Praxis Blog

MANY VOICES 21: Interview With Lisa Coyne and Evelyn Gould (Part 1 of 4)

In this first segment of this 4-part discussion, Lisa and Evelyn discuss how they began bringing acceptance and commitment therapy (ACT) into their work with parents.

Evelyn Gould [00:16]: So, welcome to this conversation with my mentor, myself, Evelyn Gould, and my mentor and friend and colleague, Lisa Coyne. We’re going to be talking a little bit about our work with parents from an Acceptance and Commitment Therapy perspective. And I’m going to start by just talking a bit about how I met Lisa and how I ended up on this journey with her that ended – or, hopefully hasn’t ended, but has produced this course. But, I was working in Ireland with very distressed families of kids with autism, and I was really there to treat, or work with, the child, and help others work with the child – help the teachers and the therapists that were working with the child, and what I was struggling with was, how do you help the parents? And, I felt…I felt kind of lost. I had these really, really amazing behavior analytic tools, behavioral principles, and I was doing a great job of teaching kids skills, decreasing difficult behaviors, really good at teaching others to work with the children and helping them in school and so on, but I was really struggling with the distress that the parents were experiencing, and helping them show up and do what they needed to do to help their child, and I couldn’t figure out like…what the missing link was for me, until I stumbled across the first ACT manual, and then went searching for, how do I do this with families? How do I make this work with parents? And, I searched and searched and searched, and came across Lisa Coyne’s and Kelly Wilson’s article on cognitive fusion in parents. Lisa, I don’t know if you remember that article, but it’s a fabulous article, and I just basically started to stalk Lisa. I was like, “I have to meet this woman. This is the person that could help me help these families. I don’t know who else could help me,” and eventually managed to corner her at a training, I believe, and asked her…I basically just…I remember just pouring my heart out and being like, “Help me, I need to help these parents so much and I don’t know what to do, and I think ACT is the thing, but how do I do it? I read the books and I don’t know what to do with it. Help me,” and she was so kind and said, “Okay, I will help you,” and here we are. It has transformed my work completely. I mean, I’ve personally, of course, applied ACT to my personal life. I also use it with the kids that I work with, I use it with staff, but in terms of family work, it is really…I feel like it’s like a superpower. It helps me move people in a way that I could never move them before, like really, really stuck – the most stuck parents, it helps me help them get unstuck and move them in a direction, not that I want them to go in, but the direction they want to go in, the values, the way they want to live their life, and what they want for their kids. It helps…it’s just transformative, that’s all I can say, and when I’m feeling really, really stuck, now that I have ACT, I can go to this place and get myself unstuck as a practitioner. I think that’s what it’s done for me as well.

Lisa Coyne [03:53]: That’s so funny. I remember that paper, and I remember I wrote that…I was in a seminar class, one of the very – actually, I think it might have been the first seminar class that Kelly Wilson ever had at his house, and I had started reading ACT and learning it and studying with him, and I, at the time, was working in Tubelo at an employee assistance program, and I had gotten this case – I haven’t thought about this case in years. It was about 16 years ago, and it was the little six year old boy with an explosive problem with rage, really aggressive behaviors, and he had been referred to the clinic with his mom who was desperate because he had threatened to bring a gun to school. He was six years old. And, I had learned how to do parent-child interaction therapy, which was developed of course by the brilliant Dr. Sheila Eyberg, and we had started to do that, and it was really difficult for this mom who was very, very anxious to learn the skills, learn how to inhibit certain things that were unhelpful, and how to really focus on responding to him in a really loving, tender, contingent way on his behavior. So, if you know anything about PCIT, it’s the in-vivo coaching approach, and I remember starting to incorporate ACT into that approach to teach her how to really be mindfully aware of and appreciate this little guy who had become so aversive to her, and we talked about values and the things that were most important to her, and seeing him thrive was one, of course, and taking care of herself was another, and she had stopped doing that. I remember her life had gotten really small. She was an artist, and she had stopped painting and she felt so ashamed to even go to this kid’s school because constantly she was getting – I think he got expelled, actually – and constantly she was getting calls from the teachers. At the end of this, after teaching her all of these skills, I remember she came to me and a couple of things were, she had started actually having really good conversations with his teachers, and that made her really proud because she was so terrified to even set foot in the school, and then, I think the very last session she told me that she had begun painting again, and she had been able to do that because through really using these skills, in addition to behavior management strategies, his behavior just improved so much, and then we were off to the races, and it was just – well, we have to learn how to do this stuff. We have to test this with more people. We’ve got to talk about how parent thoughts and feelings can get in the way of implementing really effective behaviors, and just learning this is so powerful. I agree with you, I think it can be a superpower, can supercharge things too.

Evelyn Gould [07:21]: It’s funny, Lisa, because I’m now thinking of the parents that I was working with that made me look for ACT, and one of them was a mom who was really seriously depressed and very much struggling to just come out of her bedroom, and she was just…I just wanted to help her so much. She was such a wonderful, caring mom, but she was really struggling with this depression and a lot of guilt around her child, and I just was really stuck with how to get her engaged, and another mom was a very seriously anxious parent who just kept spiraling, and her child actually did phenomenally well in treatment, the best outcome possible, and yet mom was…I didn’t move mom forward out of this anxiety spiral that she was continuously getting in. So, it was almost like her child did get better, but she was still stuck in the past, and another parent who…also something I noticed with more than one parent, almost like a PTSD response to, as their kids got better, as soon as they started to struggle, all of this stuff started to show up again, like they were in the worst of times, and I really was struggling with how to help them with that and re-engage in their life. And, another thing I’m thinking about, Lisa, as you’re talking, is the emphasis on the doing it with parents and not to parents, and that has also really changed how I work – this idea that I am moving with them through the treatment, rather than me trying to make them do something. So, ACT is like a process, and in our course, we’re going to definitely be emphasizing this, but it’s a process between two people as a relational intervention, and what you’re feeling and thinking and doing and how you’re responding to the person in front of you is just as important as how they’re responding to you, and it’s like…I don’t know how else to describe it, other than doing it with, like going through the treatment with the parent side-by-side as a collaborator, not me coming in and telling them what to do.

Lisa Coyne [09:41]: I agree, and one of the things that I think about too that’s not lost on me, just with my own kids, is I think that one piece that was missing from the stuff that is available, which is excellent and evidence-based and very good, is just this…you’re not…if you don’t kind of take into account that relation piece, right, that you’re a collaborator, that you’re a fellow traveler and that you’re going with them through this journey, you can’t harness that. Think about what it must be like. When you have kids, like I remember when I had Josie, my daughter, and they were like, “Okay,” – the third day in the hospital, they were like, “Okay, time to go home.” I was like, “Wait. You’re leaving me alone with her? I don’t know what the hell I’m doing!” and it was terrifying, right? There’s no real – I mean, there are manuals, but do any of us really read them? You’re expected to kind of know what you’re doing, and imagine how utterly humbling and terrifying that must be to walk into somebody’s office, right, and open yourself up to help, right, when you’re supposed to know how to do this, and you don’t know how to do it, or, you thought you did, and nothing’s going the way you thought it would be. I just think about that experience, how terrifying it must be for parents to come in, and like what an honor it is, really, to work with them, given that the stakes are huge in parenting work. I mean, this is…you’re trying to set somebody up for a whole life. How do you do that? So, ACT, I think, uses really good, solid behavioral strategies in addition to all of these other things which I think can be very, very motivating and helpful and work with parents.

Evelyn Gould [11:48]: Yeah, as you said, these other interventions, the behavioral training stuff is all about the child and everyone seeing the child and focusing on the child, and for me, ACT, it’s that, “I see you as a human. Not just as a parent or a person that has to do this thing for the kid, or whatever else hat you’re wearing, but I see you as a human being, and I’m here for you. Yes, we’re here for your child, but I’m working with you.” I don’t know how else to do describe it, but that bond, it makes a massive difference. It creates like a space…a space, I guess, just to do really hard stuff that other approaches don’t, I think.

Lisa Coyne [12:38]: There’s this huge kind of self-compassion piece too, because we have a tendency as verbal creatures, right, the minute you make a mistake, that’s it, you’re terrible, you’re a failure, you’ll never get this right, and all of this stuff, and of course, life goes on, and if you latch onto that, that’s a really unhelpful way to be in a relationship with anyone, especially with your child, right? So, this is all about – one of the other pieces we will really teach and go over is how do you really track, like, “Yes, own your errors. We all make them, and actually, that’s one of the best ways we have of learning, and the thing to do is to carry them forward, carry the learning forward, and see if we can kind of hold those self-critical thoughts lightly while we go.” One other interesting thing too is that, I think a lot of…when we think about sort of the skills that we’ll teach, they do not…the core of them will remain the same across childhood whether you’re talking about early childhood through teenagers, but you have to employ them differently. The developmental needs of kids change over time and shift, and I think sometimes, one of the things I see is that parents really get stuck. Parenting for a child that’s at a different developmental level than their child has grown into being, right? So, parenting itself is developmental because the tasks of growing up and the tasks of parenting differ as children age. So, when they’re younger and you’re trying to teach them how to be safe, how to discover things, it’s really…and you’re more directive, for example, you expect them to listen to you and do what you say. When they’re teenagers, it’s totally a different ballgame, and that can be really hard for parents to shift out of, and we see that a lot, actually, in our population of parents who are anxious, or who are raising kids with anxiety.

Evelyn Gould [14:51]: Yeah, like I’m just thinking of that parent I just talked about, the really anxious parent. Her child moved, she had not moved, and she was still very stuck parenting in a fearful, protective, rescuing way, and her child needed space to start to explore and be independent and try stuff out and figure out who he was, and so I agree with you, and on the unit too, I see kids start to get better and actually that start to be challenging for parents because they’re so used to being in a specific role in their child’s life, whether it’s adaptive or not, everybody’s in their role and it’s all working for the family in some way, and so when the child starts to move, the parents need to move too, and if they stay stuck, it’s problematic, so we have to help them kind of grow. It’s a process of growth for everybody.

Lisa Coyne [15:47]: And we think about kind of…one of the things we’ll teach too in this class is how do you adopt this to different populations? And, really, there are a few things that are sort of at the heart of parenting that doesn’t help, or that’s not useful for kids, for example if you’re working with kids with OCD and anxiety, a combination is a really big piece of that, and so one of the things that we’ll do is we’ll teach you how to show your parents how to encourage mindful risk taking and flexibility in discovery, which is something that’s really constrained when kids are anxious, and when we work with kids who are oppositional, for example, what you see a lot of in families that aren’t working very well are coercive interactions where one partner tries to coerce the other. We see harsh and punitive discipline because parents don’t really have the skillset, or they’re not able to effectively employ it when they need to.

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