Session Three...Setting Limits with Thinking Words Avoiding Power Struggles Is it “I Can’t” or “I Won’t”? Building Loving Relationships Winning With Cystic Fibrosis: Tools,

In This Session, You’ll Learn About: ♥ Setting Limits with Thinking Words ♥ Avoiding Power Struggles ♥ Is it “I Can’t” or “I Won’t”? ♥ Building Loving Relationships

Winning With Cystic Fibrosis: Tools, Tips, and Tactics for Raising Healthier Kids

Session Three The Cope Formula:

“O” Stands for Opportunity for Thinking and Decision Making

Parent Reading The Scoop on Setting Limits

Copyright 2009- 2013 by Foster W. Cline MD and Lisa C. Greene. All Rights Reserved.

Limits are especially important when children have illnesses because, more than is true with average children, there are definite limits on what they can do, what they can eat, and even where they can go. Let’s just start out with some basic truths on setting limits:

♥ Limit setting is important and necessary. ♥ Childhood limits can be more a

reflection of what the adult wants rather than what the child needs.

♥ It is better if children are able to have the self control to set their own limits. When children set their own limits, they’re said to be responsible. When parents need to set the limits, the message, rightly or wrongly, is that the kids are irresponsible.

♥ If “no” must be learned, there are many options that are more effective than “just saying no.”

In Parenting Children with Health Issues, we emphasize that although other techniques may be more effective (like choices or enforceable statements), parents can safely “just say no” when:

1) Children are young and parents can easily enforce the limits they set.

2) Children respect and love parents enough to do what is asked.

3) Consequences will do the teaching if children don’t “abide by the no.”

When simply told “no,” children tend to rebel in situations other than the three given above. Thus, the goal is to develop children who don't need to be told 'no' because they are self-aware and have self-control. “Just saying no,” telling kids what they “have” to do and “making” them take good care of their bodies may be self-defeating and lead to frustrations for both parent and child. So wise parents learn the essential skill of setting

necessary limits in ways that don’t evoke power struggles which is what you will be learning in this session. When it comes to setting limits around food or medically-related activities, wise parents introduce creativity and fun to help children accept these limits. For example: When Jacob does his breathing treatments, he has a special video game that he plays only then. Check out Mary Poppins for great examples of how a “spoonful of sugar helps the medicine go down.” Parents’ loving and accepting attitudes around limits generally rub off on their children. It is important for parents to find the balance between setting limits when needed but not overdoing it. Love and Logic gives us a helpful guideline: “Set as many rules as necessary but as few as possible.” Isn’t this the same thing that most Americans want from their government? So how does a parent know if a rule is necessary? Before setting a limit, ask your pre-teen or teenager: “Honey, what rules about this do you think you really need?” followed with, “And why is that?” If your kids can come up with good answers, that’s great. If their answers are nonsense, or if they really can’t say, then you might start outlining the consequences for poor choices. This gets the conversation pointed in a productive direction. It may turn out that you need to set the limit if your child does not yet have the self-control to set it for him or herself. But at least you discussed it rather demanded it. Remember: You aren’t giving up your “parental power” when you ask your kids what they think they want or need before you make the decision for them. Share the control before you “just say no” and you will be way ahead in the long run- especially during the teen years.

Parent Reading Avoiding Power Struggles

Part One: Why Do Power Struggles Happen


This is part one of two on avoiding power struggles. This article is an overview on the issue. So, first, let’s figure out why children with CF might engage us in power struggles. Some reasons are “kid driven”:

♥ Obviously chronic pain or discomfort leads most of us to be more difficult to be around. Our kids are no different.

♥ The lack of control caused by illness causes kids (and many adults) to show their need for control at times by being demanding themselves.

♥ Ill children who can’t enjoy a lot of the freedoms and options available to other kids often feel like “life’s unfair” and can easily slip into the victim role. People who feel victimized generally aren’t easy to live with!

Most of these problems can be handled by showing understanding, talking the problem over with encouragement, and acceptance of the child’s feelings and concerns. This might sound something like: “Gosh, honey, it sounds like you are frustrated about..." followed by exploration and encouragement. This approach, which we’ll dig into more deeply in upcoming sessions, should resolve most issues. But what if the complaining appears to be becoming a SOP (Standard Operating Procedure)? Rather than telling a child to stop complaining, it is more effective to set boundaries around where kids can and cannot complain (hint: children’s bedrooms are always open to receiving complaints). So, parents can gently ask a chronically complaining child to leave the room by saying something like: “Sweetheart, where do you think you could go to complain where it wouldn’t hurt our ears?” or "Honey, feel free to complain either in your bedroom or outside."

Bear in mind that we need to be receptive to as much complaining from our kids as we subject them to. We can never ask more of our kids than we ourselves are willing to give. Some reasons for power struggles are “parent driven”:

♥ Parents often become more demanding when medical requirements are absolutely necessary. The more important the medication, the more demanding parents get about taking it. And human nature says that when one demands, the other resists!

♥ In general, parents may give more demands and fewer choices.

♥ Pleading parents raise whiney children; guilty-feeling parents raise blaming children.

♥ Parents who consistently show frustration raise children who are consistently frustrating.

All of these reasons for negative behavior require parents to look at themselves. That can be tough. But it would be nice if the reasons for our children’s unhappy behaviors were due to our parenting styles, personality or shortcomings because that’s something that is under our control. The easiest and quickest way for us to figure this out (if we as parents can bear the feedback) is to approach a friend, who has great children our own child’s age, and ask directly: “Connor seems to be giving me quite a bit of trouble lately. You’ve been around us. Do you see ways that my approach could be more effective with him?" Be honest and explore the answers you get.

Parent Reading Avoiding Power Struggles

Part Two: Stopping Them Before they Start


This is article number two of two on avoiding power struggles. Part One explored some of the reasons why parents and their kids get into power struggles. Part Two covers some the tools that wise parents use to avoid power struggles in the first place. First of all, we can always say “no” or demand things be done our way. But that doesn’t avoid power struggles, it often provokes them. So let’s try other things first: Make a habit of saying “Yes Instead of No” which you learned about in this session. Use Choices which you learned about in Session 2. Use Thinking Words and Enforceable Statements which you also learned about during class time. Power struggles are often avoided by listening to our child’s point of view before we give our own and the requests we’d like to make: “Thanks for sharing with me how important you feel it is to go riding at the arena this afternoon. I’m taking that under consideration. Now that I’ve listened to your point of view, I’d like to share mine on my concerns about the dust and your asthma.” Involving your child in the problem solving process helps to avoid power struggles. Laying out the problem together and brainstorming on ideas about how to solve it invests your child in the outcome. We’ll learn more about this process in an upcoming session. Sometimes, limits simply must be set by the adult. Power struggles tend to be avoided when a parent's approach is both firm and loving which is not to be confused with being tough or demanding.

It is difficult to demonstrate “firm and loving” in writing but it involves eye contact, smiles, a sense of humor, a pleasant tone of voice, a gentle touch and the presumption that the child can and will comply: “Honey, my expectation is that you will do your breathing treatments first thing after school today. Thanks.” (And if the child back-talks or is negative, repeat the statement.) The opposite of this, which invites a power struggle, involves shouting across the kitchen, “Our agreement was that you’d do your breathing treatments right after school today so do it now!” Using questions with the assumptive “thank you” often works with younger children. It’s not always as easy as this example, but oftentimes it really is when used with loving firmness:

“Honey, I think it’s time now for your breathing treatment.” “I don’t want to do it!” “I’m sure you don’t, honey, but what am I asking you to do?” “I don’t want to.” “What am I asking you to do?” “Do my treatment……” “Right! Thanks honey.”

Remember, it’s a lot easier to avoid a power struggle than it is to resolve one once it’s started.

Parent Reading No More ‘No!’


By the time Jason was three, he had heard the word ‘No!’ about 15,000 times! And, according to some research, that number is low. So when Jason’s mom said, “It’s time to take your medicine,” what do you think he said? You guessed it! The problem is, this wasn’t just your typical toddler control battle. Jason needs his medication to stay alive because he has cystic fibrosis. Jason’s mom, unknowingly, had trained him to say ‘no.’ In fact, she trained him really well! Of course, there are times when parents need to set limits and just say no or children will become spoiled. However, too many “no’s” will eventually cause the relationship to suffer. When children are young, the word ‘no’ brings on power struggles in the form of arguing, whining and tantrums. When children are older, too many no’s can result in outright rebellion, deception or simply giving up. This can present itself as non-compliance with medical requirements as well as other risky behaviors like drug or alcohol use. Telling an otherwise healthy child or teen with CF (moderate to mild lung involvement) that they "can't" do something because they have CF is the number one way to promote rebellion or depression down the road especially if it’s a typical childhood activity like swimming, playing outside, going on play dates, visiting the playground, etc. Obviously, things are different if your child has severe complications from CF but even then, wise parents say yes as often as possible with a positive, can-do attitude. We are not saying this is easy, but you have to be able to let go and encourage them to push their own boundaries and find out for themselves what they can and can't do. For example, you should be worried about whether they are dressed well enough to go play outside in the snow- not wondering if they should be playing out in the snow.

Look into your children’s future. What do you want for them? They won't be kids forever, and if you want them to do things like go to college, have a career, and a family of their own, you have to start telling them YES YOU CAN now. This is how we raise kids who believe in themselves. So learn how to say Yes Instead of No. Parents can still set limits and say ‘Yes!’ by using the following phrases:

• “Yes! Just as soon as …” • “Absolutely! Right after…” • “Yes! And…” • “Sure! As long as ...” • “Great idea! But first…” • “Yes, if...”

Here’s how it sounds: “Mom, can I have some cookies?” “Yes! Just as soon as you finish eating your dinner.” Put the emphasis on the word “Yes!” with great enthusiasm and big smiles. It helps to pause for just a moment right after the ‘Yes!’ Here’s one for teens: “Mom, can I borrow the car to go over to Bill’s house?” “Sure! Right after you’ve done your breathing treatments.” So what about little Jason? His mom learned how to set limits without saying ‘no’ by saying ‘Yes!’ instead. When Jason asked, “Can we go to the park?” she said, “Absolutely! Let’s go right after your breathing treatments are done.” And they did. Jason’s mom also learned to use choices. This is especially important when kids have healthcare issues and other special needs. She used lots of little choices as much as possible like “Would you like to do your breathing treatments now or after playtime?” or “Would you like your medicine with apple juice or chocolate milk?” Jason was so happy to have choices that he stopped arguing about taking his medication. We are happy to report that Jason is enjoying good health and a great relationship with his dear mom.

Skill Builder Reading Thinking Words and Enforceable Statements


We’ve talked about the importance of setting limits with kids and we’ve talked about what happens when we say, “No”: we get control battles, fits, arguing, whining, and complaining! We learned how to deal with that by mastering one-liners. We also learned about using choices to stop power struggles in their tracks. Now let’s add one more power-struggle-avoiding skill to your parenting toolbox: thinking words. Fighting words tell a child what to do or what you will not allow or what you won’t do for him or her. Thinking words are different. They are a special way of setting limits on a child’s behavior without telling him or her what to do. They are another way of saying No by saying Yes to something else like when he or she can do something or telling the child the conditions under which the adult will do something or using choices. And even though we are setting limits, which most kids don’t like, thinking words work better than fighting words. Why? It’s that control thing again. Children fight against a command. They see our commands as attempts to control them. So, they exert themselves to gain more control. So remember, the more we can share control, the more control we will ultimately have.

One of the most effective ways to set limits is by using enforceable statements which are a special category of thinking words. Often we parents say things to our kids which would be difficult, if not impossible, to enforce. “Don’t shout at me” is a good example. I mean really, can we make our kids not shout at us? Of course not! But we can rephrase this into “I’ll listen when your voice is soft like mine.” Now that’s enforceable! And by simply re-phrasing it, we’ve just raised the odds that we will get a much better reaction from our kids. So, enforceable statements are a way of setting limits by telling our children what we will do. We have control over what we will do. So we start our enforceable statements with “I”:

♥ I’ll be glad to… ♥ I listen to… ♥ I’m happy to… ♥ I will ____ when you _____.

Now it’s your turn to get some practice with enforceable statements on the next page.

Children learn better from what they tell themselves than from what we tell them.

Skill Builder Exercise Enforceable Statements


Listed below are some examples of enforceable vs. unenforceable statements to get you started. Then, you’ll get to practice a few. Remember: Never tell a resistant child what to do. Describe what you will do or allow instead. Unenforceable Enforceable Do your breathing treatments. I’ll turn on the TV when you start your nebulizer. Take your enzymes before you eat. I’ll serve dinner right after you take your enzymes. You can’t go until you finish your IV meds. I will take you when you finish your IV meds. Eat your food! I give dessert to kids who eat their dinner. Now, it’s your turn. Turn the following unenforceable statements into enforceable ones. 1. Unenforceable: Quit complaining about the food and just eat it. Enforceable: _______________________________________________________________________ 2. Unenforceable: How many times do I have to tell you to pick up your stuff? Enforceable: _______________________________________________________________________ 3. Unenforceable: Put that back on the shelf! I’m not buying you anything today. Enforceable: _______________________________________________________________________ 4. Unenforceable: Get your enzymes and medications packed up now! We gotta go! Enforceable: _______________________________________________________________________ 5. Unenforceable: Take your medicine. Otherwise, you’re going to get sick. Enforceable: _______________________________________________________________________ 6. Unenforceable: I’m not giving you anymore money. You already used up your allowance. Enforceable: _______________________________________________________________________ 7. Unenforceable: You’re not going horse back riding with the girls. You might get sick. Enforceable: _______________________________________________________________________ 8. Unenforceable: Get started on your breathing treatments or you can’t go out to play! Enforceable: _______________________________________________________________________ Note: How we say these words is just as important as what we say. Remember to be kind, firm and sincere.

Parent Reading Does Your Kid Mean ‘I Can’t’ or ‘I Won’t’?


Kids can be resistant to any task and can be even more so for medical tasks. Most kids older than a toddler and younger than a teenager are not so outright resistant that they simply say “No, I won’t do it.” Instead, they “forget” or they give lots of reasons why they “can’t.” This is called passive resistance; when children are capable of performing the task but say ‘I can’t.’ What they really mean is ‘I won’t.’ Often passive resistance is obvious. But there are times when we really don’t know if the child is capable of doing the task. We might think he or she is capable but sometimes parental expectations are off. And when a child has special needs that include developmental delays or side effects from medications, then we may have no idea if a child really can’t or won’t. So, how do parents figure it out so they can respond effectively? Here are some guidelines to help:

♥ Does your child perform better for others? If your child performs better for teachers, camp counselors, or other family members then it is likely that the child is saying I can’t when he or she really just won’t.

♥ Is the home atmosphere that of over-protection and/or excessive sympathy? If so, then your child has learned that “I can’t” is a great way of getting more sympathy or not having to take responsibility.

♥ Are your child’s needs for attention, affection and control being met? If not, misbehavior might be a way to get those needs met.

♥ Does your child whine and complain when requested to do a task that is clearly within the child’s ability? If so, then that tells us that the child is probably capable of the task but just likes to whine and complain!

So, once we figure out whether a child really can’t or really won’t, then what do we do about it? Let's start with children who really can't do the task. When Your Child Can’t Do the Task When a child can’t do the task, then we need to ask:

♥ Are my expectations reasonable for my child’s

age and developmental level? Developmental milestone charts are effective in helping you know what is age appropriate especially if your child is a first-born. Also, asking other parents who are dealing with similar issues is helpful.

♥ Have the parents, doctors, etc. provided age appropriate training for the task? Just running through the steps verbally once doesn’t do it for a five-year-old learning how to start her own nebulizer. Good training is important both for the proper completion of the task and the child’s self-confidence.

How to help kids learn how to do self-care tasks: 1. Keep expectations high but reasonable. We

want to give them the “can do” message but we also don’t want to set them up to fail.

2. Teach the specifics step-by-step: ♥ Use visual cues along with verbal ones. Go

slowly. ♥ Have the child do the step right after you

show them. Children learn by seeing, hearing and doing.

♥ Respond with encouragement after each step. Say things like, “How did you do figure that out so fast?” Or “Wow! I bet you’re proud of the job you just did!”

♥ Repeat at least 5-7 times. ♥ Be silly, creative and have fun!

Adjust expectations downward only when it is obvious the child is unable to do the task. Don’t show disappointment or frustration but instead show happy anticipation by saying something like: “Hey! I have a better idea. Let’s try…” So, that’s how we handle ‘I can’t’ when the child really can’t. We make sure they really can! Now, let’s find out what to do when kids say ‘I can’t’ but really mean ‘I won’t.’ Saying “I Can’t” but Meaning “I Won’t” Kids can either be outright resistant or passive resistant to their medical tasks. Remember, passive

Parent Reading Does Your Kid Mean “I Can’t” or “I Won’t”?


resistance is when a child is capable of performing the task but says ‘I can’t.’ As annoying as it is when a child says an outright “No!” passive resistance can be harder to deal with because it’s not as clear what is going on. You just learned some tools to deal with those little tykes who simply say “No, I won’t” and Chapter 4 of Parenting Children with Health Issues is all about avoiding and handling power struggles. Whatever the reason for resistance, wise parents (at some point) try to figure out the underlying cause especially if the resistance is chronic. Let’s take a look at some of the common possible roots of resistance. Is your child: ♥ Feeling sick, hungry, tired, frustrated, in pain,

etc? Maybe now isn’t a good time to do the medical treatment and we can use choices to help the child decide when might be a better time.

♥ Resistant to the task? Some tasks are unpleasant and painful like finger pricks for glucose tests, other tasks are time consuming like 20 minute breathing treatments. Maybe the kid just flat out doesn’t want to do it.

♥ Resistant to the person requesting the task? Is the child using the task as a way to get control? Does the child often “power up” against this particular person over any task? Maybe it's a relationship issue.

Children, just like adults, aren't motivated by people that they don’t get along with. For instance, parents commonly say to an under-achieving child, “It doesn’t matter whether you like your teacher or not, you’ve got to do the work!” But it does matter to the child. So taking a look at the quality of adult relationships is important to finding possible roots of resistance.

♥ Resistant “in general?” Is the child resistant to any adult authority figure including teachers and other adults?

♥ Is the child getting his or her needs met for affection, attention, control and respect? Children, like adults, may do destructive things to get their needs met. For a kid, negative attention can be

better than no attention at all. And of course we’ve talked a lot about the need for control and how some kids will do anything to get it if they are being over-controlled.

Ask yourself: what might be the hidden payoff for resistance? Does the child benefit in some way from being resistant? Some hidden payoffs might include negative attention, getting out of doing the task, the joy of controlling a parent's responses, or sympathy.

Now, let’s look at how to respond to passive resistance. First of all, comments such as “Oh yes you can!” rarely work and can lead to arguments and power struggles. Secondly, don’t just ignore it. Reasons, even good ones, are not excuses for misbehavior. An upcoming article will talk more about that. So that’s what not to do. Here’s what you can do:

♥ Have a problem-solving discussion with your child about the resistance. Using our problem solving and communication models, you might be surprised at what your child comes up with as the root of the problem or the solution and hopefully both!

♥ Use positive consequences frequently: “I have so much energy from not having to nag you to do your breathing treatments that I’m going to take you to the movies tonight!” You’ll learn the proper use of rewards in an upcoming session.

♥ Respond with empathy and appropriately allow the consequences of not completing the task to occur. This includes natural consequences if not life-or-limb-threatening, or imposed logical consequences if the natural consequences are unacceptable.

♥ Make sure your child is personally invested in completing the task: “I am happy to take you to the ballgame just as soon as your breathing treatments are done.”

In closing, we want to emphasize the importance of figuring out why your child is showing resistance to medical tasks. If you are seeing no improvement after consistently using Love and Logic tools for three months, it might be time to visit a counselor.

Building Loving Relationships


In the busy-ness and stress that living with CF entails, we might “forget” about the most important part of parenting- love. You’re probably thinking, “Of course I love my kids!” We know that. The question is: How do you show it? It’s all about relationship… Here are some Love and Logic-isms for you:

♥ Rules without relationship lead to rebellion.

♥ Consequences without relationship lead to resentment.

♥ Rewards without relationship feel like bribes.

Here’s what Dr. Charles Fay of Love and Logic teaches us about the power of love: “It’s amazing how complicated love makes things. Have you ever noticed how much harder it is to say ‘no’ to those you love? If we didn’t love our kids so much, it’d probably be a lot simpler setting limits with them. When we upset them, we feel bad. Yes, it’s hard to say ‘no’ to those we love. This can make parenting tougher...and a lot easier. If we can parent in such a way that our kids remain head over heals in love with us, it makes it a lot harder for them to say "no" when we ask them to do things such as go to bed, take out the trash, clean up their toys, do their schoolwork (and their medical requirements). The power of love works both ways. During my eleven years of college and psychology graduate school, something really sad happened. Although we had many very brilliant professors, who taught us many important things about children and their families, we were taught nothing about the power of love. In fact, I’m not sure the "L-word" was ever mentioned! As a result, many of us came to believe success with difficult children simply required applying the correct theory, technique, or logical consequence. Over the years, we’ve met parents who’ve slipped

into this line of thought. In an attempt to cope with the frustration and guilt of having a child who’s "responsibility-challenged" they’ve fallen into the trap of thinking that the solution lies entirely in finding the right set of techniques. Parents who fall into the trap of believing that success with their kids simply involves applying the correct Love and Logic techniques soon find themselves discouraged. Then they come to our classes and say, "We tried that, and it didn’t work!" or "He doesn’t care if he gets consequences." Strong-willed kids can read us like a book! When we put the logic before the love, they’re quick to sense it...and quick to show us that they aren’t going to fall for any of our tricks. That’s why the key to lasting success involves rebuilding the parent-child relationship through sincere expressions of unconditional love. When the love comes first, the seeds of logic grow.” Here are some tips for cultivating loving relationships:

♥ At least once a day make a point to establish a moment of combined eye contact, smile, and touch.

♥ Help your kids celebrate their strengths by following the "10 to 1 Rule.” This means ten positive comments to each correction.

♥ Try to have a family meal together each day.

♥ Let them overhear you talking about how much you adore them.

♥ Help them when they are working hard on their chores.

♥ Use encouragement instead of praise. ♥ Have fun together often. Laugh a lot.

Enjoy life and be involved. There’s no substitute for love. Parent Reflection: What are some simple ways you can build loving relationships with your child this week?

Life Applications Using Enforceable Statements


In Session One, you identified a problem that you were going to work on throughout this course. Write it here: ____________________________________________________________________________________ Then, you defined the problem by observing and describing all of the “little problems” that contribute to the unhappy situation. Now, we are going to practice using enforceable statements on each one of these little problems. Let’s work with our example first: Big Problem: My child is never ready on time in the morning. Little Problem: She gets up when I wake her but then she gets back into bed. Unenforceable: Get up now! How many times do I have to wake you up? Enforceable Statements I Can Use: I’ll help you make your bed if you get up now. OR I’m happy to wake you up in the morning as long as you get up the first time. Little Problem: She takes about 15 minutes to pick out her clothes. Unenforceable: What’s taking you so long? Get dressed! It’s time for breakfast. Enforceable Statements I Can Use: I’m leaving at 7:15. Will you be going to school dressed or undressed? OR I’ll be happy to serve breakfast just as soon as you are dressed. Now it’s your turn. First, write out the unenforceable statements that you might be using. Then, turn it into an enforceable one. Experiment with using it when your child is exhibiting the problem behavior. Observe your results. How did your child respond? How much closer are you to solving the problem? Little Problem: ______________________________________________________________________ Unenforceable: _______________________________________________________________________ Enforceable: _________________________________________________________________________

Little Problem: ______________________________________________________________________ Unenforceable: _______________________________________________________________________ Enforceable: _________________________________________________________________________

Little Problem: ______________________________________________________________________ Unenforceable: _______________________________________________________________________ Enforceable: _________________________________________________________________________

Documents

Session Three...Setting Limits with Thinking Words Avoiding Power Struggles Is it “I Can’t” or “I Won’t”? Building Loving Relationships Winning With Cystic Fibrosis: Tools,