When Lianne and Ken Houston’s* daughter, Adrienne,* complained that her head was hurting, they asked her some questions to find out what was going on. They were alarmed to discover that she had been repeatedly banging her head against the wall when she felt frustrated and angry.
Although Adrienne had always been an emotional child, her mother says she was a happy, social kid who loved to dance. But around grade 2, she began to complain of various physical pains, was often upset and started to have difficulty making friends.
At age 11, she was diagnosed with a rare and painful disease called Ehlers-Danlos syndrome that affects connective tissues in the body and has no cure. She was also diagnosed with autism spectrum disorder. Adrienne was chronically in pain, and was susceptible to dislocations and other problems, which meant she could no longer dance as much as she used to. She began to feel sad and lonely, and she could become hysterical with anger and frustration at how unfair her situation was. There were times when she would say she didn’t want to live.
Mental health professionals described Adrienne as having “emotional dysregulation,” a term used to describe people who have difficulty managing big emotions. Kids with emotional dysregulation can become overwhelmed by their emotions, and may respond with sudden outbursts of anger in an effort to cope. Others may turn their feelings inward and become depressed or anxious. And others still may resort to self harm, eating disorders or substance use problems.
Adrienne felt things deeply and was easily overwhelmed. When Ken and Lianne realized how much their daughter was suffering, they were desperate to find help. They went to a myriad of professionals—social workers, psychiatrists, psychologists—who recommended many different treatments, from medication to CBT and talk therapy. But no one gave them strategies to manage issues at home.
But then a therapist recommended that Lianne connect with Mirisse Foroughe, the director of psychological services at Kindercare Pediatrics in Toronto. Foroughe introduced Lianne and Ken to an approach called emotion focused family therapy (EFFT). The basic premise behind EFFT is that the best way to work with children who have difficulties managing their emotions and behaviours is to empower parents to learn the skills to support them. A therapist has only an hour a week at best to work with a child, and kids aren’t always comfortable speaking to a total stranger. But with EFFT, the parents take the lead role in effecting positive change.
“As soon as we met her [Foroughe] and discovered that she was arming us to be the therapists, to manage it on our own, in real time, it was life changing,” says Lianne.
Adele Lafrance, a clinical psychologist and associate professor at Laurentian University who co-developed EFFT in 2007, says that if a therapist can support parents to make even small improvements in the way they support their children, this may have more benefits than “expert-led” interventions. And the approach can be applied to kids managing a range of different problems, from temper tantrums at the dinner table to aggression or depression.
To learn EFFT, Lianne and Ken began attending weekly sessions with Foroughe over several months. Foroughe taught them the five steps to emotion coaching: acknowledging the child’s emotion, labelling the emotion, validating the emotion, meeting the need and fixing it.
Lianne used these steps to help Adrienne work through her feelings. For example, when Adrienne felt despair that she wasn’t well enough to participate in her dance recital, Lianne began by acknowledging that her daughter was upset, saying, “It seems like today is a tough day.” She then helped her label the emotion—“I can see how sad and overwhelmed you are.” The next step was to validate her feelings by letting her know that she understood why she would be sad to not be able to participate in something that mattered to her so much. She would then “meet the need,” which often meant simply giving her a hug. Only at this point would she move on to problem-solving. For example, she might suggest Adrienne could help one of her favourite dance teachers backstage since she wasn’t well enough to perform.
Lafrance says that many people find the third step, validating the emotion, particularly challenging. Sometimes parents think they are validating when, in fact, they might be reassuring their child. For example, when a kid complains of not having friends at school, the parent’s natural impulse is to reassure the child that he does have friends. “The positive effects of reassurance are superficial and temporary,” says Lafrance. And in some cases, “the pain gets deeper because they can’t discharge the emotion and they feel alone in it.”
Parents should resist the temptation to jump right to fixing the problem. EFFT believes that healing happens by accepting and allowing the child to express painful emotions, not by trying to avoid or distract the child from these feelings. The key is to get at the underlying emotion, rather than focusing on the problem or the behaviour the child is exhibiting in response to the emotion, which is often a maladaptive coping strategy.
Along with the five steps of emotion coaching, some EFFT therapists also recommend that the parent apologize to their child. LaFrance says, whether an apology might help is completely dependent in the circumstances. The apology is not about the parent blaming themselves; it’s a way of sharing their child’s emotional burden with them to help the child feel less alone with their problems. And the hope is that this apology will help repair any ruptures in your relationship with your child that may have occurred.
Lianne’s apology involved telling her daughter, “I’m sorry that I contributed to your seeing yourself as only a sick person and that I didn’t do enough to show you that I could handle it, and you can handle it.” She found the experience particularly powerful. The tricky part of an apology is not to be defensive—for instance, Lianne didn’t add that she had done the best she could, as this would have likely made Adrienne feel guilty for not managing her feelings better.
After using EFFT with her daughter for many months, Lianne says there are almost no more fights, arguments or power struggles between her and her daughter.
And the constant emotional coaching? “It’s a leap of faith,” says Lianne. Sometimes trying to follow all the steps feels counterintuitive or too prescribed, she says. But overall, “life is way calmer.”
*Names have been changed