The first day of school is upon us, and many children are returning to school or starting their first day of kindergarten. This is a stressful time for children (and parents). Separation anxiety is common in school-age children. It is characterized by persistent or excessive worry about separating from a child’s primary caregiver. This translates into the dreaded emotional drop-off, a child who won’t get out of the car, they are pulled, tearful, into the school building only to scream as their parent walks away. We’ve seen it or we’ve been “that parent” only to return to our car and have our turn at crying. Not fun for anyone.

Even if your child isn’t excessively worried about going off to school, some of these techniques can ease the transition.

• Normalizing: Express to your child that he isn't the only one nervous about the first day. All of his classmates will be feeling some level of anxiety. Let your child know that his teacher is aware of this and will work to make sure everyone feels comfortable. Give examples of previous situations where your child has been nervous for something new but was able to manage these feelings successfully.
  

• Use a transitional object: Choose an object that your child can take to school. A locket with a parent's picture, a special stone to keep in a pocket and touch when feeling scared. A reassuring note from a parent that the child can read while at school. Choose this object together so that your child feels a sense of ownership. Ensure that it’s something that won’t be a distraction to other students.
  

• Validate: Let your child express fears about the first day, help him to articulate if there is something specific worrying him. Validate his fears rather than dismissing them.
  

• Plan ahead: If your child is especially fearful or has had difficulty with transitions in the past, meet with the teacher or school counselor before the first day of school. Together you can put together a plan for the drop off. This may include your child starting with the counselor, then transitioning into the classroom, or having the school counselor meet you at the curb to walk the child into school.
  

• Reassure: Convey optimism about what school will be like, new friends, new learning opportunities, recess!
  

Lastly, be aware of your own feelings. Are you as scared about your child leaving you as he is? Your child may be picking up on this, and reacting to it. Try and talk through these feelings with another adult (not your child) so that you can be emotionally available to your child. If your child is struggling to transition into school, know that it’s normal and for most children is resolved in the first few weeks.

Sometimes I can hear it in a parent’s voice when they first call to make an appointment, the trepidation, the guilt, the anger. “My kids is out of control.” They may describe a child being suspended from school or day care, or being tearful all the time. Often times the root of these concerns comes down to emotional regulation.

Emotional Regulation is a skill that isn’t innate, we learn it, we watch those around us for cues on how to do it. It takes practice, just like anything else. Generally we get better at it as we age. Think of a newborn, the response to pain, sadness, unmet needs is all the same, crying--it’s the only form of communication they know so far, and it’s highly effective. As children age they develop more sophisticated ways of managing strong emotions. In play therapy I see it as one of my primary goals to teach children feelings identification and expression. I use role plays, sand tray, puppets and games to accomplish this.  A child who acts aggressively or loses control and throws crying fits are still trying to fine tune how to express “big feelings.” I often see this in the school setting, teachers are frustrated with children who act out, and typically these same children struggle with social connections because their emotions are so unpredictable. If you are nodding your head, thinking, that’s my boy! You are not alone. This is a very common concern parents report during our first visit.

Parents tend to feel instant relief just reframing this concern into a need for skills, rather than just “bad behavior.” As I stated, emotional regulation is learned. I suggest that parents begin with this one subtle intervention.

- Label emotions for your child
For example, your daughter sulks away to her room and avoids everyone in the house, she begins crying and kicking the wall. You might say “You seem like you might be sad about something?” This not only validates her feelings and shows that you are noticing, but it may put a word to a complex emotion she is feeling. This is a starting point for regulation emotion, connecting the feeling inside your body (lump in throat, tears, weight on your chest) to the emotion.

As adults, we forget how difficult it can be to navigate life as a child when “big emotions” do come up. Typically, by the time we are adults we’ve accrued quite a toolbox of things to do when we are upset or overwhelmed. Children are just building this tool box. When they are faced with events in life that stir up an emotional response (whether that’s something as simple as not liking what’s for dinner, or the death of a parent) they are using the tools they have so far. Life tends to constantly feed us experiences where we learn more effective ways to cope, kids are on that road too. 

As a child therapist it’s my job to join them and provide some hands on ways to improve these skills.

Infertility and Father's Day--typically not a holiday many of us look forward to who are dealing with the difficulty in building a family. KSL recently featured an article I wrote on this very topic. Read on....


SALT LAKE CITY — First, a few caveats: I am not a father, or a male.

Despite this, I am married to a man, and together we survived many a childless Father’s Day. Additionally, I work as a therapist with couples experiencing infertility. Therefore, I will do my best to shed some light on infertility experienced by men via my perspective.

I have found, both personally and working with couples through my practice, that infertility grabs at the very essence of a relationship and tears away your future plans.

Undoubtedly men experience all the same feelings anyone dealing with infertility does — inability to plan one's future, difficult decisions about family building, financial strain, feelings of loss, watching friends/family experience parenthood, anger, and even shame.

But just as women experience infertility layered in our inevitable cultural expectations, men have their own version. They are not limited to: “be confident, be strong, don’t cry, be interested in a family, but don’t show emotion if it doesn’t happen.”

Even for men who don’t ascribe to these values, the undercurrent of these messages in our society is palpable.

Couples are keenly aware of the subtle stigma related to being unable to reproduce. It seems men often feel “less of a man” if the couple experiences male-factor infertility. This feeling is not exclusive to men.

If infertility problems aren’t spread evenly between the couple, one person undoubtedly feels “it’s my fault.” That fault can feel heavy for men who perceive that they are standing in the way of their wife’s dream. Men may feel helpless, their inability to “fix” this problem of infertility somehow chipping away at their confidence. The shame they may feel often translates to “something is wrong with you.”

The factor I see most commonly in men is the desire to support their wives rather than being able to show the very real grief and loss they too are experiencing.
Not to mention the awkwardness of providing a sperm sample, then hearing the results. Men may experience a shift in their sex life with their partner. For example, being intimate “because it’s time.” Men and women are often on different timelines in their family building plans. It seems men sometimes take a slower, conservative approach and may feel pressure from their wife to proceed with testing/treatment/adoption.

But the factor I see most commonly in men is the desire to support their wives rather than being able to show the very real grief and loss they are too experiencing. This is a shame, because although there are certainly some feelings inherent to experiencing infertility as a man, many of the core beliefs and experiences are shared between couples. Because who doesn’t need a companion (or two) while riding the roller coaster of infertility?



Whitney Barrell, MSW, LCSW, holds a master's degree in social work from the University of Utah. She is an "infertility survivor" and enjoys working with couples experiencing infertility. Find out more: www.whitneybarrellcounseling.com.

Emotional Aspects of Infertility

A subject near and dear to my heart, infertility. Some of the most important work I do is with women and couples around infertility. The following article is from Resolve, the National Infertility Association. If you aren't familiar with their work , skip over to their website here. They are an excellent resource for information on treatment, testing, support group (on-line and in person), books on family building. They also have an active advocacy group who work with congress to extend the adoption tax credit and work towards infertility treatment being cover by insurance. 



One of the most challenging aspects of the infertility experience is dealing with the emotional ups and downs relating to medical treatment, the uncertainty about outcomes, and the challenge of having to make important decisions such as when 'enough is enough.' It is important to learn how to take care of yourself, make sure you that get the support you need, and to manage your emotions so that your self-esteem and outlook on life remains as positive as possible.

Loss 
What does a couple who has just been diagnosed with a fertility problem have in common with a couple who just had their fourth miscarriage? The level of anguish may not be the same, but these two couples do have a lot in common: a sense of loss and disappointment, and the feeling of emotions and events being out of control. For both couples a basic assumption-that by being decent people who try hard in life, your wishes will be fulfilled-has been shattered.

Symptoms 
Even if your mind isn't consciously thinking about loss, your unconscious mind and your body may be responding to feelings of grief. Do you recognize any of the following symptoms that either appeared or worsened during your infertility experience:

• lack of energy (especially when you have an unsuccessful cycle on medical appointment days or when you will see a pregnant friend);
• headaches;
• irritability (snapping at people or making mountains out of molehills);
• insomnia.
• extreme sadness.
• inability to concentrate.

The best way to get back to "business as usual" is to take care of the emotional business at hand. And there's nothing wimpy about healthy grief work - it calls on all of your courage and resourcefulness. A Zen proverb says, "The way to control a bull is to give it a big pasture." Paying attention to grief ends its power over you. Give grief its due and you'll find the energy and concentration to get on with your life. See a mental health professional if you feel that infertility is making it hard to cope day in and day out.

Denial, Shock and Numbness 
After several months of unsuccessful attempts to get pregnant or stay pregnant, feelings of shock or numbness may result. Feelings of "this can't be happening to us" or "I know next month we will be successful" begin to change over to anger and guilt.

Anger 
Anger usually results from feeling vulnerable or helpless or both. Helpless feelings result from the lack of control that you may feel over your life plan, your body, and your future. This may be a new experience; previously, when you worked hard at something, you probably achieved your goal. Now you are working hard and doing everything you can to conceive, but without reaching your desired goal. A sense of vulnerability evolves from feeling "jinxed," or feeling that life isn't fair. You may feel as if you can no longer count on anything good happening in your life.

Anger can consume you, coloring your everyday thoughts and experiences. You may feel emotionally guarded, pulled between tears and sadness or anger and rage. The next time you feel angry, irritable, or frustrated, take an inventory of your body and identify how different parts of your body respond to the angry feelings. Do your legs feel weak? Does your heart beat faster? Do you feel flushed or shaky? Does your breathing change? Become familiar with how you react physically to these intense emotions.

Remember that anger is a normal response to infertility. You may find it helpful to try some of these techniques to manage angry feelings. There is no "right" way to do this; don't force it, and don't expect a specific response. Tears and feelings of sadness often mingle with anger.

• Take a blank sheet of paper and list all of the things in your life that you are angry with
• Get active physically
• Express your anger but use "I feel" statements rather than attacking a family member of friend.
• Talk about your anger with a counselor or therapist who can help you process and deal with your emotions.

Guilt and Shame 
Shame is a searing, painful feeling associated with faltering self-esteem, and a sense of inadequacy, defectiveness and helplessness. As repeated attempts to get pregnant come to naught, there is a realization that this intensely strived-for goal has not been, and may never be, attained. As this failure becomes more and more evident, one's self-image is assaulted. It is easy to move from procedures that have failed to the feeling that "I am a failure." Anguish, self-doubt, and chronic sadness converge as couples come to think of themselves as failing, not only in realizing their own dream to reproduce and nurture, but failing their spouse, parents, and siblings as well. Because shame embodies the painful sense of self-defect, it is often hidden and disguised, even from oneself. The tragic story of chronic infertility is that, over a period of time, the sense of failure gradually and imperceptibly spreads like a shadow over a person's experience, while simultaneously the sense of other competencies gradually become obscured.

Ultimately what heals is the acceptance of the self with all of its weaknesses and failures. The goal, then, is to reach a point where you can accept what you see as failure and no longer have to conceal these feelings of shame. The process of coming to terms with infertility is long and gradual, but it is possible to transform the sense of failure into an empathy with yourself, an affirmation of your strength, an acceptance of your limits, a pride in your endurance, and maybe most of all, an empathy with others who, as partners in the human condition, also face defeats. In time, the shadow cast upon your life can fade and the light can shine through again.

Hello, 
I'd like to share a short video on one of my favorite topics. The intersection between neuroscience, therapy and parenting. It features two highly regarded researchers and professionals in this field, Dr. Bruce Perry and Dr. Daniel Siegel. These findings help guide my treatment planning with children who have experienced trauma. Enjoy!

Good Day, Welcome KSL readers! Today KSL has published an article in which I outline the common reasons that parents bring their children to therapy. I also attempt to decrease some of the stigma related to child mental health.  Head here to read it! Or, I've also provided it below. 

Could my child benefit from therapy?

For the majority of children, the answer is no, but if you are wondering, read on.

As parents, our primary goal is to nurture and protect our children. When we consider that our child may benefit from mental health intervention many of us feel overwhelmed, guilty or ashamed. But this need not be the case. Life happens, and it happens to children too.

Therapy is a safe place to explore difficult events from the past or learn new life skills. Play therapy has some similarities and some differences from traditional talk therapy.

For example, we know that children make sense of the world through play. Additionally, their cognitive mechanisms are not fully developed yet and therefore focusing interventions purely based on talking and the use of language is less effective. We use play to bridge this gap.

When we consider that our child may benefit from mental health intervention many of us feel overwhelmed, guilty or ashamed. But this need not be the case. Life happens, and it happens to children too.
Play therapy relies on parents' input and cooperation. You know your child better than anyone else. You have the relationship and opportunity to best assist your child. Consider the therapist as a coach who provides instruction on things to do at home.

Many parents wonder if their child may benefit from therapy. There are several common reasons parents bring their children to be seen.

1. History of trauma or abuse
   
   If a child has been a victim of abuse it is to his or her benefit to process this information sooner rather than later. There are many evidence-based interventions that have proven effective in decreasing the impact on children. Their brains are still developing and learning ways to make sense of violent or abusive events and therapy helps them to re-organize and regulate better, both now and as an adult.
   
   Additionally, we often consider trauma something significant — for example, surviving a natural disaster — but more commonplace events such as car accidents or even dog bites have undoubtedly traumatized children. Often times if this is the case, you may see children re-enacting the event in their play. For example, making toy cars crash over and over again. This is a sign that they could benefit from intervention.
2. Difficulty in peer relationships
   
   Social and emotional health is a very important skill that children are learning during school years. School can also be a place of anxiety or loneliness for children who lack these skills. Conversely, children who are aggressive toward others often feel alienated. Successful peer relationships are a predictor of quality of life into adulthood. Individual and group therapy can provide a practicing ground for relating to peers in a healthy way
3. Emotional regulation difficulties
   
   Often when teachers or daycare providers give feedback to parents such as “he is aggressive toward the other kids," or "it’s her way or the highway” they are ultimately referring to the ability for children to regulate their emotions. This is a learned skill. In fact, the parts of our brains responsible for reasoning and problem solving are not fully developed until we are into our 20’s. Despite this, children can learn tools and exercises to help identify and express feelings appropriately.
   


4. Divorce or stepfamily building
   
   When families separate or new families develop, children may feel powerless because those decisions are not their own. Additionally, it’s very common for children to have a loyalty to both parents. Children benefit when parents are able to co-parent in a healthy way. This is, of course, easier said than done when any relationship ends there is inevitably pain, grief and sometimes anger. Play therapy with children focused on divorce or family building often aids in navigating this road.
   
5. Something else that just doesn’t feel right
6. We have intuition — sometimes we notice subtle changes in our child that we can’t articulate. Maybe his or her mood has shifted, perhaps there is an underlying anger brewing. At times, exploring this with a play therapist can ensure that we aren’t missing something.
   

Lastly, children are resilient. Early identification and treatment will prevent the loss of critical developmental years. Researcher Emmy Werner has identified children that are “active, affectionate and good-natured” are better able to cope with stressful life situations. Providing your child with the tools needed to work through this sometimes unpredictable world will benefit them for years to come.

Whitney Barrell, LCSW, has a master's of social work from the University of Utah. In her private practice she enjoys working with children and families on myriad mental health issues. She can be reached atwww.whitneybarrellcounseling.com.

Hello out there! I am a frequent contributor to KSL, Family Focus and other news organizations with a focus on family and mental health. What follows is an article I wrote which was originally published by KSL, WorldNow, Gatehouse Media Group and Fox NY on February 11, 2014. Enjoy!


Are you the type of parent who prefers rough and tumble play with your child or working together on artwork? Something in between? Regardless of what style of play you prefer, folding in some play therapy techniques can offer long-lasting benefits. Play therapists relying on the evidenced-based practice of child-directed play use letting the child lead, the sportscaster technique, limiting “teaching moments” and the use of labeled praise to improve relationships.

Dr. Gary Landreth and Dr. Sheila Eyberg pioneered child-directed play therapy. It's use focuses on improving the parent-child relationship as a means to improve the child's behavior. These techniques are typically used with children ages 2-7.

Researchers have long known that a good parent-child relationship (sometimes called a secure attachment) has lasting effects. Children in preschool and elementary school who have a history of secure attachment continually exceed their peers in regards to competency, empathy, feelings identification, social skills and self-confidence. Therefore, child-directed play seeks to strengthen this relationship. But these techniques don't need to be reserved for play therapy only. What parent isn't interested in instilling more self-confidence or empathy in their child.

Let the child lead

Child-directed play is most effective when used with games that involve imagination, or at least those without rules. For example, board games aren't amenable to child-directed play, but any type of artwork, role-playing games, blocks, games using figurines (animals, dolls) work perfect. If you see your child is engaged in this type of play, join them, but let them be the director.

The pace of a child's play can be slower than adults are used to, so be patient. Sit back and use behavioral descriptions (explained below) as a way to participate. If they want you to join them, ask “which animal should I be?” Resist the urge to make suggestions or impact the direction of play. This is a role reversal for parents and children, and when it's in a safe, contained environment, let your child be the guide.

Act as a sportscaster

One way to let children know what they are doing is important to you is to use the sportscaster technique. This means using behavioral descriptions. Narrate your child's play as it's happening. Say “you choose to use the pink crayon.” Or “I noticed you are really focused on making a circle.” This communicates to children that what they are doing matters and that you are present with them. As adults this would bother us, and we'd question why someone was narrating our every move, but you'll be surprised how much your child eats it up.

Abandon your instinct to “teach”

Rather than jumping in during blocks and asking questions such as “what color is this block?” or “how many red blocks do you see,” focus on observing behavior and describing it. This is easier said than done. Many parents use every opportunity to teach their children. During this time, the focus is on letting the child direct the interactions.

Use labeled praise

We are quick to praise our children, but try using labeled praise, meaning specific, descriptive praise. For example, “I like the way you didn't give up when you were frustrated” rather than “good work.” When joining your child in play, look for opportunities to point out good decisions they've made, creative problem solving or examples of pro-social choices. By using labeled praise, children will gain a greater understanding of what your expectations are.

Additionally, when you are closely observing your child, it's easier to pick out what you are impressed with and give your child feedback rather than when you are distracted by your to-do list.

Play is the language children use to communicate their feelings. By using some of these techniques with your child, you may be privy to subtleties that are easily overlooked. Channel your inner child and enjoy.

Whitney Barrell, LCSW holds a Masters Degree in Social Work and owns a private practice primarily serving children. She has extensive training and experience in working with young children. 

Original PostCopyright 2013 Deseret Digital Media, Inc.

Welcome to my newly established blog. I plan to use this space to provide  you with relevant mental health information about topics such as coping skills, play therapy, addressing relationship issues and other interesting research. Please feel free to comment and join the conversation. Thanks for stopping by!