True, we cannot force another person to be ready to change. But with Repetitive behaviors directed at the body (BFRBs), such as hair pulling, skin picking, and nail biting, hesitation to stop is not resistance. This is expected because behavior serves a function. It can be to regulate arousal, calm difficult emotions, provide reliable emotional information on an overstimulated day, or satisfy an unmet need.
If we ignore this function and force the child to stop, we often make it difficult to understand the behavior and meet the child’s needs. Encouraging a child to change their behavior, that is, to some extent, work for them, has a paradoxical effect. Behavior moves underground. Children secretly draw or choose. They can lie about it. Frustration grows. Shame on you builds The parent-child relationship, one of the child’s most protective factors, buckles under the weight of behaviors that no one will honestly discuss.
This is very difficult for parents because the instinct to protect your child is just that, instinctive. The clinical challenge is to respect the parental instinct and meet the child where they are and join them with love and interest.
Will is not a transition, but a continuum
Some children come to work on the BFRB with no interest. Some are curious, but not determined. Some are willing to talk about it, but not change it. Some will try a strategy if there is a reward attached. And some are quietly ready and just need the right doctor and the right invitation. All of these starting points are workable.
If the child is not yet ready to directly address this behavior…
There is still significant and meaningful work to be done.
Much of it is aimed at developing a clearer self-awareness of the child, helping him to find out what he is interested in, what he is good at and what he cares about. Children who can express their values have something to bond with, which is important later when they are asked to endure the discomfort of doing otherwise. Once these values are determined, the clinician and child can carefully examine whether the BFRB interferes with any of them. Sometimes the answer surprises the child, and often this is where readiness begins to change.
Therapy It also involves helping the child learn what is difficult in everyday life – not the BFRB itself, but everything around it. This includes friendships that don’t make sense, too many emotions from a teacher, emotions that come on too big and too fast, or emotional experiences that others don’t notice. These daily struggles are often the context that drives the BFRB.
An important part of therapy is building skills such as cognitive flexibility that BFRB serves. emotional regulationdistress tolerance and interpersonal effectiveness. If a child’s BFRB is, among other things, a coping strategy for excessive stress, developing additional coping strategies for coping with excessive stress does not require directly targeting (eg,) weight. As the toolkit fills up, the function is found elsewhere and the behavior is often softened.
Self-compassion is also important. A child who has quietly hated their hands, scalp, or skin for months or years carries a heavy burden. Helping them to look at them with kindness will change the internal environment of the behavior.
And then there’s communication. Shame develops in isolation, and shame is one of the most powerful forces that keep BFRBs at bay. Books and videos that others have BFRB can be deeply disarming. So can private communities at conferences, retreats, and support groups. Children who are resistant to working on their BFRB will sometimes go into other people’s rooms with their therapists, or pull away and leave.
Rewards and systems can help if there is some will
This is where family systems come in handy. Involving parents in planning praise and rewards can reinforce practice motivationbut it should be collaborative and child-centered. The child decides what he wants to do care giver to help What is really useful? What’s boring? What do they want the caregiver to say if they notice a BFRB occurring? What would a caregiver prefer not to say? Putting the child in the driver’s seat preserves autonomy, gives the caregiver an approved role, and prevents the cycle of secrecy and resentment.
When one is ready to speak, but has not yet changed, the hesitation itself is the work. A child can create two lists: reasons for working on the BFRB and reasons for keeping it. Both are honest. Rather than arguing from one side, sitting with hesitation often allows for action.
Basic readings of body-directed repetitive behaviors
A word about parents and educators
Sometimes the person in the family who needs the most help is the parent or caregiver. If a caregiver is experiencing significant grief, a caregiving session alone can be invaluable as a place to listen and share information they may not have heard. This includes the fact that many children and adults live full, healthy lives with BFRB; The worst stories found on the Internet at two in the morning or at night imagination not the usual course; Common myths like “he’s doing it for”. attention,” “Something must be deeply wrong” or “a better parent would have prevented this” is not true; and less anxious a caregiver is a more effective partner in caring for their child.
If the child is comfortable, caregivers can also be invited at the end of the session to talk about what they have been working on and how they can gently replicate this approach at home.
Will is not expected, it is built
Left untreated, BFRBs can have real physical, emotional, and social consequences. It’s understandable that caregivers now want to intervene. But intervention does not mean “stopping the child”. This may mean finding a clinician who understands BFRBs, meets the child where they are, treats the whole child, and protects both caregiver and child autonomy and the caregiver-child relationship. It’s not a wait. This treatment – and often, this treatment – makes the targeted BFRB work possible and effective.
Will is built. It grows out of feeling recognized, capable, alone and less ashamed. Children often do not want to change to therapy. With the right support, what they can achieve is understanding themselves and who they want to be. This is almost always enough to get started.
To find a therapist, Visit the Psychology Therapy Directory today.
