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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Friday, February 17, 2017

Children and Obedience: A Clinician's Perspective

A recent discussion on a child psychology listserv brought up once again some misunderstandings about Reactive Attachment Disorder. One correspondent, who spoke of a child who had been diagnosed with RAD, surprised me by offering the old holding-therapy-related symptom list, including “superficial charm” and “lack of cause-and-effect thinking”. I responded by pointing out that even now, when few practitioners do holding therapy, there are dangers in the associated authoritarian belief system—a system that considers disobedience a symptom of poor attachment and holds that once a command is given, a child must be made to comply with it. (This view was the one that led to the death of Candace Newmaker in a situation which was not in itself dangerous unless pushed much too far.)

 During the ensuing discussion, some really valuable comments about obedience were made by Dr. Bradley White, a clinical child psychologist at Virginia Tech, and I asked him whether I could summarize and quote some of what he said for this blog. In his very nice message of agreement, Dr. White commented on how much he has learned about these issues from his own children, but I want to point out that he learned from them because he was paying attention, not because he just happened to be in the same house with them!

Dr. White’s remarks stressed what early-childhood educators call developmentally appropriate practice: the understanding that an action can have different motives and meaning when performed by a child at different times in his or her life. When belief systems or associated treatments assume that all disobedience or noncompliance is pathological, they fail to take developmental changes into account and therefore lack real understanding of what the child’s behavior means from his or her own perspective. These mistakes lead to behavior that fails to provide an adequate model for the child—often at the same time that the adult is expressing concern about the child’s lack of empathy.

Dr. White commented: “If one sees noncompliance as developmentally appropriate and expected, it may simply be accepted and either ignored or redirected. If it is seen as problematic but functional or reflecting a skills or knowledge deficit, it may be helpfully viewed as a learning opportunity requiring extra support including gentle exploration, guidance, and rehearsal of alternatives.” (When adoptive or foster children have had few opportunities for leaning about social behavior and social relations, this viewpoint may be especially helpful. JM) Dr. White pointed out that when child behavior is always interpreted as provocative or manipulative, parents may see punishment as the only suitable  response—potentially damaging the child’s attachment relationship with the adults as well as teaching the child coercive methods for solving problems. Parents’ interpretation of child behavior helps determine how, and how effectively, they respond to the behavior.

Commenting that becoming socialized (understanding social rules and taking the perspectives of other people) takes many years and progresses slowly, Dr. White also made this important statement: “I think we adults are … often impaired at seeing the world through the eyes of a child or adolescent, since it calls for empathic sensitivity and perspective taking, which often don’t come automatically but require effortful focus. Yet from a child’s point of view caregivers are often overly demanding and distracted due to their over-involvement in boring, confusing, or simply weird and senseless adult-level responsibilities e.g. getting the kids to school on time, holding down a job, maintaining order and organization), in contrast to the things  perfectly reasonable kids care about (e.g., eating sweets, sleeping in, grabbing others’ attention with gross/silly/provocative acts, having fun now, and exploring how the world works by pushing and pulling on it and tossing it all around the house and yard, etc.).” In addition, Dr. White pointed out, it’s hard to cope with adult demands when tired, hungry, excited, and so on—“which arguably summarizes at least half of the day of an average healthy young child.”

Neither Dr. White nor I wants to argue that children don’t need to comply with rules and adult requests. Safety alone demands a certain level of obedience and cooperation, because adults often are able to foresee dangers that children know nothing about. The point here is that there are many reasons why a developing  child may sometimes--  perhaps often—fail to comply with adult rules, ranging from the limited abilities of the young child to the budding negotiating powers of the preschooler to the growing autonomy of older children and adolescents.

 From a practical point of view, a partial solution to this problem may be to have few rules and make few demands, but to follow through carefully on the ones you have. A corollary of this would be never to institute a rule or make a demand that cannot be enforced, especially if the issue is that a child is not capable of obeying.  And, of course, working toward a good, mutually supportive and cooperative relationship between adult and child will do more good than all the exertion of authority in the world.

It is a huge mistake to define obedience or disobedience as indications of mental illness or as related to emotional attachment. Thinking in those terms increases parents’ anxiety and makes them feel that there is a crisis that must be addressed every time a child fails to comply. Such anxiety limits the parents’ ability to use the “effortful focus” Dr. White mentioned. It also makes the parents vulnerable to unconventional and potentially harmful ideas about children’s mental health. 

1 comment:

  1. This was a essay I wanted to share with a Facebook group of adoptive parents in Colorado, a state where Attachment (Holding) Therapy beliefs still survive after "restraint as therapy" was outlawed in 2005.

    I personally found that being alert to hunger and fatigue in a young child was one of the most effective things I could do as an amateur single parent. That and timely follow through on consequences.