Monday, April 28, 2014

Ferberization- Is it healthy for your child?

Quite a few pediatricians in India have begun recommending Ferberization as a way of encouraging babies to sleep independently.
Here is the outline of his methods (from his book)
Dr. Richard Ferber discusses and outlines a wide range of practices to teach an infant to sleep. The term ferberization is now popularly used to refer to the following techniques:
  1. Take steps to prepare the baby to sleep. This includes night-time rituals and day-time activities.
  2. At bedtime, leave the child in bed and leave the room.
  3. Return at progressively increasing intervals to comfort the baby (without picking him or her up). For example, on the first night, some scenarios call for returning first after three minutes, then after five minutes, and thereafter each ten minutes, until the baby is asleep.
  4. Each subsequent night, return at intervals longer than the night before. For example, the second night may call for returning first after five minutes, then after ten minutes, and thereafter each twelve minutes, until the baby is asleep.
A host of different academic research institutes have supported this method citing research that Ferber's method helps children sleep longer and through the night.  It has been a popular method in the USA for many years now. (http://www.med.umich.edu/pediatrics/ebm/cats/ferber.htm)

I find myself very anti- ferberization and fortunately, recent research supports my point of view. While the method does help the  children to sleep through the night, it is also teaching the child that he is alone without a back up.... leading to insecurity and separation anxieties.

When you leave a child unattended, crying for you, his cortisol level shoots up. Cortisol is a stress indicator. What is even more surprising is that the cortisol level shoots up every night even when the child is not crying. What that means is, while you have trained the child not to cry, his distress is very much present. Distress at such a young age is an important factor in adult anxiety, panic disorders and other mental conditions.

So then, does the intermittent reassurance by the parent (as suggested in the Ferber method) bring down the anxiety. On the contrary, I believe it doesn't. Because there is no comforting or picking up the child when he is crying, it leads to more distress. Seeing your parents make an appearance when one is evidently upset but watching them do nothing before disappearing, again, can feel like betrayal. And because this sleep method is employed in the pre-verbal stage, its processing and impact on memory could be devastating. 

Researchers at Harvard who examined emotional learning, infant brain function and cultural differences claim that babies who are left to cry themselves to sleep suffer long-lasting damage to their nervous systems.
By employing the Ferber method, you are teaching your baby that you cannot be depended on and that you cannot be trusted to help her when she needs it.

Now, even Dr. Ferber, in the 2006 edition of his book, advocates co-sleeping as a better solution and accepts that different strategies work for different families!!

As a psychologist, and even as a parent, it seems like the method does not take into account the child's emotional well being. While it seems to get the job done and puts your child to sleep, there is no way to know what collateral damage it has done.  To me, that's a big risk to take with your precious one.




Acceptance

Growing up, at home, I sought my parents approval. At school and college, I needed validation for my hard work. When I started working, I wanted my seniors to appreciate my efforts. A pat on the back, a gold medal, a good appraisal followed by a decent hike in my take home pay were all indications of bring approved of. I was hooked. My self worth was inextricably linked to my achievements and every little setback or failure caused me feel worthless. If I don't achieve, I am a failure.

I have heard these words and seen them in deeds, so many times. I wish it wasn't so. So many of us have been scarred by this one thing that was drummed into us in early childhood. Unconscious comparisons with the better behaved cousin or the high achiever classmate by our parents, teachers and society, at large, meant that every average Joe was not approved of..........and accepted.

One had to be a somebody to be successful. Why? Aren't all children specially gifted. One may be better at academics, the other at art, another at social skills and someone else at coming up with out of the box ideas. Each one has a unique talent. And it is job of a good parent and teacher to help the child find it. 

The first step to that is the acceptance of the child for who she/he is, with all the seemingly odd tendencies and quirks. This acceptance can go a long way in building self esteem and self worth. This acceptance also serves as the reserve strength to tackle difficult life phases, inevitable failures and other setbacks. It provides the child and later his adult self, the encouragement to continue walking optimistically on his life journey reaching for his goal. And because his self worth is not linked to someone else's approval, he accepts life's ups and downs as inevitable companions of his journey. His self worth remains intact and he accepts himself, with his strengths, weaknesses and eccentricities.

A child who seeks validation and approval is a result of an unaware parenting style. As a parent the most important thing you can do is accept your child. Everything else will follow.

Monday, April 21, 2014

Empty Nest Syndrome

Till now, as a mother, I was the most important person in my son’s life. But now that he’s a teenager, he only comes to me when he needs something. While I understand his need to be independent, I have begun to feel the twinges of grief… When it gets to a point where he leaves home for good, I don’t know what I would do then!”
That’s my client’s story but it could be yours, too.
I have dealt with ‘Empty Nest Syndrome’ [ENS], as it is referred to by most clinicians, with a lot of my clients. ENS is characterised by feelings of grief and loneliness that parents or guardians feel when their children leave home for the first time to attend college, a job in another city or just to move to their marital home after they get married. While mothers seem to be affected the most, by no means are fathers spared. While ENS is not a psychiatric disorder, it often needs therapy and support just like any other ailment.

Getting through the grief

It seems almost inevitable that parents would go through some feelings of desolation as their last child leaves home. While most parents understand and accept the need of their child to move out for work, education, marriage or to live independently, the emotions evoked by this event are hard to control and manage. The sadness at seeing their child go away, being powerless to have a say in most aspects of their lives, worrying about their safety, being concerned about their ability to manage without parental guidance, and the sudden emptiness in their lives and homes, can be very hard on parents.
Stay-at-home parents, women experiencing menopausal symptoms, parents who have recently retired and single or separated parents may feel the loss much more than others.

Preparation is everything

You can’t prepare for it just a few months before your children are ready to go out in the world. Preparation starts much earlier… in fact, from the time your children are young kids.
  • Raise independent and self-assured children: It is important to integrate certain practices in your everyday interactions with your kids. Provide them with acceptable choices, allow them to make decisions on their own, respect their selection, provide support for any [potential] negative fallout. Show your children that you are with them and their preferences. The warmth that you create by doing this stays with them throughout their lives and they will continue to be in touch with you.
  • Encourage independent thinking: Listening to your children’s ideas and allowing them to interpret their environment as they see fit can do wonders for their thought process. Follow some rituals that engage your children at the family level. For instance, watching a movie together, sitting down for meals with each other, and having a brief chat before bedtime can a long way in creating strong attachments between you and your child. The combination of independent thought and family rituals will ensure that your child will be able to live independently and but will still reach out to you for guidance and love.
  • Keep the channels of communication open: Regular, non-intrusive conversations about their state of mind and their feelings help promote a continuous dialogue between you and your children, even after they have moved out. By doing this, you ensure that your child will keep in touch with you and keep you in the loop about any concerns in his life. This knowledge can help in cutting down your anxiety.
  • Accept the facts: Accepting that your children’s need to live their life cannot be based on your personal experiences may sound scary but is actually a freeing experience. Once you are able to accept and trust your children, you can help, support and encourage their endeavours. In this way, they will still need you but in a different way than before.
  • Live your life: I cannot stress enough the importance of living your own life. Cultivating a hobby and involving yourself in meaningful work can be a life saver when your child’s departure leaves behind a sense of emptiness. Involve yourself in a home or work project or sign up as a volunteer at the local school or charity. A fellow counsellor, whose kids have left for another country, has learnt to sidestep her anxiety by devoting many hours teaching English at a girl’s orphanage. She says it makes her feel wanted and it keeps her too busy to feel lonely.
  • Focus on your partner: Children moving out is also a wonderful opportunity to reach out to your spouse. There was probably no time to devote to each other when both of you were busy bringing up the kids and working towards their future. Plan some activities with each other, go for walks, and watch that movie you never found time for or read together daily. Going on a holiday together will also help you deal with the feelings of loss.
  • Change your point of view: Look at the children’s departure from a different perspective. It’s time you patted yourself on the back for all your efforts through the years. Relax, sit back and enjoy the results of your labour. A lot less housework, more time for your hobbies and significantly reduced financial burden can be very liberating.

ENS and the single parent

A single parent can get badly bruised by the empty nest syndrome. In most cases, a single parent has worked overtime to raise his/her children. Working a full time job to meet the financial demands of the family and often doubling up as the cook, housekeeper, tutor and nanny to the children can be physically and mentally demanding. But you are also rewarded by the child’s undivided love and loyalty. Due to the lack of a partner, this relationship often takes the form of a friendship and can be extremely rewarding for both the child and the parent.
To find yourself suddenly alone after the kids have flown the nest can bring on feelings of isolation, exclusion, melancholy and agonising concern for the children. These are some of the things single parents can do:
Reach out to friends: Especially other single parents, irrespective of the stage of life they are in. They can empathise far better with your state than others.
Become part of a support group: Ask a therapist to guide you to one. Online communities can also be an effective support structure. This will tell you that you are not alone and provide you with someone to talk to when you are going through a tough time.
Rediscover your hobbies: Pursue them diligently. You now have the time to focus on yourself. Take advantage of it.
Volunteer your skills at an orphanage, old age home, centre for the blind or at a school: This gives a symbiotic opportunity to someone in need and provides you with a feeling of being needed.
Start an exercise programme: The endorphins released during a workout help in keeping negativity at bay. There is also the added advantage of keeping yourself healthy and in good shape

Watch for signs of depression

Allow yourself to mourn the loss of the relationship you enjoyed with your child. But if you find yourself indulging too much in nostalgic rumination and weeping about it for more than a couple of weeks, a visit to a therapist might be a good idea. A few counseling support sessions will do you good. Depending on the severity of your condition, your therapist may put you on medications ranging from the innocent Bachflower remedies to stronger anti-depressants.

Not all’s doom and gloom

Empty nest syndrome is definitely difficult to cope with, though some studies have shown that parents whose children leave home do not necessarily experience the level of grief normally associated with this syndrome. A study done on British, Chinese, Southern European, and East Indian families living in Vancouver found that although parents felt some sadness at their children moving out, a majority experienced increased marital happiness and joy from extra leisure time. The study found that the anticipation of children leaving home was more frightening than the actual departure.
And, just to put things in perspective—empty nest syndrome means that your children are independent and capable of taking care of themselves without your daily support. It means you have done a great job of raising them. Rather an Empty Nest Syndrome than “Boomerang Kids” who come back to live with you!
Reproduced from Gaurai Uddanwadiker's article in the August 2013 issue of Complete Wellbeing

Monday, April 14, 2014

New parent for your child: Steps to follow when introducing a step parent to your child

Unlike the negative portrayal of step-parenting in fairytales like Cinderella and Snow White, the real life experience can be a positive one. The basic parenting guidelines remain the same—provide the child with a sense of belonging, security and unconditional acceptance. But here are some additional steps to follow when introducing a step-parent into your child’s life…
Communicate: Talk to your children about the new person in your life. Based on their [favourable] response, give them the details about where you met, why you like him/her, etc. Give your children the space and time to evaluate their feelings. Also, give them the freedom to express their feelings and opinions. If they seem upset, allow them to vent their feelings and wait for them to get used to this new development.
Be honest: Being honest about your relationship and where it is heading is important. It takes away the surprise element from the picture, allowing your children the time to mentally prepare themselves to accept the new parent. Try to respond to all queries calmly to allay any fears. Remember, it is normal for a child to have reservations. Do not react with anger and counter his/her response with over justification in defense of your relationship.
Have an informal introduction and casual meetings: Provide multiple opportunities to your child and your partner to interact with each other in low pressure situations. Busy workdays and large family gatherings are not the right choices. Weekends or holidays, half day picnics or quiet dinners at home are a great start to getting to know each other. As they get comfortable with each other, progress to having your children spend the entire day with your partner, sometimes in your absence.
Spend time with your child: This is especially important after your children have met with your partner. Answer their questions in the best possible way. Allay their fears of abandonment by stressing on the fact that you will always be their parent, no matter what. You will be there with them every step of the way and now they will have another parent to share their thoughts and feelings with.
Talk about the logistics of the decision: Here is a list of some of the things that you should go over with your child [after a discussion with your to-be-spouse]:
  • Where will you stay?
  • If you move into a new house, will your child be able to take his/her belongings along?
  • Will he go to the same school?
  • Who will drop and pick him from the school/ bus stop?
  • Will he have new rules and a new structure with this change?

A word of caution

You might come across an increase in emotional demands and associated tantrums. Your child may sulk more often or become unnervingly quiet for a few weeks to a few months. S/he may even ignore the new parent or deny their very presence. All of this is normal and is a part of the process of acceptance. Keep your cool.
Once you and your partner are married, continue to communicate with your child. I cannot stress enough the importance of having a continuing dialogue through this transition and thereafter. Remember, your child is an individual with his own mind. Respect his needs and he will respect you. Listen to what he says and keep the channel of communication open.
In your enthusiasm to ensure everything is going well, remember to take a back seat once in a while. Take a hiatus from some of the daily activities that you did with your child. Let your partner take over. Setting new daily rituals such as a game of scrabble before dinner, a walk in the evening or reading bedtime stories go a long way in creating a bond.
Do not shield your child unnecessarily from your partner. Have faith in your spouse and allow him/her to discipline ‘your’ child. You are now a family and you need to give your spouse the freedom to have a one-on-one relationship with your child. Beside, it sends out a consistent message. Only then, will you function as a cohesive unit.
This was first published in the October 2012 issue of Complete Wellbeing. This article is written by Gaurai Uddanwadiker

Monday, April 7, 2014

Spirituality and Religion in the therapy room

For most of us in India, irrespective of our religious affiliations, rituals and other spiritual practices have been a large focus of every festival and for many an inevitable part of their day. It has shaped our views, bound us to prejudices and for some, liberated us from the race to be at the top.

As adults, most of us follow some rituals, at least partially. Sometimes to seek comfort in the nostalgia, often from force of habit and sometimes succumbing to the demands of the extended family. A small percentage of us have felt disgusted by the superstitious or irrational processess and have completely shunned any spiritual practice. But, whatever the reason, it is difficult to escape the influence of the Higher Power.
 
The influences of the superego and the resultant dynamics are shaped in some part by our spiritual and/or religious experiences.  Our behavioral responses are often rooted in it. And yet, surprisingly, it took counselors many decades to start using it for and in therapy. The journal of American Psychologists Association, recently had multiple articles based on Religion and Spirituality. It couldn't have come sooner.

Let me tell you a story about a woman. One of the biggest influences in her life ( let's call her Preeti)  was her time with her grandparents. Both of them spent the early morning hours in devotional rituals in the family temple. Preeti, as a young child would often join them, without brushing her teeth or finishing her morning ablutions. A sacrilege for a Hindu:) Being the favorite grandchild, she had a lot of equity with them and was indulged. This shaped a lot of her concepts of right and wrong. Her grandpa bumped her ahead on the Kohlberg scale- "Rules could be changed  under certain circumstances", by just allowing her to sit in on the rituals without the prerequired hygiene rituals. As a result her relationship with the Higher power was not defined by a strict set of rules that she needed to follow. Preeti thinks of God as her friend Who she confides in, Who helps her through her downs and most importantly who does not stand over her in judgement. Over the years this has influenced so many other areas in her life. Her ability to think outside the box and look for alternative solutions at her advertising job is partly a result of her religious experiences. In her personal life, Preeti is flexible about making changes and very tolerant of friends and family who are different from her or who hold contradictory world views. Because she knows that there is more than one way to look at life. She accepts that there is no single set of rules to accomplish a task but that you can make your own rules as you go along.

I very strongly believe in using spirituality in my therapy practice. I certainly make an effort to understand the client's spiritual leanings. While I will not bring up the discussion unless the client prompts it, but if he does, I do like to spend some time on understanding the client's perspective of it. It is always a welcome input for me as a therapist because it helps me to understand the underlying inflences and resultant associated behavioral tendencies. It helps me make sense of the client's  motivations, guilts and other components of the his mind. Like I said, I am glad about APA endorsing it. It is one more tool in the therapist's arsenal.