Long Post Describing How to Manage Children's Behavior with Nurturance

This long vignette is meant to try to articulate what I do as a therapist that I really value but that is often lost in our current world of parent management training, behavioral therapy, and evidence-based treatments. I'm happy to respond to comments or questions.

A family comes in wanting parent management approaches to help with their young son who is aggressive. The mom herself is anxious. Like all parents who come into my office, she feels like an utter failure as a parent and is exhausted. She wants immediate answers, concrete solutions. There is also a younger sister who is so sweet and cute and is sometimes hurt by the boy.

Once in the waiting room, the siblings are fighting over a toy, and he impulsively punches her. Mom snaps at him and gives him a stern look that crosses into contempt. She then turns away from him to soothe her daughter. She looks at me mortified and states that this is what happens all the time. He bows his head in shame, which the mother does not see. I do, but I don’t do anything. I’m just as bulldozed by how quickly this happens and don’t know how to respond.

A few weeks later, a similar thing happens. The siblings are fighting over a toy, and the sister throws her jacket at her brother. He immediately starts to pummel her and she falls to the floor. Everyone is shocked again. The sister starts to cry, stands up and goes to her mom to be comforted. Mom looks contemptuously again at her son and looks at me in disbelief and deep embarrassment that her children act up so much in public. 

The son bows his head again in shame.

I gently kneel next to him, stroke his back, and say with some urgency, "I saw what happened. You didn’t mean to hit your sister, but she threw her jacket at you and before you knew it you were punching her and now you feel really bad about it! I can see that.” 

He bows his head further and then minutely reaches up to grab the hem of his mother’s jacket. She doesn’t register such a light touch. 

I say, “Now you wish your mom would comfort you too.” I say this loudly hoping that his mother hears me and turns to him. 

She doesn’t. He walks away and plops down into a chair. 

I move next to him and keep repeating, “It’s okay. It’s not your fault. It happened really fast and you started punching before you even knew it.” 

He says, “Yeah, I didn’t mean to punch her. It all happened so fast.”

Mom whips around to look at us in utter disbelief, because he usually just laughs, continues to provoke, or denies that he did anything wrong. She says, “He’s never said anything like that before! How’d you do that?”  

Then, we begin weeks of me working with mom in the sessions, teaching her to read her child’s emotions and behaviors to reveal his underlying shame and anxiety. Initially, he finds this work incredibly anxiety provoking and he becomes very agitated to the point that I spend two full sessions having to restrain him physically because he begins to punch his sister. I restrain him while saying, “You’re energy is becoming too intense and you are losing control of your body. I’m going to help you stay in control because I need everyone to feel safe in here.” I teach him belly breathing during the restraint. We do 5 belly breathes and then I release one limb to see if he can show me that that limb is relaxed like wet spaghetti. If he starts to tense up we start all over. If he can keep that arm calm then I praise him and we do 5 more breathes to see if we can calm another limb. We go until he is fully released. 

He immediately becomes silly again and pretends to punch his sister, so I have to restrain him again. We have to repeat this cycle maybe 5 times in a given session. I’m struck by how intentional this feels, especially because he doesn’t really punch her and is looking at me when he does it. He’s turned this into some kind of game. He doesn’t fully resist being restrained and seems to find some comfort in it even while fighting it. At the end of the session, I praise him for practicing self-control with me. 

By the end of two sessions like this, he says that I’m hurting him and wants me to hold him more loosely. I comply and relax my grip enough so that he could easily just pull away if he wanted to, but instead he says, “that’s better” and let’s me continue to hold him. He is tiring of the game and begs to be released without going through the relaxation procedure. When, I refuse, he begins to cry in a full way, out of exhaustion, frustration, and who knows what else. I start to feel really bad for him because it is a pitiful cry and I don’t like putting him through such a trial. I let him go and he falls to the ground and continues sobbing. 

I’m struck by the fact that he doesn’t turn to his mother and his mother is also sitting there frozen and confused. Remembering his reaching out for the hem of her jacket, I instruct her to reach out to him to comfort him. She kneels down to touch his back somewhat awkwardly. He does not respond and continues to cry. She drags him up and puts him on her lap. He’s very big for her lap so the position is awkward. Nevertheless, he lets out another big cry and collapse into the comfort. 

For the next few sessions, we work on teaching mom to catch those moments when he needs comfort and to work harder to reach out to him. She also continues to work on naming what she sees happening to him in the moment in a way that is nonjudgmental and more focused on naming emotion and intention. 

He begins to transform. He begins to talk about anxiety and tell us when his anxiety is starting to get higher and when it starts to calm. When we start sessions, his mom might want to talk about bad behaviors at school, but he whimpers, “No, no! I don’t want to talk about it! It’s making me anxious!” And we learn to stop and focus on regulating his anxiety instead of shaming him into compliance. 

Nowadays, his parents are completely focused on understanding his bad behaviors as stemming from incredible anxiety. He himself spontaneously said this amazing thing, “when my anxiety gets too high, I start to punch my sister, and I really don’t mean to. I’m sorry I do that.” He and his sister now team up against the Anxiety Monster. She protects him from ghosts and they practice exposure exercise games together, like walking through the hallway alone or staying in the waiting room by themselves when he is afraid that a scary monster might get him. 

His mother also proudly shared that she is beginning to learn to help him better on her own. One day, she promised to pick up a special treat and give it to him when she came to pick him up from school. She forgot. He began to tantrum right in front of all the other parents and the teachers. In the past, she would have been so mortified by his public tantrum that she would have either mollified him with a promise of future treats or reacted harshly to try to stop the tantrum. Instead, she said, “You’re angry at me for not bringing you the treat.” He nodded, she apologized, and the tantrum ended. Simple as that: no behavior management required. No rewards, no consequences. Just reconnecting in the relationship.

For me, the true highlight wasn’t what this mother had done. Instead, it was the fact that she recognized that her own anxiety needed to be controlled first and that she stayed calm under one of the most anxiety provoking situations for her (public shame). And, most importantly I felt proud because she was proud of what she had done, , because at core, this mother feels like the worst mother in the world and she fights the same demon of anxiety and self-loathing that haunts her son. So, as she heals her son, she heals herself; and as she heals herself, she heals her son. And, her courage and bravery stands out above all else as the thing I’ll cherish most in my memory of them.