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(My book Therapeutic Parenting and When Love Is Not Enough by Nancy Thomas provide the background and context for these specific techniques. It is not advisable to use these techniques without reading the books as these suggestions could easily be misunderstood and misapplied if not used in the context of a whole therapeutic philosophy and regimen. To order)
In order for an oppositional defiant, mood disordered or reactive attachment disordered child to remain living at home through adolescence it is essential she understand the concept that her parents are deserving of respect and they are going to take good care of themselves regardless of what she chooses to do. She also must initially master one pivotal behavior. She must be able to go to her room (or do strong sitting) after one voice command. The message to the child is, "If you want to live here you must obey the house rules. If you cannot follow the rules then you are not safe, the house is not safe and I am not safe. In order for this family to remain safe then you must leave until you are willing to cooperate and be respectful and responsible." The messages to the rest of the family are, "We have rights to peace and quiet. No one person can be allowed to sabotage the family environment." and, "The parents in this home are strong enough to keep us all safe from someone who is acting out." The longer a family waits to obtain this level of compliance, the harder it is for the child to learn. To wait until the child is an adolescent to begin this level of discipline is very risky for the child and the family. A child who can comply with a parent's request will generalize that skill to other skills, such as chores and homework, and to other settings, such as school and employment. The earlier it is learned the better.
Refusing to comply involves a typical scenario: A child is told to do something, perhaps a chore. She refuses. Her mother tells her to go to her room until given permission to come out. She refuses. The child will be helped on the path to healing if the room is not full of treasures and endless entertainment possibilities. Setting up the room so it is an optimum environment for creating thoughtfulness is essential. First, everything and anything that has sentimental or financial value needs to be removed. It is not helpful to have an angry child stomp off to her room, destroy everything in it and then feel guilty. Guilt is not a particularly useful emotion when emotional healing is just beginning. It drives children deeper into hopelessness rather than change. When things of value are destroyed it also has a tendency to arouse anger and resentment in the parents who have invested heavily in their child's possessions and hate to see what they have lovingly given trashed. Secondly, games and activities that contribute to thoughtfulness are left in the room. Legos, cards, puzzles, books, latchhook project, etc are left in. Telephone, computer, Game Boys, Nintendo, television, etc are removed. (A typical bedroom of a child just entering therapeutic foster care has a bed and a bookshelf for a minimum amount of clothes and toys. That is all.)
Due to the organic and habitual nature of many oppositional and defiant behaviors, it would be better if the situation does not escalate when the child becomes uncooperative. Optimally the adults would de-escalate the situation while remaining firm on what she must do - that is go to her room. Many children with Bipolar Mood Disorder, ODD and RAD thrive on a high level of adrenaline. They are accustomed to high levels of anger and fear in their environment. They are not only accustomed to it but are comforted by it. When they can create an angry and aroused situation then the chaos they have created in their environment is finally in sync with the chaos in their brain. Rather than having the child imitate the rhythms of a calm adult, they become successful at getting the adult to imitate their frantic, frenetic hyperarousal. Parents generally become angry because they believe their authority role and their ego are being attacked. A child's resistance is not about the parents and parents need to separate that issue out. Anger and resistance are about the child. If the child is to heal, parental anger must be avoided and the situation must not be allowed to escalate.
What, then, are the parental options? They are numerous, depending on the situation.
The first rule is for both parents to agree on parenting issues and approach. "A house divided cannot stand." If they do not agree and must get outside help or couple's counseling in order to agree that must be the first order of business.
The second rule is to make sure parents are not engaging in an issue that is inappropriate or unwinnable. Briefly, parents should only engage in battles they can win. They can only win on battles that directly and primarily affect them. Therefore, the issue must be very carefully chosen. Battles to avoid are those which have to do with school, friends, hygiene, food, etc. Those are all met with a "good luck message." Worthwhile battles to"engage in have to"do with chores, respect for parents and the home environment (the books detail this concept).
Next, if the issue is something that directly affects the parents or the home environment then it is permissible to carry a very small child who refuses to cooperate to her room, if it can be done easily without anyone getting hurt. If that is appropriate then the parent can say, "Would you like to go to your room with your feet touching the floor or not touching the floor?" Then the parent follows through depending on what the child chooses. Not to choose is to choose to have the parent carry her.
If the child is older and refuses to comply with the command to go to her room, then, ideally, immediate arrangements will be made for her to go to a respite home. It is important that no threats are made. Do not say, "If you do not go to your room then I will call Mrs. Jones and she will come get you." You have already explained the rule, so further talking is not helpful. Do not waste your words when children are not in a thinking state. Act. If she is not complying, call respite and remove her.
If the situation is not ideal and respite is not immediately available then ignore the situation (unless it is dangerous to do so, in which case you need to call the police). Get a book, read, and pour a cup of coffee. If the child is not compliant but is not a danger to the house or others, then the parent can either go to his/her room or leave the house. The point is to calm yourself and at the first opportunity, the child leaves. Do not escalate the situation by making threatening moves toward the child or physically forcing the child to comply. Frequently a child will calm down and be ready to comply. However, just because she calms down and promises to be good does not negate the fact that when she was told to go to her room, she refused. She must leave the house, regardless of how good she is being at that moment, unless she demonstrates she is willing to follow through on a consequence which will make her more thoughtful faster in the future. The point is a child must do what the parent requests when the parent requests it in order for an appropriate parent-child relationship to develop. For the child to do what the parent wants, but on her timing, negates the impact of the interaction and allows her to manipulate the adults. Explain, "Honey, I know you are being good right now. However, that does not negate the fact that when I told you to go to your room you didn't. So now you need to go somewhere else and practice going to your room when told."
If she is going to be allowed to demonstrate compliance the parent can say, "Now you need go to your room quietly for one hour. Before I will give you permission to come out you need to do 50 jumping jacks as often as I ask and then mop all the floors when you earn coming out. Good luck on that." (Hug and kiss) At any time during the hour the parent can pop into the room and give the child a hug and kiss, telling her how easy it is to have her around when she is cooperative.
Going-to-the-room practice needs to occur numerous times during the day in order to ritualize it and carve a new pathway in the brain that will kick into automatic when required. A child can be helped to go to her room in a variety of ways.
When no one is aroused, just enjoying each others company, interrupt the activity and tell her she needs going-to-her-room practice. She needs to go to her room, close the door, and then wait for you to call her. Call her and she can come out as soon as she calls, "Yes, Mom." If this arouses her then go to the broken record technique or one of the following suggestions.
The broken-record technique is calmly repeating the same phrase repeatedly. "Caroline, go to your room." "Caroline, go to your room." "Caroline, go to your room." Key is not being sucked in to her diversions such as needing to go to the bathroom, it's not fair, I'm hungry, etc. No matter what she says, you quietly and firmly say, "Caroline, go to your room."
When she asks for something, for instance a glass of milk, tell her you will give it to her as soon as she goes to her room and goes through the above scenario. Every time she makes a request for anything it is an opportunity to practice. "Please take me to soccer, Mom." Response is, "I will be glad to take you to soccer practice as soon as you spend 20 minutes quietly in your room." End with a hug.
Another possibility is to tell her you are about to tell her to go to her room, but before you do you want to give her an opportunity to have a tantrum and refuse. Predict for her the pattern of her behavior so she has an opportunity to change it if she chooses. Say, "I know how hard it is for you to do something the first time you are asked and that you often prefer to scream and yell first. So lets get that out of the way before I tell you to go to your room. OK?" If the child says she can go to her room without screaming and making a scene then express mild disappointment and tell her she can do it that way if she wants, but really you don't mind if she screams first. If the child tantrums as directed then compliment her on a very fine tantrum and ask her if she needs to throw another one or if she is ready to go to her room yet. Either way, she is doing it your way. She is either going to her room without a tantrum, which is what you want. Or, she is going with a tantrum, which is what you told her to do.
Another possibility is to face her directly and tell her to face you. If she allows you to put your hands on her shoulders and/or she is willing to put her hands on your shoulders that would be preferable. Either way, with or without touching, tell her to scream in your face, "You're not my boss." "You can't make me go to my room." "I'm not going to my room." Etc. (This works because she is screaming on your terms, not hers. Before you can stop a behavior, you have to control it.) After she is done screaming ask her if she is ready to hear you say, "Go to your room." If not, repeat. If she is ready, tell her to go. Teach her she always has the option of saying, "I don't want to and I will do it anyway." It is best that she says "and" instead of, "But I will do it anyway" as "but" takes away the positive feeling.
If she immediately cooperates and goes to her room with a good attitude the first time she is told then she may leave her door open. If she must be escorted to her room then the door is closed. If she is snarky and uncooperative then an alarm needs to be put on.
If she continually comes through the alarm there are several options. One is to have her spend 20 minutes longer in her room for every time she sets off the alarm. Another is to send her to respite. Another is to lock the door and remain nearby reading or working quietly. Some states allow a child to be locked in a room as long as an adult is within a certain distance. Some states only have laws which refer to foster children, not the parents legal children. This would need to be checked out. When it can be used, it is extremely effective. Generally, the child hates it so much that it only needs to be used once or twice before the child learns to stay quietly in the room for the required amount of time.
Whatever happens, do not get into a physical tug of war over the door with the child trying to open it and the parent trying to hold it closed. This allows the child to hold the parent hostage by forcing the parent to hold onto the doorknob. Rather than being held hostage, let the child win on control of the door and add time on to what must be spent in the room before the child can come out. If she keeps opening the door when it is supposed to be closed then the 20 minutes of quiet time in the room does not begin until the child voluntarily closes the door.
Once she is in her room, she needs to have a minimum of 20 minutes of good quiet time. After that, when you are ready, you can go to her room and ask her if she is ready to do 50 jumping jacks (or 10, or 25 depending on the age of the child). After she has done the jumping jacks then she can come out and do the chore she refused to do which set in motion the whole going to her room scenario.
The longer it takes her to go to her room, the longer she needs to quietly stay there before she can do the jumping jacks and come out. If she is in her room a very long time then she will need to have some sort of "potty-chair". If she uses it she will have to clean it as part of the condition for coming out.
When she is sent to respite then she cannot come home until she has done the chore, or one similar to the one she refused to do while at home, several times. She also needs to practice going to her room upon command and completing 50 good jumping jacks with hands clapped over her head, without stopping. The respite home must be emotionally distant and withholding so as not to compete with her family for warmth and attention. (See training directions for respite homes.) When a child becomes aroused and getting her to respite becomes dangerous have the respite provider pick the child up after school so an adrenaline pumping scenario at home is avoided.
If respite is not available then when the spouse, typically the father, comes home at the end of the day he sends the child to her room. When he arrives home, he asks mom, "How are you doing? Was Caroline helpful to you today or are you drained?" If she was helpful then Dad can spend some time with her to reward her for being cooperative with her mother. If Caroline was not helpful then Dad says, "Hop off to your room. Mom is totally drained by being around you so I need to spend some time just with her. Stay there until Mom decides she is not so empty." The child may come out a few hours later or may stay in her room until the next morning. If she is in her room through a meal time then Mom or Dad can bring her a sandwich and something to drink, give her a hug, thank her for staying in her room as she is so much easier to live with that way, then leave.
The point is that it is not appropriate to reward a child who is trashing mom by giving her time with dad. Mom needs dad more than the child does at that point and feels pushed aside when the child is rewarded for her bad behavior by getting time with dad. Mom needs time with dad! It also sends a clear message to the child that the marital relationship is more important than the parent-child relationship and the child cannot manipulate and/or triangulate that relationship. The parents are a team and what hurts one hurts the other. If she is allowed to come out of her room during the evening then it would be appropriate for mom to have her practice going to her room several times during the rest of the evening, with dad there to reinforce the demand if necessary.
Relying on dad to reinforce discipline is an age-old, effective technique, although it has fallen out of favor during the feminist movement. What is important is the child learns to go to her room when her mother tells her to. The goal is not ego massaging a mom who needs to prove she is just as capable as a man. It is obvious mom is incredibly strong and just as capable or she would not be still raising such a difficult child! This is not about male-female politics. When dad backs mom up he is saying, "I love your mother and you are not going to be allowed to hurt the woman I love. I am standing by her and what she says goes." He is saying he will not allow their child to manipulate them against each other. It is an essential message that both the mom and the child need to hear! If dad cannot be supportive in this way than marital therapy is in order.
Other members of the "circle of support" (Nancy Thomas's phrase) are friends, relatives, caseworker and therapist. Each of these people, in their own way must support the mom's directive to the child to go to her room. Friends and relatives do not interact warmly with the child unless they ask mom if the child is going to her room when she is told and the answer is yes. If the answer is, "No" then they can say things like, "Well, honey, good luck on that. As soon as that changes your mom will let me know. Until then, I cannot be real friendly with anyone who is trashing someone I love." The caseworker must use part of her visit to send the child to her room and then have mom send the child to her room while she observes. For every time the child has not gone to her room when told the first time by her mom the caseworker sends her to her room twice during her visit. The mom and the caseworker can just sit at the kitchen table over a cup of coffee and talk casually while taking turns sending the child to her room. The therapist must also reinforce this behavior as essential. During therapy the child must be directed to scream in the therapist's face phrases expressing her anger over being sent to her room. For example, "Mom is not my boss." "She can't make me go to my room." "I'm not going to do it." "It makes me mad mom is always sending me to my room." Etc. The child must express in therapy the same feelings and words she expresses at home with the same intensity. The child must also be told to do things by the therapist in front of the mom and by the mom in front of the therapist. "Pick up the book and hand it to me." "Go stand by the door and count to 10." "Do 50 jumping jacks." This rewires the child's brain and gives her practice getting over her resistance. This allows mom to see that she is not the only one being vilified and disrespected by the child. It also shows the child that whatever behaviors she uses at home must be worked through again in therapy. It demonstrates clearly to the child that the parents and the therapist are working together and cannot be triangulated and manipulated. If the therapist wants to see the child behind closed doors and work on issues he and the child choose instead of the behaviors occurring at home, find another therapist!
Regardless of how parents and their circle of support teach a child to cooperate, it is critical that children be under the voice control of their parents, and, by extension, other adults. One pivotal skill taught in our therapeutic foster care homes is "Going to the room". By sending a child to her room when she is using her disrespect and volatility to control the family environment the child learns her behavior must be reciprocal if she is to be allowed around other members of the family. Teaching a child self control is one of the best gifts a parent can give!
Foster Cline describes the importance of these lessons being taught early by saying, "You can either have short term gain and long term pain or short term pain and long term gain." In other words, it is hard to teach these skills early but the long-term results are worth it. Failure to teach cooperation and respect at an early age because it is so difficult only causes problems in the future. Parents lose track of the bigger picture, however, when they think discipline, and this article, are about getting a child to go to her room. Being able to go to her room when told merely exemplifies the larger goal of the development of respect and reciprocity. Once the child has mastered this skill then the next skill is "strong sitting" as described in When Love Is Not Enough and Therapeutic Parenting. Each successively difficult skill generalizes to other skills, such as doing chores right the first time. It takes many months of patient, determined and consistent effort before a child internalizes the messages that (1) parents mean what they say, (2) they can be loving when they say it and, (3) regardless of what the child chooses to do the parents are going to take good care of themselves.
One way to keep cool, calm and collected while the child learns is by remembering it is not up to the parent to force a child to change or to make a child do what she says. Parents are only responsible for giving their children numerous opportunities to change and get control of their behavior. If a child refuses, it is not about the inadequacy of the parent or that the child is attacking the parent's ego, it is about the child. The child is saying, "I need more practice on this skill." "I need to practice doing what I am told to do when I am told to do it."
The attuned parent will make sure the child gets the practice opportunities she is asking for before she gets any older.
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