autonomy cymhsu collaborative castlegar bc dec 2014

Help me find myselfThe Struggle for Autonomy

Todd Kettner, Ph.D., R. Psych.

School District 81

December 15, 2014

CYMH Collaborative

Diagnosis –arrested development vs.

symptom description

• Dr. John McKinnon “An Unchanged Mind”

• Understanding our students entails an attention to

the obstacles that delayed their development

AND an awareness of their immaturity

• Effective treatment then entails

• Removal or mitigation of obstacles that delayed

psychological development

• Encouraging and prodding a stuck teenager to

GROW UP

December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 82

A quick review of Erickson’s

Developmental Stages

December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 83

A word about DSM diagnosis and

medication

• Focusing on the push for maturity

does not mean ignoring psychiatric

disorders or pharmacological

treatments.

• It’s a matter of emphasis

• Remember….

we reinforce what we focus on.

December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 84

Key Issues of Delayed MaturitySTAGE

(month

s)

KEY TASK OR

STRUGGLE

CHARACTERISTICS TYPICAL

FAMILY &

LIFE ISSUES

HELPFUL

RESPONSE

0 - 12 Attachment Lack of trust, poor

boundaries

“I don’t know if I exist.”

Adoption,

abuse,

neglect,

chaotic

Predictable

Nurturing

Attuned

6 - 18 Separation/

Individuation

Anxious, moody,

enmeshed, collapses

under stress

“I can’t be alone.”

Overprotective

parents,

enmeshed,

poor limits, no

hierarchy

Attuned

Reassuring

Encourage

independence

Available

18 - 36 Autonomy Securely attached,

individuated but angry,

resist authority

“You can’t control me.”

Giving in to

tantrums, no

limits,

overpowering

Clear,

consistent

limits w/o

power struggle

ReassuringDecember 15, 2014 CYMH Collaborative

Todd Kettner, Ph.D., R. Psych. School

District 85

“You Can’t Control me!”

December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 86

“I’m so Special.”

December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 87

Characteristics of an autonomy

struggle Teen

• Angry

• Direct – “You can’t control me!”

• Passive – “I’m so special that expectations don’t

apply to me.”

• Shame – anger towards oneself for being

inadequate

• Key anxiety - Fear of being exposed

• Resistant to authority

• Key issue – “You’re not the boss of me…”December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 88

Narcissism in teens

• The world revolves around me

• No one can tell me what to do

• I am unaware of and/or don’t care about others

feelings and needs

• Can lead to holding in feelings of shame, anger, hurt

which then explodes intermittently (hey that sounds

like a psychiatric diagnosis)

• Pushes others away – leads to social failures/isolation

– leads to further feelings of inadequacy and shameDecember 15, 2014 CYMH Collaborative

Todd Kettner, Ph.D., R. Psych. School

District 89

“I don’t have to Listen to you…

I’ll be sad or angry if you say no”

December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 810

Poorly resolved early autonomy

struggle

• Self-centered

• Entitled

• Lacking in empathy

• “pseudo adults” – haven’t done the work or earned the right to be legitimate adults

• Lacking emotional availability

• False sense of self that is easily wounded

December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 811

Healthy resolution of autonomy struggle

(ages 2 to 4)

• Certain level of legitimate independence

• Understand restrictions and limits on their freedom

• Acceptance of authority

December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 812

Why is Tyler looking

down?

Is he scared?

December 15, 2014

CYMH Collaborative

Todd Kettner, Ph.D., R.

Psych. School District 813

“Look what I just did!”

MORE IMPORTANTLY:

“look at who I am…”

Brave

Adventuresome

Talented

Capable

Independent

Strong

December 15, 2014

CYMH Collaborative

Todd Kettner, Ph.D., R.

Psych. School District 814

Though I’m too

scared to go as

high as my little

brother, I’ve

climbed way up

here too!

December 15, 2014

CYMH Collaborative

Todd Kettner, Ph.D., R.

Psych. School District 815

I am….

December 15, 2014

CYMH Collaborative

Todd Kettner, Ph.D., R.

Psych. School District 816

I am…

December 15, 2014

CYMH Collaborative

Todd Kettner, Ph.D., R.

Psych. School District 817

Clinical ParentinG

1. A teen’s need for recognition and limit-setting prod her to take the

next step in maturity

2. Setting limits is critical in the context of recognition

3. Useful recognition and limit-setting only take place within a

relationship

4. Parenting is a task that must change at each developmental level

5. Maturity is not just information and skill, but a cognitive and

emotional approach to the world and others

6. Well-timed recognition and limit-setting propel teens towards

positive character development

- From McKinnon “To Change a Mind”December 15, 2014 CYMH Collaborative

Todd Kettner, Ph.D., R. Psych. School

District 818

Responding well

• Avoid power struggles… AND…

• Set firm limits – with expectations and consequences that are clear and consistent

• Provide choice within the expectations

• Mentor – guidance and assistance and reassurance

• Encourage mature responsibilities and genuine behaviors

• We’re the substitute punching bags for awhile (may be several years of conflictual relationships with teachers and parents)

• Coach, model and expect that parents will be strong members of the treatment team by supporting limits and consequences

December 15, 2014 CYMH CollaborativeTodd Kettner, Ph.D., R. Psych. School

District 819

Success Earned

• Recognition is deserved

• Success is achieved

• Sense of self is developed

• Autonomy is gained

• Purpose is defined

tkettner@sd8.bc.caDecember 15, 2014

CYMH Collaborative

Todd Kettner, Ph.D., R.

Psych. School District 820