Is your child ready to speak?
Jarrisvette Villarreal, is from South, Texas in the United States. She worked as a Speech language Pathologist Assistant in Brownsville, Texas and then moved to Spain to pursue a Masters in Bilingual and Multicultural Education at la Universidad de Alcala in Alcala de Henares. She has been living in Span for 4 years and working as an English Language assistant with a variety of ages within the school system. She is currently working as a Speech therapist at Sinews and is excited to be a part of the team.
Do you notice that your little one is not yet speaking? Are you asking yourself why? Have you done a lot of research on how to promote talking, but can’t quite make it happen? Maybe we should take a step back, and ask ourselves if they are ready to talk? Have they acquired the pre-language skills that set the foundation for words?
As babies grow, their abilities change. Babies are like sponges; they absorb so much during their first years of life. They go from newborns who mostly sleep to walking, talking toddlers. This doesn’t happen overnight; there is a lot that happens in between these two phases, called “baby steps.” Little by little, they are going through minor changes every day and learning how to become these walking, talking toddlers. We always celebrate the big changes, like them producing their first word or taking their first steps. It’s incredible to witness the little ones learning and growing, but it’s easy to overlook the minor changes. These minor changes are what lead to their walking and talking, they are the skills that build the foundation for words and steps to happen.
We know that each baby is different and develops at their own pace, so maybe not every single one of them will hit that milestone mark at the, “said age.” However, there are still certain skills that a baby should acquire before they reach that milestone. Some children might need some extra help and guidance to gain these skills.
Pre-language skills
Pre-language skills are prerequisites for speech and language. They are a set of skills that should develop alongside one another in both normal developing children and children with language disorders. These skills might not show up in the same order in every toddler, but they will show up before language emerges. These skills are what children use to communicate before they are able to form words. Pre-language skills must be consistently present, and stable in order for the child to be ready to talk.
How will I know if my child is ready to talk?
Lucky for us, Laura Mize, Speech Language Pathologist, has an awesome detailed podcast series that thoroughly describes pre-language skills. She talks about “11 skills a toddler must use before words emerge.” She helps us understand what they are, how to identify them and why they are important.
The pre-language skills mentioned in her podcast are:
- Responds to events in the environment: do they notice things around them? Children must be able to process things they hear and see. They must be aware of their surroundings, and react to it.
- Responds to people: are they interested in people? Children should interact with people. They’ll respond when you call them by name, or look for you, so you can play with them.
- Develops an attention span: attention spans in toddlers are typically 3-6 minutes long. They can notice something and are interested in it. They stay with it for a while and give themselves the chance to see how it works.
- Exhibits joint attention: they can share the moment. They can use a toy with you, and shift their attention from the toy to you.
- Plays with toys: toddlers learn through play and using toys. Toys are meaningful to them. Do they know how to appropriately play with the toys? For example: rolling a toy car on the ground.
- Understands and uses early gestures: Do they communicate with their bodies? Can they wave bye-bye, nod yes or no, follow a point?
- Understands early words and follows simple directions: Do they recognize names of familiar people or things they use every day? If you say “Where’s dad?” or “Do you want water?” they will understand.
- Vocalizes: Are they noisy? Toddlers should make intentional and purposeful sounds with their voice, before they can even speak.
- Imitate actions, gestures, and words: They copy what you are doing. They use a toy the same way you use it, they clap when you clap.
- Initiates interaction: They take the lead to try and get your attention. They want to play with you, they try to get you to look at them or grab something for them.
- Turn taking: They are able to play back and forth. They can roll a ball or a car back and forth.
These are the 11 skills a toddler must develop before they start talking. Each one of these skills are essential to language development. Toddlers must have these skills firmly established in order for words to flow.
You can listen to the first part of the podcast clicking here and to the second one clicking here.
How can I help prepare my child for words?
As a parent you know your child best. You know what they are able to do and what they are not. You must be able to identify if these skills are present, consistent and strong in order for language to emerge. If one of these skills is missing, or isn’t strong, those are the skills you need to target and strengthen to prepare your child for words.
Questions we should ask ourselves when trying to determine how to help our children talk:
- Which of these skills are present in my child? Which aren’t?
- Which of these skills show up consistently? Which of them only every once in a while?
- Which of these skills are strong? Which need some extra work?
We must determine which of these skills need reinforcement and which ones need to be introduced. Once we know what to target, we can work with our little ones to prepare them for words.
Should we go to a speech therapist?
Some people will tell you “don’t worry words will come on their own, he/she is still young”. While that might be true sometimes, that is definitely not always the case. It’s great that you’re getting informed and learning more about how to help your child. You are the expert on your child and know them best, so if you have a gut feeling to seek help, there is no harm in that. The earlier children get the support they need, the better their outcomes.
Pre-language skills play a key role in language development. Children must go through all these skills before they start talking. If our little ones are late talkers, we must look at this list and determine what is missing, and work on those skills with them, or seek help from a speech therapist . It is important for us to not skip any steps that will lead to communication. We don’t want to push for words when our little ones aren’t ready yet. We need to set them up for success, by giving them the tools they need for language. Once we attain these eleven skills, we can focus on speaking words.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Possible challenges about being a parent of a child on the Spectrum
Nerea Arranz is a psychologist focused on children and young people, with extensive experience in neurodiversity, especially autism and its comorbidities. Her aim is to understand holistically what families are experiencing and work with parents and education to promote their role as agents of change. Her approach to implement interventions is evidence-based, therefore she adapts the intervention to the individual needs and strengths of each person.
Most people say that being a parent does not come with an instruction manual, this becomes even truer when one or more of your children live in a world that has not been designed for them, this is the case for autism. This blog aims to introduce and name a number of challenges that may arise when autism is part of your family. It is not intended to be an elaborate and complete list where we all have to fulfil criteria; these are challenges that might be experienced or not by parents. If you are a parent of an autistic child and have not related with what is raised in this blog or feel that other challenges have not been mentioned along the way, we would be delighted to hear from you, because every comment, opinion and shared story opens up new queries and helps us to understand more about the diversity that exists in autism.
What do we mean by autism?
Autism is a condition with its strengths and needs that affects the way the brain processes information from the environment, and therefore, how autistic people relate to it. Autism is considered a disability and is listed in the DSM-5 diagnostic and statistical manual as a neurodevelopmental disorder. There are many myths about autism, but a key one is to understand that autism is not linear. You don’t have more or less autism, you are either autistic or you are not.
This image proposed by @autism_sketches aims to help us understand in a visual way how to recognize this condition that implies a challenge to live with, but also inspires, awakens curiosity, compassion and opens our minds to understand different ways of communicating and experiencing the world around us:
Autism in itself is a challenge and when it is the first time it happens in a family, it is accompanied by intense and deep feelings, to the point that it could be described as overwhelming. It is likely to generate doubts and big questions that will accompany you throughout the development of your son or daughter.
We are all different. There is no such thing as the «right» way of thinking, being, learning or behaving. Autism falls within the concept of Neurodiversity, which describes differences in neurodevelopment, alongside strengths and challenges. Neurodiversity is also a social movement that seeks to reduce the stigma around conditions such as autism. Autistic people like to use terms such as neurodivergent or neurodiverse to refer to this differentiation in brain development. A development that changes and affects different areas of a person, and that will vary over time.
So, what are the challenges that parents may face? Here are a series of questions that you may have asked yourselves or, if you are beginning to notice differences in the development of your children, you may be asking right now:
1. Why is this happening to me?
The first and one of the biggest challenges is to understand what autism means for your child and to accept that it is happening. A common saying is that sometimes we cannot see things we do not understand and, therefore, recognizing that your child is showing signs of a developmental differentiation is in itself a challenge. Especially because of the uncertainty it creates. But also because it is very likely that you have already imagined a life with your child that you are now being told you will not be able to live. This is often experienced as grief. In this process of acceptance, there are some bumps in the road, one of them is that the cause of autism is unknown. Not being able to understand the origin of things, generates lack of control, and this lack of control can end up freezing our ability to face what comes after, how we live the present and therefore how we behave with our children who we did not know were going to be as they are.
What could I do?
- Hearing from those with neurodiversity, they know first hand what autism can mean. Autism is a lifelong condition, this means that there are not only children with autism, there are adults with autism. Among these adults, we find a number of people whose aim is to raise awareness of neurodiversity and therefore we have at our fingertips first-hand information of how it could be to live with this condition. Here you have some resources: 45 Autism Youtube Channels For Autistics And Autism Parents, A list of autistic bloggers and YouTubers, A Story Of Undiagnosed Autism and different Stories from the Spectrum.
- Meeting other parents who are also going through a similar moment or who have already gone through it. In other words, participating in a community where you will find understanding and knowledge. One way to find these families, is to connect with specific autism spectrum associations where you live. If you are not yet at that point where you are able to talk about the reality in which you live, you can always start by reading or watching how other people describe the experience of being a parent of a child with special needs. This video is about a story and here you have a playlist with plenty of videos of the autism spectrum.
2. This is called the autistic spectrum, so what now?
While trying to process this grief there is at the same time a clear demand, the need to seek support and services that are going to help your child. The idea of being able to make a decision about what is best for your child, without yet understanding what is happening to them, is challenging in itself.
Therefore, seeking services and support can be a complicated and daunting process, as there are many options and it is not always easy to know which option is best for your family. Among those paths in which a parent finds himself/herself, there is the path of trying to make your child look like the others, which is the aim of certain type of therapies, those that understood autism as something to be corrected. But there is also the way to accept that one can be different and work from those strengths. To teach him/her skills that are going to help him/her to live in the society we live in, but without changing fundamental aspects of his/her being. In order to be able to distinguish what the different treatments offer, and what can be better for your child, it is necessary to understand more about autism and what it means to your family.
In addition, to help autistic people, parents must be involved actively and directly in using strategies in every aspect of the routine, sometimes almost every minute of the day. This is very difficult to juggle with other demands of adult life. Many of the services and possible treatments are also not available for free, so cost and availability will also play a role in the level of help each child can receive.
That is why the phrase «less is more» is important. Start small with what you can get involved with (routine and stability, play, communication, sensory, etc.) and take some time to get to know and trust those people who want to guide you in how to support your child. Consistency will be key, but if you do not trust what they recommend, it will be hard to find the strength to keep trying strategies that will never work right away. It takes time and perseverance to start seeing results, so it is best to take it one step at a time, because there will be many aspects to cover.
For exploring different number of treatments or where to start:
3. How far will it change the life I imagined?
On the journey that starts after recognizing that there is a difference and after hearing the word autism, we find another challenge. How to balance family life and the life of the autistic child: Autism is often accompanied by inflexibility, it is in fact one of the diagnostic criteria. This inflexibility, especially during childhood, will lead parents to have to tolerate or introduce changes in their daily life that they did not expect. In addition, it often falls on brothers or sisters who are more tolerant or have a greater capacity for waiting and understanding.
The difficulty of achieving this balance can generate feelings of helplessness, pain and anger. As well as an opportunity for parents to develop unimaginable skills to meet the needs of different family members. The change in the way parents face day-to-day life will help to find that balance, to be able to observe and differentiate how to promote the autonomy of the child and to identify what things need to be done for him/her instead of to him/her, will bring us closer to that balance.
All this entails a cognitive burden for adults, which may be accompanied by a feeling of exhaustion, which generates rejection or the need to move away from the family nucleus to seek respite or perhaps, on the contrary, an activation and reactivity where others are not allowed to take care of your children. Many professionals place great emphasis on self-care, but the reality is that in the beginning it is very difficult to find that space to take care of yourself and to accept that you will have to sacrifice hopes and wishes in order to ensure that your child achieves his or her full potential, while making sure that no one else in the rest of the family goes unnoticed, including yourself.
It is important to consider the idea that giving your best will be enough to build a world you did not expect, step by step.
4. Why don't others understand me?
Among all these feelings, there is a major challenge and that is the emotion of loneliness. Autism is becoming a more common condition as its incidence is increasing, but that does not mean that your family and friends know or understand what you are going through.
The unpredictable behaviours that often occur when an autistic child has to face a new place are like a constant reminder that your family is different. Therefore, activities such as going to the park, dining out or visiting a museum, places where there are other children with apparently expected development, will remind you of what you are not experiencing.
The neurodiverse community has a long way to go in terms of advocacy and sharing the existance of more than one way of experiencing the world. Therefore, those behaviours that are atypical for us are also valid. In this website you can check more information on neurodiversity.
Everyone, maybe including you, will have experienced rejecting the unknown at some point. This means that on many occasions, as a parent of a child on the spectrum, you will experience rejection and discrimination first hand. You will have to try to be able to separate that those feelings that others share with you, those looks or comments have more to do with how they are feeling and not so much with you. Being able to separate what might be arising from ignorance or fear will help you to cultivate courage on your journey.
Being brave enough to speak up in a society that is not designed or familiar with neurodiversity is not easy, and may take years. Remember that, although you could raise awareness about autism, it is a responsibility that you do not have to impose on yourself. There are always different ways that may work best for you, although they often include seeking help from others, whether professional or informal support, which might change that feeling of discomfort, which many refer to as loneliness.
5. But what is considered atypical behaviour?
Neurodiversity entails behaving in a way that is not usually accepted or expected in the social and cultural context in which the child finds him/herself. It is common, in the course of their development, for autistic children to exhibit what is known as challenging behaviour. The first thing to understand is that this word does not refer to the child as being defiant, but to the fact that his or her behaviour is a challenge to the adult. The responsibility for managing these behaviours lies with the adult and therefore the challenge lies in being able to understand and manage these behaviours. The emotions they generate in adults and how to respond to them is one of the greatest challenges of neurodiversity.
As you become more familiar with what autism will mean for your family, I would like to propose a series of questions you can ask yourself when these behaviours occur. When you do not understand something, your child has done, you can ask yourself:
- Is this autism?
- What is happening in the environment? is it predictable enough for him/her? Could this be related his/her sensory experience?
- How many demands has my child perceived today?
- What happens when he/she acts like this? Does this behaviour help him/her to get something out of it or does it help him/her to avoid something?
- What is my role in mantaining this behaviour?
- What skill could my child learn to reach the same outcome, but in a way that is less challenging for me?
- What can I do next time to prevent it?
Explore more about challenging behaviour in this website or this other website.
To conclude, I would like to name what Dr. Stephen Shore, autistic American professor and advocate for autism once said:
If you know one autistic person, you only know one autistic person.
Just as autism is experienced so differently from person to person, this is also reflected in the challenges that each parent will face. It is important to remember that this is not something you have to do alone, that you could seek support to explore those questions that autism raises for you as a parent, and to look for practical ways to implement on a daily basis that will enhance you family quality of life.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Film review: God's Crooked Lines (2022)
The successful novel written by Torcuato Luca de Tena in 1979 has reached the big screen taking the same name of the book that has managed to hook readers since it was first published. Luca de Tena, with Los renglones torcidos de Dios or God’s crooked lines, takes us into a psychological thriller in which the reader will not be able to stop reading as questions will swirl around in his mind and he would hardly be able to leave those questions unsolved for the next reading. The film, on the other hand, engages the audience with the main character’s discourse -logical and very organised, which will generate new inquiries. Flashes from the past will make us reflect on the veracity of the facts.
Synopsis of the movie
The novel, and its eponymous film, tells the story of Alice Gould, a private investigator, who is admitted to a mental asylum on behalf of a client in order to clarify the circumstances of a murder. To do so, Alice documents herself about a mental illness, paranoia, and she pretends she is suffering from that illness. Recall that in the era in which the novel is set, wives had to ask their husbands for permission on certain things, getting Alice to trick her husband into signing the application for her admission to the sanatorium.
Throughout the pages and minutes of the film, readers and audiences will be making decisions about the reliability of what at one point seemed very obvious, the sanity of the main character of this story. But for the author of the book and the director of the film, sanity and insanity are separated by a very thin line.
Comparison with reality
According to the author of the novel himself, in order to write the book he had to voluntarily commit himself for 18 days in a psychiatric institution to be able to adjust to the reality of what was really living within those walls. Finally, in the dedication included in the book, he wants to thank the entire medical community for their work and tenacity to «straighten out» those crooked lines of God, the patients. Those patients who met himself and on whom he got inspiration from.
The main interest that this novel can generate in society lies not only in a simple leisure activity, but also in the progress that psychiatry and psychology have experienced since the time in which this thrilling story is framed. The different illnesses or conditions of the patients shown in the film and the book, bring mental health closer to anyone outside the field of health, although in some cases not in the most accurate way. The reader or the audience will be able to experience the close relationship between mind and physiology, the different techniques that were used for different disorders and even how patients were treated in these institutions. Nowadays, all of it may seem abusive or unacceptable for the audience but we shouldn’t put the spotlight on that. On the contrary, we should focus on the advances that have been experienced in those fields to preserve dignity and security of patients without depriving them of the inherent freedom to the human condition.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Why should you go to a nutritionist?
According to the regulation of healthcare professionals, a Dietitian-nutritionist is the healthcare professional legally qualified to perform diet and food-related activities for patients (always individualising the recommendations according to the physiological and/or pathological conditions), and to provide nutritional advise and treatment.
Currently, we live in the era of information, and it is becoming increasingly easier to find food-related advice and recommendations in magazines, newspapers and, of course, on the internet. However, it is very important to take into account that not all the information available out there is reliable and up to date. What it’s more, all of this flood of information is very ambivalent and what according to a source is beneficial, it appears as the opposite in a different one. This is why you can find arguments to support a position as easy as to disprove it. Hence the importance to attend a dietitian-nutritionist who will provide with individualised recommendations and always with scientific evidence.
What exactly is a dietitian-nutritionist?
It is very often that when people hear the word “Nutritionist” the first thing that comes to their mind is “lose weight” and “dieting”. However, a dietitian- nutritionist is a healthcare professional whose functions go far beyond this, as they are experts in nutrition and dietetics who not only manage the nutritional treatment in a wide variety of conditions and the nutritional approach in all the stages of life, but also the quality management, food security and, lastly, the prevention of lifestyle and nutrition-related conditions.
A Dietitian-Nutritionist will provide individualised recommendations not only considering the general situation of the patient, namely age, stage of life, associated conditions and so on, but also other personal situations, such as their culture.
When should I go to a Nutritionist and how can it be helpful?
These are some of the reasons why you should attend a consultation:
- Change of dietary habits to help prevent lifestyle-related conditions such as type 2 diabetes mellitus, hypercholesterolemia or hypertension, as well as contribute to the nutritional management once diagnosed. In these cases, nutrition is the first line of action, and even when pharmacological treatment is necessary, nutrition is still a key part of the treatment.
- Specific moments in a woman’s life such as pregnancy or breastfeeding. In these stages, the nutritional requirements are increased, and it is essential to ensure an optimal nutrition intake from all macro and micronutrients.
- Nutritional approach in all different stages of life from childhood to advanced ages in both health and disease, and always considering the singularities of every different stage.
- Infant nutrition. Dietary advice in transitioning from exclusive breastfeeding to solid foods, that is, how and when to introduce the different solids gradually. Also, with the baby-led weaning (BLW), which has been on the rise in recent years: precautions, benefits and inconvenients, which foods and how to cook them, textures and much more.
- Optimisation of the sports performance in order to adapt recommendations according to the type of sport discipline and individual requirements as well as to assess potential needs for supplementation to enhance performance.
- Gut disorders: fructose and sorbitol intolerance, Small Intestine Bacterial Overgrowth (SIBO), non-celiac gluten intolerance, celiac disease, Chron disease or ulcerative colitis.
- Nutritional management in other conditions such as renal disease or cancer. Also, in hormonal problems such as hypothalamic amenorrhea.
- Learn how to eat healthily and nutritional education. You do not have to be sick or have a specific situation to attend a Nutritionist. Sometimes a person might just want to learn how to eat better and make a habit change.
- Vegetarian diets. Either due to animal welfare reasons, the environment or because of other personal arguments, sometimes a person decides to reduce or eliminate the animal-derived products from their diet to some extent. In any case (ovolactovegetarian, vegan…), a nutritionist can assist in making the transition progressively, and can also provide alternatives to substitute all these products for other plant-based options to make sure that all the important nutrients are covered.
In summary, our health is very important and for that reason we should always aim to find qualified healthcare professionals to always make sure that the dietetic recommendations will be coherent, evidence-based and individualised depending in the individual circumstances.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
A Superhero therapy tool kit to help your children cope with difficult situations
Superhero therapy, is that a thing?
Janina Scarlet PhD, adapted an evidence-based therapy called Acceptance and commitment therapy (ACT) and turned it into the superhero lover’s dream. To help children and adults manage their symptoms of depression, anxiety, post-traumatic stress disorders and other mental health conditions. ACT and Superhero Therapy’s objective is to help people learn to have a healthier, more flexible relationship with their thoughts, feelings and other significant private events. Which in turn will allow them understand who they want to be and to move towards what is truly valuable to them.
Working on values with children can be a very challenging task given its abstract background. Asking children or teens to do what is important above all pain or discomfort might seem impossible. Fortunately, That is where superheroes come in handy. Using an ACT framework, a therapist can help a patient relate to a fictional superhero, understand that superhero’s origin story and discuss how that superhero has overcome many of their own challenges (probably social, emotional or psychologically related) by taking actions toward their values (Washington, 2019). Prompting children to connect with a superhero’s story will allow them to play with different perspectives which can help them clarify what is important to them.
So how can we use superhero therapy in our everyday life?
Ideally, superhero therapy should be used as a guideline for evidence-based therapists to use with children or adults in session. However like Marvel Comics creator Stan Lee said, “The person who helps others simply because it should or must be done, and because it is the right thing to do, is indeed, without a doubt a real superhero.” So grab your cape and lets bring out our superhero within.
1 – Find a superhero your children can relate to. Can you think of a superhero or a character your child can relate to? It can also be their favorite character, it does not have to be a superhero in a strict sense of the word. It can be any character in their favorite book, movie or series. It can even be a family member or a person in their life they admire. A character that might have an origin story or a struggle they can relate to.
For example, for Dr. Scarlet it was Storm from X-Men. When she was very young, Dr. Scarlet was exposed to a nuclear explosion because she lived in a small town near Chernobyl. This had incredibly debilitating effects on her health. To make matters worse, her symptoms where heavily influenced by the weather, if it was hot outside she would get severe nose bleeds, if it was humid she would get migraines or seizures and so on. When she was twelve her family decided to move to the United States, thinking the situation would get better being away from radiation but there she faced other types of struggles. In school her new classmates could not understand what she had gone through. She had to endure intense bullying, she was called radioactive or contagious, her peers were afraid to touch her or be near her. This made her feel completely alone and depressed but it all changed when she watch X-Men. The “Super mutants” made her feel less lonely specially when she discovered Storm a superhero who could control the weather. A superpower she always wished to have since her own struggles depended on the weather.
Is there any superhero that could make your child feel a little less alone in the world. A character they love or admire? It can be Batman, Ironman, Hulk, Harry Potter, Katniss Everdeen, even a Disney princess, a character from Encanto, Frozen and anime series. Anything you can think of.
2 – What is their superpower? Try to find out what is it that your kid loves so much about this character. What superpowers do they have. What struggles have they faced and what have they needed to overcome them. What are they like, what characteristics have hook you child to this character. This is a conversation you can have with younger children too, they might not be as clear as older children but if they tell you they like batman because he is good at getting out of trouble there are a couple of characteristics you can take away from that, like smart, problem solving, quick, strong. There is always something behind the obvious answer, this superpowers might be the window to your children’s values.
3 – Superhero diary. Once you have found the superpowers your child looks up its important they are translated into actions. Find a way you and your child can be a little bit more like Superman, Batman, Elsa, Katniss or whoever you have chosen. To make it more fun think of them as special missions and write them down in a Superhero Diary where your child can draw or write all the things they have done like their superhero so they can come back in difficult times and remind themselves all they are capable of.
4 – Find a Superhero Mentor. Every Superhero has a sidekick or a mentor who supports them during their missions. Batman has Alfred, Harry Potter has Ron and Hermione, Ironman has Jarvis, Katniss has Haymitch. Encourage your child to find a sidekick or a mentor it can be a family member, a friend, a pet or even a therapist or a counselor. Sinews can be a great source for counseling, we great group of child therapists that will gladly jump at the chance to be a superhero mentor.
5 – Every superhero journey starts with a struggle. Last but not least remind your children that all superheroes have an origin story that usually involve some kind struggle. Batman lost his parents, Harry Potter not only lost his parents he had to endure the horrible family he had left, Hulk was exposed to radiation. This stories turned them into the superheroes they are, the struggles helped them develop the incredible superpowers that we all admire. So if your children feel like life is a little daunting remind them it will turn them into amazing superheroes.
References:
Scarlet, J. (2017). Superhero Therapy: Mindfulness skills to help teens & young adults deal with anxiety, depression and trauma. New Harbinger.
Washington, K. (2019, April 25). What is superhero therapy?. Denver Health Blog. https://www.denverhealth.org/blog/2019/04/what-is-superhero-therapy
Sinews MTI
Psychology, Psychiatry and Speech Therapy
The importance of setting limits and how to do it: children and adolescents
We encounter daily situations of «disobedience» on the part of children. It is normal and necessary that it happens when the child is in the moments of consolidation of his individuality. And even more so when dealing with people with whom the emotional involvement is intense, so we should not feel like victims.
There are always difficulties and contradictions when educating children but let us keep in mind that the lack of consistency and clarity in transmitting the rules makes children insecure and nervous (more crises, tantrums, and whims). Those who live with the child must agree on the rules and educational guidelines that will be asked.
If disobedience is continuous, we should think that the child is not happy and that he/she is asking for help.
Why do they sometimes provoke us?
The child loses limits easily, which distresses him, so he calls the adult to see if the same thing happens to us and to know with our example how to react. What reassures him/her is to see our security (it is not that he is asking for a spanking to calm down).
As adults, we must adapt our authority to the new individual who is growing up, with his own desires and rights that come up against the limitations corresponding to the desires and rights of others.
What are boundaries for?
Throughout their growth, children need limits and rules that help them know their possibilities, how far they can go, and what is expected of them. It is about providing a frame of reference and not so much about what to do when the child becomes «impossible».
Limits help them grow, while punishments create anxiety and low self-esteem. Through them, you can teach your son or daughter self-discipline; he or she will learn to deal with his or her own responsibilities without being reminded, developing strategies to impose limits on himself or herself.
The first limits have to do with the care provided to the baby in the attention to his basic needs, and allow him to differentiate little by little what he is from what others are, the internal and the external, with which he will be able to advance in the organization of his personality.
Limits will also help the child learn to deal with uncomfortable emotions such as frustration, anger, boredom, or sadness. Every boundary is an opportunity to learn to manage emotions.
Through boundaries, we teach our children that we care about them. Very often, children test limits to see how adults will react. Implementing negative consequences for breaking the rules shows that the adult is not letting the situation get out of control, creating security in the child.
Thanks to limits, he/she will learn to be able to postpone the immediate satisfaction of his desires, which favors coexistence and socialization. They will also be able to advance in their autonomy, from the external control provided by the adult to the development of their own criteria, being responsible for their actions and self-control.
How to set boundaries?
When setting boundaries, we must consider certain factors that will help us to do it correctly:
- Be clear that limits are necessary for the child.
- Be calm when we request or prohibit something from the child, so he/she will be more willing to comply with what is asked of him/her. That is to say, do not wait to set limits when they have already exceeded our patience.
- If the child reacts to a small frustration with a tantrum, we must wait until it passes, restrain him physically if there is a risk of injury, and then put into words what has happened («you got angry because of…»).
- When we forbid something, we can offer the allowed alternative. Knowing how to give him alternatives helps them learn to decide.
- It is better to select and establish the highest priority that we are going to ask for and wait until it is achieved, rather than trying to make him respect new rules. Neither wear out our authority in the face of unimportant details nor fall into the extreme of «let them do it» for everything.
- Offer explanations or reasons to justify the demands («it can break… «you can hurt yourself… «it is not yours…») without trying to justify ourselves.
- Do not try to discuss the reason for the limit. It is enough to give a reasoned explanation of the expectation we have, sometimes silence is a powerful tool.
- Few commands, but clear and expressed in a positive way (negative commands invite rejection, create more resistance and desire to transgress them). In other words, express what you want, not what you don’t want.
- Make sure that the rules are appropriate to the child’s maturity level (make sure that the child understands them) and that they are coherent, not contradictory or arbitrary. And also, they must be true.
- The limit must be set in time and the child must be made aware of it, and even know how much time he/she has to react to the proposed rule. We cannot always demand immediate obedience as soon as we try to set a limit since we are not looking for a submission but for learning.
- Involve your son or daughter in the creation of limits or house rules. In this way, not only are they motivated to follow the limits and routines by having participated in their creation, but they are also learning problem-solving skills.
- Let’s try not to mix up the different situations; it’s not the best time to «teach» rules when we spend time having fun through play and conversation.
Setting boundaries in adolescents
In adolescents, being able to set boundaries is one of the best ways to improve communication and build more trust, thus reducing conflict. At this age, knowing how to set and shape boundaries (perhaps from when they were younger) forces you to recognize the fact that your son or daughter is growing up and needs the control established when they were younger to be loosened and adapted to their new circumstances so they can mature.
It is especially important in adolescents that the limit be very clear; the following formula can be used:
Limit or rule (what is not allowed) + exceptions to the rule + consequences of not complying.
Important points to keep in mind when setting limits for adolescents:
- Be consistent with the rules, it is especially important to agree with everyone in the house on what the limits are and not to forget to apply the consequences. Adolescence is a period in which it is normal to try to find inconsistencies in the rules we are given in order to break them.
- Allow them to understand the natural consequences of their actions and decisions. Many times, it is not necessary to set a limit but to make your son or daughter understand that he or she will be responsible for the consequences of his or her actions. For example, if their actions result in a financial cost, they will be responsible for paying for it with their own money, or they will do a chore around the house that is monetarily equivalent.
- Respect in the same way you want to be respected. Adolescents are beginning to create their own identities and understand their place in the world, and to do so they need to feel respected as individuals by their parents. It is through mutual respect that we manage to set limits that they themselves choose to respect.
At the end of the day, we have to remember that rules and limits are essential, but from the support, affection, and above all the understanding that makes us understand the struggle between complying with certain rules and limits and the child’s need to assert their independence and autonomy.
We must find a balance between the socialization of our children and their need for affirmation, autonomy, and independence. It is from here that they will be able to face the negative emotions that appear throughout their lives without having to recur to alternative ways (alcohol, drugs, violence…) to manage them.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
After Lucia: Grief, Bullying, and Violence
After Lucía is a Mexican production that deals with issues such as bullying and violence in the classroom in a raw and cold way, intertwining this main theme with problems such as grief, lack of limits in adolescents, and lack of emotional management skills among many others.
The film tells the story of Alejandra, who moves to Mexico City with her father after the death of her mother in a traffic accident in which she was present. There, a series of events is unleashed that give rise to bullying that escalates until it explodes. The tragic death of Lucia, the mother, has turned Roberto (the father) and Alejandra into vulnerable beings, who have not yet overcome their grief. Hence the title of the film, since this vulnerability is a facilitator for the bullying to occur to such a high degree, the protagonist not being able to count on her father as a source of help and support.
The film takes care of disconcerting the viewer, using a very slow and realistic narrative, in which we slowly get to know Alejandra, and together discover all the hardships she is going through. At times one might think that such coldness in the face of suffering is impossible in young people, but reality can surpass fiction.
Unprocessed grief
In the first half of the film, we see several scenes in which the director subtly reflects the lack of a healthy processing of Lucia’s grief. The first scene shows how Roberto picks up the car from the accident at the mechanic’s shop and leaves it abandoned on the street, with no explanation to the viewer as to what is going on. We also see how Alejandra says that her mother stayed in Porto when asked about her, or how Roberto does not want to use the same things from the old house. Through these examples of avoidance in the face of the impossibility of facing reality, in addition to small details and many walls of silence and sudden explosions of emotion, Michel Franco lays the foundation on which all the subsequent violence is maintained.
The Bullying
Alejandra’s relationship with her classmates begins as normal, a new girl who joins the popular group, they go to a party, drink and do drugs together and she has sex with one of them, who records everything. Here we begin to see Alejandra’s self-injurious behaviors, who agrees to be recorded without imagining what could happen next. The virtualization of the video at school is the trigger of harassment that increases exponentially, going from verbal annoyances to physical and sexual violence and social exclusion, being ignored, while she suffers all kinds of mistreatment. In addition, it is seen how electronic devices facilitate the rapid increase in harassment.
To understand the film, it is necessary to look at the phenomenon of naturalization of violence in schools, which is becoming more and more established, becoming a «normal», «everyday» violence.
Causes and consequences of bullying in After Lucia
We see how Alejandra’s relationship with her father is apparently good and «relaxed», which is in reality quite fragile and superficial, with no trust and based on lies and cover-ups, making the protagonist more vulnerable. She has no support to defend herself, recently orphaned from her mother, with a father who doesn’t know how to devote quality time to her, being the new girl who needs friends no matter what. There is also latent guilt in Alejandra for the death of her mother, which is never explained to the viewer; this guilt may be the cause of the passive attitude she shows in the face of harassment, almost implying that «I deserve it».
Where are the adults?
Something that is very evident throughout the film is the lack of adult presence, not only on the part of Roberto who does not find out until the end of what is happening to his daughter but also from teachers and parents of other students. There is a scene, in which we see how they mistreat Alejandra on her birthday after a class in which we do not see a single adult intervene in any way, although this happens inside a classroom of the institute. Neither in meetings at classmates’ homes nor on school trips, do we hardly see the presence of adults setting any kind of limits.
The social tribe
One of the greatest complexities in adolescence is the codes generated among peers. One of them, latent in this film, is that denouncing is equivalent to exclusion since the one who takes it «puts up with it». Alejandra abides by these codes fiercely, being the moment in which she lies when asked directly what is happening at the point of no return. Here the aggressors are aware of their impunity and everything begins to unfold at breathtaking speed.
We also observe the establishment of roles and the desperation to get out of the role of the victim. We see at the beginning that one of the boys in the group is the one who fulfilled this role before Alejandra arrived, being an overweight adolescent. As soon as the ban is opened to harass the protagonist, this is one of the characters who harasses more strongly, since he sees the opportunity for someone else to take the role he had been playing until now, and feels that he belongs to the group in a stronger way.
The consequences of bullying that we see in Alejandra are evident: anguish, sadness, isolation, social phobia, learned helplessness, anxiety, suicidal ideation, and depression. The aftermath of bullying usually accompanies people into adulthood, resulting in depressive adults, with a tendency to addiction or prone to develop a psychological disorder.
Conclusion
After Lucía is not an «easy» film but a hurtful, uncomfortable, and raw film that makes you feel the hopelessness of the protagonist and generates feelings of anguish, helplessness, and rejection. The great achievement of this film is that it makes you feel the pain of the characters. The viewer finds himself wanting it to end or for something to happen that generates some kind of justice… and the ending will not leave any viewer indifferent.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Attached, a book to better understand your love relationships
Love is, without a doubt, one of the subjects that have fascinated us most (and tortured us, in equal parts) since the beginning of civilization, but also one of the great scientific questions: how does love work and, above all, why do we fall in love with whom we fall in love? In psychology, one of the theories seeking explanations, investigating, and solving, in part, these enigmas is the attachment theory.
The beauty of this theory is that if we know our attachment style, we can also resolve some of the love contradictions we fall into and make better romantic decisions. For example, «Why is it that if, in general, I consider myself a confident person, the moment the guy I like behaves distantly with me, I feel terrible and like I’m worthless?». Perhaps someone else is wondering: «I normally have no problem falling in love, but why is it that when the relationship becomes steady, I start to find they have too many flaws and decide to break up quickly?»
First, let’s put this theory in context: Initially, the study of attachment was not related to romantic relationships but to the bond that arises between infants and their parents or affectionate caregivers. In 1958, Bowlby, an English psychiatrist working in a hospital with children, coined this term when studying the effects of the mother-child relationship on the infant’s cognitive, emotional, and social development. Even if their physical and nutritional needs were met, the babies who had been prematurely separated from their mothers (because, for example, they were orphans during the Second World War) suffered serious consequences in their cognitive development due to the absence of contact with their attachment figure.
Thanks to this theory, we learned that when we are born, we need the protection of an adult to meet our physical needs – such as food and shelter – but, above all, we need the bond to feel loved, cared for, and comforted when our nervous system and stress response are activated.
It was not until much later, in the late 1980s, that Cindy Hazan and Philip Shaver helped us understand that the need for attachment is not unique to children. The security we feel or don’t feel in our romantic relationship also awakens our attachment styles. To put it simply, the bond created in our relationship with our parents functions as the blueprint for understanding our expectations in our future intimate and social relationships.
In this book, ‘Attached’ by Levine and Heller (2010), they take an in-depth look at how our attachment style influences the romantic decisions we make.
As children, people with a secure attachment style learned that the world was a stable, predictable place. They felt they could trust the people around them to be available whenever they needed them. That is why they tend not to feel much doubt in their romantic relationships. They feel comfortable showing themselves vulnerable to the person they love. In general, they feel deserving of such affection.
In contrast, people with an anxious attachment style grew up in an environment in which their physical and emotional needs were met ambivalently or intermittently: at times, they were there to care for them, and their affectionate caregivers understood what they needed, and at other times, they were not there or did not feel available to them. As we know, infants’ primary goal is to ensure their proximity to their attachment figure. That’s why children with an insecure-anxious attachment developed a very adaptive strategy to achieve this: to get even closer to their attachment figure especially when their caregiver moved away. As an adult, if you identify with this style, you probably criticize yourself a lot. When the person you like is distant or ambivalent, their attitude generates a lot of anxiety within you. To calm yourself down, you seek to get even closer to them. Please do not criticize yourself or call yourself «desperate» remember, in the past; this was an adaptive way to survive.
People with an avoidant attachment style learned that their caregivers might reject them or be distant from them. Therefore, they learned to rely only on themselves and not count on anyone else because if they were too trusting, they were afraid of being hurt later on. In their romantic relationships, they say they want intimacy and closeness, fall in love easily, and have no difficulty having intimate sexual relations. However, as soon as they deepen a relationship, they are afraid of losing their independence and become distant.
This book helps us identify our attachment styles and, from that knowledge, to take steps to find relationships that «heal» us. Specifically, it explores in depth the affective needs that each style possesses. For example, people with an anxious attachment style will need frequent contact, stability, clarity about what the other person feels, etc. Having these needs is valid, and more than that, it is essential to be aware of them and seek romantic relationships that are aligned with those needs. If we validate our own needs and communicate them openly, we will observe how our partner reacts and if they are ready to meet our needs (or not). From there, it will be easier to decide to prioritize relationships with people who offer us a secure base and transmit the affection and trust we need so much.
In ‘Attached’, we can have a first approach to attachment theory and how it influences our romantic relationships. But, in this book, several issues are left out; for example, the book does not reflect examples of LGTBQ+ relationships. Nor does it attempt to explain how attachment styles would influence polyamorous or non-monogamous relationships.
In any case, I think this book is an excellent start to reflect on your romantic choices and catch yourself on toxic patterns before they happen.
Good luck on this journey finding healthier relationships!
Division of Psychology, Psychotherapy and Coaching
Psychologist
Adults and adolescents
Languages: English and Spanish
“Nine perfect stangers” and the danger of pseudo therapies
The premise of this Amazon Prime series is simple: nine people go to «Tranquilum», a peaceful and luxurious resort in California, which promises healing and a change in their lives in a few days. But almost nothing is as it seems. As a mental health and psychological wellness professional, there are many reasons why I recommend this series.
First of all, because of the characters which are all very well designed: they are all people with very different backgrounds and different life stories. Among them I would highlight a family that has not yet overcome the terrible grief following the suicide of their eldest son three years earlier, a best-selling writer in the dumps both professionally and personally, a depressed former elite athlete, bitter and addicted to painkillers, an insecure and angry recently divorced woman, a young couple newly rich thanks to winning the lottery living a very shallow life. Also the character who is the director of the center, Masha (played by Nicole Kidman), shows us a very complex person, who faces serious traumas from her own past. In general, through the experiences of the characters who come to Tranquilum in search of healing and improvement, we see very serious problems such as mourning for the loss of a child, suicide, loneliness, post-traumatic stress disorder and depression.
I also recommend it for the moment we are living in.
The growing need for mental health services is a clear trend in Spain and in the rest of the world and that undoubtedly has been increased by the effects of the pandemic. For this reason, I believe that “Nine Perfect Strangers” is a series that, aside from its undeniable cinematographic qualities (it has a first-class cast, a fast-paced script, and manages to move in a rather crazy but always successful way between comedy, drama and a thriller) is seen with different eyes today, since it hits close to home for many people. After all, the pandemic has made visible the large number of people who suffer and need psychological or psychiatric care. Also why isolation, loneliness and suffering have increased and in the series, despite the wrong environment, the protagonists initially experience something similar to support thanks to the fact that they are sharing their experiences and traumas with other human beings who have suffered and need help. The impact of sharing our experiences with other people is well recognised as a healing process in group therapy, although the way this is done in «Tranquilum» makes any healing and improvement impossible.
Among the few unorthodox therapeutic methods used in Tranquilum is the use of hallucinogenic drugs. Without a doubt, it is a much more niche trend in the real world, but it is not non-existent or new for this reason. Although there is debate in the academic world about the scientific evidence that in very controlled contexts and in very small doses, the consumption of certain substances, under the supervision and guidance of a qualified mental health professional, can help in the therapeutic process, the series shows us the dangers of the uncontrolled use of hallucinogenic substances with supposed curative purposes when it is done in excessive doses, without supervision or with the supervision of the wrong person, who is not qualified. In general, in everything related to the use of hallucinogenic substances, prudence is what is called for.
Finally, in the series we also see reflected an increasingly widespread trend in many areas of life but especially dangerous in mental health: the search for quick, almost miraculous solutions to our problems. The lack of time in modern life encourages solutions of this type and it is precisely where professional intrusiveness and pseudoscience sneak in, profiting on the suffering of people, promising the impossible, even without having the qualifications or the knowledge suitable as a professional.
In the end, the characters (actually victims) instead of going to a psychologist or psychiatrist and facing a slow but effective path, prefer to believe the promises of a guru with hidden pretensions who tells them that she will heal them in just a few days. They accept being drugged in an uncontrolled way to face their pain, fears and obsessions. For all this, in addition to being an excellent audiovisual product, intelligent entertainment, «Nine Perfect Strangers» is a series that highlights, in contrast to the dangers of pseudoscience and «alternative» treatments, the importance of the work that mental health and emotional well-being professionals perform, more necessary than ever in the face of the great demand for mental health that the population requests.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Movie Review: The Break-up (2006)
“The Break-Up” is an ideal movie to understand the inner workings of relationships. It is about Brooke (Jennifer Aniston) and Gary (Vince Vaughn), a couple who decide to put an end to their relationship after some years together, which then leads to a series of circumstances: the fight for who keeps the apartment they shared, and later, the way they both go through this breakup.
A scene that is key happens at the beginning of the movie, where the couple has an argument over superficial matters. Brooke accuses Gary of not helping her wash the dishes, and then continues saying that he never buys her flowers or takes her to the ballet. Gary then responds in a frustrated manner, saying he feels like nothing is ever good enough for Brooke and that she will never be happy with it.
This kind of argument can often happen within relationships, and there are times where the couple may not realize the message that is behind the superficial talk.
Within this couple’s dynamic we can observe how one’s thoughts and actions can feed into the other person’s, and viceversa, therefore creating a vicious cycle (or how we call it in therapy: circularity). In this case, if we reduce this dynamic to a simple mechanism, we would see it this way:
Brooke thinks “Gary doesn’t appreciate me”, therefore she feels like she isn’t valued, frustrated and demotivated. Consequently, she tells Gary that he doesn’t do anything for her. This leads to point number 2.
Gary thinks “Whatever I do, Brooke will never see it as enough”, therefore he feels incapable, frustrated and defensive. Consequently he doesn’t try to do things that Brooke would like. And this leads to point number 1.
Within this circularity, it would be necessary to make changes in order to create a new and healthier dynamic.
Moreover, later we see how Brooke does just this, by communicating exactly what she was meaning to get across in the first argument: she doesn’t feel valued or appreciated by Gary. In fact, we can see how Gary is much more receptive to this kind of vulnerable and direct communication, and therefore doesn’t act defensive because he doesn’t feel like it is an attack.
All in all, this romantic comedy is a tool that can show us how a relationship can become complicated due to dynamics that they can get stuck in and can tend to become chronic. But it can also show us how a small change in the dynamic can open new doors towards change and evolving within the relationship.
You can see the clip of the fighting scene here:
The Break-up Movie (2006)
Division of Psychology, Psychotherapy and Coaching
General Health Psychologist
Adults, adolescents, couples and families
Languages: English and Spanish