Lessons from the seal show

Did you hear what she said about ‘shaping’, maybe that’s relevant for the kids as well? Giving lots of positive feedback on the behaviours you want?”. My husband looked pleased with this “new” idea.

We had just watched a seal show at Mooloolaba Underwater World and the trainer explained how they teach the seals by a method called shaping. Trainers work with the animals through rewarding specific behaviours that increasingly resemble the final behaviour they are trying to teach the seal (such as waving to the crowd), making the rewards harder and harder to get as the seals get the idea and work to improve their skills.

I think whatever I say now will sound cheeky. Thing is, I am a parenting researcher. Meaning I have studied parenting programs, their effects, the way they work (or don’t) and their adoption by different groups of parents, for years now. Do you think I have tried to convey at least the most basic ideas and tools of these programs to my husband – my co-parent? Correct. Do you think I have been very successful? Correct again.

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Photo: Fanni Sarkadi, actually taken at Tooronga Zoo, Sydney – we seem to have gotten into seal shows lately

Needless to say, kids are not seals, and human behaviour has more layers than the stimulus-response learning cycle used in shaping would suggest. Nevertheless, rewards, whether it is attention, food, sex or prizes, monetary incentives, respect, or even being feared by others, powerfully influence our behaviours.

Behaviours that are socially reinforced will continue, whereas behaviours that are not reinforced will cease – this is the essence of social learning theory, the theoretical underpinning of many parenting programs. Our motivations to behave in one way or another are influenced by the social environment and we learn to control and direct our behaviours on the basis of our previous experiences and later on, our beliefs and values. But all our lives, we depend on the reinforcements we get.

So when I told one of the naughtiest little classmates of my son on my volunteer session at their school that he was doing a great job listening nicely, the few seconds he actually was, he started listening much better. I kept reinforcing his behaviour and I could see he worked hard to keep up his attention.

The teacher caught my eye, nodded and she too praised him; up his name went on the chart for those doing a good job listening. Because his previous reinforcements had been the other kids’ attention, even if that often meant irritation or telling on him, it was important to try and move him to a new form of reinforcement he could earn, that would be more positive for him on the long run. The proud smile on his face held that promise.

So when a seal show comes along to help me finally get my point through to my husband I have to be very thoughtful of what I say. Upon our next discussion I will not wail, as I might like to: “What do you think I have been trying to tell you all those times when you told me my research had nothing to do with real life parenting?”. No, I will say, “Yes, encouraging behaviour you would like to see more of, like in shaping, sounds like a great idea.”

In fact, we might play a new game called “Catch them being good” together. Because, as my husband quite rightly likes to point out, parenting theory is something quite different than acting on your knowledge – and I sure need practice!

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Photo: Fanni Sarkadi, Tooronga Zoo, Sydney

Unconditional positive regard

I am officially off the “meat market”. Turning 40 next year I walk around the world not worrying too much about what men, or anyone, for that matter, think about me. Of course I care for my appearance and to stay fit, but more for my own sake. I was never much of a flirter anyway. Unlike my husband or best friend, who both can get their ways past any queue or defer any ill-tempered official (of any sex) through flirting intensely, I tend to be serious and slightly on guard with strangers.

Which is why it took me by complete surprise that the Egyptian concierge at the hotel in Qatar, where I stayed between my flights, flirted with me extensively. First I ignored it and thought it part of his job description: be nice to women traveling alone. Then he upgraded me to the suite. I said there was no need. Yes, there was, no extra charge, please enjoy.

When I asked for an adapter I called down twice and walked down the third to simply get it. He made a funny scene out of what a true pity it was that I had to come down to fetch it. I found myself giggling like a 16-year-old. I had been very clear that my husband had booked the hotel so there was nothing there to wonder about. But just the fact that he gave me a different picture of myself than I had decided to act upon was a tiny gift I decided to accept.

I looked at Doha at my feet, enjoyed my complementary tarts, high-speed Internet connection, a warm shower and the sleep in a huge bed – a commodity I would miss during my long-long flight to Melbourne. Upon my departure he made an operette-scene about having to see me again, all of it becoming slightly more than I could muster so I slipped into the cab and waved good-bye.

But isn’t this exactly what I try to do for other people, especially children: to give them a picture of themselves as lovable, for whom they are? I am not stupid, I know there was a sexual undertone of the concierge’s flirt, but the essence remains the same; I want to let you know you are a likable person, in my own way.

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Photo: Fanni Sarkadi

On my visit to Sweden I took my niece to a musical and as we walked she told me how someone she had met seemed to take to her so easily. “Sweetheart, I said, you need to know that you ARE easy to like, there is nothing strange about that woman liking you!” She said nothing, but smiled to herself.

“Suck it in, I thought to myself, suck it in and never let it go. No matter what some asshole along the line will tell you, no matter how the cool girls in high school will make you feel – know your worth! Know that you are lovable”.

Love and acceptance is so central in our lives that we do the strangest things to get it. Just read Alice Munroe! The basis of all good therapy then is what Carl Rogers termed “unconditional positive regard”. It gives to people what they might have missed during their childhood: a sense of being possible to be loved, accepted, and “contained”, irrespective of the things they think, say, or achieve.

No wonder then that studies on e.g. depression convincingly show that it is the relationship to the therapist rather than the form of therapy itself that makes the greatest difference for results. And yes, the pope is Catholic.

Although most of us are not professional therapists, there is lots we can do for one another and our children in our everyday life. Of course we can’t provide unconditional positive regard to everyone we meet: real life involves conditions and conventions we need to live by. But we certainly could muster a bit more generosity. Maybe flirt a bit more, irrespective of age and gender?

When my eldest daughter was on her way to a wedding and sent me a picture of herself in the dress I replied: “Whoever gets to sit beside you tonight is a lucky person. You are such pleasant and kind company!” The hearts and smileys bouncing back on my screen said it all. I could see the smile on her face all those miles away. And the one on mine still lingers when I think of my Egyptian concierge waving after the taxi. Maybe turning 40 is not so bad after all.

The Good Samaritan becomes annoyed

Recently I spread a You-tube video to my research group because I found it a fascinating example of communicating research results. It was a simply animated very pedagogical piece on the epidemiology of emergencies that happen on airplanes and contained some advice for medical practitioners who are called upon for assistance.

The main message was that most emergencies are minor and can be treated on board and that the Good Samaritan law applies in terms of legal liability, i.e. someone who helps out in an emergency should not be liable unless gross negligence has occurred.

The piece begins by the words “You’re in that half-conscious state between wakefulness and sleep when a voice calls out on the PA system: ‘Is there a doctor on board?” I was not sure if I was dreaming of that clip or waking to an actual call.

But a call it was. A young man with ample nosebleed for more than 20 minutes sat pale on the toilet. The crew were alarmed because “there was blood everywhere”. Any medical student who has gone through their obstetric training without fainting away from the scene will have seen “blood everywhere”. So I could see right away that the blood loss per se was not of concern for the patient’s safety.

A nurse, who had also come to answer the call, started cleaning the patient up while I took the history. Another doctor popped in his head and asked the most relevant question: are you on any blood clotting inhibitors? With a “no” to that he was gone, nothing dramatic was going to happen.

The young man’s blood pressure was fine and he had no blood dripping in the back of his throat. For being a public health physician and not seeing all that many patients nowadays I remember most of my training very well and like treating patients. The dripping at the back was something the ENT surgeons had always warned us for.

He had no such thing, but he was still bleeding a bit in the front and the staff was getting nervous because of the time that had passed so I applied a makeshift tamponade. I had to change it once to remove the clotting and put in the second tamponade to stay for a couple of hours.

I was asked to write a full medical report and while the event was still ongoing I was also required to assess the patient and state if he was fit to fly. With eight hours to go of the flight the captain was relieved to know that the patient was stable for now. He had contacted the ground medical officer who advised nasal congestants which I gave when I removed the first tamponade.

The staff was very thankful as was the young man’s family. It hadn’t been anything major, but I did spend two hours on it in the middle of the night and signed off the patient for continued flight. Because of that signature I felt it was not just a short advice I had given, but we (the Airline and I) had entered some kind of a formal relationship.

Because the halving time of favours is very short I made my way to the service desk upon arrival and asked if they could make a note in the system that I would very much appreciate to be upgraded to business class on the long leg flight on my way back. No such thing was going to happen.

I like being the Good Samaritan; like most doctors, I actually enjoy helping people. But was it really an unreasonable request to ask to be upgraded if there was availability on the way back? The last time I helped out the airline made me pay for two kilos extra on my luggage on My return flight. Things like this make any Good Samaritan annoyed. Well, pissed, to be honest.

Will I get up next time they call? Sure, the Good Samaritan never learns. And being able to help out is not a bad reward after all.

How the system failed Daisy

I felt I was probably being unprofessional, but I couldn’t help myself. While the consultant, the medical students and the junior doctors were all discussing Daisy’s test results and charts with the nurse by the foot end, I stood by the cot and stroke her, one hand holding her tiny fingers around mine and the other hand caressing her head.

The nurses in the ward said they knew right away it was Daisy crying when they heard her. I now saw why, she let out a hoarse, ancient, moaning cry when we undressed her to examine her pale and fragile body. The sound was miles from the high-pitched, demanding scream of a healthy infant. She moaned and fretted and was clearly disturbed by the fuss we made with her. Maybe that’s why I was so touched when she let me soothe her, easing her head into my hand as I stroke her hair.

For the medical students Daisy was a rich source to learn infant neurological pathology. Her head lagged heavily at four moths of age where she should have been able to hold it up steadily and she had no gaze fixation. Instead, her roaming eye movements indicated she had vision impairment.

Her MRI scan was something of a sensation and indicated severe anomaly of the brain. Instead of flexing and extending all four limbs symmetrically when lying on her back, Daisy only used her arms, the legs peculiarly extended. Her pallor was striking, but what hit me most was her skin hanging loosely from her bones. I had never seen such a malnourished baby in a Western country, only on pictures from developing countries and in paediatric textbooks. And this was days after she was first admitted!

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Although clearly not a normally developing infant, no one around Daisy seemed to notice. Not a first child, the mother should have wondered why she never managed to breastfeed. But never mind the parents, they clearly had a number of issues. What I care about as a public health physician is the system. I don’t work with individual children (which is probably a good thing, given my impulse to adopt every child in need); I work with systems.

And the system designed to provide developmental surveillance and protection to Daisy failed her bitterly. The nurse who had seen and weighed her repeatedly had noted “normal developmental milestones”. Even if milestones are not a completely reliable way to assess motor development, this child was off the charts!

The fact that she after one month still hadn’t regained her birth weight should have sent a million signals to the nurse. Any medical student will give you the major causes of failure to thrive including both developmental disorders and psychosocial failure to thrive. Missed appointments or called-in weights are other signs to note.

The nurse finally referred the family to a GP. The mother seemed reluctant, she said Daisy ate well from the bottle, and although she seemed not to grow that much, mom wasn’t worried. Although parental worry is a strong predictor of something being wrong, absence of parental worry is not so sensitive a sign.

But the GP wasn’t worried enough to make any notes on it, having seen the baby only once and mom being quite relaxed. The social services were worried, but not primarily about Daisy, they were investigating domestic violence. Although there was an anonymous report on the infant not developing well the social services apparently lacked sufficient ground to make a home visit. So Daisy fell through the cracks of surely caring and knowledgeable professionals.

It took the watchful eye of a triage nurse at a hospitaI to spot Daisy in her mother’s arms, labouring to breathe, tiny, pale, and having what looked like seizures. Still, the family wasn’t worried, they weren’t even at the hospital for Daisy’s sake. But the staff insisted and Daisy was in the ICU in less than an hour. Now everyone worried – would she even survive?

And everyone wondered – how can a severely disabled child in a socially vulnerable family situation not be picked up by the welfare system they actually attended?  Why was there no communication between services? Why were no home visits made? Maybe someone was intimidated, maybe failing her infant didn’t fit with the nurse’s image of the mother. Maybe the nurse worried losing the family altogether. We don’t know.

But that’s what interests me. And if you think it can’t happen where you are, you’re probably wrong, because systems do fail. On the other hand, systems can also overdo things. To get it right, to provide universal services that reach all and pick up those in extra need are the mantra of us public health physicians. Our work is to make sure that Daisy and her likes don’t fall between the cracks, while first-time parents are not made anxious by weighing and measuring happy, healthy, thriving infants excessively.

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Daisy will not have an easy life: disability, social disadvantage, and a tough start will take its toll. As I pull my hand away I don’t know what to wish for her. But I promise her we’ll work on the system until we get it right! And maybe I wasn’t being so unprofessional after all, caressing, rather than assessing this baby. In a recent article published in The New England Journal of Medicine, a colleague described how sometimes our being humans before professionals can really mean something to those we care for.

I am sorry, Daisy, on the system’s behalf. I wish we could make it up for you. If nothing else, you should know that none of this is your fault.

*Daisy is of course not the real name of this infant. Photographs taken by Fanni Sarkadi Kristiansson

How not to write a peer review

Although I am by no means a rookie I was shocked by the tone of the latest review I got from a journal. It wasn’t just any journal, it was the one where my most cited article had been published and I was under the impression that we were on good working terms. I doubt that now.

I have published a number of papers and most of them have been through several rounds of peer review. Similarly, I have been an active reviewer for a dozen or so journals in the past ten years. I would like to think that I am respectful and constructive as a reviewer and responsive to well-intentioned criticism as an author. Because the motor of all scientific endeavours is peer review it is essential that some basic rules of conduct are appreciated in the process. Unfortunately researchers do not receive formal training in peer review. Critical thinking is not the problem – that we are trained to do – it is how to express oneself in a way that is conducive to respectful scientific debate.

The review I got was short and undoubtedly the person who wrote it, very angry. “I am sure you know about epidemiology and psychometrics, så (sic) I don’t understand why you wrote that”. The person left a Nordic vowel in the text so now I have to live with the fact that it is most likely a colleague in my country. Also, the phrases ”I am sorry on your behalf” and ”Did you not perform pilot studies in a project of this magnitude??” render this review completely inappropriate. Notwithstanding the possible validity of some of the comments, I am shocked that the editor let it pass.

Because of the harsh and personal tone of the review I wonder if the colleague who wrote it has any personal or professional issues with me. If so, he or she should have declared a conflict of interest to begin with since the journal does not employ a double-blind process and my name was open to the reviewer. Although a perfect opportunity to unpunished beat up someone whose face you hate, that is not what peer review is for.

The other end of the spectrum is, of course, when no review is done at all. In a recent “sting operation” Science sent a spoof paper to 304 open-access journals, half of which had accepted the paper, which was completely concocted and had fatal scientific flaws. Open-access journals charge fees for publishing so it is easy enough to draw the conclusion that money, rather than scientific merit was in front of the eyes of the editors who accepted the spoof paper.  (Although the problem is more that of peer review rather than open access.)

But what was in front of the eyes of the editor of my journal where the reviewer submitted this despicable review? Have editors become so desperate to get review that anything will do? A colleague recently received a very kind letter from an editor stating that she had tried to send the paper to 11 (!) potential reviewers, only one of whom subsequently returned with a review.

In any case, I have done my fair share of peer review this week: I submitted one and said yes to another  due in three weeks. The one I reviewed had the bad luck of a basically identical paper having been published just a few months before theirs and they didn’t cite it. I still didn’t feel the urge to tell them “Did you not perform proper literature searches when writing up your study?” and “I am sorry on your behalf, but you have nothing new to say”. It’s just not how to write a peer review.

ImagePhoto taken by Fanni Sarkadi Kristiansson at Toronga Zoo, Sydney.

How I suddenly became motivated to start my e-learning session on workplace bullying

As a researcher I have deadlines for almost everything I do. Deadlines are my worst enemies and best friends: I hate them because they stress me out and I cherish them because they help me prioritize and structure my work. Even if they are a pain at times, the truth is that without deadlines things just wouldn’t get done. So when I looked through my introductory package of e-learning at my host institution MCRI, the special part of my brain that registers deadlines zoomed in on the sessions that were due, which I completed, and stored the fact that there were more things there, among them one on bullying, with a deadline two months ahead. They didn’t look extremely exciting so I simply postponed their completion until the deadline was going to approach.

Now someone at the HR department might ask themselves: Why can’t people just do as they are told and complete the e-learning tasks as soon as they start their employment? When we are asking people to behave in one way or another, whether they are patients, clients, or employees, we are into the territory of motivation and behavioural change. A few things in life are so intrinsically motivating that people will do them anyway. Such things are eating, having sex, and seeking flow through whatever way is accessible to a person. Some people do sports to achieve flow, others play or experiment, some build, some cook, and some find their flow in art or music. All other things in life we need motivation to do.

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The health belief model (HBM) and the transtheoretical model are two helpful tools to understand why people choose to behave the way they do. Given they actually have choices, that is. Both models have been developed in the framework of prevention and health promotion. The HBM says that the perceived barriers to action have to be smaller that the perceived benefits of that action. In addition, the person has to feel susceptible to the outcome we are trying to prevent, needs to believe in his or her own capability to make that change (self-efficacy), and needs a signal for action.

The transtheoretical model was developed by Proschaska and describes the steps involved when a person changes their behaviour. In the Precontemplation phase people are unaware of the need to change and need information. Contemplators are aware of the need to change, but typically perceive barriers to change as significant and gains as too little. People in the Preparation phase are ready to start taking action and here self-efficacy and available support becomes paramount. People in the Action phase have changed their behavior recently and need to work hard to keep moving ahead. In this phase, positive reinforcement and rewards are likely to help the person to keep on the right track. 
People in the Maintenance phase have fully adopted a new behaviour, but need to be aware of the risks of ”sliding back” in the face of e.g. stress.

My signal for action was the workshop I attended at the Grand Rounds, held every week at the Royal Children’s Hospital. It was called the “Mock Court” and was a very well prepared improvisation theatre type of performance. It was held by a couple of lawyers who had started a company to educate people about the implications or labour law in the court system. In no time, we in the audience were in a courtroom where hearings had commenced for allegations of workplace bullying. The “witnesses” were actual employees at RCH, making the experience all the more real. When the cross-examination started I felt the chills down my back.

Two more witnesses came in and were equally diced during the cross-examination and I really wasn’t sure who would win the case. All the while, a slide in the background showed the legal definition of bullying. It was easy enough to understand what the employee’s lawyer was doing when he asked the employer’s representative if the consultant’s alleged bullying behaviour was repeated and inadequate. The defence lawyer, in turn, banged her points into our heads: “You had many options open to you, sir, when your manager wasn’t forthcoming with the support you wanted in this situation”. And she spat out the options with despise, again and again. I think everyone got the point.

This signal threw me into the Preparation phase so I logged onto my e-learning hub to have a look. I set a deadline and on Monday it’s time for Action. I believe now it’s important for me to learn about workplace bullying, I feel susceptible to the consequences of being ignorant to the procedures, and I feel I can overcome my resistance to put in the time needed to complete the online training. And a deadline is a deadline!

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The Talk

Walking down the beach path with my teenage daughter I see a man staring at her legs. With her blond hair blowing in the wind and with her long Scandinavian thighs sticking out of those tiny shorts she is quite a sight. But that stare is aimed at a woman, not a fourteen-year-old girl who is busy developing her identity and enduring her useless and embarrassing parents. I want to punch that fifty-something, self-assured guy with his gold necklace and dark sunglasses right in the stomach. How dare he? I know that look, that assessing gaze, sizing up the breasts, buttocks and the legs, not the face, or the person, for that matter.

I ask my daughter is she noticed the man staring at her. She continues kicking herself on with the Penny-board, shrugs and says she doesn’t notice or care, but that her father has told her that men sometimes stare at her. “So how do you feel about that”, I venture. “I dunno, I like wearing these shorts, they’re comfy”. And off she rides leaving me with a knot in my stomach: we really need to have The Talk soon.

But how do you talk to your beautiful teenage daughter about the risks she exposes herself to by merely being young and possessing a body that some men might want to exploit? How do I talk to her about not wearing too short pants or too deeply cut tank tops without automatically subscribing to every single rape myth. The official definition of rape myths is “false beliefs about rape that serve to deny and justify male sexual aggression against women.” (Lonsway, 1994). Blaming the victim in rape is an extremely prevalent reaction: if the female rape victim engages in any kind of “incautious” behaviour, chances are that she is going to be judged as at least partly being at fault for what happened (Pollard, 1992).

A recent overview of rape myth endorsement patterns found that males are more likely to subscribe to these myths along with people who hold traditional gender role ideas and have racist or hetero-normative values (Suarez, 2010). What a surprise! Well, even if there are no surprises there, rape myth acceptance predicts victim blaming even among policemen specially trained for sexual violence investigations (Sleath, 2012). A gutsy, drunk or clueless woman should simply suit herself! So if I tell my daughter that those shorts are basically dangerous for her to wear, I identify her not only as a potential sexual object for a man, but also as a victim, who is to blame.

When we get home, I muster some courage and try a version of my mother’s suggestion:

“You know the thing is that you just need to be a bit aware of the reactions you might evoke by the way you dress”.

“I should bloody well be able to walk NAKED if I want without having to be afraid of anyone raping me!”

I choke on my water both because I can’t help but laugh, but also because I now panic that this Talk is not going quite so well. And how come she even knows I am alluding to rape? I do, however, feel both proud and relieved that my daughter has not subscribed to any rape myths, so far.

This is when my husband steps in. “Yes, Darling, that would be great, but fact is…”. I leave the room and go upstairs to shower. I chicken out from one of the most important Talks a mother has to have with her daughter and let her dad take care of it. Might as well, maybe he has more trustworthiness as a male.

I let the warm water stroke my face and a memory suddenly strikes me. I was exactly my daughter’s age when a man stained my white shorts. It was on a packed tram and my cousin and I just jumped off and ran. I didn’t quite understand what the sticky fluid on my shorts was, but I had seen it come out from that man’s penis and was scared and disgusted. The next thing I remember is standing in the hot shower at home, freezing despite the hot summer day and trying to wash the disgust off myself. I blamed the white shorts and felt it was somehow my fault.  Blaming the victim, as it were. I have never worn shorts again.

My husband assures me that he has continued the Talk with our daughter, mentioning to her rape as a war crime among other things, just to show her that however surreal these things might seem, they do happen. I am not quite sure that’s relevant knowledge for a 14-year-old, but I keep quiet, because I just cannot make myself have the Talk so he has to. I feel caught in a catch 22 situation where if I warn her I subscribe to rape myths and if I don’t I expose her to possible danger. Fact of life, my husband says. And I should know.

Walking the talk

Being a parenting researcher means I know quite a lot about the theory of good parenting. I have had reason to read the content of a number of parenting programs and picked up ideas I especially like. Friends sometimes ask me for advice with their kids and I often discuss parenting issues with educators, social workers, and mental health professionals. I also enjoyed my placement in child psychiatry because so much could be achieved with some sound parenting advice. However, all too often, I forget to walk the talk myself.

The latest example was our trip to Sydney. We planned it to be a two day drive and the first leg took us from Melbourne to Camberra. We had planned some stops on the way and had a fair idea of the time each leg would take. We had water bottles, charged iPads, and fruit with us. The children played and sang and looked at the view and the trip went really well. We made two fun stops, the second one including a nice surprise with the host on the family estate guiding us around to see something as unlikely as beautifully renovated royal horse carriages from the 1800s in a shed!

Then we forgot all about planning. We spent a night and half a day in the capital city, which just happened to host the open day event for several of the embassies, and then set off to Sydney. No water bottles, or fruit, no planned stops, not even planning for meals and other necessities. I was really beating myself up because it was so stupid, so easy to prevent and still, there we were, killing the enjoyment of the trip with kids fighting in the back and parents ready to give up. By the time we arrived it was dark and dinner still had to be cooked. The only good thing was we weren’t dependent on me to orient in the dark…

There is something in the Positive Parenting Program called the Planned activities routine. It is NOT rocket science. But it works, especially in high-risk situations, such as long trips in the car. Such planning also works well with children who have a hard time adapting to changes and new situations or dislike transitions from one activity to another. Planning ahead and making these plans clear for the children, or indeed involving them in the planning, is something that minimises the risk for the whining and fighting that can occur when everyone is tired, hungry, stressed, overloaded, or all at the same time.

Luckily, when things were at their worst, we stopped at Wollongong, a town right by the sea, and had a long chill on the beach. Because although planning is very effective in decreasing stress and making life easier, what really counts is to be able to deal with difficulties constructively. When sitting in the car and keeping going was just not a viable option, we took a break. The younger ones sat in the sand and built a fortress with water around and our teenager photographed the waves coming in. No one said much, we all needed some peace and quiet, fresh air to breathe, the waves to listen to. But it was one of the nicest hours of our trip, a sunset by the sea, given to us unplanned, unforeseen, but deeply appreciated.

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I guess there is no need to say that when we set out for a day in Sydney, the backpack was properly packed and distances, along with ferry timetables, duly checked. I even had nuts in the car so that the starving troops would have something to munch on until we got home in the evening. But we did take care not to pack the day too tight so there would be time for surprises. For you can only plan so much and you don’t want to have kids believe that everything can be planned and that all uncomfortable things can be avoided.

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Nonetheless, take my advice and use some smart planning before your next long car trip. State your expectations, keep the kids busy and engaged, encourage the behaviours you would like to see and implement consequences for the ones you want to avoid. And be realistic! I will certainly remember to try and walk the talk myself next time around.

You can do it!

The night before my first solo driving trip in Melbourne I had nightmares. It’s not that I don’t like driving – in fact I am an experienced driver and have driven lots of different cars on all sides of the road, big and small, manual and automatic. I drive carefully and confidently and I think I am considerate on the roads. But I am spatially challenged, meaning that I have no sense of direction whatsoever and have therefore serious issues with finding my way. In addition, I cannot tell right from left without thinking hard about it. This challenge of my spatial intelligence is reflected in those parts of the IQ test where you are supposed to match up 3D images with one another to see which of four possible pieces fits with the sample image missing a part. Impossible! How can people figure that out?

Because I am adamant not to let such things restrict me I have had many detours and sweaty arrivals just because I did not take extra precautions or double check my choices on which way to turn while en route. But now that I am soon turning 40 I figure that I have to find a way to live with my spatial challenge and maybe give myself a brake. So I spent some of the evening consulting Google maps while my husband had a fun time proposing seven different routes because it didn’t matter. Well, it did for me, and I chose the most straightforward route that was a bit longer, but much simpler than the others. I memorised the street names and distances, although I also planned to have my laptop on the passenger seat.

Nonetheless, when the morning came I had a lot of excuses ready for why I shouldn’t go or why my husband should come with me. My hesitation could have to do with the fact that, while I was at it, I planned four meetings that day so I not only had to get to one destination, but three, and there was no time for messing up. The reason I didn’t seriously consider just dropping the whole project of driving a fat jeep in left traffic to parts of a huge city I had never been to before was my self-efficacy. I believed I could do it.

In fact, I knew I could do it, that I would figure it out. The term self-efficacy was coined by the psychologist Albert Bandura in his book on Social Learning Theory from 1977. Self-efficacy is a very widely used and cited concept and is related to the person’s belief about his or her ability to complete or master a certain task or meet a challenge effectively. It is for good reason that sports psychology uses self-efficacy as one of its core concepts: you can only visualize yourself with a gold medal in hand if you have high self-efficacy. I did my PhD on Type 2 Diabetes and one of our very interesting findings was the importance of self-efficacy for metabolic control in diabetes. I dare to say the same goes for every single chronic condition and in fact health behaviour in general. We also see the major role self-efficacy plays in parenting.

As simple as it seems, it is true: if you believe you can do something, the odds are that you will succeed. Well, unless you mix up boasting or an unrealistic self-image with self-efficacy. Having high self-efficacy means that you take responsibility for your actions and that the possibility of both success and failure lies within your reach. The good news is that self-efficacy is possible to affect, which indeed is what a lot of cognitive behavioural therapy does. If you don’t believe you can make a change in your life you need to start working on why you don’t believe you can make a change.

I did find my way to all my destinations, drove a total of 72 kilometers, and was not even late. It did help to plan and to ask my researcher colleague for directions at my first destination. It turned out that she knew exactly what it was like to be spatially challenged. So when the road I was driving on did this impossible thing dividing itself into two going in complete different directions I knew what to do because she had told me: stick to the right, let’s see, it’s this hand! I am not alone, in fact there are plenty of us spatially challenged, otherwise rather intelligent, people out there. You can do a simple test to tell: if you call on us to turn right too quickly and without pointing, we will either turn left or say which right?

It did feel a bit phony, but when things got tough that day I just said to myself: you can do it! The best news with self-efficacy is in fact that successes create a positive loop with better self-efficacy and more successes. Parents intuitively know this. So keep chanting “you can do it” to your child the next time it runs into a challenge and a small miracle is bound to happen in front of your eyes. 

Knowing when to let go

“He climbed up there, he’ll get down”, the mother shouted from the bottom of the stairs in the Children’s Hospital. She turned back to her friend and the member of the hospital staff in the stairs and I looked at each other. I offered the child my finger to help him down, but he gave me a terrified look so I just lingered around to catch him in case he fell. The stairs were way too high for a child his age, made of white stone, hard and edgy. The little boy had huge curls surrounding his face and dark brown eyes, conveying no trust in this world. When he had landed safely I continued up the stairs. The staff member rolled her eyes: “Interesting parenting you see around here sometimes”. The scene made me depressed for the rest of the morning.

Teaching a child to learn the consequences of its actions is a core task in parenting. It is a fine line parents need to walk – when to support individuation and let the child experience the consequences of their choices and when to shield them from their own immaturity. It takes sensitivity, afterthought, and a lot of trial and error to know when to let go, when the child is ready to understand the concept of consequences.

Logical consequences is a specific strategy in the Positive Parenting Program, Triple P, but several parenting programs have similar tools. Its purpose is to help children experience consequences of their behaviour in a predictable way. So if two children fight over a toy or device despite the parents asking them to start sharing instead or the toy will go away, the object indeed goes away for five minutes. Logical consequences make sense to the child and are closely related in time to the inadequate behaviour, helping the child make the link. A logical consequence can also be shorter time for play because of time spent whining instead of getting ready or not being able to go shopping with a friend because of missed homework that has to be done.

A logical consequence for the little boy in the stairs for not listening should have been to sit in the pram. In fact, given that he was only about 18 months the best choice would probably have been to distract him with something else or why not walk with him a couple of times, telling him that mommy will be busy later on and he can be a good boy playing with some toys after the walks in the stairs. There was no logic to the consequence of possibly letting him fall.

At times, however, children will and should fall. A book that provoked a lot of debate in Sweden problematized the consequences of what was termed “curling parenting”, a Swedish version of alleged overprotective parenting where the path is cleared for children, as the ice is swept clean in the sport of Curling by the Sweepers for the granite stone to glide as smoothly as possible. The authors Carl Lindgren and Frank Lindblad argued that in parents’ efforts to protect their offspring from injuries and negative experiences, the children were left without resilience for the normal challenges of life.

Given the links between overprotective parenting and fearfulness and anxiety in children (Rapee, 2009), they seem to have a point. Of course children who are temperamentally inhibited, less sociable and more fearful of new situations, might elicit this type of parenting when they are toddlers. So the causal pathway could go either way, but being overprotective certainly does not improve these children’s bravery or resilience.

To be honest, I tend to be pretty protective of the children. Helmets, sunscreen, and life vests are non-negotiable and they are all tired of hearing me talk about never going anywhere with strangers. But I like to exercise “controlled risk”, as in letting them walk on their own to the store and back, secretly checking on them or biking behind the bus when they are riding it on their own for the first time to school. I hate letting them go to camp or downtown with friends, but I do, because I figure that is part of being a good parent. And because my husband tells me not to be such a mother hen…

But I have to stop myself from making up all kinds of terrible scenarios in my head and something in me will not settle until the kids are all back and sound asleep in their beds so I can peep in and listen to their even breathing. That will, of course not be like that forever, because we have to let go of our children: the question is only  when and how.