Thursday 14 July 2011

The relationship mirror

Earlier today I was in the hairdresser’s for 2.5 hours – a perfect opportunity to update my blog whilst doing an excellent impression of a jellyfish.  Those of you who don’t go in for hair colour may not recognise that metaphor, so – just for you, here is a clue:
I have been reflecting lately on how important it is to ensure that there is good communication between parents, when parenting a child with autism.  This is also true when parenting a typically developing child of course, but when autism is in the mix, and especially where you have a verbally challenging child, in my experience, it is crucial.
I think that as parents, and without really realising it, we sometimes fall into dysfunctional patterns of communication that are unhelpful for our family dynamics – such as sniping at each other in front of the children.  We may never really stop to consider the impact of this kind of communication on our children.  So, for example, “As usual – it’s me doing all the cleaning and ironing” could be how Mum expresses her frustration with Dad for not taking an equal share of the housework.
If this sort of throw-away comment is shared in front of a child, the child could easily ‘recycle’ the idea to use as a put down in a subsequent disagreement with Dad – perhaps when Dad highlights that it would be helpful if the child tidies up after himself.  This creates a lose/lose situation – everyone is frustrated and the child is not supported to take responsibility for his own actions.
There are other things that happen in relationships that can become barriers to positive parenting.  Some of these are rooted in our childhood experiences and play out later on when we are adults.  Examples of this can be found throughout attachment theory.  In the early years, parental responses lead to the development of patterns of attachment in children; these, in turn, lead to internal working models which will guide the individual's perceptions, emotions, thoughts and expectations in later relationships.  Attachment disorder arises from a failure to form typical attachments to primary caregivers, which result in the absence or distortion of age appropriate social behaviors with adults.  For example, in a toddler, attachment-disordered behavior could include a failure to stay near familiar adults in a strange environment or to be comforted by contact with a familiar person, whereas in a six-year-old, attachment-disordered behavior might involve excessive friendliness and inappropriate approaches to strangers. 
In ‘The Cradle of Thought’, Peter Hobson shows how crucial interpersonal relationships are in shaping thought.  He points out that attachment studies have shown that ‘……the secure(ly attached) infant has become a child who seems able to turn to inner resources and to have a kind of mental space to think.  Many insecure(ly attached) children appear to be stuck in aggressive or attention-seeking patterns of relatedness, where they live out unsatisfying relationships and have less ability to reflect.’
Interestingly, he also discusses the findings from research that followed up children whose attachment had been assessed early on in their childhood.  Research on these children’s mothers showed that the mothers’ styles of talking about their own childhood relationships were related to the mothers’ qualities of attachment with their infants.
Other patterns of behaviour, whilst not falling into the category of attachment disorder, can disrupt or negatively affect our self confidence and self esteem, as well as our ability to have healthy relationships.
I was discussing this recently with a family I am working with.  Dad noted how living in an all female household had created certain cultural expectations for him as a child.  As an adult, he went on to have certain expectations about gender roles and responsibilities that he considered to be grounded in this experience.  Mum related how she felt the death of her mother at an early age had impacted on the way she saw the world and her response to it.  When we ‘unpacked’ how this combination of patterns of thinking impacted negatively on behaviour and relationships it was really quite revealing.  We were able to start put in place strategies to address what had become dysfunctional patterns of interaction that were impacting on both parents’ ability to parent their teenager.  Parents are now also seeking a referral for Family Systems Therapy to help them look further at how they can improve their patterns of communication.
I really admire these parents for being able to take a good, long, honest look into their relationship mirror.  It takes real courage to be able to look at relationship weaknesses, to put aside resentments that have built up over a long period and to make a commitment to rebuilding trust.
I have heard autism referred to as ‘extreme parenting’ because of the impact it can have on family dynamics.  I know of many families for whom this is true.  Studies of so-called ‘higher functioning’ children with autism show that they can often be more challenging and cause the family significantly more stress than so-called ‘lower functioning’ children with autism.  Research published in the Journal of Autism and Developmental Disorders (Mailick Seltzer, 2009) shows that mothers of children with high levels of behavior problems have the most pronounced physiological profile of chronic stress’ and that the level of chronic stress experienced is comparable to that experienced by combat soldiers (yes, I know…..combat soldiers).
An NAS Information Sheet (2005) states, ‘In contrast to other types of disabilities, parents of children with autism appear to be at greater risk for depression, anxiety, social isolation, fatigue and frustration in obtaining accurate diagnoses and services. Indeed, Bouma and Schweitzer (1990) found autism to contribute more to family stress than did cystic fibrosis.’
Some of the things we put in place in the family I am working with included parents changing their communication style from imperative to declarative (i.e., making invitations to communicate rather than issuing commands and reprimands); ensuring parents are consistently using agreed boundaries and limits; making sure parents are ‘on the same page’ regarding all things parenting-related; using Ross Greene’s ‘collaborative problem solving’ approach to help to address disputes or disagreements; and supporting parents to become aware of their own ‘triggers’ and their emotional responses to these triggers, so that they could take time out to regulate themselves emotionally before trying to resolve any problems/disagreements with their teenager.
We have accepted that whilst the family is working on remediation with their teenager through RDI, there will be a need to put certain compensations into place, to manage any disagreements.  So, for example, the family has developed a set of ‘family rules’, which set out how they want to function as a family - how they want to be treated and treat each other. 
To ensure they are 'on the same page', parents have agreed together :
1.  When one parent begins to set limits with a child, they must follow through with no interference from their partner.

2.  Limit setting techniques should only be discussed when children are not present, after any incident.  Parents should try to come up with a 'game plan' on how to deal with this type of incident, should it happen again.

3.  Children become aware very quickly of what is important to each of their parents, but they also need to know that one parent can't be played off against the other.

4.  Couples need to be seen to agree, and to work towards agreement.  Mixed messages are not helpful.

The family I am working with have regular family meetings where they review their progress in managing family communication.
We do this too in my family.  We also use the family meeting to talk about what each of us individually is good at and what we’d like to work on.  At the moment, Philip and I are both working on recognising when something is beginning to frustrate us.  Eventually, being able to recognise approaching emotional overload should enable us to pause for reflection or take time out before making an inappropriate response.
Although this is mine and Philip’s objective, the whole family are taking part in labelling degrees of emotional response in everyday situations.  This takes the spotlight off individuals and also helps all of us to recognise that everyone sometimes has some degree of difficulty with emotional responses.
Our family RDI Consultant recently shared with us that in her family, they have a white board in the kitchen that they use to leave comments for each other about individual achievements.  She related that Dad had worked really hard on doing some painting and decorating.  Sometime afterwards, he returned home from doing a chore to find that his daughter (who is in the RDI programme) had written – unprompted - on the white board, ‘Great job with the painting Dad – thanks J
I thought this was a lovely way of enabling family members to acknowledge and praise each others’ achievements, to promote supportive family dynamics and to help promote self esteem all round.  Often someone in the family will do something that is appreciated by others but in the hurly burly of life, an acknowledgment slips through the net.
Our Consultant said that the comment from his daughter really made Dad’s day.
In ‘Seven Habits of Highly Effective Families’, Stephen Covey shares an insight that Barbara Bush related to graduating students: ‘As important as your obligations as a doctor, lawyer or business leader will be, you are a human being first, and those human connections – with spouses, with children, with friends – are the most important investments you will ever make.  At the end of your life, you will never regret not having passed one more test, not winning one more verdict, or not closing one more deal.  You will regret time not spent with a husband, a child, a friend, a parent……our success as a society depends not on what happens in the White House, but in what happens inside your house.’
And so say all of us.