave, then use consequences.

This is SUPER important: ld  When you reward a desired behavior, they’ll do it more. Punishing a bad behavior works, but not as well as rewarding a good behavior.

So what’s a reward? Giving them something they actually want, or removing something they don’t want. Rewards are as unique and individual as your child, but most kids feel rewarded by: more leisure time, less chores, more freedom, less demands, more praise, less criticism, and so on. If you reward kids consistently, their behavior will get better. Also-once in a while-going above and beyond with rewards works too.

It’s pretty common, after a few sessions with a therapist, that parents are given instructions on how to use a behavior chart at home. (Thank goodness no one recommends Mr. Skinner’s electrical box.) Behavior charts can be very simple or pretty complex. Start with a simple one. You can do this with your child. Decide how many behaviors your child will work on. Kids ages 2-5 should have only about 4 chart behaviors. Kids ages 6-10 can have 8 chart behaviors. The limit for older kids should be 10 chart behaviors. The behaviors should be specific, but simply stated. For example, “If I use it, I clean it.”

Get a piece of posterboard. Make 8 columns from top to bottom. Leave the leftmost column blank. In the second column, at the top, write “Monday.” Moving left to right, write the remaining days of the week-one in each column. Leaving room at the bottom of the page, make as many rows (lines from left to right, under the days of the week) as you need for the chart behaviors. Write each behavior in the leftmost column, one per row.

At the bottom of the chart, write the exchange rate. How many daily stickers does your child need to get the reward? To start, shoot for about 80%. Same for the weekly stickers reward. Then, as behavior improves, make the ratio of behaviors-to-rewards higher, so that the child will eventually need 100% stickers to get rewards.

What’s the deal with the stickers? Once a day (about 2 hours before bedtime), you and your child will review the behavior chart and discuss how he did. He gets a sticker in the day’s chart behavior, only if he did it. He does not get a sticker if he did not do the behavior. Apply or withhold the reward as appropriate.

Stick to your plan, mom and dad! If your child did all the chart behaviors, then he gets the reward. Period. Even if later he misbehaves or you feel angry with him, he still gets his reward. Same goes for withholding the reward. If your child did not do the chart behaviors, no reward. Not even if you feel sorry for your child. Not even-especially not even-if your kid is throwing a tantrum about not getting the reward.

A behavior chart should be used consistently for about 3 weeks, before you can determine if it’s effective or not. Use Mr. Skinner’s research to mindfully reward your little rats and pigeons! This stuff really works.