Is it okay that my child at times verbally punishes his stuffed animals?

--Anonymous November 2014

This is the type of behavior I see in play therapy. Play therapy allows for access into a child's mind through their play. Kids usually don't sit in a chair and tell you how they feel about themselves, their family, or the world. This is where a child's play can be informative. A child's play is usually a projection of what they are thinking and feeling.

So in this instance of punishing a stuffed animal, I would look for a few things. Is the punishment justified, did the animal do something to be punished? If he is dishing out punishments for no reason, that's one thing, but if the toy animal did something worthy of reprimand, then that can be a healthy thing. He's coming full circle in the latter case. He was playing with the stuffed animal, it did something wrong, and he's implementing a punishment to curb the behavior. Most parents would agree that is a logical and appropriate form of parenting.

But what if it's the former, a punishment without cause? There might be a few explanations for this behavior. He might be angry, it could be part of the game, or it could be how he perceives his reality. If he's frustrated, then being aggressive in pretend play is a normal and natural way of managing frustration. As a kid, especially under the age of 5, you have minimal control or power in your life. He is directing the play, and is the punisher instead of the punished. Both give him a sense of power and control in a healthy way. It's age-appropriate.

The second option is punishment is part of his play. If so, this is a teaching and learning opportunity. If there is no apparent reason for the punishment, you can engage and co-construct what's happening. If he says the animal is in trouble because he says so, you can suggest that maybe the animal should not be in trouble since the animal did nothing wrong. You could also say the animal apologized so it should be forgiven. The play can also turn into an empathy exercise by asking, “How would you feel if you were in trouble when you did nothing wrong?”

Lastly, a child's play is symbolic of reality. So if in his play, he goes through each step (bad behavior → punishment → acceptance and apology → punishment over), then your child has a basic understanding of rules and relationships. If the animal is punished for no apparent reason, then it might be a sign that he doesn't understand why he is punished in reality. A good method to assess his understanding is to ask what he did that was wrong, why is he being punished, and what he can do differently next time. Sometimes what is obvious to a parent is confusing to a child.

You can also gauge your child's knowledge by asking similar questions as you watch a cartoon, read a story, or see another child who is doing something positive or negative. These situations are great ways of speaking indirectly to your child, rather than putting your child on the spot. It's always rewarding when your child is well-behaved; but poor behavior, even a meltdown, is an opportunity to learn and improve. 


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Someone I know has an addiction. How do I approach them about it? 

-- Anonymous October 2013

Addiction is a challenge to overcome. There is a reason why it can take multiple attempts to kick an addiction. You hear about people who stopped smoking cigarettes cold turkey, or conquer an addiction after (re)committing to their faith. These stories happen, but more common is the personal struggle and loss of what is important in life due to an addiction. How do you handle someone struggling with addiction? First, let's understand the underlying process of addiction.

For me, all addictions have the same psychological underpinnings. Whether we are talking drugs, alcohol, porn, or any other vice, they all have the same root. Addiction is a mixture of a biological predisposition + a void in one's life + inadequate and inefficient coping skills and resources. Before I say more about this addiction mixture, there is a great presentation on TED Talk about addiction and the brain. It's a an excellent resource.

Biological predisposition. I believe people have a predisposition to everything. Whether it's depression, obesity, or artistic ability. There is a potential within us for anything. Factors (e.g., environmental, family, biological) in our lives moderate the maturation and expression of a predisposition. These factors over time can lead to a sensitivity and affinity to certain predispositions.

Personal void. Every person I have worked with who is struggling with addiction has a personal void. Whether it's a chaotic childhood, loneliness, attachment issues, or a failure to manage daily stress, there is a glaring void in their lives. An addiction serves two purposes: 1) it superficially fills the void and 2) it pushes personal inadequacies out of consciousness, for that moment.

Ineffective coping skills. You can argue that any psychological issue is the result of having limited coping skills. With addiction, the same applies. The specific, unhealthy behavior gains an addictive quality because it is helping the person cope with something that had been unmanageable. This is what makes addiction so hard to overcome, it's difficult to let go of an effective coping mechanism, even if it's unhealthy. A major component of addiction treatment is understanding triggers and how to cope with these stressors..  

So how do you talk to someone with an addiction?

In a previous post, I wrote about how to have a difficult conversation with someone you love. Similar rules apply to addiction, but there are differences.

1. Speak gently and non-critically. You are talking to someone with limited coping skills and an inability to manage daily life. Keep the stress level low.
   
   
2. Be consistent and honest. You don't have to be critical to say the person's choices have negatively impacted their life and yours.
   
   
3. Speak with love. Make sure it is clear that you are approaching them out of love. “I'm talking to you about this because I love and care about you.”
   
   
4. Ask for honesty. It may not work, but it's worthwhile to see if the person is in denial or wants help.
   
   
5. Listen. Allow the person to talk. Ask questions that are open-ended, that allow for dialogue.
   
   
6. Have resources ready, and be prepared. If the person has a specific addiction, do some research and see what supports are available in the area.
   
   
7. Establish boundaries by taking care of yourself. Support the person, but not at the expense of you. This will be the first exercise for the person to learn about healthy boundaries.
   
   

Being there for someone who is struggling with an addiction is difficult. Find your own support to ensure you remain healthy.  

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I’ve been asked this question by friends, strangers, aspiring mental health professionals, and even patients. It’s an interesting question, but I always find myself surprised when it is asked.

I also give the same response every time. In my years of being a clinical psychologist, I’ve never come across the same type of person twice. I have worked with many people who have presented with depression, anxiety, family conflict, etc., but each person had their own unique background and story.

Yes, common themes do arise in therapy: grief from losing a loved one, anxiety related to control, reoccurring relational problems, poor self-esteem due to a chaotic, neglectful home life. However, each person has their own experience, and the same experience can have a different impact from person to person.

Even the loss of a loved one can impact people differently. One person could be grief-stricken for months or years, while another may process the loss by becoming more active in personal pursuits as life isn't limitless.

People are complex, and it’s immensely rewarding and actually energizing to be able to work with people from different backgrounds. It’s a privilege to be allowed access to others’ experiences.

To be completely honest, sometimes there are moments of feeling disconnected during a session. Some might describe this moment as boredom or disinterest, but it's different. It's more about the interaction being superficial versus meaningful. It's getting caught up in the minor details instead of focusing on the central issue.

The disconnect during a session refers to the emotional connection between the patient and therapist. The patient or therapist can feel disconnected in a moment, the feeling isn't exclusive to either. Part of the therapy work is verbalizing and exploring this emotional distance, and recognizing if and when the same disconnect occurs in other relationships.

So for those who have that friend who only wants to talk when there is a problem, or only shares their own successes, take a moment and reflect on the relationship. Consider your perspective, but also connect with the perspective of others.

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Hey Salmaan, I wanted your opinion regarding conversion therapy considering you are in the field. Particularly because you are a Muslim, what's your opinion about conversion therapy and what role do your religious beliefs play in working with someone who is gay.

-- Anonymous, August 2013

I openly admit I do not have first-hand experience with conversion therapy, I have only heard stories from those who were willing and unwilling participants. The stories I have heard have been negative; however, I know there are positive stories out there.  I am not sure if a “conversion” to heterosexuality makes the therapy a success, or if the goal of conversion therapy is to manage homosexual desires in a heterosexual manner. It's certainly controversial, and therapy in general is usually a failure if the participant has been coerced into therapy.

In my professional work, when someone who is confused or struggling with their sexuality enters my office, I focus on the struggle and confusion. I never have and never will push someone to one orientation or another. That's me speaking as a psychologist and a Muslim. Maybe I'm doing my faith a disservice, but I don't think so. In my life and work, I believe it’s not my place to judge; my role is to increase understanding and awareness in your life.

Part of therapy with me is having a conversation about what would it be like to be straight and what it would be like to be gay. This allows for a genuine analysis of how the person feels and may bring clarity regarding their sexual orientation. If someone wants to talk about the role of their faith, that conversation is certainly explored. Many do struggle with balancing their religious beliefs and their orientation.

In my experience, people know their sexual orientation upon entering therapy. Therapy is usually more confirmation and supportive than analytical. A major part of the therapy is how to manage current relationships, especially family relationships. For many, the major stress is how to tell family, especially if the family is opposed to the lifestyle. The fear of being ostracized and disowned from their family is very real for many.

For those who have been adamant that homosexuality is a choice, I always say your political/religious affiliation is a choice, so spend the next 5 years genuinely being of a different political mindset or different religion. That might provide perspective into what it is like to pretend to be something that you are not. That’s my personal belief.

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Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN. If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville on facebook here or can follow me on Twitter here. Thanks for your support! 

I recently saw two young boys, one punched the other in the stomach and the other slapped the first across the face. Both of them are around the ages of 8-10. I know it may be "normal" for boys or even girls to behave aggressively with other children on occasion, what bothered me is both of their mothers ran to their own child’s defense and was convinced that only their child was wronged. No one focused on the act itself, they focused on defending and legitimizing what their child did.

What would be the best way to approach that kind of situation as a parent? Where you want to support your child but not legitimize what they did and hold them accountable even if it wasn't their fault. I want to feel prepared when we have kids at this age.

--Anonymous, May 2013

In that situation, I'd point out what each child did right and what each child did wrong. I would also emphasize that physical aggression should only be used in self-defense. Then I would go to the emotion, specifically empathy. Ask your child how the other child would feel to be slapped on the face. That may be too indirect, if so, then I would ask how it would feel to be punched or slapped in the face. When they express the emotion, take that moment to praise them for sharing that feeling. If they express an inappropriate feeling, instead of dismissing it, ask how they came to that feeling. It's also important to emphasize that bad behaviors or choices doesn't make your child a bad person.

In almost all physical alterations, there is a build up from calm to physical aggression. So you might initially have annoyance, then frustration, then anger, and finally physical aggression toward others. Learning how to express emotions can decrease frustration and even supplant physical aggression. Reviewing these steps with your child can also serve as an effective way of helping your child (and you) in becoming aware of their emotional state in a stressful situation.

In these situations, you have to be consistent. Here the children were obviously upset so I would talk about other ways to express anger other than hitting. Help your child find ways to express thoughts and feelings in a way that is heard and respected. Don't expect radical changes, as one talk isn't going to fix everything. However, the great (sometimes not so great) part of human nature is behavior repeats itself, so you’ll have plenty of opportunities to talk about the issue. Take each opportunity as a chance to educate and correct the behavior. 

One thing to watch for is make sure your child is in the correct mindset to have a conversation. If your child is yelling or throwing a tantrum, a talk won’t be effective. Also, make sure you are in the right mindset as well. Adults can throw tantrums too. Check to see if your child can summarize the conversation. This will assure that your child was listening and understood what you were saying.

The other issue is what your child is seeing at home. If the child has parents that blame one another or even worse, hit one another, then that is going to be your child’s frame of reference. Teach your children that it’s okay to make a mistake, to be imperfect. That if they make a mistake they aren't going to be harshly criticized. Parents have to model healthy behavior. This includes saying, “I’m sorry” and “Oops, I was wrong.” Kids tell me that they feel so relieved to know they have imperfect parents, like a weight has been lifted off their shoulders, that it’s okay to be imperfect.

It's normal to be thinking about these things, but honestly you can't really prepare for all that parenthood entails. No one is ever completely ready to be a parent. What's important is communicating with your partner about planned and unplanned situations. And trust me, you'll have many, many more unplanned situations than planned. That's when the gray hairs happen :)

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Occasionally I get questions from friends, readers, and strangers on a number of topics. With their consent, I thought it might be helpful to post their questions and my responses.

Question: My kids are insanely picky eaters. I am concerned that my children aren't growing well and sometimes I find empty bags of snack food in their beds. Any advice? 

Answer: Picky eaters are all too common for families, especially younger children. First, I would recommend consulting with a pediatrician to determine if further assessment is warranted regarding food allergies or other medical conditions. Honestly, if a pediatrician isn't concerned, keep that in mind. 

Let's assume there are no medical conditions. Here are a few tips for picky eaters:

Consistency. Be consistent about what time you eat snacks and meals. Even if your kids show no interest, have a variety of foods available at meals in case they are curious. 

Be consistent in not giving your kids three or four options each meal. If they don't want to eat option one or two, then leave it at that. The next meal is always only a few hours away. 

Modeling. If you want your kids to eat a variety of foods, you should eat a variety as well. Kids are more likely to experiment with new food if you do. 

Creativity. Get creative in how you prepare and talk about food. A common strategy is to puree vegetables into sauces or baked goods. 

Talk about foods, not how they taste, but how they look, smell, and have different textures. 

Respect. Even though it can be incredibly frustrating and worrisome, be respectful in your interactions with your kids about their eating. 

Fun. Make eating fun. No, I'm not talking about food fights. Make food into cool shapes, pretend you're a family of dinosaurs and chomp dinner, or have your kids help you with the prep.

Talk about how their favorite character/superhero eats healthy foods sometimes and how it can help your child as well. 

Avoid power struggles. Food should be about food, not about the child being disobedient or defiant. Just because a child isn't eating what you serve doesn't mean they are being malicious. You don't want your kid to avoid meals because they think it's going to be a battle of the wills. The last thing you want is for your child to associate frustration and resentment with food.

Think if someone offered you food and you didn't like it or you weren't hungry, does that make you defiant?

Acceptance. Sometimes kids aren't hungry or interested, just the way it is. Accept where your child is at. They will have a less selective diet as they get older. As long as they are growing and healthy, they are okay.  

Having a picky eater is an opportunity. Be consistent, continue to offer alternatives, try to be creative and fun, and accept your child as they are. 


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