Parent-Child ACT
Chris McCurry, Ph.D.
ABCD, Inc.
Seattle, WA
cmccurry@abcdseattle.com
Disclosure
The presenter has a pitifully
small financial interest in two
books in the bibliography
Objectives
 Participants will learn how ACT theory and concepts
help clinicians understand typical child development
and important parent-child transactions
 Case presentations will describe, from an ACT
perspective, presenting problems commonly seen in
child clinical practice
 Research-informed strategies and techniques for
improving child and parent functioning will be
demonstrated
The Referral Path

Children rarely refer themselves

Who owns the problem





The child?
One parent or the other?
The pediatrician?
A teacher?
A grandparent?
Relates to values and goals
The Hairball Model of
Psychopathology
We need an understanding of
Eifert and Forsyth, 2005, p. 4
Early Childhood Development and
Parent-Child Transactions
“Me? I thought you were raising them.”
Attachment

Between about 6 months and 1 year of
age a child will develop certain behaviors
in response to the absence of the
caregiver or the presence of a threat

These behaviors will coalesce into a
predictable pattern marked by general
distress, signaling, withdrawal or
proximity seeking
Attachment

Depending on the caregiver’s response,
a child may reliably obtain relief or not

A child’s “distress behaviors”, shaped
by the parenting environment, will be
subtle or dramatic, clear or ambiguous

Internal Working Models of how the
world operates (safe or threatening,
helpful or unhelpful) will develop
“Individuals whose needs for
security are not met come to view
the world as comfortless and
unpredictable, and they respond
either by shrinking from it or
doing battle with it”
John Bowlby
In Other Words
Avoidance
or
Control
Cognitive Development:
Born Fused and Inflexible

Egocentric

Idiosyncratic / Magical

Literal (psychic equivalence)

Rigid

Binary

Fusion (internal and external)
Under stress, they
(we) will regress
A Common Process:
The Distress Gambit
A child’s distressed behavior invites
(compels) the caregiver to participate in
the distress as a witness, confidante,
cheerleader, task master, lifeguard, or
most commonly, as a rescuer
The Distress Agenda

The child’s behaviors are an
effort to engage the caregiver in
the dance, in order to achieve …

Emotional Avoidance utilizing …


Escape/Avoidance
Attempts at Control
“dog”
Fear
Fear
“Bad”
“dog”
Fear is meant
to feel bad!!!
Fear
“Bad”
“dog”
Rescue
Mom
Cry
“Bad”
Fear
“Good”
“worry”
“dog”
“Bad”
irritation
“demanding”
“Bad”
irritation
“demanding”
Guilt
Mother
More
“Bad”
Yell
More
Stress
“Mom”
“Bad”
Danger!!
“demanding”
Job
Stress
irritation
Spouse
The Limits of Parent Training

Parent Management Training (skill building)
has been shown to be helpful, but parent and
child may have reverted to old patterns at
follow-up

High stress families are most vulnerable to this
erosion positive behavior change

Stress is known to constrict attention and
enhance a negative attentional bias
The Parent-Child Ecosystem
 Parenting is a large and diverse class of
behaviors embedded within a larger
ecosystem or “field”
 Parenting behavior is influenced by distal,
indirect, unhelpful, and (dare I say)
unconscious factors- Setting Events
“It’s a magic potion that makes everything you say interesting”
The Reactive Dance
1.
Child becomes distressed (and regressed)
2.
Child, seeking rescue, acts out his distress in
dramatic, regressed, or confusing ways
3.
Parent becomes distressed (and regressed)
4.
Parent seeks escape from this situation
5.
The immediate goal for both parent and child
becomes escape or control in the present,
avoidance in the future
Mutual Parent-Child Experiential
Avoidance
Held in place by negative
reinforcement, also known as
“the coercion trap”
Tolerance
 Inconsistent parenting leads to increases in
negative child behavior
 Inconsistent parenting is often due to the
parent’s behavior falling under the control of
distal setting events, typically life stressors
 Basic parent “leaning in” and “leaning back”
must be under the control of the child’s behavior
and what the current situation actually calls for
Tubes
Team Captains
A Responsive Dance
1.
Child becomes distressed, regressed
2.
Child acts out; seeks contact, communication,
rescue
3.
Parent is alert to becoming distressed, regressed
4.
Parent models distress tolerance
5.
Parent acknowledges distress with specific
language and connects to cause
6.
Parent orients child to the original goal, to a
solution, or to appropriate coping strategies
Changing The Dance
1. Increase awareness
2. Shift the focus of attention
3. Take values-driven action
Increasing Awareness
Classic Definitions of Mindfulness

Paying attention in a particular
way: on purpose, in the present
moment, and non-judgmentally

Bringing one’s complete attention
to the present experience on a
moment-to-moment basis
More “Active” Definitions of
Mindfulness

“Stepping back from unproductive ways of
coping . . . in order to see more clearly
how best to respond”- Jean Dumas

“An open, probabilistic state of mind…
finding differences among things thought
similar and similarities among things
thought different” - Ellen Langer
Mindfulness Exercises








Observing the breath
Eating
Listening
Smell
Touch
Seeing
Descriptions v. Judgments
Taking your mind for a walk
S.O.B.E.R.

Stop

Observe

Breathe

Expand

Respond
S.O.R.B.E.T.






Stop
Observe
Relax
Breathe
Expand
Teach
Graybar’s First Law of Human Behavior
“All behavior is a message, and a
behavior won’t begin to change
until the person knows the
message has been received”
Validation

Closes the communication loop:
“message received”

Provides accurate and nuanced
emotional vocabulary

Replaces ineffective reassurance in
many situations

Says nothing of the “appropriateness”
of that thought or feeling at the time
Validation



Promotes mentalizing and
undermines fusion and psychic
equivalence
Links outer events with private
events and the wanna-do’s
Articulates the process; both
currently and what’s possible
Validation Strategies

Simple and specific “Ah” statements;
“Ah, you’re feeling …”
 “You’re having one of those ‘I can’t do it’ ideas now”


Identify expectations;
“You thought there would be popsicles”
 “Ah, you want me to carry you now”


“I wonder” statements
“Mommy needs to get mad at you in
a weird calm voice now”
Whole Body
Validation
Shifting the Focus of Attention
 Shift attention from unhelpful
private events to actionable goals
 Breathing and orienting to an
“affect neutral” stimulus as a
“pivotal response”
The Role of Attention
The word “attention” comes
from the Latin attendere,
meaning
“to stretch forward”
As opposed to “vigilance”
Isabelle
 7-year old female
 Diagnosed with Separation Anxiety D/O and phobias:
the word “Zombie”
 Can’t be alone in any room of the house: “Marco Polo”
 Lots of avoidance or trying to control situations
 Mother, Holly, is the primary “dance partner”
Isabelle and Holly’s Dance

The Situation: Any transition or anticipated separation

Setting Events: Holly’s work stress, other children

The Initial Behavior: Resistance and inertia from Isabelle,
then focuses on some stimulus that evokes a pantrum

Holly’s reaction: Cajoling, reassuring, then pleading, then
yelling/threatening

And then...? Holly may angrily physically guide Isabelle
through the transition or Holly may acquiesce to Isabelle’s
implicit demands
For Isabelle’s Mother
 Facilitated Listening
 Tube Awareness
 S.O.B.E.R.
 Validation
 Tolerance
 Child Directed Play
Child Directed Play
Dictionary.com
English
Portuguese

“I’m scared”

“Tenho medo”

“It’s not fair”

“Não é justo”

“I’m a loser”

“Eu sou um perdedor”
Dictionary.com
English
Portuguese

“I’m scared”

“Tenho medo”

“It’s not fair”

“Não é justo”

“I’m a loser”

“Eu sou um perdedor”
Swahili

“I’m a loser”

“Mimi nina loser”
Dictionary.com
English

“Zombie”
German

“Schlangengottheit”
Sterling

11 year-old male

Symptoms of ADHD and O.D.D.: conflicts with father,
Alistair

Binary/perfectionist, avoids school work, lies about
assignments- “I did it at school”

Strong sense of fairness, many rules and qualifiers; “Only
nerds do homework”, “I can’t because…”

Very competitive; can show up as rude, angry, entitled
behavior, especially toward younger brother

Deeply devoted to sports
Sterling and Alistair’s Dance

The Situation: Getting homework started and completed

Setting Events: Alistair’s own history with school, plus marital stress

Initial behavior: Sterling’s avoidance, arguing that homework is
irrelevant to his future

Alistair’s reaction: Argues, debates, throws up hands and leaves

And then…? Sterling’s mother steps in and helps Sterling complete
the work step-by-step
Projective Identification or The Hot Potato: “He who cares least
has the most power”
Rule-Governed Behavior

“Behavior that is controlled by verbal
specification of contingencies rather than by
direct contact with contingencies”

Enormously helpful: “Don’t eat those, they’re
poisonous”

And, behavior based on rules tends to be
insensitive to feedback from the environment:
e.g., buying lottery tickets
“And then it hit me: I’m salivating
over a x#!m% bell”
Defusion Exercises

Naming and cataloging

Emotional vocabulary

Boats on a river

Matt Smith
Common Categories of Private Events
Sterling
Alistair
 “Scorekeeping”
 Impatience
 Frustration
 Frustration
 Impatience
 Worry
 Worry
 Regret
Emotional Vocabulary

Angry

Annoyed

Frustrated

Belligerent

Indignant

Dudgeon
Defusion Exercises

Naming and cataloging

Emotional vocabulary

Boats on a river

Matt Smith
Matt Smith is a big, fat idiot.
OK
“Homework is irrelevant
and stupid”
OK
“It’s not fair”
OK
“This kid will never learn”
OK
Taking Values-Driven Action
 Orienting away from avoidance and control of
thoughts and feelings and toward the goal
 “Oh, yeah. What were we trying to accomplish
before all this commentary showed up?”
 “When you’re going through Hell, keep going!”
 Willingness vs “wantingness”
Commitment
 A pledge or promise: obligation
 The act of committing, pledging, or
engaging oneself
 The motivational story we tell
ourselves
 The choice to limit our choices
Commitment and Acceptance:
Two Sides of the Same Coin
To Be A Good
Team-mate
Effort,
Frustration,
Sacrifice,
Thoughtfulness
Commitment and Acceptance:
Two Sides of the Same Coin
To Be A Good
Student
Effort,
Frustration,
Sacrifice,
Thoughtfulness
Commitment and Acceptance:
Two Sides of the Same Coin
To Be A Good
Brother
Effort,
Frustration,
Sacrifice,
Thoughtfulness
Commitment and Acceptance:
Two Sides of the Same Coin
To Be A
Good
Parent
?????
More Defusion Exercises
 Passengers on the bus
 Goggles
Fiona

15-year old female

Anxiety by Hx- now emerging depression;
low mood, low energy, anhedonia

Starting to “try out” cutting

Somatic: stomach aches, migraines

Lots of school absences

Comprehensive avoidance/paralysis
around school work

Few friends
Fiona’s Family

Older brother in the military, recent deployment to
Afghanistan

Parent-Child conflicts around school and Fiona’s
“attitude”

Parents frantic and ineffective when not simply
preoccupied- Mother with worry about brother, father
with recent unemployment

Parents anxious and paralyzed: don’t know when to
push and when to yield
Strategies For Fiona and Parents

Facilitated Listening

Contingency and Sensitivity

Tolerance

Chess Board

Choices and Decisions

The Distraction Paradox
 Valued Living Questionnaire (behavioral
activation and parent-daughter time)
Acceptance
 “Be equal to your fate”
I Ching
 “The Fates lead him who will.
Him who won’t, they drag”
Seneca
Strategies For Fiona and Parents

Facilitated Listening

Contingency and Sensitivity

Tolerance

Chess Board and losing an important piece

Choices and Decisions

The Distraction Paradox

Valued Living Questionnaire (behavioral
activation and parent-daughter time)
Fiona’s VLQ (partial)
Importance
1–10
1. Family
7
Goals
2. Social Life
9
Goals
3. School
4
Goals
4. Physical
3
Goals
/Health
Walk with mother twice
Skype or email brother
Eat lunch with Sarah
Put pictures of cat on FB page
Meet with counselor
Plan for completing late work
Walk with mother twice
Eat some fruit daily
Carl Gustav Jung
“Life’s truly important
problems cannot be
solved, they can only be
outgrown”