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My Parenting Journey – Part 2 (The App Tracking Trap)

From all of my experiences as a child and adolescent psychiatrist, I knew how important it was to set reasonable expectations for myself and my future child. However, knowing, believing, and enacting do not always align! Early in this journey, I found myself getting stuck in the details caused by my baby tracking app. I had been given advice to find an app to track sleep, diapers, nursing, etc. This all made sense to me and seemed like a simple solution to help organizes are newly chaotic lives. While tracking this data has been helpful in some ways, I have found that it sometimes makes me lose perspective. For example, the app will chart out sleep patterns for the baby. I have spent an embarrassing amount of my day combing through the data to try to figure out the “exact right time” to put the baby down for a nap or for bedtime. I even have made a google sheet of data trying to find some “perfect” schedule that will get my baby the “right” amount of awake time, nap hours, and sleep time. I’m sure you notice I have put quotations around the words “perfect”, “exact”, and “right.” This is, of course, because I really truly don’t believe there is a perfect, right, or exact here. I completely have gotten stuck in the tiny details and caught in some perfection trap. Whenever I ask my pediatrician questions about the baby being “OK” or not, the answers are very simple. Is she gaining weight and having enough diapers? That’s it. She does not ask about awake windows, bedtimes, or nap times. Even without those numbers, I can look at her and see if she is calm or fussy, comfortable or in distress. Even though it has only been a few months, there is a true gut feeling and parent intuition that can guide me and tell me whether the baby is truly OK or not. Giving myself some moments of mindfulness, which usually occur during my daily walk, helps bring me back to a healthier perspective. On the other hand, sitting and staring at my phone and baby tracking data does quite the opposite.

So how does this relate to my patients and their parents? Life obviously gets quite a bit more complicated as your kids grow up. You need to focus on a few more details than just weight gain and poopy diapers 😊 However, I believe that our parental focus can still be more zoomed out and focused on the big picture than it often is. With my new perspective, I encourage parents to do two particular things. First of all, think of what are the basic things that are important to your child’s wellness? What are those few things you really need to keep track of to make sure your child is OK? You can start with general areas, like physical health, emotional health, and school. Then, consider some basic goals in each area. If your child is not meeting those goals, then start with a smaller goal and know you can always allow them to grow into your more aspirational goals. Next, give yourself daily moments of mindfulness (or, a time and place during which you can think uninterrupted at the minimum) to check in on those goals. I think of this as a daily reboot for my brain. While I may sit and try to draft up a nap and bedtime schedule like my child is an engineering problem set from my college days, when I go on my walks, I drop those details. I remember that she has been gaining weight like a champ (and her adorable baby rolls remind me that she probably continues to do so) and is also a diaper champ (not always my favorite achievement of hers, but still important). My added goal is that she seems generally happy. Judging from the endless smiles and coos we get all day, I can check that box as well. While I would love for her to be on a schedule so there is more predictability in our lives, that is still aspirational. I have not given up on it, but I surely can sleep better at night when I let myself remember each day that she is doing OK. So, parents, give yourselves that opportunity to remind yourself that your child is OK when they actually are doing OK. This way, if they truly are not, you will be able to recognize this more easily and respond to it more effectively.

Lessons learned from a child and adolescent psychiatrist and new mom (Part 1 of infinity 😊 )

For years, I have been aware that, despite all of my clinical training, I just never could really truly understand the experience of parents until I became one. So, while I provide evidence-based recommendations to parents, I was also looking forward to the day I could say “I understand how difficult this is” and really, truly understand it from my own experience. Well, just over 3 months into parenthood, I wanted to share some of the lessons I have learned from my own parenting journey. I will try to write them as I discover them and imagine this is an endless journey.

First of all, “parenting journey” was a very intentional use of language. My baby is changing every day. The tricks that worked yesterday for soothing her or getting her to sleep do not necessarily work today. It is not her fault and it is not my fault. She is not a “bad baby” and we are not “bad parents.” She is just growing and developing and we need to be aware of it and go along on the journey with her. There are many moments that I feel hopeless and helpless after trying to get my crying baby to sleep using the exact techniques that worked yesterday and that are only inciting her more! However, after getting some space from that moment (and a little nap for myself), I have been able to approach my parenting with more self-compassion and to remind myself that this is actually normal. It is only “bad” or “wrong” if I don’t pay attention to her cues and grow and change with her. Otherwise, she is going along her journey of development and I am just left behind.

How does this relate to my own clients and their parents? Parents, remember you are on a developmental journey with your children and adolescents. If some technique was effective with parenting your child in the past but it not anymore, maybe it is because your child is developing and you need to go back to brainstorm an updated solution. Often, it is not a completely new solution, just a tweaked version of the prior one. Brainstorm with your partner, if there is one. I have had to leave my ego at the door and accept that some days my husband found a better solution than me (even though he has had zero experience with children!) Some days I found a better solution and he follows my steps. Remember, no matter who solves the problem, everyone wins here if the updated solution is more effective! If you are parenting with a partner, remember that you are on the journey together and it is ok for one of you to find the next path that works. What is not effective is if you resist taking those steps because you did not find it or because it was not the prior path. So, parents, I am on this journey with you finally. It is hard and scary and I try to take moments and pat myself on the back when I find something that works, for the moment at least. When is feels like I am in the middle of a “failing technique,” I am just letting myself take slow, deep breaths and hoping that sense of calm and comfort transmits to my baby.

New Year, same goals

Several times a week, I will coach a parent, teen, or adult patient about how to use the principles of behaviorism to change his or her behavior or the behavior of someone else. This year, I finally have found some success applying it to myself! I have been wanting to get more active for a long time both to improve physical and mental wellness. I often have created goals for myself, even created a worksheet to fill out on my refrigerator with a reward system. However, change would last for a couple weeks at the most. By combining enough behavioral principles, I finally found some movement (literally and figuratively) . I had bought a pedometer months ago hoping tracking steps would motivate me..not so much. What does motivate me, though? Chai lattes! (positive reinforcer). I started by just monitoring how many steps I was getting on average per day. The answer was, quite low. Using the principles of shaping, I decided to set my first week goal to just a little higher than my usual average in order to start with some success. Knowing that some days I have too many patients and meetings to meet my goal, I allowed myself one day to miss my goal. At the end of the week, if I met my goal 6 out of 7 days per week, I get a new Peets card to use.  It has been about 4 weeks and I have been able to increase my weekly goal by 2,000 steps, have felt more energetic, have been sleeping better, and actually lost a little bit of weight. In essence, I finally practiced what I preached. Some of the key points here are first to monitor where you are at. It would have been too much to expect 10,000 steps per day when I sometimes barely made it to 2,000. Next, think of a reward that will actually reinforce you to change your behavior and make sure to implement the reward. Even better, I sometimes will get half of my steps in by walking to Peets to use my reward! It is helpful to give yourself “partial credit” so that if you cannot do the behavior every day you still get some sort of reward (ie. 6 out of 7 days per week). Once you master one step, keep moving toward your final goal (ie. shaping). That is why I am now 2,000 steps higher and plan to increase my goal by 1,000 steps next week.  A final help can be the accountability factor. My partner and I both set steps goals and update each other daily. He also holds the Peets cards so I cannot reward myself if I do not meet my goal and I get the pleasure of asking for my reward at the end of the week!

This article is helpful on discussing how to shape someone else’s behavior: http://www.nytimes.com/2006/06/25/fashion/what-shamu-taught-me-about-a-happy-marriage.html. You can also read a book that was recommended in my dialectical behavioral therapy (DBT) training called Don’t Shoot the Dog: The New Art of Teaching and Training.  So, next time you are hesitant to set a new goal for yourself, just remember, just because you did not have success before does not mean you will not have success in the future. You may have asked for too big of a change right away or may not have picked enough reinforcers for yourself to change the behavior. I still am not sure how I feel about the fact that humans can train ourselves and others just like we can train animals, but I’m not thinking about it too much as I sip on my delicious Chai Latte!

Driven to be mindful

Yesterday I went to an alumni drop-in session for the Compassion Cultivation Training (CCT) course I took last year.  During the session, the moderator asked participants to journal about various ways we have used mindfulness this past year and goals for the next year. Upon reflection, I was glad to see that I have taken several steps toward more fully integrating mindfulness into my life.  I have begun to put my phone away  much more often. Out of sight is not quite out of mind,  but it is much easier to prevent myself from getting distracted with the future or the past and to stay in the present moment. I also have attended a few sitting meditation events locally.  I realized how much I have been craving to start a daily meditation practice and have set the intention to begin doing so in the coming year.  When we shared with the larger group, one of my peers mentioned that she sets an intention every morning about her day.  I loved this idea and already have set my morning alarm to remind me to set a mindful intention.

Interestingly, as I sat and listened to how others have been integrating mindfulness, I came to the realization that I actually have been utilizing mindfulness and compassion regularly while driving since taking the class. During my CCT class, we spoke quite a bit about the usefulness of using mindfulness while driving. For example, my teacher noted that once she realized that getting upset and stressed while stuck in a traffic jam did not get her to the destination faster and only led to suffering in herself. I realize that I now start to notice when I am getting upset about running late and much more often remind myself that I will get to the destination at the same time and I do have control over my emotional state when I arrive. This is when I will take a few deep breaths to lower my heart rate. We also spoke about how angry we would get at drivers who would cut us off or drive unsafely. We discussed how we could choose to get angry and irritated with these drivers or we could practice compassion toward others. We could realize that sometimes we are that driver and we often have very justifiable (or we justify to ourselves) reasons for our actions. Instead of reacting with a negative response, we can instead react with curiosity. I realize that I often will make a neutral comment in response to these drivers. “That car is driving fast” in a neutral tone affects me much less than thinking “what a jerk!” Instead of arriving to my destinations angry and frazzled, I have been able to drive much more calmly, and I imagine, also safely. I wanted to share this realization with others to help give you some examples of how to integrate mindfulness into your daily lives and also to keep myself accountable to continue working on these skills. Mindfulness is like a muscle. It improves the more we practice. That is while I encourage you all to be driven to drive more mindfully!

Dialectics – No (ifs, ands, or) buts

Dialectical thinking is one of the most influential concepts that I have learned from Dialectical Behavioral Therapy (DBT). I not only teach this to my patients regularly, but I also have shared it with my friends and family and practice it myself. This is an extremely useful life skill.  You can learn more about DBT, a therapy originally developed by Marsha Linehan to help chronically suicidal patients with Borderline Personality Disorder at the following website: https://behavioraltech.org/resources/faqs/what-is-dbt/.

From my understanding, dialectics is the concept that two things that seem opposite and contradictory can both be true. For example, my parents can be very strict and they can still love me. I can do badly on an exam and still be very smart and hard-working. For most individuals, especially at times of distress, we tend to think non-dialectically and this can create problems for ourselves. The beauty about dialectics is that there are some simple tools we can use to change our mindset. For example, I try to eliminate the word “but” from my language. When I talk with parents about communicating better with their children, I remind them that when they are supporting their child, avoid the word “but.” A parent might say, “Honey, I’m so sorry you are disappointed about not making the volleyball team, BUT you were feeling stressed out anyways and now you have more time to do your schoolwork.” Your distressed child likely just heard “You need to focus on your schoolwork” and did not hear any support from you. A lot of times, the word “but” magically eliminates others’ recollection of the statement that preceded it. Instead, try to replace “but” statements with “and” statements. If I’m telling my friend, “I care a lot about you AND I’m worried about you because…”, they are much more likely to hear support and to feel validated then if I use the word “but.”

In addition to eliminating “but” from my language, I also have tried to eliminate other non-dialectical words. These are strong words that are often judgments and lead to strong emotions: Hate, dumb, jerk, etc. Even more interestingly, by changing the way I speak, I also change the way I think.  “But” and other non-dialectical words and thoughts have begun to diminish in my mind before the words reach my mouth. By thinking more dialectically, negative emotions often can be less intense. Dialectics allows us to look at all the facts instead of thinking more rigidly, or having black and white thinking. Black and white thinking involves seeing things as either one extreme or the other: good or bad, smart or stupid, love or hate. When we thinking dialectically, we look at all the other options in the middle.  Maybe our friends are lovable and sometimes mean; maybe our parents try really hard to do their best and sometimes make mistakes.

When we think more dialectically, this often leads to less intense negative emotions and also affects our behaviors. For example, if my friend says something non-supportive, instead of thinking “He’s a jerk” and ignoring him, I may think “Wow, those words were hurtful. He is normally supportive and today he was not. I wonder why?” Of course, I am still upset. However, being dialectical allows me to be more curious and to investigate further instead of reacting immediately. I may be more likely to calmly tell my friend how he upset me and to be better equipped to hear his side of the story. Instead of assuming this person is suddenly not a good friend, dialectics helps me realize that I am probably missing useful information here.

If you take just one useful tip from this post, try to notice when you use the word “but” and try to work on replacing it with “and.” Just by doing this, you may already notice some positive changes in your thinking, your emotions, and your relationships. If you feel like this is too much to ask, maybe think: “I’m really busy AND this is really important so I will just do my best to start to make changes.”