autonomy cymhsu collaborative castlegar bc dec 2014
TRANSCRIPT
Help me find myselfThe Struggle for Autonomy
Todd Kettner, Ph.D., R. Psych.
School District 81
December 15, 2014
CYMH Collaborative
Diagnosis –arrested development vs.
symptom description
• Dr. John McKinnon “An Unchanged Mind”
• Understanding our students entails an attention to
the obstacles that delayed their development
AND an awareness of their immaturity
• Effective treatment then entails
• Removal or mitigation of obstacles that delayed
psychological development
• Encouraging and prodding a stuck teenager to
GROW UP
December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 82
A quick review of Erickson’s
Developmental Stages
December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 83
A word about DSM diagnosis and
medication
• Focusing on the push for maturity
does not mean ignoring psychiatric
disorders or pharmacological
treatments.
• It’s a matter of emphasis
• Remember….
we reinforce what we focus on.
December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 84
Key Issues of Delayed MaturitySTAGE
(month
s)
KEY TASK OR
STRUGGLE
CHARACTERISTICS TYPICAL
FAMILY &
LIFE ISSUES
HELPFUL
RESPONSE
0 - 12 Attachment Lack of trust, poor
boundaries
“I don’t know if I exist.”
Adoption,
abuse,
neglect,
chaotic
Predictable
Nurturing
Attuned
6 - 18 Separation/
Individuation
Anxious, moody,
enmeshed, collapses
under stress
“I can’t be alone.”
Overprotective
parents,
enmeshed,
poor limits, no
hierarchy
Attuned
Reassuring
Encourage
independence
Available
18 - 36 Autonomy Securely attached,
individuated but angry,
resist authority
“You can’t control me.”
Giving in to
tantrums, no
limits,
overpowering
Clear,
consistent
limits w/o
power struggle
ReassuringDecember 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 85
“You Can’t Control me!”
December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 86
“I’m so Special.”
December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 87
Characteristics of an autonomy
struggle Teen
• Angry
• Direct – “You can’t control me!”
• Passive – “I’m so special that expectations don’t
apply to me.”
• Shame – anger towards oneself for being
inadequate
• Key anxiety - Fear of being exposed
• Resistant to authority
• Key issue – “You’re not the boss of me…”December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 88
Narcissism in teens
• The world revolves around me
• No one can tell me what to do
• I am unaware of and/or don’t care about others
feelings and needs
• Can lead to holding in feelings of shame, anger, hurt
which then explodes intermittently (hey that sounds
like a psychiatric diagnosis)
• Pushes others away – leads to social failures/isolation
– leads to further feelings of inadequacy and shameDecember 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 89
“I don’t have to Listen to you…
I’ll be sad or angry if you say no”
December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 810
Poorly resolved early autonomy
struggle
• Self-centered
• Entitled
• Lacking in empathy
• “pseudo adults” – haven’t done the work or earned the right to be legitimate adults
• Lacking emotional availability
• False sense of self that is easily wounded
December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 811
Healthy resolution of autonomy struggle
(ages 2 to 4)
• Certain level of legitimate independence
• Understand restrictions and limits on their freedom
• Acceptance of authority
December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 812
Why is Tyler looking
down?
Is he scared?
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 813
“Look what I just did!”
MORE IMPORTANTLY:
“look at who I am…”
Brave
Adventuresome
Talented
Capable
Independent
Strong
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 814
Though I’m too
scared to go as
high as my little
brother, I’ve
climbed way up
here too!
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 815
I am….
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 816
I am…
December 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 817
Clinical ParentinG
1. A teen’s need for recognition and limit-setting prod her to take the
next step in maturity
2. Setting limits is critical in the context of recognition
3. Useful recognition and limit-setting only take place within a
relationship
4. Parenting is a task that must change at each developmental level
5. Maturity is not just information and skill, but a cognitive and
emotional approach to the world and others
6. Well-timed recognition and limit-setting propel teens towards
positive character development
- From McKinnon “To Change a Mind”December 15, 2014 CYMH Collaborative
Todd Kettner, Ph.D., R. Psych. School
District 818
Responding well
• Avoid power struggles… AND…
• Set firm limits – with expectations and consequences that are clear and consistent
• Provide choice within the expectations
• Mentor – guidance and assistance and reassurance
• Encourage mature responsibilities and genuine behaviors
• We’re the substitute punching bags for awhile (may be several years of conflictual relationships with teachers and parents)
• Coach, model and expect that parents will be strong members of the treatment team by supporting limits and consequences
December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School
District 819
Success Earned
• Recognition is deserved
• Success is achieved
• Sense of self is developed
• Autonomy is gained
• Purpose is defined
[email protected] 15, 2014
CYMH Collaborative
Todd Kettner, Ph.D., R.
Psych. School District 820