Module 3-PACK-Teen Parent Handout #14
Family Empathy Interviews
Directions: Pair with a teen from another family and alternate asking and answering questions with them, until the interviews have been completed. Write down answers as you go, and prepare to share the responses with the group when the interviews are done.
Parents Ask Teens (paired with teen from another family):
1. What would you think, feel, and do, if your parents didn’t come home one night (and didn’t answer their cell phones)?
2. What is your greatest fear related to one or both of your parents?
3. What is your top wish for one or both of your parents?
4. What is something you regret saying or doing within your family?
5. If you could have a do-over, of # 4, what would you say or do instead?
PACK-Teen Module 4
To begin PACK-Teen Module 4, refer to the Introductions, Check-Ins, Guidelines, and Orientation section that can be found at the beginning of PACK-Teen Module 1.
“Win–Win” Conflict Resolution
Inform parents that a number of the nation’s experts on effective parenting, including Ross Greene, Thomas Gordon, and Sam Goldstein advocate for a collaborative problem-solving approach to parenting. Ross Greene has demonstrated that his program, aptly named Collaborative Problem Solving, effectively reduces aggression and explosive behavior in outpatient samples (Greene et al., 2004), as well as on acute psychiatric units (Greene & Ablon, 2006). Many parenting experts argue for efforts at “win–win” conflict resolution between parents and teens—a life skill that can serve teens well across settings and throughout their lifetimes. Many models for effective management of corporations likewise call for a “win–win” (Covey, 1989) philosophy of leadership. The point should be made, using a Socratic approach, that any outcome other than “win–win,” in the context of a relationship, especially one as important as that between parent and teen, constitutes a “lose.”
Discuss with the group that the premise of a collaborative problem-solving approach is for parents to project a spirit of cooperation and compromise. This approach involves expressing empathy, active listening, or mirroring, followed by problem solving around any issue, conflict, or problematic behavior. The message parents should strive to convey is, “Let’s work together to figure out a way to solve this dilemma so that we both get what we want.” This style of conflict resolution is the mainstay of customer service, well-run businesses, and family and couples therapy. Often, it is considered alternative and even radical by parents, but many experts argue and have demonstrated that it is a very effective approach to parenting, particularly in the case of oppositional teens. Win–win conflict resolution and collaborative problem solving builds relationships, enhances self-esteem, and fosters resiliency in youth. Adolescents in particular, as they navigate the psychological phase of development, often termed separation-individuation, are highly invested in being heard and inputting to decisions affecting them. If parents habitually engage in a collaborative discussion with their teens, rather than approaching them in a more dogmatic or directive fashion, they increase the odds of their teens responding cooperatively and flexibly. Additional benefits to this style of communication include strengthening those relationships and communication channels, building trust, and enhancing adolescent self-esteem.
Review with the group the typical sequence of events and interactional patterns that occur between any two people who are at odds, when one or both of them is upset. No conflict or problem can be addressed in a creative, collaborative, and productive manner unless both parties are totally or at least mostly calm, open, and receptive. What tends to happen, when an exchange around a conflict occurs in the face of heightened negative emotions in either party or both, is a sparring match. Essentially a verbal volley ensues, and as negative emotions intensify and defensiveness escalates, the tone and context become increasingly toxic and derogatory. Remind the group again of the rule of thumb that stipulates one should only attempt to tackle a conflict or problem when calm.
Parental Resistance
It has been common for parents to bristle and recoil at the recommendation that they adopt an empathic and collaborative approach to conflict resolution with their teens. They are inclined to perceive this approach as comparable to “giving in” or conceding in parent–teen power struggles. They sometimes recount childhood memories of having been raised via an authoritarian style of parenting where compliance, respect, and deference to parents were essentially demanded and where the potential or real consequences for disobedience were particularly grim and menacing, such that parental threats and intimidation powerfully influenced and controlled child behavior. Parents often ask, “Why can’t our kids just respect and listen to us, like we did with our parents?” They often express frustration and a sense of dismay and demoralization regarding their sense that youth of subsequent, successive generations have presented as increasingly “entitled,” “disrespectful,” and “spoiled.
You can offer feedback to the group and facilitate discussion regarding the gradual shift that has occurred in society in general, especially in professional environments during the past 50 years or so, which has paralleled the power and dynamic shift that has emerged in most modern American families. As delineated by Daniel Goleman (2005), in a series of books he authored on the modern-day construct of “Emotional Intelligence,” relating its applications across society as well as business environments, there has been a gradual morphing of culture and dynamics in professional settings from one that was rigidly hierarchical to one that is increasingly collaborative, embracing of diversity and team-oriented. The role and value of “emotional intelligence,” that is, social competency and skill in reading and reaching other people, has increasingly burgeoned as a set of occupational and leadership skills that are sought and considered essential to workplace success. In earlier decades, dating back prior to 1980, organizations tended to designate clear and supreme bosses who unilaterally made decisions and exercised supreme power and authority, without input or consent from subordinates, regarding the company’s mission, vision, and operations. In more recent decades, especially as technology has exponentially advanced and global reach has become the norm, successful enterprises have increasingly embraced a philosophy of worker empowerment and team collaboration as the most productive and optimal style of operating. Family dynamics and relational patterns, along with family role expectations and power differentials, have followed trends in American society and businesses in general, where all parties expect to have a voice and to have their views given due consideration. The goal of family (team) synergism is pursued, with the consolidation of input from varied and multiple parties considered exponentially more valuable than that of a few or of just one individual.
Setting the Stage for PSTc
Highlight with the group that problem solving is another skill set that is often deficient in many youth who struggle with anxiety, depression, dysregulated mood, or impaired impulse control. When agitated or upset, which such teens often are, they simply cannot think “outside the box.” They cannot think of multiple, creative options and solutions to any given dilemma and become “black and white” thinkers, when distressed. Hence, they are likely to resort to defiant, explosive behavior or other forms of “melting down.” Parents can help their teens build skills and—at the same time—increase cooperation, foster resiliency, and strengthen the parent–adolescent dyad by routinely employing this type of collaborative approach.
Encourage parents to recall the physiology and psychology of the “fight-or-flight” response. Point out that many youth who struggle with emotion regulation, depression, anxiety, or impulsivity are vulnerable to entering a state of fight of flight at the slightest provocation. They are “sensitized” (as are their parents many times) and tend to become hyperaroused quite readily in response to environmental cues. Remind parents that the first step toward calming their teen is learning to calm themselves down or, better yet, remaining calm in the first place. If they are to be effective, parents need to disconnect from their adolescent’s emotional and agitated response and remain objective and rational. Until such a skill is mastered, advise parents to at least “act as though” they are calm and deploy a body posture, facial expression, and tone of voice that is “matter of fact” and rather unemotional. They must train themselves to become impervious to the teen’s affective state if they are to calm their adolescent and effectively manage or, better yet, avert explosive behavior. They should be continuously mindful of the utility of refraining from interpreting their adolescent’s outburst personally and instead strive to understand the factors which precipitated it.
Reiterate the point that feelings are contagious. Although this is human nature, this tendency to assume the feeling state of those in our midst, especially family members, can be overcome with effort and practice. Parents can learn to will themselves to step back, think things through, and develop an effective strategy that has not been unduly influenced by strong negative affect, for intervening with their youngster. Help the parents recognize that when they remain calm, they maintain their capacity for rational, logical, and creative thinking. In addition, they are more likely to maintain their capacity for experiencing and expressing empathy, solving problems, and supporting their adolescent. They also are modeling the appropriate regulation of affect and impulse control for their teen. If parents can remain calm, they can then move to helping their teen lower his or her level of arousal.
Sometimes, if a parent and/or adolescent has become too escalated, a “time-out” or a “cooling-off” period is needed before a conflict should be addressed. Some youth become so agitated so quickly that they need some time by themselves before they are capable of responding in a productive way and accepting the supportive intervention of their parent. Ultimately, with practice, parents can learn to anticipate their teen’s temper outbursts and reverse their trajectory before they become full-blown. Likewise, adolescents can practice and master relaxation and calming techniques in their workshops. These skills ideally are frequently practiced by youth at home and modeled and reinforced by parents.
Lowering Arousal
Methods for lowering arousal were introduced in PACK-Teen Module 2 and can be reviewed again briefly with the group. Using a didactic style of teaching, invite the group to recall approaches for lowering arousal. In sum, one must use a calm, reassuring tone of voice and nonthreatening body posture. The most effective and relationship-building language-based technique for lowering arousal and defusing upset in youth—or anyone, for that matter—is the verbal expression of empathy, empathy, and more empathy. Mixing empathy with mirroring can go a long way toward helping youngsters feel as though their feelings and perspective are understood, validated, and respected.
Remind parents of the previously suggested guideline that they spend at least 3 minutes empathizing and listening, to their teen before they react or even begin to communicate their own agenda. During this 3-minute process, direct parents to refrain from adding any new or original ideas or feedback of their own to the discussion with their adolescent. Advise them simply to listen with undivided attention or, if they feel a verbal response is necessary, to use empathy statements or mirroring techniques. Their only mission is to focus completely on developing a deeper understanding of their teen’s feelings and perspective regarding the situation at hand.
Picking Your Battles
Ask the parents to generate a list of domains of conflict that they commonly encounter with their teens. Invite them to share examples of behaviors exhibited by their adolescents which they wish would stop, as well as cite behaviors which they would like to see their teens start. When families initially enter treatment, especially at an intensive outpatient level, they are often demoralized and exasperated, having developed long-standing patterns of conflict-ridden, adversarial interactions. Parents often develop patterns of intense emotional reactivity, wherein they tend to exhibit equivalently strong, negative reactions to all instances of negative behavior, failing to moderate their responses, relative to the magnitude of the behavioral infraction. In other words, caregivers and their adolescents are prone to becoming ensconced in a chronic “battle of wills,” in which nearly every issue can become fodder for intense conflict and debate, sometimes out of proportion to the issue.
“Zoning” Behaviors
Given the common family dynamic which has evolved in families who present for treatment, it is helpful to provide a structure or system for parents (and teens) to prioritize behaviors and disagreements and put them in perspective, relative to one another.
On the dry erase board, create the following three headings, side by side:
| RED Zone | YELLOW Zone | GREEN Zone |
This method of prioritizing behaviors is similar to those proposed by Ross Greene et al. (2003) and Stanley Turecki and L. Tonner (2000), who advise parents to reflect upon and order parental goals, before developing or implementing any behavioral interventions. The “Red Zone” category is intended as a place to list behaviors which are unsafe or illegal, constituting examples which are not at all negotiable and pose a potential risk of loss of life or limb. Initially, parents often argue for the inclusion of behaviors which are not dangerous or illegal in this category, insisting that from their perspective, certain behaviors are utterly intolerable. Examples could include “cursing,” “being disrespectful,” and “dressing inappropriately.” However they should be offered feedback, that although such behaviors may represent important priorities in their households; they certainly do not pose a potential threat of serious injury, death, or incarceration. Those behaviors can nonetheless be assigned a high level of priority, and slated as targets to be addressed, by listing them under category “Yellow Zone.”
The “Yellow Zone” category is intended for behaviors which are important to the caregivers, but for which the details and nuances are open to some degree of debate and negotiation. These behaviors will serve as fodder for the PST exercises that follow and are recommended as the agendas upon which families should focus, in their parent–teen interactions and behavioral contract negotiations. Examples include homework, hygiene, friends, chores, curfew, cell phone, and computer access. The last category, “Green Zone,” represents behaviors which the parent might find annoying but that they are willing to ignore or forgive, for the time being, given the other behavioral priorities they have identified. Examples might include their teen’s choice of style of hair or dress, poor table manners, consumption of junk food, or choice of music. Provide parents with PACK-Teen Module 4 Handout #17 with the three above-mentioned categories as headings and invite them to work together and with their teens, to create a customized list of behaviors, relevant to their household, as part of the family homework.
Problem Solving Together
Make the point to the group that the “problems” that arise in families, which tend to generate conflict between family members, especially between parents and teens, typically involve wishes that are at odds or compete with one another. It is often helpful to reframe family “problems,” which represent parent–teen conflicts, as competing “wishes.” In other words, the goal of parent–teen problem-solving efforts is really to clarify, accurately define, and reconcile or align the competing wishes each party is entertaining. Any time the term problem-solving is used in reference to efforts to address parent–teen conflicts, the verbiage “wish alignment,” can be substituted. Such a reframe can be powerful in generating buy-in to a process for parent–teen conflict resolution, as it is hard not to feel inspired by a goal of “wish alignment” or “wish reconciliation.” In addition, applying that verbiage forces the parties to present their concern in an affirmative manner, rather than negatively or in a way that could activate the other person’s defensiveness. For example, if a parent is concerned about school, they are required to reframe their concern as a wish, such as “I would like Johnny to complete all homework daily,” versus “Johnny has to stop blowing off school.” Or if a parent is concerned about dating, they might state their wish as “I want to ensure Suzy is safe, at all times,” versus, “Suzy is behaving inappropriately, when it comes to dating.” Lastly, with a goal of wish alignment under consideration, the ideas for solutions generated are more likely to address the concerns or agendas of both parties. Consider the following examples:
• A teen would like to borrow the car to drive to a friend’s house at night, while the parent wants to ensure the teen returns home safely, prior to the neighbor curfew. How can these two wishes be reconciled?
• A teen is spending time each afternoon playing video games, but the parent is worried about homework and chores being completed. How can these two wishes be reconciled?
• A teen is asking to spend the night at a friend’s house, but the parent wants the teen to remain home to spend time with visiting relatives. How can these two wishes be reconciled?
• A teen would like to obtain a belly button piercing, but the parent would like the teen to wait a few years before deciding. How can these two wishes be reconciled?
As part of anger management and problem solving or “wish reconciliation,” training in the corresponding adolescent workshops, the teen facilitators teach the acronym D.I.R.T., which is comprised of the followingd:
D stands for define, as in define the problem (represent as two “wishes” if a parent–teen conflict).
I stands for identify, as in identify possible solutions.
R stands for reflect, as in reflect on the possible solutions.
Introduce parents to this same acronym so they can be aware of the format that is familiar to their adolescents. The problem-solving or wish alignment steps represented by D.I.R.T. are inclusive only of the intellectual or cognitive parts of problem solving. The application of the D.I.R.T. steps is predicated on the party using the steps having already processed their upset feelings and achieved a state of relative calm along with lowered physiological arousal. For parents, however, the steps for problem solving—as related to approaching disagreements or conflicts with their adolescents—include an additional, essential component that serves to defuse upset feelings, build an alliance, and bolster self-esteem in their teen. The problem-solving steps for the parents can be remembered as “The 5 D’s” of PST, which include the followinge:
Defuse: Parents can defuse upset by presenting themselves as a calming force, expressing empathy, and using mirroring. Parents can use empathy formulas to express empathy in a nonthreatening way.
Define: Parents should define the problem or competing wishes, first from the teen’s perspective and then their own. It is essential to avoid blame, derogatory language, criticism, or premature suggestions of definitive solutions. Offer the following PST problem definition stems to ensure that the parent follows a model most likely to maintain calm, lower defensiveness, and build an alliance:
“I hear you saying that…. However, I am worried that….”
“I understand you feel as though…. However, I get upset when….”
Da’ Party: Invite the teen to a problem-solving (wish alignment) or idea brainstorming party. Begin with, “Let’s put our heads together and see if we can figure out a solution where we both get what we want.” This brainstorming session is best facilitated by the active avoidance of any critique or commentary regarding ideas and by simply writing them all down, even the provocative or outrageous ones. Essentially the message at this juncture is that “anything goes” or “anything is possible.”
Decide: Review the list of ideas and contemplate which ones are “hot-headed,” and which are “cool-headed.” Together with the teen, pick one that is realistic and acceptable to both parties.
Do it: Implement the plan, ensuring a mechanism for tracking its success.
Through Socratic discussion within the parent group, make the point that any conflict, dilemma, or problematic behavior may be approached and resolved a myriad of ways. In the business world, good managers know that if they involve staff in the process of developing a system or strategy to achieve the company’s agenda, the staff is much more inclined to feel valued, inspired, and motivated to follow through. Adolescents, likewise—especially those who are defiant or defensive—want to have input into the events and decisions that affect their lives. They respond more cooperatively if they feel as though their feelings have been understood and validated and their agenda was at least considered while possible solutions were being formulated. They are much more likely to cooperate with their parent’s agenda if they have been invited to play at least some role in identifying a solution.
Many parents will express concern about the suggestion of following the PST process in approaching conflicts with their adolescent, feeling as though it may lead to permissiveness or “giving in.” They often relate their desire to be “in charge,” endorse feeling entitled to “call the shots,” and complain that they should not have to negotiate solutions to parent–teen conflicts with their adolescents. The parents can be asked to relate how effective a coercive, dogmatic, or directive approach has been, in addressing concerns with their adolescents. They will typically readily admit that such tactics are not only ineffectual, but generate intense conflict and served to “drive a wedge” between parents and teens. Using a Socratic method of teaching, help the parents appreciate that engaging in a collaborative process inevitably increases the chances that the teen will voluntarily cooperate, internalize a desire to change his or her behavior, and take ownership for his or her actions even when the parent is not present.
Having used themselves as a calming force, expressed empathy, and done some mirroring, the parents will have reassured the adolescent that their agenda or concern is understood, respected, and firmly “on the table” for consideration. The teen typically will calm and “soften,” knowing that he or she has been heard and that the parents are not about to dismiss his or her agenda or attempt to control or box him or her in (a defiant, defensive teen’s worst fear). It is only then that the adolescent is likely to be more receptive to hearing the parents’ concerns and agenda. The parents can summarize the teen’s feelings and viewpoints and then briefly mention the parents’ own agenda. The parents should keep this part short and must be very cautious with respect to how they word their concern. They will rapidly lose their audience and alliance if they begin to launch into a long lecture or lesson. So, too, it is essential that the parents just state the facts regarding the problem behavior and that they be specific.
It is important for the parents to avoid judging or interpreting the behavior. Parents should be careful to avoid the use of shame, blame, or put downs and are wise to completely avoid the use of the words “but” or “you” when stating their concerns. To the degree possible, the parents should avoid even mentioning the adolescent at all and instead share their worry or concern in a more generic way that does not specifically implicate the teen. In addition, parents should be careful not to insert their own solution prematurely but rather only briefly highlight their feelings and viewpoint.
In summary, the principles regarding ideal wording of the parents’ version of the problem or wish (after hearing their teen out, expressing empathy, and mirroring) include use of neutral language, use of feeling words, and identification of a specific behavior about which the parents are concerned. What works best is for parents to recap the adolescent’s feelings and agenda before succinctly sharing their agenda. The parent can use standard verbiage or “stems” such as those mentioned above, under the definition portion of the “5 D’s” of PST. Consider the following examples:
Johnny has been hitting Suzy. Rather than saying “I’m concerned about how nasty and rotten you are to your sister,” it would be better to say, “Johnny, I hear you saying that Suzy annoys you a great deal; however, I get upset when one person I love hits another person I love” or, “However, I’m not okay with name calling or hitting.” They could then formulate their agenda in the style of expressing a wish, such as “I’d like our family to express anger in a safe way, at all times.”
Tommy has been refusing to shower and change his clothes. Rather than saying “You’re going to have to shower and change your clothes daily,” it would be better to say, “Tommy, I hear how much you hate showering and changing your clothes; however, I worry about health when showers aren’t taken” or, “However, I am concerned that not showering may lead to poor health.” The wish that corresponds might be expressed as “I’d like my family to maintain healthy hygiene at all times.”
Bobby has been refusing to complete his homework. Rather than saying “You must do your homework,” it would be better to say,” “Bobby, I understand you find homework frustrating and you’d rather play video games; however, I worry that if the homework doesn’t get done, it will be hard to learn” or, “However, I get upset when the homework doesn’t get done.” The parent might state a corresponding wish as “I’d like my children to complete all homework daily, and turn it in by deadlines.”
Reiterate that the goal is to lower arousal in the parent and teen, build an alliance between the parent and teen, and then put the teen’s concern on the table followed by the parent’s. With the problem defined from both the adolescent and parent’s perspectives, the brainstorming and problem-solving process can begin. Effective and cooperative problem solving (or wish alignment) can only occur if both parties are calm, feel listened to, and have established a spirit of collaboration.
Help parents recognize the reality that most youngsters, when calm and in a cooperative state of mind, are fully capable of creative and effective problem solving or wish reconciliation. In fact, while calm and in a cooperative frame of mind, youth are often willing and able to generate ingenious and creative solutions, even above and beyond options parents are able to conjure up on their best day. Many adolescents with emotional and behavior disorders, however, are not masterful at regulating their feelings and controlling their impulses. They need help and support around modulating and coping with the intense, negative feelings that often overwhelm them. In the case of youth with severe mood dysregulation, the most powerful intervention parents can provide is assistance with monitoring, labeling, discussing, and processing their feelings. Parents can model calmness, serve as a calming force, and use mirroring and empathy to achieve that end.
As in any brainstorming session, ensure that the parents appreciate that it is essential for all parties to refrain from commenting or critiquing. This, again, is well known in the business world. The idea is to facilitate the generation of a wide array of ideas and potential solutions. No idea is wrong or out of the question, at least during the brainstorming phase. It is extremely powerful for the parent to go ahead and write down all ideas. In the beginning, this process may seem awkward and go slowly. Parents and adolescents may need to grow into this process if they never have attempted it before. It is better if parents encourage teens to generate ideas rather than supplying the majority of ideas themselves. Often, parents can readily identify a simple, mutually satisfactory solution, but they should attempt to hold back and allow the teen an opportunity to solve the problem. We repeatedly recommend to parents that they strive to “play dumb” with their adolescent whenever they are engaged in a mutual problem-solving exercise; instead, they should work to solicit as many ideas as possible from their teens.
Suggest that the underlying goal of this style of approach is to propel youngsters to become invested and intrinsically motivated to pursue a workable solution. This is more likely to occur once they feel heard and validated and have been invited to generate ideas for solving the problem and/or resolving the conflict. It may help to ask parents, “Whose idea is the most brilliant, anyway?” A defiant, defensive teen, especially, is most likely to find his or her own idea the most brilliant and therefore embrace it. Every session of problem solving is an opportunity for relationship building and learning. The youngster is being taught effective conflict resolution and problem-solving skills, which in turn foster resilience or the capacity to “bounce back” from stress. In addition, the odds of cooperation increase if the adolescent has been actively involved in the process of evolving a reasonable agreement that is acceptable to both the parent and the teen.
After parents have engineered a creative brainstorming session with their youngster, during which a number of potential solutions have been identified and written down, the parent and teen can set about the process of selecting the most viable option. Some of the potential options will seem workable and some may sound outrageous, but it is important for parents to nonetheless tolerate them all and jot them down as possibilities during the brainstorming phase. Usually, after this process has occurred, the adolescent has become calmer, more flexible, and more willing to compromise and cooperate. With both parent and teen working together as a problem-solving team, effective and positive outcomes are likely to be forthcoming.
Distribute to parents the PST script located on the book’s companion website as PACK-Teen Module 4, Handout #16 and also printed for your reference at the end of the bulleted outline for this module. This script was developed to illustrate how the process might look in an ideal world. Ask two parents to volunteer and read the script that appears below, aloud as if role-playing the scenario:
The problem: Your older daughter Laura, aged 13 years, has been insulting and threatening your younger daughter Emily, aged 5 years:
Mother: I’ve noticed Emily has really been on your nerves a lot lately.
Laura: Yeah. She is an annoying little brat and won’t leave me alone.
Mother: Sounds like you’ve had it with Emily.
Laura: Well how would you like it if she followed you around all day and constantly took your stuff?!
Mother: So you feel as though she won’t respect your privacy and your things.
Laura: Exactly—she’s so spoiled and gets away with murder! I can’t stand her. I wish I was an only child!
Mother: It sounds like you’ve had it with Emily. I can see you really just want her to leave you, your room, and your things alone.
Laura: Plus she also deliberately mimics everything I say and do. I hate that. Why can’t she get her own personality?
Mother: So you also want her to stop imitating you and do her own thing. I can see your points and get why you’re so frustrated. However, I get upset when one person I love says hurtful things to another person I love. I don’t want to see anyone I love get their feelings hurt. Plus I’d like this family to work out their differences in a more positive way.
Laura: She deserves it. She brings it on herself. I warn her, but she doesn’t listen!
Mother: So you’ve been trying to give her warnings, but she hasn’t been listening. I hear how much she annoys you and agree that her behaviors have contributed to the problem. I’d like us to work out other ways of dealing with Emily, that won’t leave her feeling put down. Let’s put our heads together and see what we can come up with, so that she’ll leave you alone, and you won’t get so frustrated that you resort to yelling. What ideas do you have?
Laura: Give her up for adoption.
Mother: That’s one idea—I’m writing it down. What else?
Laura: I could lock my door.
Mother: Okay, that’s another option. Anything else?
Laura: I could lock up or hide my stuff that I don’t want her to touch.
Mother: Do you have any things you don’t mind her playing with?
Laura: A few. I could set up times to play with her, because I think what’s really going on is just that she wants more of my attention.
Mother: We could set up rules about which things she can and cannot touch and certain times she’s allowed to be in your room and other times she’s not. We could even post a schedule on your door. Also, you could reward her by playing with her when she respects your property and privacy. If she violates the contract, then play times with you could get revoked.
Laura: Those are actually pretty good ideas. I’m going to write up a schedule and contract for her to sign. I can also come up with some things of mine that I wouldn’t mind giving her, if she follows our agreement.
Through didactic discussion, the details regarding the nature of the problem being explored with PST and the potential solutions are not important. The bottom line goal is for parents to approach any conflict or problem with a spirit of collaboration. The sense parents should convey is that “We’re in this together,” “We’re on the same side,” and “We can work this out if we put our heads together.” This process will facilitate communication, build the relationship, teach and model life skills, and foster resiliency.
PST Role-Plays
Here again, as with empathy and effective parent–teen communication, this process is fairly straightforward to comprehend intellectually but often difficult to employ in reality—especially in the heat of the moment. Encourage parents to role-play problem solving during the workshop. Give them copies of PACK-Teen, Module 4 Handout #15, describing the PST Steps for Parents: The 5 D’s, along with copies of the PST worksheet, PACK-Teen Module 4, Handout #18, available on the book’s companion website—to use as guidelines, and coach them throughout these exercises.
The parents can also be provided with “business cards” describing the “5 D’s” to keep in their wallets, as a handy reminder. Sample scenarios are available on the book’s companion website in the Module 4 PACK-Teen Therapist’s Toolbox. Some cards have been left blank deliberately so they can be used by parents to write down their own examples derived from actual experiences with their adolescent. Caution the parents that their teens are likely to say provocative things during this exercise but that they should avoid taking the bait. During the brainstorm, anything goes, and the parents should be advised to write down all ideas without commenting about whether they are good or bad. During the subsequent week, while home, encourage parents to “play dumb” and seek advice from their teens regarding problem solving.
Joint Session for Module 4
During the second IOP session of the week, after first having the parent and teen groups check in separately, have them join to practice problem solving together. In a group format, have the adolescents teach the steps for problem solving to their parents, using the D.I.R.T. acronym. Invite suggestion of an issue or behavior that might be mildly contentious, between parents and teens, that most participants would agree falls into the “yellow zone” category. The example can be a real one or hypothetical. It is recommended that the first issues or behaviors tackled during practice of PST, represent issues that are “low stakes” and not sources of intense and long-standing feelings and parent–teen conflict. This point should be reiterated multiple times, especially in discussions of recommendations for practice at home, within families. As greater ease and mastery of the PST process is achieved within families, parent–teen dyads can increasingly use the steps to resolve higher stakes, more “hot button” issues.
Using the example agreed upon, facilitate one or more PST exercises with the group using the steps and verbiage familiar to the adolescents. Invite the group to define the problem, which reflects a real or hypothetical parent–teen conflict, in two parts or as two wishes. Encourage the group to word the wishes affirmatively, devoid of blame or criticism for the other person. Empathize that it is essential for both parties in the dyad to feel satisfied with the description of their version of the problem or wish. Also cue the group to brainstorm about solutions that might aptly fulfill the wishes of both parties, or satisfy both the teen and parent’s agendas. Remind the group that the goal is to arrive at a “win–win” resolution for the conflict. The point should be made, via Socratic questioning, that in relationships, especially priority ones within families, any outcome other than a “win–win” is a “lose.” As with some of the other techniques presented in this book, it is a good idea for the parent and teen groups to have rehearsed separately before joining them together to practice.
Family Homework
For homework, encourage each family to negotiate potential behaviors or issues, upon which all would agree fall into the “yellow zone” category, that is, there is room for compromise.
Advise the families to practice the PST technique at home with real scenarios, at least twice prior to the next session, although caution them to initially practice on minor issues, that are more readily resolved and less contentious. As they develop mastery of this process, they can move to medium-sized conflicts and ultimately graduate to high-stakes zones, with histories of heated debates.
Therapists should discuss and hand out the Practice with PST: The 5 D’s worksheet located on the book’s companion website in the PACK-Teen Parent Workbook section, under PACK-Teen Module 4, which can be assigned to facilitate family homework. You can provide parents with extra copies of the worksheet and have them use it as a reference, while practicing PST at home with their teens. Invite them to report back on their efforts, at the next workshop. The teens have been learning the acronym for problem solving D.I.R.T. concurrently during MaPS-Teen Module 4, which maps onto the second–fifth D of the parent “5 D’s” acronym.
PACK Module 4 Summary Outline
Materials Needed
Established Parent Introductions and Check-Ins
• Have the introduction and check-in format for new versus established parents written on the board.
• Go around the room and have each established parent take turns doing as follows:
• Ask each parent to identify themselves by first name.
• Ask each parent to mention their teen’s first name.
• Ask each new parent to mention one “victory” or success (required) and “challenge” (optional), from the past week, related to their teen.
• If there are new parents, invite each established parent to help in orienting the new parents to the workshop format and guidelines.
• Established parents may check-in regarding their family progress, including approaches they tried which were effective thus far.
Workshop Guidelines
• Workshop consistently starts on time and finishes on time, punctuality required, leaving early or stepping out of workshop during session, are not allowed.
• Confidentiality required, “What is said in here, stays in here,” playfully termed the “Vegas Rule.”
• Exceptions are safety issues (suicidality, homicidality, violence, abuse/neglect).
• Refrain from developing personal relationships outside group while in program.
• All cell phones, pagers, electronics of any kind must be turned off during group.
New Parent Introductions and Check-Ins
• Have the introduction and check-in format written on the board.
• Take turns having each parent introduce themselves and check-in as follows:
• Ask each parent to identify themselves by first name.
• Ask each new parent to mention one positive feature or strength of their adolescent and mention one “challenging behavior” they’d like to focus on.
• Ask established parents to comment on commonalities noted during new parent check-ins.
New Parent Orientation
Discuss “Win–Win” Conflict Resolution
Setting the Stage for Problem Solving
Review Empathy and Mirroring
Introduce PST
• Generate discussion regarding patterns of family conflict.
• Parent–teen conflicts or “problems” typically represent two wishes or agendas that compete or oppose one another.
• The goal of family problem solving or “wish alignment” or “wish reconciliation” is to evolve a plan whereby both the teen and parents feel satisfied that their wish will be realized to their satisfaction.
Introduce the Teen Version of PST—Acronym D.I.R.T.
Introduce the Parent Version of PST—The 5 D’s
• Defuse: Parents can defuse upset by presenting themselves as a calming force, expressing empathy, and using mirroring. Parents can use empathy formulas to express empathy in a nonthreatening way.
• Define: There are two versions of the “problem” or two opposing “wishes” to consider. Parents should define the problem or “wish” first from the teen’s perspective and then their own. It is essential to avoid blame, derogatory language, criticism, or premature suggestions of definitive solutions. It is helpful to reframe for the “problems,” as “wishes” which are at odds. Instead of “problem solving,” this process can be termed “wish alignment” or “wish reconciliation.” Offer the following PST formulas to ensure that the parent follows a model most likely to maintain calm, lower defensiveness, and build an alliance:
• “I hear you saying that…. However, I am worried that….”
• “I understand you feel as though…. However, I get upset when….”
• Da’ Party: Invite the teen to a problem-solving or idea party. Begin with, “Let’s put our heads together and see if we can figure out a solution from which we both get what we want.” This brainstorming session is best facilitated through the avoidance of any critique or commentary regarding ideas. Instead, simply write them all down, even the provocative or outrageous ones.
• Decide: Review the list of ideas and contemplate which ones are “hot-headed,” and which are “cool-headed.” Together with the teen, pick one that is realistic and acceptable to both parties.
• Do it: Implement the plan, ensuring a mechanism for tracking its success.
Present an Example of Effective Problem Solving
Perform PST Role-Plays
Discuss Troubleshooting if the Solution Does Not Work
• Parents may ask, “What if the plan you and your teen agree upon works for a while and then fails? Suppose the teen reverts to his or her old ways? What then?”
• Parents either can go back to lecturing and punishing or go back to the drawing board.
• Even the most perfect plan will not be permanent. What worked for the teen when he was 15 years old may not work for him when he turns 16. Parenting is a continual process of readjustment and facing new problems. By involving teens in the search for solutions, parents provide them with the tools they need to help them solve the problems that confront them now and in the future when they are on their own.
• Example of parental approach when solution has failed:
• Parent: “I’m disappointed that our ideas aren’t working anymore. I’ve observed you hitting your brother again, and that’s not okay with me. Should we give the old plan another chance? Should we try to figure out what’s getting in the way? Or, do we need to come up a new plan?”
Review, Answer Questions, and Wrap Up
Family Homework
• Discuss and hand out the Practice with PST: The 5 D’s worksheet (located in the PACK-Teen Parent Workbook Module 4 on the book’s companion website).
• The teens also have been learning steps for problem solving during their MaPS-Teen Module 4 session. Encourage parents to seek advice from their teens regarding problem solving at home throughout the following week.
• Ask families to complete at least two D.I.R.T. exercises during the subsequent week.
Joint Session for Module 4
• During the second PACK and MaPS Teen IOP session of the week, there is an opportunity for teens and parents to join together for 60 minutes.
• Have the families negotiate a list of behaviors or issues for which there is “wiggle room” or an opportunity for compromise, aka “Yellow Zone” issues.
• As a group, work through a sample PST exercise.
• Encourage the group to define the problem or parent–teen conflict as two wishes, and word the two components affirmatively without assigning blame or criticizing the other party.
• Cue the group to brainstorm solutions that could result in potential “win–win” resolutions or potentially fulfill the wishes or address the agendas of both parent and teen.
• Point out that any outcome of a disagreement, in the context of a relationship, other than a “win–win” is a “lose.”
Handouts/Business Cards
Module 4-PACK-Teen Parent Handout #15
Problem Solving Together (PST) Steps for Parents: The 5 D's
• Use yourself as a calming agent (soft voice, nonthreatening posture, lower to adolescent’s eye level).
• Display empathy: “You sound___.” “You seem____.” “You look____.” (Insert feeling word such as upset, frustrated, disappointed, sad, hurt, angry, or worried.)
• Use mirroring: “So it sounds like you feel as though….” “So what I hear you saying is….” “So what you are saying is that….” “So the way you see it is….” “So in other words….” Paraphrase or infer the teen’s feelings and viewpoint.
• First summarize the teen’s feelings and point of view and/or their “wish.”
• Summarize your feelings and point of view and/or your “wish.” Use neutral language, describe behavior, and keep it short—no blame, no shame, no put-downs. Start with “I hear you saying that…. However, I am worried that…” or, “I understand you feel as though…. However I get upset when….”
• “Let’s put our heads together and see if we can find a solution where we both get what we want.” “Let’s see if we can find a solution that works for both of us.” “Let’s think of some ideas to solve this problem.”
• Do not critique: No idea is considered good or bad at this point.
• Go down the list and with your teen identify which solutions are “cool-headed” and which are “hot-headed.” Try to pick one that will work for both you and your teen.
Possible next step (optional):
• For recurrent, important problem behaviors or conflicts, you and your teen can write out a behavioral contract with target behaviors, a tracking system, and rewards.
Adapted with Permission from Cook, M. (2012). Transforming Behavior: Training Parents and Kids Together, Brookes Publishing, Baltimore, MD.
Module 4-PACK-Teen Parent Handout #16
Sample Problem Solving Together (PST) Scenario
The problem: Your older daughter Laura, aged 13 years, has been insulting and threatening your younger daughter Emily, aged 5 years:
Mother: I’ve noticed Emily has really been on your nerves a lot lately.
Laura: Yeah. She is an annoying little brat and won’t leave me alone.
Mother: Sounds like you’ve had it with Emily.
Laura: Well how would you like it if she followed you around all day and constantly took your stuff?!
Mother: So you feel as though she won’t respect your privacy and your things.
Laura: Exactly—she’s so spoiled and gets away with murder! I can’t stand her. I wish I was an only child!
Mother: It sounds like you’ve had it with Emily. I can see you really just want her to leave you, your room and your things alone.
Laura: Plus she also deliberately mimics everything I say and do. I hate that. Why can’t she get her own personality?
Mother: So you also want her to stop imitating you and do her own thing. I can see your points and get why you’re so frustrated. However, I get upset when one person I love says hurtful things to another person I love. I don’t want to see anyone I love get their feelings hurt. Plus I’d like this family to work out their differences in a more positive way.
Laura: She deserves it. She brings it on himself. I warn her, but she doesn’t listen!
Mother: So you’ve been trying to give her warnings, but she hasn’t been listening. I hear how much she annoys you and agree that her behaviors have contributed to the problem. I’d like us to work out other ways of dealing with Emily, that won’t leave her feeling put down. Let’s put our heads together and see what we can come up with, so that she’ll leave you alone, and you won’t get so frustrated that you resort to yelling. What ideas do you have?
Laura: Give her up for adoption.
Mother: That’s one idea—I’m writing it down. What else?
Laura: I could lock my door.
Mother: Okay, that’s another option. Anything else?
Laura: I could lock up or hide my stuff that I don’t want her to touch.
Mother: Do you have any things you don’t mind her playing with?
Laura: A few. I could set up times to play with her, because I think what’s really going on is just that she wants more of my attention.
Mother: We could set up rules about which things she can and cannot touch and certain times she’s allowed to be in your room and other times she’s not. We could even post a schedule on your door. Also, you could reward her by playing with her when she respects your property and privacy. If she violates the contract, then play times with you could get revoked.
Laura: Those are actually pretty good ideas. I’m going to write up a schedule and contract for her to sign. I can also come up with some things of mine that I wouldn’t mind giving her, if she follows our agreement.
Module 4-PACK-Teen Parent Handout #17
Module 4-PACK-Teen Sample and Blank Scenario Cards for PST Practice Therapist Tool #6
Module 4-PACK-Teen, PST Steps for Parents Therapist Tool #7
Module 4-PACK-Teen Parent Handout #18
Practice with Problem Solving Together (PST): The 5 D's
Defuse: Lower arousal; listen to your teen’s thoughts and feelings.
Calm yourself, calm the teen, display empathy, and use mirroring.
Parent: ______________________________________________________________________
Teen: ________________________________________________________________________
Parent: ______________________________________________________________________
Teen:________________________________________________________________________
Parent:_______________________________________________________________________
Teen: ________________________________________________________________________
Parent (sum up your teen’s point of view):
___________________________________________________________________________
Define: Summarize their problem or “wish”; then add your worry or feelings and “wish.”
After reiterating the teen’s viewpoint, begin by stating “I hear you saying that…. However I am worried that…” or, “I understand you feel as though…. However, I get upset when….” Or, use assertiveness formula or “I statements.” Express your feelings and state your concern without blaming or attacking. Keep this short!
Parent: ______________________________________________________________________
_____________________________________________________________________________
Da’ Party: Brainstorm solutions with the teen.
Encourage the teen to start by stating, “Let’s put our heads together and figure out a way that we both can get what we want. “Play dumb” (“I just can’t think of anything else,” “I wonder what would work— …this is a toughie”), write down all ideas, and avoid commenting or critiquing until the end.
Parent: ______________________________________________________________________
Teen: ________________________________________________________________________
Parent: ______________________________________________________________________
Teen:________________________________________________________________________
Parent: ______________________________________________________________________
Teen: ________________________________________________________________________
Parent: ______________________________________________________________________
Decide: Discuss which ideas are best, pick one together, and make a plan to follow through and track progress. For recurrent, problematic behaviors, consider a written contract.
Parent: ______________________________________________________________________
Teen: ________________________________________________________________________
Parent: ______________________________________________________________________
Teen: ________________________________________________________________________
Parent: ______________________________________________________________________
Do It! Implement the plan, ensuring a mechanism for tracking its success.
Parent: ______________________________________________________________________
Teen: ________________________________________________________________________
Parent: ______________________________________________________________________
Teen: ________________________________________________________________________
Parent: ______________________________________________________________________
Possible next step (optional):
Write a contract
For recurrent, important problem behaviors or conflicts, you and your teen can write out a behavioral contract with target behaviors, a tracking system, and rewards.
Adapted with Permission from Cook, M. (2012). Transforming Behavior: Training Parents and Kids Together, Brookes Publishing, Baltimore, MD.
Pack-Teen Module 5
Introductions and Guidelines
To begin PACK-Teen Module 4, refer to the Introductions and Guidelines section that can be found at the beginning of PACK-Teen Module 1.
Communication Test
After the usual beginning routine, hand out another “pop” quiz to start off this session. Provide the same directions as given for the “empathy test.” Invite parents to choose the answer that most closely matches their typical approach. Remind them that no one will be grading the quizzes and that they are only intended to generate discussion. A hard copy of the test appears after the bulleted outline section of this module, as well as in digital form within the PACK-Teen Workbook section on the book’s companion website. Once finished, ask them to set aside the completed tests for later review and discussion.
Cooperation Busters
Just as in the case of empathy, there are a variety of common, typical parenting approaches that inadvertently sabotage good communication and decrease the chances of a cooperative response from youngsters. Introduce these “communication busters” by writing them on a dry erase board. Then present examples and ask parents to select which type of “buster” is being illustrated by each example. The list of “communication busters” includes the following, remembered using the acronym “O.S.P.L.A.T.T.!”f:
Cooperation Busters (“O.S.P.L.A.T.T.!”):
Examples: “Go and clean your room right this minute!” “Mow the lawn, now.” “Take out the trash,” “Feed the dog,” “Do your homework.”
Examples: “I’ve told you a hundred times,” “You need to stop acting like a baby,” “You never listen!”
Examples: “You are such an airhead!” “You are irresponsible…lazy…selfish…(whatever)…”
Examples: “Do you understand how important it is to have nice manners? First impressions are important. If you want to be respected, you need to be polite and make a good impression. You’ll never get a job if you can’t learn how to act right.”
Examples: “You never listen,” “You are so careless,” “How could you?” “If you only planned ahead…” “It’s your own fault,” “You should know better.”
Examples: “You hit your sister one more time and I’ll give you a smack,” “If I catch you lying again, you are grounded for life,” “If you don’t shape up, I’m sending you to military school (or to live with your Dad).”
“The Golden Rule:” A useful rule of thumb, termed “The Golden Rule,” states, “No Shame, No Blame, No Put Downs.”
Through a process of Socratic questioning, help the parents recognize that the approaches described by “The Cooperation Busters,” first of all, aren’t effective, but secondarily tend to alienate youth. Any approach involving a put down can become a self-fulfilling prophecy. For example, if a youngster hears from an adult, especially a parent, that they are viewed as lazy, irresponsible, selfish, they tend to become increasingly that way. Youth see themselves through their parents’ eyes. The labels, good and bad, which are attached to adolescents, tend to tenaciously adhere and become integrated into their self-images. Derogatory labels erode self-esteem and produce shame, as well as generate resentment toward the label user. Youth are not inspired to assume a spirit of cooperation when they are being insulted. It’s hard to follow directions and do what is asked, when someone is telling you what is wrong with you. In addition, teens are made to feel defensive and once defensive, their primitive threat response is activated, which results in them experiencing anything subsequently said as static or the garble that represented the teacher or parent’s voice from Charlie Brown’s cartoon series.
Facilitate a discussion regarding the fact that lectures are a turn off for everyone, especially for youth. Ask the group what adolescents hear, when adults launch into a lecture. The group might mention the teacher’s voice in the old Charlie Brown cartoons. Help the parents recognize, through a course of didactic discussion, that “Wha wha wha wha wha” is what teens generally hear, when a grown-up launches into a long lecture. Lectures are usually not only ineffectual but also experienced as irritating. They don’t improve communication, strengthen relationships or increase cooperation. Most youngsters need to learn most of life’s lessons, on their own, via direct experience. Most youth, especially adolescents, don’t do what parents say but instead what parents do. Suggest to parents that they delete lectures from their repertoire of approaches for effecting positive relational and behavioral changes.
Generate discussion about the use of threats, helping the group appreciate the fact that threats raise anxiety and lower self-esteem. Elevated anxiety usually only aggravates acting out and aggressive behavior. Threats additionally don’t teach anything, improve relationships or enhance psychosocial skills. Parenting goals may be reviewed, briefly. Through a method of Socratic teaching, guide parents to recall their underlying, long-term goal that their youngsters will do the right thing, even when parents are not in the room and even when not faced with potential threats, punishments, or rewards. An additional concern that should be highlighted is that threats drive a wedge between parents and adolescents. Although intimidation and threats do result in compliance in some youth, they nonetheless always pose a risk of jeopardizing an alliance and good relationship between parents and teens.
Besides which, it can be noted, that threats usually don’t result in compliance or cooperation, when applied to defiant, defensive, and willful youth. Threats are experienced by defiant, defensive youth as a challenge and they typically respond with escalated defiance. Another concern is a tendency for many parents to make empty threats. Examples include, “You are grounded forever,” “I’ll never buy you another jacket,” “I’m going to send you to military school.” Sometimes parents make realistic threats but don’t follow through and in so doing, they lose credibility and effectuality.
Orders or commands are also ineffectual and alienating, especially to defiant, defensive youth. Parents are encouraged to think about how they feel when their spouse or boss commands them or gives them an order. Most adults resent commands and are more likely to resist doing whatever it is that’s being asked. Most prefer being asked politely. Some examples of instructions which are more likely to achieve a cooperative response are, “Please take out the trash,” “Please walk the dog.” “Once you do, you can play video games, whatever.” Commands that would alienate and decrease the odds of a cooperative response include, “Clean your room … NOW!” or “Do your homework this minute!” In sum, parent utilization of “Cooperation Busters,” is likely to activate defensiveness, increase defiance, and heighten arousal.
Review Test on Communication
After introducing each of the busters, invite the group to review the test on communication together. Go around the circle and ask the parents to take turns reading each question aloud and then reading the answers. As they read the answers, they should indicate whether the answer illustrates a “Cooperation Buster,” or sounds like a potential “Cooperation Builder.” If they state that an answer represents a buster(s), advise them to indicate which specific one(s) is being demonstrated.
What About My Teen Examples?
After covering each major topic, it is worthwhile for the facilitators to pause and invite some brief discussion, regarding specific examples or applications of the material or skills covered, as related to the child for whom they are attending treatment. The parents and caregivers might be asked to provide an example or two, of instances during which they noted that their child’s level of cooperation seemed to diminish, when approached in the form of a “Cooperation Buster.”
Four Styles of Communication
Before delving into optimal parenting approaches, termed “Cooperation Builders,” by PACK-Teen, which tend to engender cooperative attitudes, the clinicians facilitate a discussion, using the dry erase board, regarding the four styles of communication. Cue them to especially consider patterns of communication around instances during which one individual is expressing concerns, frustration, or anger, to another individual, to whom those concerns pertain. The facilitators use a method of Socratic teaching, as always, starting with and building on what the group members already know. The four types of communication are eventually defined as followsg:
Passive: A passive style of communication implies saying or doing nothing when faced with a social conflict or distressing situation.
Passive–Aggressive: Passive–aggressive communication refers to a style whereby people display hostility or aggression in a covert way. For example, they might deliberately lose or forget something, or show up late to meet someone with whom they are angry.
Aggressive: Aggressive communication refers to physical or verbal aggression, whereby overt hostility is expressed in a way intended to deliberately hurt others.
Assertive: Assertive communication is considered the ideal style. It involves openly and honestly expressing one’s feelings without using shame, blame, or put downs and making simple and clear requests of others.
Relay to parents that assertive communication is the key to “Talking So Kids Will Listen” (Faber & Mazlish, 1980). The counterpart of assertive communication is empathic listening which is the key to “Listening So Kids Will Talk.”
Encourage discussion regarding the importance of imparting and empowering youngsters to stand up for themselves and their beliefs, using words. Aggression and anxiety usually go hand and hand. Youth often behave aggressively when they feel threatened or hurt, or when afraid they won’t be heard or get their needs met. However, aggressive communication obviously comes with a price and typically does not lead to teens getting what they want or need, although nonetheless some persist in this style. Messages delivered in an aggressive style, whether overtly or covertly, whether through body language, tone of voice, or word choice are met with an activation of a threat response from the individual to whom the message is sent. The target of aggressive communication will instinctively and almost instantaneously run away, hide, or fight back.
Invite parents to brainstorm strategies they might deploy to foster a transition in their adolescents, from using a predominately aggressive, to adopting an assertive style of communication. As youngsters become increasingly masterful at regulating their feelings and communicating assertively, they are increasingly able to achieve desired goals and improve their relationships, outcomes which are inherently and powerfully reinforcing. Parents can model assertive communication as their primary style and cultivate an appreciation that assertiveness, rather than aggression, provides them with an ideal mechanism for expressing their needs, which will increase the likelihood that they will get what they want.
Present the following two scenarios, and then read each answer aloud, asking the parents to identify answers as either passive, aggressive, passive–aggressive, or assertive, as you read each answer:
1. You have been waiting in line to purchases tickets to a concert of your teen’s favorite band. You plan to surprise your teen for their 16th birthday. You heard they are running out of tickets and two couples cut in line in front of you.
b. You politely point out the long line and ask them to move to the back (assertive).
c. You start loudly complaining about how rude they are (passive–aggressive).
d. You loudly yell curse words and threaten them if they don’t leave (aggressive).
2. Your coworker asks to piggy back on your presentation right before an important meeting because he went out every night with friends instead of preparing.
a. You pretend you don’t hear him and don’t respond (passive).
b. You call him lazy and tell him to get lost (aggressive).
c. You roll your eyes, sigh loudly and mutter insults under your breath (passive–aggressive).
d. You calmly and politely say, “Sorry man, you need to do your own work.”
Some reflection and review of the guidelines, regarding defining their version of the problem, in following “The 5 D’s” of PST, is useful, at this juncture. The principles to be followed, in ideally wording the concern during assertive communication, are the same and include the deliberate use of neutral language, use of “I statements” and feeling words, identification of a specific behavior, and avoidance of derogatory language, shame, blame, put downs, or accusations. Here again, as with PST, the parent would be wise to avoid the use of the words “But” or “you,” and if possible, avoid specifically mentioning the teen, altogether, while still pointing to a specific behavior about which they have concerns. The therapists are referred back to the narrative section of Module 4, on PST, for additional details and examples.
In our experience, in applying the assertiveness formula to negative feelings and behaviors, parents have been inclined to spend too much time detailing the problem behavior; they occasionally even turn this part of the formula into a lecture. In addition, parents typically make the mistake of using derogatory language and negatively interpreting or judging the behavior rather than just stating it in a brief and neutral way. The behavior needs to be defined concisely, simply, and precisely. Consider the following examples:
Rather than saying, “I feel angry when you are rotten and selfish,” it is better to say, “I feel upset when you call your sister names and won’t share.”
Rather than saying, “I feel frustrated when you turn your room into a pigsty,” it is better to say, “I feel frustrated when you leave your clothes on the floor.”
When done well, assertive requests increase the likelihood that the other person will want to change their behavior, compared to other styles of communication. The most reliable and important barometer of whether or not an individual was effective with their assertive communication is how the person to whom the message was directed responds. Many folks perceive themselves as assertive, but others experience them as aggressive. The assertive communicator must be careful to word their message in a manner that is devoid of “Shame, Blame, or Put Downs.” The listener should respond by exhibiting interest and receptivity to the assertive communicator’s message. The recipient should not react defensively, but instead should demonstrate openness and even express a willingness to change their behavior. An ideally delivered assertive message should elicit a compassionate response and should lead to resolution of a conflict and positive changes in behavior.
Discuss with parents that not only does their use of assertive communication model a desirable behavior; it also significantly increases the chances the adolescent will respond cooperatively and internalize a desire to change their behavior, for the long term. The facilitators suggest a method of using “I statements, to first say how they feel, point out the specific behavior they don’t like, in a nonderogatory, nonblaming way and make a request for a change. The bottom line with assertive communication is that it constitutes the essence of ‘speaking in a way that others will listen.’”
Assertive Communication+Empathic Listening=’s “Win-Win” Conflict Resolution
Remind the group that the counterpart to expressing a message assertively, is empathic listening, which constitutes the essence of “listening so others will talk.” Help the group recognize the merit of honing the skills of assertive communication, along with empathic listening as they relate to facilitating optimal conflict resolution, by presenting the following metaphor:
Conflict Resolution Is a Game of “Precision Catch”
A successful, mutually satisfactory, assertive and empathic interchange is a prerequisite that must transpire before any productive conflict resolution or interpersonal problem solving, can occur. Masterful empathic listening, coupled with astute, on point “mirroring,” requires intense focus, a good deal of self-restraint and a hefty dose of maturity. Dialogues that set up and promulgate effective, synergistic, “win-win,” conflict resolution can be likened to a novel, hypothetical game that might be aptly named “precision catch.” What typically transpires when two individuals experience a disagreement or conflict is that they instinctively and precipitously launch into a contentious debate, akin to a tennis match. In tennis, of course, the object is to “win,” at the expense of one’s opponent, possibly humiliating them in the process. Each player attacks the ball and rallies as rapidly as they are able, never pausing to hold or examine the ball, or give any consideration to the wants or needs of their opponent. The contender with the fastest and most agile maneuvers, coupled with the most powerful and aggressive blows, will most likely triumph over their rival and reign victorious. However, by contrast, consider a game of “precision catch,” perhaps involving a football, in which the goal is simply for a team of two, to achieve the highest percent of completed passes. The passer and the receiver roles are interdependent and interchanging. They are at once on the same team, so therefore continually and enthusiastically rooting for one another. If one does well in their role, it increases the odds of both winning. The receiver is beholden to the passer, to engineer a tight spiral and deliver an accurate, gently arcing, softly thrown football that lands precisely and effortlessly in the receiver’s outstretched hands. The passer is beholden to the receiver to remain open, focused, and prepared for each toss. Such is the case in effective assertive communication—the speaker must transmit their message in a most predictable, discernable manner, devoid of potential for inducing harm, or being deflected or dropped. If the passer is skilled in their throwing abilities and the receiver also competent and attuned, the odds of a successful team outcome are optimized. Of note, in precision catch, the receiver must be solely focused on the role of catching the ball (message) from the passer, during that phase of the game. While preparing to make a catch, the receiver cannot simultaneously be contemplating a passing strategy if they wish to ensure they make their reception. Similarly, during collaborative conflict resolution exchanges, the listener must remain wholly focused on the speaker, rather than mentally forging ahead and preparing their rebuttal. In precision catch, once caught, the ball is held momentarily, before the receiver, who now becomes the passer, lobs it back to the original passer (now the receiver). There is a rhythm and a turn-taking that must transpire, as well as a synergy that is cultivated when both passer and receiver are aligned in a mission to make accurate, gentle passes and catch them carefully and reliably.
Programs for assertiveness training, such as that by Sheila Hermes (1998), often advocate starting out with a formula for assertiveness such as the one that appears below, under “Cooperation Builders Part I.” The group can practice and commit a similar formula to memory. As parents master this style of communication, they can ad lib more and become less reliant on such formulas. Still, these are tough skills to master, even for adults. Mastering this skill set is typically fairly challenging but not untenable.
Reiterate repeatedly the need for the listener, who is intended as the recipient of the assertive message from a speaker, to initially respond by “mirroring” or reflecting back the message they heard, before introducing their own response or potentially competing agenda. What we’ve often observed, when families begin rehearsing assertive communication, is the listener bypasses the empathic listening and mirroring step and instead responds with their own assertive statement that represents their own potentially competing agenda, which leads to head-butting and obstruction of communication flow. The listener can bring their concern or agenda to the negotiation table, but only after demonstrating they’ve clearly heard and understand the viewpoint and feelings of their counterpart.
Summarize to the group that assertive communication means saying what’s on one’s mind in a firm, but polite way, but without attacking, belittling, or blaming the other person. The goal of assertiveness is to put others “in their shoes” and help others understand their perspective and feelings, that is, how they are being affected by the other person’s behavior.
“Business cards” listing the four styles of communication and the assertiveness formula are available on the book’s companion website in the PACK-Teen Module 5 Therapist’s Toolbox section. These cards may be cut out in advance and distributed to the parents, after the four styles of communication have been introduced. The cards may be used during the workshop, to assist with the exercises that follow, and later on, as reminders, for outside the program. Encourage the parents to keep the cards handy in their wallets, backpacks, or purses, and use them, to mentally rehearse the steps for assertive communication, as well as practice the steps in vivo. The teens are being taught the same communication styles and techniques concurrently, in the MaPS-Teen Module 5 workshop, so parents can model and reinforce them with their adolescents.
Practice with Assertive Communication
Assertive communication techniques can be additionally reinforced a variety of ways. Provide each parent with a sample and blank scenario card, for practice of the assertiveness formula, available for cut out on the book’s companion website in the PACK-Teen Module 5 Therapist’s Toolbox. Allow the group a few minutes to fill in their blank scenario card. Once a series of potential scenarios has been generated, ask the parents to contemplate options for addressing the concern on their sample scenario cards and then invite the group to take turns presenting their examples. Invite group discussion regarding the possible responses that demonstrate all four communication styles.
Another helpful exercise to employ with the parents is to have them take turns role-playing scenarios in which assertive responses would be appropriate. The parents often enjoy and embrace such role-plays, because it is an opportunity to dramatically act out the behavior of another person, perhaps their teen, in a manner that discharges frustration in a playful way. Either provide cards with sample scenarios to the parents or invite them to offer scenarios based on their own life experiences. Sample scenarios include the following:
The hairdresser cut your hair two inches shorter than you requested—you feel hideous.
Your teen keeps taking your toiletry supplies such as your toothpaste, shampoo, soap, etc.
Your spouse has a habit of interrupting you mid-sentence.
Your teen tends to address you in a demeaning and disrespectful manner whenever they have friends over.
One of your coworkers keeps teasing you about your voice and laughing and it bothers you a lot.
Your coworker routinely fails to complete their assigned tasks on joint projects.
You want to stay home and watch a movie but your spouse want to go party across town.
Your friend shows up late, changes their plans or cancels, every time you make plans.
During the assertive communication role-plays, keep reminding the listener to respond empathically and first “mirror” or paraphrase what they heard, prior to introducing their viewpoint or agenda to the discussion (again using assertive method).
Expressing Positive Feelings Using the Assertiveness Formula
Ask the parents, “Do you think we can only use this formula if we are talking about feelings that do not feel good, such as anger and upset?” The answer sought, of course, is “No! It works well for positive feelings, too!” Invite the parents to take turns practicing the expression of positive feelings using the formula. Facilitate discussion by asking the group, “If you share your positive feelings this way, do you think the person will be more or less likely to do the thing you like?” The answer sought, of course, is “much more!” For homework, ask the parents to use the assertiveness formula at least twice each day for the next week, stating one positive and one negative feeling without insulting, shaming or blaming the other person. Tell the parents that when expressing positive feelings about desirable behavior, it is fine to make the comment personal and use the word “you;” however, when expressing negative feelings about undesirable behavior, it is better to make the comments neutral and global, omitting the word “you” if possible.
When practicing assertiveness, urge parents to practice using the formula to identify strong positive feelings regarding behaviors they appreciate and wish to reinforce. A reasonable ratio of reflecting positive feelings versus negative feelings about behavior is between five and ten positive comments for every one negative comment. If desired, only the first part of the formula may be used (i.e., “I feel ______ [insert strong, positive feeling word] when you _________!”). If a youngster repeatedly displays behavior that reflects an admirable, pro-social character or quality, the parents may wish to use the rest of the assertiveness formula to point out that perception and reinforce that desirable attribute. For instance, a parent might say, “I feel thrilled when you help your little sister with homework because it shows me how kind and patient you are!” Or, a parent might say, “I feel elated when you clean your room on your own because it shows me how responsible and grown up you are!” A third example might be, “I feel so proud to see how hard you practice football because it shows me how determined and hardworking you are!”
Cooperation Builders
After the group has done the work of highlighting all the typical parenting approaches that diminish the chances of obtaining teen cooperation, present some better options. Again employ the dry erase board and write a list of options. Then present a series of examples and invite the group to identify which strategy is being illustrated by each example. The following options and examples are presented, remembered using the acronym A. (2) B. C. (2) D. (3)h:
(State Feelings) I Feel_________(Insert Feeling Word)
(Identify Problem BRIEFLY/NEUTRALLY) When ____________
(Explanation-Optional) Because________________________
(Make a Request) If You Would _______________________
(What They Get In Return) Then I Will Feel/Do____________
Examples: Your teen comes in from school and asks, “Can I go to the skate park?” Better to say “Sure you can, after you finish your homework,” rather than “No, of course not. You need to do your homework.” Your teenage daughter has neglected her chores and asks, “Can I have a sleep over,” Better to say, “You bet you can, Jessie, as soon as you’ve cleaned your room.” Your teen asks, “Mom can you take me to get supplies for my project?” Better to say, “Sure. Just let me finish making dinner.”
Be Brief or Ultra-Brief (Skip the Lecture):
Examples: “The dog,” “Your lunch,” “The trash,” “Your homework,” “Your room.” Or just use a gesture, point, hold up the leash, hand them the dog dish.
Examples: “Would you like to clean your room or set the table first?” “Would you like to walk the dog now or right after dinner?” “Would you like go out Friday or Saturday?” “Would you like to help with the dishes or the vacuuming?”
Examples: “I’d love it if you helped me clean this up,” “Why don’t you find some ripe tomatoes?” “I bet you could fix this,” “Can you hand me the wrench,” “Can you stir the noodles?”
Example: “The light was left on,” “The trash is full,” “The dog needs a walk,” “The towel is on the floor.” Or “When the lights are left on, the bill goes up,” “When cheese is left out, it goes bad,” “Food in the bedroom will invite ‘roaches,” and “Dishes that don’t get rinsed won’t come clean.”
Example: The parent suggests, “Why don’t we clean your room together?” or “How about I help you with the weeding?”
Disengage and Evacuate (D & E):
Example: The parent removes him- or herself from the situation or area, where the teen is located, so long as the teen is refraining from engaging in unsafe behavior. The goal is to avoid escalation of a negative, coercive cycle or engagement in power struggles or senseless debates.
Again reinforce to parents that when using the “Assertiveness Formula” to express negative feelings about negative adolescent behaviors, it is essential that they describe the negative behavior neutrally and briefly. It is easy for parents to launch into lectures, use derogatory language or labels and assign blame, when expressing negative feelings about undesirable behavior. For example, “I feel upset when one person I love hits another person I love” is highly preferred over “I feel upset when you bully your little sister.” Another example would be, “I feel disrespected, when someone calls me a name,” is highly preferred, over “I feel upset when you act disrespectfully.”
Generally, adolescents don’t want to hear their parents talking. They readily zone out, especially in regards to negative feedback about their behavior or coercive efforts to elicit compliance with chores, etc. So the briefer, the better, from a teen’s perspective. Using a brief phrase or one word reminder or better yet, a nonverbal gesture, will be preferred and more likely yield a cooperative response.
When offering choices, it is easy to instead pose a question wherein one of the choices actually represents a veiled threat. The facilitators remind parents that threats only cause youngsters to become agitated and defensive and don’t enhance compliance and cooperation. For example, a parent might say, “Would you like to clean your room right now or go straight to bed?” depicts a “boxed in” scenario for a youngster, without a genuine choice.
Answering requests affirmatively can be a little tricky and often met with resistance by some parents who are afraid they will be “giving in” and that this strategy implies permissiveness. It is helpful for therapists to first respond to parental resistance by validating their feelings and concerns. They might then be gently encouraged to maintain an open mind and try out new approaches, even if at first, they are anxious and uncomfortable doing so. Resistant parents can be asked about the level of success they’ve experienced, with their previous, more traditional, authoritarian approaches. Since usually they’ve exhausted every option they could identify, they are often more willing to attempt approaches that fall outside their “comfort zone,” and usual repertoire of parenting tools.
Use a Socratic style to invite the group to reflect on the fact that defiant, defensive youngsters often act as though looking for a fight. The minute they hear “No,” or “Don’t,” they are prepared to protest and defy. It’s more effective for parents to present things affirmatively such that youngsters, especially defiant, defensive ones, don’t feel as though they’re being boxed in or controlled, which is what they fear most. The parents are invited to find a way to say no without using the word, “No.” Often, however, the answer can actually be “Yes,” but the “Yes” is contingent upon a task the teen must first complete. Defiant, defensive youth especially respond better when parents begin a reply to their request in an affirmative manner, even if the reply has a condition or contingency tied to it. This tactic works even when parents are not quite ready to approve the request entirely.
Discuss with parents that what these “Cooperation Building” techniques have in common is that they are “face-saving,” to youngsters. If done well, they do not put youth on the defensive or lead them to feel ashamed, wrong, or bad. Instead, these strategies offer adolescents an opportunity to tell themselves what to do and choose to “do right” by their parents and behave in a pleasing manner. In a sense, these strategies have the parents behave as though perhaps the teen does not know any better and so the parents are simply providing a neutral cue or information to guide the teen’s way. It is true, of course, that most of the time the adolescent actually does know better, but he or she will likely be more agreeable if the task is presented in an optimal, face-saving manner.
Most youth really do want to please their parents and other adults most of the time, although parents often are skeptical about this. In general, when youth are presented with an opportunity to help, to redeem themselves, and to make things right, most of them will rise to the occasion. Youngsters generally will jump at the chance to turn things around and please their parents once they are given clear guidance as to how to do so, in a way that doesn’t leave them feeling put down or blamed. You may ask resistant parents about the level of success they have experienced with their previous, more traditional authoritarian approaches. Because they usually have exhausted every option they know, they often are willing to attempt approaches that fall outside of their comfort zone and usual repertoire of parenting tools.
The parent handout on cooperation builders can be disseminated after discussing each one and should be kept handy, as a reminder, for the role-play practice exercises to follow. “Business cards” reviewing the material from this Module, are available digitally on the book’s companion website and can be cut out and handed to parents to serve as reminders during the workshop, as well as at home.
Cooperation Building Role-Plays
Begin this activity by highlighting the utility of role-playing effective communication rather than just discussing the concept. The elements of good communication usually seem sensible and are readily understood on an intellectual level; however, when it comes time to employ the elements and put them into play in the heat of the moment, most parents struggle. The techniques are easy to comprehend and describe but generally are not so easy to put into action. During the role-playing activity, focus particularly on practicing the use of the assertiveness formula as detailed above. This strategy has universal applicability and is difficult to master. The adolescents also are being taught assertiveness, including the formula, during their workshop.
Once the parents have discussed the various cooperation busters and cooperation builders and considered several examples, ask them to take turns selecting cards on which are printed sample scenarios of negative adolescent behaviors to use in practicing the cooperation builders. Sample scenario cards are available on the book’s companion website and can be cut out in advance for practice during the workshop. Some cards were left blank deliberately to allow for parents to fill in their own examples derived from actual experiences with their teen.
List the cooperation-building approaches on the board and cross each one out as it is demonstrated for the sake of ensuring that each strategy is role-played at least once but also to economize time in the session. Advise the parents that when it is their turn, they must pick one of the remaining cooperation builder options to act out, in relation to the scenario on their card. Regardless of which approach a parent chooses to use, whenever a teen expresses a feeling or viewpoint it is recommended that the parent pause to empathize and acknowledge the teen’s perspective before further responding. Following is a typical set of scenarios used for role-plays followed by some examples of approaches that are recommended:
1. Your teenager has left the water on in the sink … again.
Examples of cooperation-building approaches:
b. “Water left running will overflow.”
c. “What can you do so that you’ll remember to turn off the water?”
2. Your adolescent has returned the car on empty.
Examples of cooperation-building approaches:
b. “You’re welcome to use the car again, just as soon as you fill the tank.”
3. Your teen has left a mess in the kitchen.
Examples of cooperation-building approaches:
a. “You can eat your sandwich right after you clean the kitchen.”
c. “I’m angry about the mess.”
4. Your adolescent is neglecting the dog.
Examples of cooperation-building approaches:
b. “Dogs will pee in the house if not walked.”
c. “I thought we had a deal. I’m frustrated that you haven’t been caring for the dog the way we’d agreed.”
5. Your adolescent asks to go out but has not studied.
Examples of cooperation-building approaches:
a. “You can go out … after you study.”
c. “Studying will help your grades. Better grades will better your access to the car.”
Love Languages
Introduce this section by remarking and generating discussion regarding the indisputable and pervasive fact that teenagers behave in ways that often leave their parents feeling confused, irritated and even outraged or infuriated. Remind parents that the major psychological developmental task of adolescence, known as “separation-individuation,” detailed in Module 1, involves a delicate dance between asserting independence and pushing parents away, while still maintaining a connection and relying on parents to serve as guides and furnish “safety nets.” Invite discussion regarding the phenomenon that teens are in an awkward and challenging phase of life where they are no longer children, requiring continuous protection and direction from parents, yet they certainly do not have the skills and knowledge to function autonomously.
Gary Chapman (2010) has developed a theoretical paradigm for understanding and categorizing individual differences in preference in regards to modes of expressing and receiving love and affection, which he has termed “Love Languages.” He authored a book describing how these constructs might be applied to teenagers and we have incorporated his ideas into the PACK-Teen program with positive results. Introduce these concepts to the group, inviting feedback and discussion as the information is being relayed. List the five “Love Languages” on the dry erase board. The five “Love Languages” described by Dr. Chapman are summarized as followsi:
Love Language #1: Words of Affirmation
This form of expressing love involves parental verbalization of praise or affection. Guidelines for effective praise include the description of specific examples of behaviors or qualities, in a timely and sincere manner. Verbal expressions of affection would include parental comments regarding their positive feelings about the teen’s behavior or qualities. It is important to praise and express positive feelings not just about achievements or behaviors, but additionally about positive or virtuous qualities and abilities, so the message is conveyed that the teen as a person is valued and appreciated, regardless of their behavior or accomplishments.
Examples: “I admire your determination. You never give up!” “I appreciate your honesty—it took guts to admit the truth.” “I am so proud that you made the Honor Roll!”
Love Language #2: Physical Touch
Use of physical touch to express love and affection toward teens is a delicate maneuver, about which parents must be sensitive and thoughtful. For instance, physical affection typically will best be received in private and will be experienced as embarrassing and intrusive if performed in public, especially in front of peers. In addition, physical touch can take many different forms, and individual adolescents will typically prefer one form over another, such as hugs preferred over kisses, etc. Furthermore, teens will receive physical affection warmly only when in a positive, approachable mood. When angry or irritated, adolescents will likely escalate and express hostility, if offered physical touch or affection and may interpret it as an effort by the parent to exert control.
Love Language #3: Quality Time
The provision of “quality time” implies that parents will give teens their undivided attention and listen without judging, lecturing, scolding, reassuring, or advising. The parents should be coached to use “The Empathy Formulas” and mirroring technique to increase the degree to which teens will feel accepted and inspired to talk in a candid, uncensored way. The connection and comfort level between parents and teens will be enhanced, if parents schedule “quality time” that is recurring and predictable. For instance, they can negotiate standing appointments for 1:1 time with their teens, which revolve around recurring activities such as a tradition of having breakfast every Sunday morning or going for ice cream, after every volleyball game. There will be moments when adolescents “refuse to talk,” depending on their mood and parents should respect their need for privacy and self-reflective time.
Love Language #4: Acts of Service
Acts of service imply that the parent perform tasks or favors for teens that are not contingent on the teen saying or doing anything in return. The message is that the parent is simply performing an act of service to demonstrate their unconditional love to their teen, with no hidden agenda. Acts of service, from parent to teen, might include washing and folding a sports uniform, packing a lunch with the teen’s favorite foods and a note of encouragement, planning a weekend ski trip for the teen’s birthday, to which they can invite a friend or detailing the car, prior to the teen’s use for travel to a school dance.
Love Language #5: Gifts
Gifts should be associated with a ceremony and emotional meaning. Gifts of cash or excessive material value, without associated ceremony or emotional meaning are experienced as empty and fail to keep the attention of youngsters. Examples of gifts which might effectively convey love and affection would be the purchase of tickets to a game of a favorite sports team, for an occasion that is memorable, such as a birthday or graduation. Another gift with emotional meaning might include a piece of jewelry, such as a charm bracelet or watch, with an engraved message commemorating a special day or containing charms reminiscent of a memorable occasion.
Encourage the parents to reflect upon and openly discuss with the group, their preferred modes of giving and receiving love and affection. Help them recognize that others, unless told explicitly, may lack awareness regarding their preferred modes of receiving love and affection. Conversely, they may not have an accurate sense regarding the preferred “Love Languages” of the loved ones in their lives. Make the point that most individuals enjoy occasional expressions of love and affection in the form of all five Love Languages, but typically have a preference for one or two. For parents to uncover the preferred Love Languages of their teens, they must pay careful attention to their teens’ behaviors and listen intently to their words. They should ask questions and experiment with different expressions of love, while carefully noting their teens’ responses. You can provide the parents with the Module 5 PACK-Teen Communication Styles and Love Languages Handouts to take home for use as a reference in practicing assertive communication during the week.
Responding to Parental Resistance
This module focuses on imparting a series of parenting strategies that are likely to engender a cooperative attitude and response from youngsters. As parents struggle to understand and master approaches that typically are novel and initially feel awkward to them, they are likely to become discouraged. When their efforts are not met with immediate success, it is not uncommon for them to report, “I tried such and such and it didn’t work!” Responding to any frustration verbalized by parents is always recommended as a first step. It is also useful to repeatedly acknowledge that none of the tools taught in PACK-Teen are guaranteed to work every time with every teen; however, the point that traditional, authoritarian approaches to parenting that rely heavily on threats and punishments are nearly always guaranteed to fail, especially when deployed with youth who are chronically defiant, defensive, and dysregulated, can also be repeatedly highlighted.
Family Homework
For homework, encourage families to use the assertiveness formula at least once daily to express a positive or negative feeling while being careful to avoid shame, blame, or put downs. Advise families to practice first with low-stakes issues or mild conflicts until they feel more confident and masterful in their assertive communication skills. Likewise, advise families that they may wish to first practice assertiveness by focusing on the expression of positive feelings, regarding behaviors or qualities in others, that are appreciated and enjoyed.
Joint Session for Module 5
During the second IOP session of the week, there is an opportunity for parents and adolescent to join together for 60 minutes, during the later portion of the workshop. Have the teens and parents briefly review what they’ve been working on and have learned. Then invite the parents to pair up with teens from other families, break up into small groups, and practice using the assertiveness formula, while therapists provide coaching as needed. Advise the group to initially practice using “low-stakes” scenarios and avoid domains of intense parent–teen conflict, until a high level of mastery in assertive communication techniques is achieved. Have the teens practice and receive feedback from their “adopted” parents and then ask adopted parents to practice, receiving feedback from teens.
Prior to cueing this exercise, it is important to reiterate the guidelines for assertive communication, especially in regard to how the concerning behavior should be framed—that is, providing an ultra-brief, neutrally worded, description of behavior of concern, without use of the word “you” or inserting any derogatory language, blame, or put downs. The speaker can have a copy of the Assertiveness Formula handy, along with a list of feeling words. The Assertiveness Formula and sample feeling words can also be scribed on a dry erase board, while the initial topic review occurs and exercise is being described.
The speaker should be sure to state feelings in a neutral way, and then follow that up with a positive request regarding the behavioral change they’d like to see in the listener. Then the speaker can finish off their assertive message by pointing out how their feelings would change, should the listener accommodate the request and they may also, if desired and appropriate, offer to do something positive for the listener, in return. Ask the listener to “mirror” what they heard and refrain from reacting to or disputing whatever the speaker said.
Sample scenario cards can be provided to use as examples during the role-plays, or the group members can invent hypothetical situations, but ultimately, practice in reference to real issues should occur. After rehearsal using at least one real issue has occurred, advise the teens to reunite with their real parents. Again, invite the pairs to practice assertiveness, using the verbiage derived from earlier practice and feedback with adopted parents. Remind the group to have the listener “mirror” what they heard and refrain from reacting to or disputing whatever the speaker said. The group can reunite, and process their experiences of practicing assertiveness together, before moving on to the next exercise.
Provide all group members with their own copy of the MaPS-Teen and PACK-Teen Module 5 Love Languages worksheet handout, with a blank pie chart for each person to complete, outlining their preferred Love Languages, in reference to the parent–teen relationships, dividing up categories as percentages. Allow a few minutes for each person to complete their worksheet. Then advise the parents to pair up with their own teens and take turns, with their teen, describing their pie chart, and most preferred “Love Languages.” Encourage the group to be sure to share specific examples of past behaviors performed by the other family member that exemplified their preferred Love Languages and made them feel loved. Once finished, cue the larger group to come back together, and encourage parents and teens to take turns conveying this information to one another using the following formula: “I feel loved when _____________.” Ask the listener to “mirror” what they heard and refrain from reacting to or disputing whatever the speaker said.
PACK-Teen Module 5 Summary Outline
Materials Needed
• “Business cards” on which are printed cooperation busters, cooperation builders, communication styles, and the assertiveness formula
• Sample and blank scenario cards for practice of assertiveness and cooperation builders
• Note: All handouts and business cards are available on the book’s companion website and should be held and only disseminated immediately following the discussion regarding the content. If given out earlier, they may become a distraction and impede learning.
Established Parent Introductions and Check-Ins
• Have the introduction and check-in format for new versus established parents written on the board.
• Go around the room and have each established parent take turns doing as follows:
• Ask each parent to identify themselves by first name.
• Ask each parent to mention their teen’s first name.
• Ask each new parent to mention one “victory” or success (required) and “challenge” (optional), from past week, related to their teen.
• If there are new parents, invite each established parent to help in orienting the new parents to the workshop format and guidelines.
• Established parents may check in regarding their family progress, including approaches they tried which were effective thus far.
Workshop Guidelines
• Workshop consistently starts on time and finishes on time, punctuality is required, leaving early or stepping out of workshop during session are not allowed.
• Confidentiality is required, “What is said in here, stays in here,” playfully termed the “Vegas Rule.”
• Exceptions are safety issues (suicidality, homicidality, violence, abuse/neglect).
• Refrain from developing personal relationships outside group while in program.
• All cell phones, pagers, electronics of any kind must be turned off during group.
New Parent Introductions and Check-Ins
• Have the introduction and check-in format written on the board.
• Take turns having each parent introduce themselves and check in as follows:
• Ask each parent to identify themselves by first name.
• Ask each new parent to mention one positive feature or strength of their adolescent and mention one “challenging behavior” they’d like to focus on.
• Ask established parents to comment on commonalities noted during new parent check-ins.
New Parent Orientation
Administer Multiple Choice Test on Communication
Review and Discuss Cooperation Busters
These can be remembered using the acronym O.S.P.L.A.T.T.:
• Orders: Examples: “Go and clean your room right this minute!” “Mow the lawn, now!” “Take out the trash.” “Feed the dog.” “Do your homework.”
• Scoldings: Examples: “I’ve told you a hundred times….” “You need to stop acting like a baby.” “You never listen!”
• Put downs: Examples: “You are such an airhead!” “You are irresponsible (or lazy, selfish, and so forth).”
• Lectures: Examples: “Do you understand how important it is to have nice manners? First impressions are important. If you want to be respected, you need to be polite and make a good impression. You’ll never get a job if you can’t learn how to act right.”
• Accusations: Examples: “You never listen.” “You are so careless.” “How could you?” “If only you had planned ahead.” “It’s your own fault.” “You should know better.”
• Threats: Examples: “You hit your sister one more time and I’ll give you a smack.” “If I catch you lying again, you are grounded for life.” “If you don’t shape up, I’m sending you to military school” (or to live with your Dad).
Review the Multiple Choice Test on Communication
• Go around the room and have parents take turns reading the question and each answer.
• Ask them to indicate whether a response represents a communication buster or sounds like a communication builder.
• Have them specify what specific cooperation buster(s) is being illustrated.
Some answers may demonstrate more than one type of cooperation buster.
Discuss the “What About My Teen?” Examples
Review and Discuss the Four Styles of Communication
Provide cue that these styles are especially relevant in contexts of sharing concerns or expressing anger, frustration, or upset and include the following:
• Passive: A passive style of communication implies saying or doing nothing when faced with a social conflict or distressing situation.
• Passive–Aggressive: Passive–aggressive communication refers to a style whereby people display hostility or aggression in a covert way. For example, they might deliberately lose or forget something, or show up late to meet someone with whom they are angry.
• Aggressive: Aggressive communication refers to physical or verbal aggression, whereby overt hostility is expressed in a way intended to deliberately hurt others.
• Assertive: Assertive communication is considered the ideal style. It involves openly and honestly expressing one’s feelings without using shame, blame, or put downs and making simple and clear requests of others.
• Provide the two examples and discuss answers (ask group to identify style of communication illustrated by each answer):
1. You have been waiting in line to purchases tickets to a concert of your teen’s favorite band. You plan to surprise your teen for their 16th birthday. You heard they are running out of tickets and two couples cut in line in front of you.
b. You politely point out the long line and ask them to move to the back (assertive).
c. You start loudly complaining about how rude they are (passive–aggressive).
d. You loudly yell curse words and threaten them if they don’t leave (aggressive).
2. Your coworker asks to piggy back on your presentation right before an important meeting because he went out every night with friends instead of preparing.
a. You pretend you don’t hear him and don’t respond (passive).
b. You call him lazy and tell him to get lost (aggressive).
c. You roll your eyes, sigh loudly and mutter insults under your breath (passive–aggressive).
d. You calmly and politely say, “Sorry man, you need to do your own work.”
Assertive Communication
• The key to “Talking So Kids Will Listen.”
• If effective, the person receiving the message should listen well and respond with openness, compassion and a willingness to change their behavior.
• Reaction and response of listener are the best barometer of effectiveness of assertive communication.
• Assertive communication must be devoid of “Shame, Blame, Put Downs.”
• Use sample scenario cards to role-play practice use of assertiveness formula (appears below and can be written on dry erase board during exercise).
• Encourage the listener to mirror or reflect back the message they heard.
• Assertive Communication+Empathic Listening=’s “Win-Win” Conflict Resolution
• Remind the group that the counterpart to expressing a message assertively, is empathic listening, which constitutes the essence of “listening so others will talk.” Help the group recognize the merit of honing the skills of assertive communication, along with empathic listening as they relate to facilitating optimal conflict resolution, by presenting the following metaphor:
• Conflict resolution is a game of “Precision Catch”
• A successful, mutually satisfactory, assertive and empathic interchange is a prerequisite that must transpire before any productive conflict resolution or interpersonal problem solving, can occur. Masterful empathic listening, coupled with astute, on point “mirroring,” requires intense focus, a good deal of self-restraint and a hefty dose of maturity. Dialogues that set up and promulgate effective, synergistic, “win-win,” conflict resolution can be likened to a novel, hypothetical game that might be aptly named “precision catch.” What typically transpires when two individuals experience a disagreement or conflict is that they instinctively and precipitously launch into a contentious debate, akin to a tennis match. In tennis, of course, the object is to “win,” at the expense of one’s opponent, possibly humiliating them in the process. Each player attacks the ball and rallies as rapidly as they are able, never pausing to hold or examine the ball, or give any consideration to the wants or needs of their opponent. The contender with the fastest and most agile maneuvers, coupled with the most powerful and aggressive blows, will most likely triumph over their rival and reign victorious. However, by contrast, consider a game of “precision catch,” perhaps involving a football, in which the goal is simply for a team of two, to achieve the highest percent of completed passes. The passer and the receiver roles are interdependent and interchanging. They are at once on the same team, so therefore continually and enthusiastically rooting for one another. If one does well in their role, it increases the odds of both winning. The receiver is beholden to the passer, to engineer a tight spiral and deliver an accurate, gently arcing, softly thrown football that lands precisely and effortlessly in the receiver’s outstretched hands. The passer is beholden to the receiver to remain open, focused and prepared for each toss. Such is the case in effective assertive communication—the speaker must transmit their message in a most predictable, discernable manner, devoid of potential for inducing harm, or being deflected or dropped. If the passer is skilled in their throwing abilities and the receiver also competent and attuned, the odds of a successful team outcome are optimized. Of note, in precision catch, the receiver must be solely focused on the role of catching the ball (message) from the passer, during that phase of the game. While preparing to make a catch, the receiver cannot simultaneously be contemplating a passing strategy if they wish to ensure they make their reception. Similarly, during collaborative conflict resolution exchanges, the listener must remain wholly focused on the speaker, rather than mentally forging ahead and preparing their rebuttal. In precision catch, once caught, the ball is held momentarily, before the receiver, who now becomes the passer, lobs it back to the original passer (now the receiver). There is a rhythm and a turn-taking that must transpire, as well as a synergy that is cultivated when both passer and receiver are aligned in a mission to make accurate, gentle passes and catch them carefully and reliably.
Expressing Positive Feelings with the Assertiveness Formula
• Ask the parents, “Do you think we can use this formula only when we are talking about feelings that do not feel good, such as anger and upset? The answer sought, of course, is “no, it works great for positive feelings too!”
• Have each parent practice expressing positive feelings, using the assertiveness formula.
• Ask the group, “If you share your positive feelings this way, do you think the other person will be more or less likely to do the thing you like?” The answer sought, of course, is “much more!”
Review and Discuss Cooperation Builders
This can be remembered using the acronym A.(2) B.(2) C.(2) D.(3). Provide the parents with the cooperation builders handout, PACK-Teen Module 4, which appears on the book’s companion website.
Perform Cooperation-Building Role-Plays
Discuss the “What About My Teen?” Examples
Note: Regardless of which approach is chosen by a parent, whenever a youngster expresses a particular feeling or viewpoint, it is recommended that the parent pause to empathize and acknowledge the teen’s perspective before further responding. Discuss sample answers for scenarios within PACK-Teen Module 4.
Introduce and Discuss Love Languages
Review the PACK-Teen Mantras
“If you accept teens as they are … then they will change!”
“Model the behavior you want to see.”
Review, Answer Questions, and Wrap Up
Family Homework
In PACK-Teen Module 5, parents and teens alike discussed and practiced assertive communication techniques.
• For homework, encourage families to use the assertiveness formula at least once daily to express a positive or negative feeling while being careful to avoid shame, blame, or put downs.
• Advise families to practice first with low-stakes issues or conflicts until they feel more confident and masterful in their assertive communication skills.
• Likewise, advise parents that they may wish to begin practicing by expressing positive feelings to other individuals about the individuals’ behaviors that are appreciated and enjoyed.
Joint Session Ideas for Module 5
• Have teens join parents for 60 minutes at the end of the PACK-Teen Module 5 workshops. Options for joint session exercises include the following:
• Have the teens and parents review what they’ve been working on and have learned.
• Have the teens pair with parents who are not their own and break up into small groups to practice using the assertiveness formulas together.
• Remind the group to have the listener “mirror” or reflect back the assertive message they heard.
• The pairs should offer feedback to one another. The therapists can also provide coaching if needed.
• Invite teens to return to their real parents and again perform assertiveness practice, using a real concern they just rehearsed with their “adopted” families. Parents should also do the same.
• Provide each person with a copy of the Love Languages worksheet, with pie graphs and have them complete it independently.
• As a large group, take turns having teens and then parents relay to one another their preferred mode of receiving love and affection, using the stem, “I feel loved when…” Encourage specific examples to be included in these expressions.
Handouts/Business Cards
• Communication Tests Handout #19
• Cooperation Busters Handout #20
• Cooperation Busters Business Cards Therapist Tool #7
• Four Styles of Communication Handout #21
• Cooperation Builders Handout #22
• Assertive Communication Practice Sample Scenario Cards Therapist Tool #8
• Cooperation Building Practice Sample Scenario Cards Therapist Tool #9
• Assertiveness Formula Business Cards Therapist Tool #10
Module 5-PACK-Teen Parent Handout #19
Multiple Choice Tests on Communication
Choose the answer that most closely resembles your typical response.
1. You find your 15-year-old son has spilled paint in the garage:
a. How could you? You know better!
b. I’m so sick of your messes!
c. Here’s something to clean up the paint.
2. Your 13-year-old son left his computer on all night:
a. How many times must I tell you to turn the computer off?!
b. Do you know how much electricity you are wasting? Do you have any idea how much I pay in utilities each month? I’m going to go broke ‘cause of you!
3. Your 14-year-old daughter says “Mom, you need to take me school shopping right now!”
a. How dare you talk to me that way?
c. This is how I like to be asked, “Mom, will you please take me to the store?”
4. Your 15-year-old son forgot his American history book.
a. You are so forgetful! I’m surprised you don’t forget your own head.
b. Too bad. Now you’re gonna’ fail.
c. What can you do so you’ll remember next time?
5. Your 16-year-old daughter scratched up the family car.
a. You are so irresponsible. You can never use the car again.
Module 5-PACK-Teen Sample and Blank Scenario Cards for Assertive Communication Practice Therapist Tool #8
Module 5-PACK-Teen Parent Handout #20
Cooperation Busters
“O. S.P.L.A.T.T.!”:
Orders:
Examples: “Go and clean your room right this minute!” “Mow the lawn, now.” “Take out the trash,” “Feed the dog,” “Do your homework.”
Scoldings:
Examples: “I’ve told you a hundred times,” “You need to stop acting like a baby,” “You never listen!”
Put Downs:
Examples: “You are such an airhead!” “You are irresponsible … lazy … selfish … (whatever…)”
Lectures:
Examples: “Do you understand how important it is to have nice manners? First impressions are important. If you want to be respected, you need to be polite and make a good impression. You’ll never get a job if you can’t learn how to act right.”
Accusations:
Examples: “You never listen,” “You are so careless,” “How could you?” “If you only planned ahead…” “It’s your own fault,” “You should know better.”
Threats:
Examples: “You hit your sister one more time and I’ll give you a smack,” “If I catch you lying again, you are grounded for life,” “If you don’t shape up, I’m sending you to military school (or to live with your Dad).”
“The Golden Rule:” “No Shame, No Blame, No Put Downs!”
Adapted with Permission from Cook, M. (2012). Transforming Behavior: Training Parents and Kids Together, Brookes Publishing, Baltimore, MD.
Module 5-PACK-Teen 4 Styles of Communication Parent Handout #21
Module 5-PACK-Teen Parent Handout #22
Cooperation Builders A. (2) B. C. (2) D. (3):
(State Feelings) I Feel_____________________________________________(Insert Feeling Word)
(Identify Problem BRIEFLY/NEUTRALLY) When ____________________________________
(Explanation-Optional) Because______________________________________________________
(Make a Request) If You Would _____________________________________________________
(What They Get in Return) Then I Will Feel/Do_______________________________________
Answer Affirmatively:
Examples: Your teen comes in from school and asks, “Can I go to the skate park?” Better to say “Sure you can, after you finish your homework,” rather than “No, of course not. You need to do your homework.” Your teenage daughter has neglected her chores and asks, “Can I have a sleep over,” Better to say, “You bet you can, Jessie, as soon as you’ve cleaned your room.” Your teen asks, “Mom can you take me to get supplies for my project?” Better to say, “Sure. Just let me finish making dinner.”
Be Brief or Ultra Brief (Skip the Lecture):
Examples: “The dog,” “Your lunch,” “The trash,” “Your homework,” “Your room.” Or just use a gesture, point, hold up the leash, hand them the dog dish.
Choices:
Examples: “Would you like to clean your room or set the table first?” “Would you like to walk the dog now or right after dinner?” “Would you like go out Friday or Saturday?” “Would you like to help with the dishes or the vacuuming?”
Create a Helping Opportunity:
Examples: “I’d love it if you helped me clean this up,” “Why don’t you find some ripe tomatoes?” “I bet you could fix this,” “Can you hand me the wrench,” “Can you stir the noodles?”
Define the Problem:
Examples: “The light was left on,” “The trash is full,” “The dog needs a walk,” “The towel is on the floor.” Or “When the lights are left on, the bill goes up,” “When cheese is left out, it goes bad,” “Food in the bedroom will invite roaches,” and “Dishes that don’t get rinsed won’t come clean.”
Do It Together:
Examples: The parent suggests, “Why don’t we clean your room together?” or “How about I help you with the weeding?”
Disengage and Evacuate (D & E):
Examples: The parent removes him or herself from the situation or area, where the teen is located, so long as the teen is refraining from engaging in unsafe behavior. The goal is to avoid escalation of a negative, coercive cycle or engagement in power struggles or senseless debates.
Adapted with Permission from Cook, M. (2012). Transforming Behavior: Training Parents and Kids Together, Brookes Publishing, Baltimore, MD.
Module 5- PACK-Teen Sample and Blank Scenario Cards Cooperation Building Practice Therapist Tool #9
Module 5-PACK-Teen Parent Handout #23
The Five “Love Languages”
Love Language #1: Words of Affirmation
This form of expressing love involves parental verbalization of praise or affection. Guidelines for effective praise include the description of specific examples of behaviors or qualities, in a timely and sincere manner. Verbal expressions of affection would include parental comments regarding their positive feelings about the teen’s behavior or qualities. It is important to praise and express positive feelings not just about achievements or behaviors, but additionally about positive or virtuous qualities and abilities, so the message is conveyed that the teen as a person is valued and appreciated, regardless of their behavior or accomplishments.
Examples: “I admire your steadfastness. You never give up!” “I appreciate your honesty–it took guts to admit the truth.” “I am so proud that you made the Honor Roll!”
Love Language #2: Physical Touch
Use of physical touch to express love and affection toward teens is a delicate maneuver, about which parents must be sensitive and thoughtful. For instance, physical affection typically will best be received in private and will be experienced as embarrassing and intrusive if performed in public, especially in front of peers. In addition, physical touch can take many different forms, and individual adolescents will typically prefer one form, over another, such as hugs, preferred over kisses, etc. … Furthermore, teens will receive physical affection warmly only when in a positive, approachable mood. When angry or irritated, adolescents will likely escalate and express hostility, if offered physical touch or affection and may interpret it as an effort by the parent to exert control.
Love Language #3: Quality Time
The provision of “quality time” implies that parents will give teens their undivided attention and listen without judging, lecturing, scolding, reassuring, or advising. The parents should be coached to use “The Empathy Formulas” and mirroring technique to increase the degree to which teens will feel accepted and inspired to talk in a candid, uncensored way. The connection and comfort level between parents and teens will be enhanced, if parents schedule “quality time” that is recurring and predictable. For instance, they can negotiate standing appointments for 1:1 time with their teens, which revolve around recurring activities such as a tradition of having breakfast every Sunday morning or going for ice cream, after every volleyball game. There will be moments, when adolescents “refuse to talk,” depending on their mood and parents should respect their need for privacy and self-reflective time.
Love Language #4: Acts of Service
Acts of service imply that parent perform tasks or favors for teens that are not contingent of the teen saying or doing anything in return. The message is that the parent is simply performing an act of service to demonstrate their unconditional love to their teen, with no hidden agenda. Acts of service, from parent to teen, might include washing and folding a sports uniform, packing a lunch with the teen’s favorite foods and a note of encouragement, planning a weekend ski trip for the teen’s birthday, to which they can invite a friend or detailing the car, prior to the teen’s use for travel to a school dance.
Love Language #5: Gifts
Gifts should be associated with a ceremony and emotional meaning. Gifts of cash or excessive material value, without associated ceremony or emotional meaning are experienced as empty and fail to keep the attention of youngsters. Examples of gifts which might effectively convey love and affection would be the purchase of tickets to a game of a favorite sports team, for an occasion that is memorable, such as a birthday or graduation. Another gift with emotional meaning might include a piece of jewelry, such as a charm bracelet or watch, with an engraved message commemorating a special day or containing charms reminiscent of a memorable occasion.
Module 5-PACK-Teen Parent Handout #24
Module 5 - PACK-Teen Cooperation Busters Therapist Tool #10
Module 5-PACK-Teen Cooperation Builder Summary Cards Therapist Tool #11
Module 5-PACK-Teen Communication Style Summary Card Therapist Tool #12
Module 5-PACK-Teen Assertiveness Formula Summary Cards Therapist Tool #13
PACK-Teen Module 6
To begin PACK-Teen Module 6, refer to the Introductions, Guidelines, and Orientation section that can be found at the beginning of PACK-Teen Module 1.
Thought Correction
Cognitive restructuring forms the cornerstone of cognitive-behavioral therapy (CBT), a mode of therapy whose efficacy and durability are well established for pediatric anxiety disorders and adolescent depression in both individual and group formats (Clarke et al., 1995; Compton et al., 2004; Kendall et al., 1997; Weersing, Iyengar, Kolko, Birmaher, & Brent, 2006). The term “cognitive restructuring” is used widely in the CBT literature, but for the sake of discussion with teens and families, use the term “thought correction.” The steps involved in cognitive restructuring or “thought correction,” include the following:
1. Introduce the fundamental tenets of CBT by presenting and discussing the CBT paradigm (Compton et al., 2004; Weersing et al., 2006).
2. Introduce and discuss examples of distorted thought patterns, termed “Cognitive Distortions (CDs)” in the CBT literature, but “Toxic Assumptions (TAs)” with teens.
3. Introduce and discuss examples of “Socratic questions” which can be used for challenging distorted thoughts or “thought correction.”
4. Introduce and discuss the concept of thought records.
5. Introduce and discuss the concept of “self-talk” and also “coping statements.”
CBT Paradigm
Introduce the topic of CBT by drawing the classic CBT triangle, representing the CBT paradigm, on the dry erase board with arrows connecting the words as follows (Compton et al., 2004; Weersing et al., 2006)j:
Use didactic discussion to help the group recognize that feelings and behaviors are influenced by thinking. Elicit examples from the group regarding how their thinking may have influenced their feelings or behavior in the past. Facilitate discussion regarding the fact that thoughts are incredibly powerful. Share with them that there is an extensive amount of research indicating that this type of treatment, CBT, that is, monitoring and challenging unhelpful ways of thinking, is highly effective in treating depression and anxiety. In fact, CBT is actually the gold standard of psychotherapy treatment for most psychological disorders (Compton et al., 2004; Weersing et al., 2006).
Facilitate discussion regarding the fact that many youth who are anxious, depressed, or prone to explosive temper outbursts may be especially inclined to engage in flawed or distorted thinking patterns. They typically overestimate the odds of bad things happening, catastrophize (or assume the worst), and underestimate their ability to cope with a bad outcome. Often, they develop rigid, circular, and negative thought patterns, which may be disrupted through examination of the evidence for their thoughts. A helpful metaphor involves imagining a freight train, driving forward at full speed. Encourage the group to consider the phrase “train of thought” but to imagine that when one is intensely distressed, that process morphs into a “thought train” that can garner momentum and be difficult to halt.
Parents of such youth are likewise at increased risk of anxiety and depression and may also be prone to distorted perceptions and thought processes. The goal is to help the parents recognize and correct distortions in their own thinking, as a way of modeling more balanced and realistic thinking for their adolescents. Helping parents recognize that individuals have the power to alter their thinking habits, which in turn, can significantly impact feelings and behavior, is a revelation which they typically find inspiring and cathartic.
Provide cards on which are printed examples of ambiguous scenarios (i.e., the situations may be seen as positive or negative depending on the parent’s interpretation), and brainstorm with the group how different individuals might perceive or react to each situation, given their pattern of automatic thoughts. Have the parents take turns selecting cards and identifying possible emotional reactions and behavioral responses to the sample scenarios, that are deliberately vague. Sample and blank cards on which are printed ambiguous situations are available in the PACK-Teen Module 6 Therapist’s Toolbox on the book’s companion website. Sample scenarios include the following:
Your teen is attending his or her first day of a new school.
You receive a call from your teen’s teacher.
Your teen is trying out for the basketball team.
Your teen left you a vague voicemail message, stating “I need to tell you something…”
You received a visit from a neighbor who you do not know well.
Your spouse wants to talk to you.
Toxic Assumptions
The concept of CDs is fundamental and common to all CBT protocols, although many different authors have formulated their own, customized lists of CDs, customized for their specific programs (Clarke et al., 1995; Compton et al., 2004; Kendall et al., 1997; Weersing et al., 2006). For the sake of discussion with teens and families, supplant the term “TAs,” in place of “CDs.” Facilitate discussion regarding the term “TAs” and inquire about what message might be implied by this phrase. Provide an explanation regarding the meaning of the term.
Introduce the group to a list of common types of CDs or TAs. Similar lists of types of CDs are mentioned in CBT manuals for pediatric anxiety and depression, including those developed by Kendall, Flannery-Schroeder, Panichelli-Mindel, et al. (1997) and Clarke, Hawkins, Murphy, et al. (1995). As you present the list of “TAs,” invite the group to generate examples from their own experiences during which they misperceived situations or engaged in distorted thinking. In our experience, the simpler and briefer the list of TAs provided, the more useful and memorable they are to teens. So the list that follows represents some broad categories of potential patterns of distorted thinking, into which a few more specific types of cognitive errors could be collapsed. This list was created for and used successfully with youth:
Overestimating the Risks: This “TA” is comparable to catastrophization, wherein an individual mentally inflates the risk of a bad outcome or ruminates about a potential outcome that is particularly disastrous. Youth struggling with anxiety and depression are especially prone to imagining the worst case scenario and ruminating about it, however unlikely. In sum, a person adopts the viewpoint, “I know I will screw up,” or “I know this will end in disaster.”
Examples: Ruminating about failing a grade and having to be held back, after receiving a low score on one test or assignment. Or assuming after a break up with a love interest, that they will be alone forever and never find love again.
Underestimating Yourself (or Others): Assuming you cannot handle things when you really can.
Examples: Assuming you would be devastated and unable to cope if you failed a class, or faced a break up, or parental divorce, or rejection of some kind. In sum, the person says to themselves: “I know I’m not good enough” or “I know I can’t handle this.” Assuming that you will fail in a try out, or screw up in a performance, or face rejection in a job interview. Or failing to give another person the benefit of the doubt and automatically assuming they won’t support or help you. Or that another person deliberately said or did something with intent to hurt or offend you.
Assuming without Knowing: Assuming you know what someone is thinking without checking. In sum, a person presumes the following: “I know what you’re thinking.” Examples: “I can tell he hates me,” “She’s going to break up with me,” “I don’t think they like me,” “I already know they will say ‘no.’”
Global Judging: A rigid style of perception, alternatively termed “black–white” or “all or nothing” thinking. Seeing things as either all bad or all good, which is a distortion because situations and people are usually a mix of bad and good. When words such as “Always,” “Never,” “All,” “Total” or “Complete,” or “Everyone,” are used, it is likely that extreme and exaggerated and unrealistic, interpretations are occurring. In sum, a person says to themselves, “I know I’m 100% right,” or “I know what I know.”
Examples: “You never help me!” “They always forget me!” “I never get asked out!” Assuming someone is a “total jerk,” because he failed to say hello one morning.
Name Calling: Using derogatory or pejorative labels to describe yourself or others. In sum, a person presumes that, “I know what you’re about.”
Examples: “He’s a jerk [or a liar or a loser],” “I’m so stupid [or lazy or foolish].”
Making It About Me: Adolescents tend to be very self-conscious and rejection-sensitive. In our experience, it is extremely common, especially among teens with mood or anxiety disorders, for them to interpret random events as personal attacks. The person thinks to themselves, “I know this is about me.”
Examples: Assuming that the negative facial expression, unenthusiastic greeting or lack of response to an email or text message is a personal rejection that has no other explanation or contributing factors, other than pertaining to them, personally.
Challenging TAs
A useful next step, in fostering more balanced, and healthier thought patterns, is to encourage the group to begin monitoring their thinking and to “catch themselves,” using any of these distortions. Teach the parents that awareness is the most important first step and once they master the process of monitoring their thoughts, the next step toward more balanced thinking involves examining and challenging their thoughts. Remind the parents that monitoring and challenging their own thought patterns is the goal, rather than trying to point out distorted thinking in others. CBT programs for youth, including those developed by Kendall (1995) and Clarke, Hawkins, Murphy, et al. (1997), advocate a similar process. Introduce the following Socratic questions, which are useful for challenging potentially flawed or distorted thoughts:
“Is there another way to look at this?”
“Do I have all the information?”
“What would I say to a friend?”
Another simple, easy to remember, strategy for challenging CDs is to ask “What might be a more realistic or helpful thought?” For example, if a parent has the thought, “My teen is completely out of control,” this would not be a realistic thought because it’s not true that a teen would be “completely” anything. The verbiage is too extreme to be realistic. It also would not be a helpful thought because it can lead to catastrophic thinking and negative judgments. Encourage the parents to talk through the trajectory of a situation that evokes a distorted thought that evokes negative feelings and unhealthy behavior. Then inquire about whether the thought was helpful or realistic? Next, use the same situation, but encourage the group to come up with a different thought that might be more helpful or realistic. Then, using the alternative thought, ask parents to again talk through the trajectory of how the new thought might impact feelings and behaviors.
Realistic Reframe
Introduce the parents to a formula, for reframing a TA or distorted automatic thought. It is important that they acknowledge the underlying fear, as they formulate a new, more realistic thought, but then offer an alternative or balancing thought. A formula appears below, with examples of potential verbiage for both the initial and follow-up portion of the reframe.
Although ___(fill in)____ (e.g., this may be difficult or I am feeling overwhelmed right now or progress has been slower than I hoped or things might seem hopeless to me right now, etc.), I know that ___(fill in)__ (I can ask for help or I have been successful at this before or I have many ways to cope or the worst case scenario is very unlikely, etc.).
“Business cards” listing the common TAs and Socratic questions for challenging thoughts are available digitally on the book’s companion website in the PACK-Teen Module 6 Therapist’s Toolbox. These cards can be cut out and handed to parents to use as reminders during and outside of the workshop.
Thought Records
Thought records are another valuable tool for examining and challenging thought patterns. Thought records often are used by cognitive-behavioral therapists to help anxious, depressed, or dysregulated patients. Sample thought records appear in nearly every CBT manual, for all patient populations (Clarke et al., 1995; Compton et al., 2004; Kendall et al., 1997; Weersing et al., 2006). PACK-Teen Module 6, Handout #27, available on the book’s companion website, contains an example of a thought record that has been used successfully with anxious, depressed, and dysregulated youth and their parents.
Using the dry erase board, encourage the group to complete a sample thought record together, regarding a real or hypothetical situation which the parents experience as relevant or relatable. Then, distribute PACK-Teen Module 6, Handout #27, for the parents to complete independently, for homework, using real or hypothetical situations, prior to the next workshop.
Self-Talk
A concept that is closely related to automatic thinking has been termed “self-talk” in the CBT literature (Clarke et al., 1995; Compton et al., 2004; Kendall et al., 1997; Weersing et al., 2006). In fact, there is little distinction between the constructs of “self-talk” and “automatic thoughts.” Similar processes are recommended for monitoring, challenging, and correcting flawed self-talk, as were proposed for modifying unhelpful and distorted thought patterns. Youth with excessive anxiety, depression, or anger tend to engage in escalating, negative, sometimes catastrophic, self-dialogue. For instance, they are prone to say things to themselves such as “Oh no, I’m going to fail this test,” “I’m going to get all the questions wrong,” “I’m going to fail tenth grade,” “Oh no, oh no, oh no….” Their parents, likewise—especially if they too suffer from anxiety, depression, or mood dysregulation—may engage habitually in negative self-talk. Encourage the parents to begin monitoring their own self-talk and to strive to engage in more balanced positive self-talk when faced with a difficult situation such as, “I may be nervous, but I can handle this.”
Challenging Self-Talk
Facilitate a brainstorm with the group regarding their ideas for a list of potential coping statements such as the ones that follow:
“Although this is tough, I can handle it.”
“I can get help, if I need it.”
“Business cards” listing the above coping statements are available digitally on the book’s companion website in the PACK-Teen Module 6 Therapist’s Toolbox. These cards can be cut out and provided to the parents for use during the workshop and as a reminder outside of the workshop.
Family Homework
As a homework assignment, ask the parents to rehearse their thought and self-talk challenging skills, during the subsequent week. Ask them to habitually examine their thoughts and self-talk for evidence of CDs, and use coping statements and a method of Socratic questioning to correct their thoughts. Additionally, encourage the parents to reflect upon their patterns of feelings, associated with their self-talk and thoughts. Advise them to especially monitor any changes in feelings, associated with modifications or corrections in thinking.
Joint Session for Module 6
As described in detail in the format and operations section, parents and teens are brought together, once weekly, related to each Module set, to participate in discussions and exercises, which build upon and further reinforce the skill sets that were initially introduced and rehearsed separately. The “joint” session for PACK-Teen and MaPS-Teen Module 6 takes the form of a game, playfully named, “Guess My Toxic Assumption” or “TA.” This game requires some advanced preparation by the group facilitators, outside of workshop time. The clinicians should provide a set of cut-out cards, on which are printed the various types of TAs, available on the book’s companion website. Invite the teens to pair up with a parent from another family and have first the parent randomly select a card, listing a TA, from the stack of cut-out cards.
Instruct the parent, in each pair, to provide clues, comprised of examples of hypothetical thoughts, to hypothetical situations, which might illustrate the type of TA, listed on their card. The teen must guess their TA, based on those clues. Once the TA is correctly identified, using the example of the final clue that led to the teen’s correct guess, teens should suggest one or more Socratic questions for the parent to use to challenge the last sample automatic thought clue given. Using Socratic questions, the parent should then apply the formula to come up with a “Realistic Reframe,” to replace the hypothetical distorted thought. The group can reconvene and take turns presenting their experiences with this exercise, after each round. Several rounds can be performed, with the parent–teen pairs taking turns giving clues and suggesting Socratic questions versus guessing the TA that was randomly drawn from the card stack and using the questions to formulate a “Realistic Reframe.” You can award prizes, such as chocolate, or gum, to the teens and parents who guess their TA correctly first, among the group, for each round.
A sample of this exercise might go as follows:
Parent (or Teen) draws TA card that lists “Underestimating Self.”
Parent TA Clues: “I’ll never make the team,” “No one will ask me out,” “I won’t pass the test…”
Teen TA Guesses: “Overestimating Risks?” “Assuming Without Knowing?” “Underestimating Self?” Parent informs teen that their last guess was correct.
Teen Suggest Socratic Question/s: “Have I succeeded before?” “Am I looking at the whole picture?”
Parent’s Reframe (Using Last Clue, Socratic Question/s and “Realistic Reframe” Formula): “Although I didn’t study as much as I wanted, I have done well in this class on past tests.”
PACK-Teen Module 6 Summary Outline
Materials Needed
• Copies of parent handouts (available on the book’s companion website in the PACK-Teen Module 6 section)
• “Business cards” listing types of CDs and Socratic questions
• “Business cards” with coping statements
• Sample scenario and blank ambiguous situation cards
• Cards for the Thinking Straight game
• Note: All handouts and business cards are available on the book’s companion website and should be disseminated immediately following the discussion regarding the content. If given out earlier, they may become a distraction.
Established Parent Introductions and Check-Ins
• Have the introduction and check-in format for new versus established parents written on the board.
• Go around the room and have each established parent take turns doing as follows:
• Ask each parent to identify themselves by first name.
• Ask each parent to mention their teen’s first name.
• Ask each new parent to mention one “victory” or success (required) and “challenge” (optional), from the past week, related to their teen.
• If there are new parents, invite each established parent to help in orienting the new parents to the workshop format and guidelines.
• Established parents may check-in regarding their family progress, including approaches they tried which were effective thus far.
Workshop Guidelines
• Workshop consistently starts on time and finishes on time, punctuality is required, leaving early or stepping out of workshop during session is not allowed.
• Confidentiality required, “What is said in here, stays in here,” playfully termed the “Vegas Rule.”
• Exceptions are safety issues (suicidality, homicidality, violence, abuse/neglect).
• Refrain from developing personal relationships outside group while in program.
• All cell phones, pagers, electronics of any kind must be turned off during group.
New Parent Introductions and Check-Ins
• Have the introduction and check-in format written on the board.
• Take turns having each parent introduce themselves and check-in as follows:
• Ask each parent to identify themselves by first name.
• Ask each new parent to mention one positive feature or strength of their adolescent and mention one “challenging behavior” they’d like to focus on.
• Ask established parents to comment on commonalities noted during new parent check-ins.
New Parent Orientation
Review
Introduce CBT Paradigm
• Present an overview of the CBT paradigm. Draw PACK-Teen Module 6 Figure 1 on the dry erase board.
• Distress can trigger a negativistic cycle of thought patterns, “train of thought” morphs into a “thought train” that garners momentum and is difficult to halt.
• Use sample ambiguous situation scenario cards to generate discussion regarding possible variations in styles of thinking.
Toxic Assumptions
• Overestimating the Risks: This “TA” is comparable to catastrophization, wherein an individual mentally inflates the risk of a bad outcome or ruminates about a potential outcome that is particularly disastrous. Youth struggling with anxiety and depression are especially prone to imagining the worst-case scenario and ruminating about it, however unlikely. In sum, a person adopts the viewpoint, “I know I will screw up,” or “I know this will end in disaster.”
• Examples: Ruminating about failing a grade and having to be held back, after receiving a low score on one test or assignment. Or assuming after a break up with a love interest, that they will be alone forever and never find love again.
• Underestimating Yourself (or Others): Assuming you cannot handle things when you really can.
• Examples: Assuming you would be devastated and unable to cope if you failed a class, or faced a break up, or parental divorce, or rejection of some kind. In sum, the person says to themselves: “I know I’m not good enough” or “I know I can’t handle this.” Assuming that you will fail in a try out, or screw up in a performance, or face rejection in a job interview. Or failing to give another person the benefit of the doubt and automatically assuming they won’t support or help you. Or that another person deliberately said or did something with intent to hurt or offend you.
• Assuming without Knowing: Assuming you know what someone is thinking without checking. In sum, a person presumes the following: “I know what you’re thinking.”
• Examples: “I can tell he hates me,” “She’s going to break up with me,” “I don’t think they like me,” “I already know they will say ‘no.’”
• Global Judging: A rigid style of perception, alternatively termed “black–white” or “all or nothing” thinking. Seeing things as either all bad or all good, which is a distortion because situations and people are usually a mix of bad and good. When words such as “Always,” “Never,” “All,” “Total” or “Complete,” or “Everyone,” are used, it is likely that extreme and exaggerated and unrealistic interpretations are occurring. In sum, a person says to themselves, “I know I’m 100% right,” or “I know what I know.”
• Examples: “You never help me!” “They always forget me!” “I never get asked out!” Assuming someone is a “total jerk,” because he failed to say hello one morning.
• Name Calling: Using derogatory or pejorative labels to describe yourself or others. In sum, a person presumes that, “I know what you’re about.”
• Examples: “He’s a jerk (or a liar or a loser),” “I’m so stupid (or lazy or foolish).”
• Making It About Me: Adolescents tend to be very self-conscious and rejection sensitive. In our experience, it is extremely common, especially among teens with mood or anxiety disorders, for them to interpret random events as personal attacks. The person thinks to themselves, “I know this is about me.”
• Examples: Assuming that the negative facial expression, unenthusiastic greeting or lack of response to an email or text message is a personal rejection that has no other explanation or contributing factors, other than pertaining to them, personally.
Challenging TAs
Realistic Reframing
• Although ___(fill in)____(e.g., this may be difficult or I am feeling overwhelmed right now or progress has been slower than I hoped or things might seem hopeless to me right now, etc.), I know that ___(fill in)__(I can ask for help or I have been successful at this before or I have many ways to cope or the worst case scenario is very unlikely, etc.).
Thought Records
Self-talk
• Make the point that youth with excessive anxiety, depression, or anger tend to engage in escalating, negative, sometimes catastrophic self-dialog.
• Examples of negative self-talk include the following: “Oh no, I’m going to fail this test.” “I’m going to get all the questions wrong.” “I’m going to fail fourth grade.” “Oh no, oh no, oh no!”
• Encourage the parents to monitor their self-talk and strive to engage in more balanced positive self-talk, such as, “I may be worried, but in the past, I was able to cope with difficult situations like this one.”
Challenging Self-Talk
• Parents can be coached to talk to themselves differently. For example, if their typical self-talk goes “Oh no—I can’t handle this; I’ve got to get out of here now,” then coach them instead to say something like, “I may be uncomfortable, but I’m not in danger and I can handle this. I’ll use my relaxation techniques to lower my anxiety and stay in control.”
• Encourage parents to stay “within their own triangle.” In other words, parents should not be correcting teen’s CDs and teens should not be correcting parents’.
Coping Statements
Review the PACK Mantras
Review, Answer Questions, and Wrap Up
• Encourage the teens and parents to practice techniques for thought correction and modifying self-talk.
• Provide parents with extra copies of PACK-Teen Module 6 Handout of Thought Records, to use for homework during the week in practicing cognitive restructuring before the next session. Again, this worksheet can be found in the PACK-Teen Module 6 Therapist’s Toolbox on the book’s companion website.
• Ask the family members to complete at least two thought records during the subsequent week.
Joint Session for Module 6
• During the second PACK and MaPS Teen IOP session of the week, there is an opportunity for teens and parents to join together for 60 minutes.
• Set up and facilitate the “Guess My TA” exercise.
• Provide a set of cut-out cards, on which are printed the various types of TAs, available on the book’s companion website.
• Invite the teens to pair up with a parent from another family and have the parent initially draw a card, listing a TA, at random, from the stack.
• Instruct the parent, in each pair, to provide clues, comprised of examples of hypothetical thoughts, to hypothetical situations, which might illustrate the type of TA they have.
• The teen must guess their TA, based on those clues.
• Using the last example or clue that led to correct guess, the teen should suggest one or more Socratic questions for the parent to use to challenge and “reframe” the last automatic thought example given.
• Advise the parents to then generate a “Realistic Reframe” using the formula presented above (which also appears of worksheets for this exercise).
• The teens and parents can present their experiences to the group, after each round of play.
• The group can perform several rounds of play, alternating roles and inviting the teens to generate clues regarding TAs and coaching parents on the use of potential Socratic questions and formulating “Realistic Reframes.”
• You can award prizes, such as chocolate, or gum, to the teens and parents who guess their TA correctly first.
Handouts/Business Cards
Module 6-PACK-Teen Parent Handout #25
• Overestimating the Risks: This “TA” is comparable to catastrophization, wherein an individual mentally inflates the risk of a bad outcome or ruminates about a potential outcome that is particularly disastrous. Youth struggling with anxiety and depression are especially prone to imagining the worst case scenario and ruminating about it, however unlikely. In sum, a person adopts the viewpoint, “I know I will screw up,” or “I know this will end in disaster.”
• Examples: Ruminating about failing a grade and having to be held back, after receiving a low score on one test or assignment. Or assuming after a break up with a love interest, that they will be alone forever and never find love again.
• Underestimating Yourself (or Others): Assuming you cannot handle things when you really can.
• Examples: Assuming you would be devastated and unable to cope if you failed a class, or faced a break up, or parental divorce, or rejection of some kind. In sum, the person says to themselves: “I know I’m not good enough” or “I know I can’t handle this.” Assuming that you will fail in a try out, or screw up in a performance, or face rejection in a job interview. Or failing to give another person the benefit of the doubt and automatically assuming they won’t support or help you. Or that another person deliberately said or did something with intent to hurt or offend you.
• Assuming without Knowing: Assuming you know what someone is thinking without checking. In sum, a person presumes the following: “I know what you’re thinking.”
• Examples: “I can tell he hates me,” “She’s going to break up with me,” “I don’t think they like me,” “I already know they will say ‘no.’”
• Global Judging: A rigid style of perception, alternatively termed “black-white” or “all or nothing” thinking. Seeing things as either all bad or all good, which is a distortion because situations and people are usually a mix of bad and good. When words such as “Always,” “Never,” “All,” “Total” or “Complete,” or “Everyone,” are used, it is likely that extreme and exaggerated and unrealistic, interpretations are occurring. In sum, a person says to themselves, “I know I’m 100% right,” or “I know what I know.”
• Examples: “You never help me!” “They always forget me!” “I never get asked out!” Assuming someone is a “total jerk,” because he failed to say hello one morning.
• Name Calling: Using derogatory or pejorative labels to describe yourself or others. In sum, a person presumes that, “I know what you’re about.”
• Examples: “He’s a jerk [or a liar or a loser],” “I’m so stupid [or lazy or foolish].”
• Making About Me: Adolescents tend to be very self-conscious and rejection sensitive. In our experience, it is extremely common, especially among teens with mood or anxiety disorders, for them to interpret random events as personal attacks. The person thinks to themselves, “I know this is about me.”
• Examples: Assuming that the negative facial expression, unenthusiastic greeting, or lack of response to an email or text message is a personal rejection that has no other explanation or contributing factors, other than pertaining to them, personally.
Module 6-PACK-Teen Parent Handout #26
Challenging Toxic Assumptions
Module 6-PACK-Teen Sample and Blank Ambiguous Situation Cards Therapist Tool #14
Module 6-PACK-Teen “Thinking Straight” Game Cards Therapist Tool #15
Module 6-PACK-Teen Toxic Assumption (TA) Cards Therapist Tool #16
Module 6 PACK-Teen Parent Handout #27
Module 6-PACK-Teen Parent Handout #28
Module 6-PACK-Teen “Guess My Toxic Assumption (TA)” Game Cards Therapist Tool #17
Module 6-PACK-Teen Coping Statement Summary Cards Therapist Tool #18
