308 | Toileting Battles and the Need for Power: CCPT Parent Coaching

0
00:00:00,469 --> 00:00:04,309
You're listening to the Play Therapy Podcast with Dr. Brenna Hicks,

1
00:00:04,469 --> 00:00:08,180
your source for centered and focused play therapy coaching.

2
00:00:08,510 --> 00:00:08,710
Hi,

3
00:00:08,789 --> 00:00:09,850
I'm Dr. Brenna Hicks,

4
00:00:09,859 --> 00:00:10,590
The Kid Counselor.

5
00:00:10,750 --> 00:00:12,750
This is the Play Therapy Podcast where you get

6
00:00:12,750 --> 00:00:15,229
a master class in child-centered play therapy

7
00:00:15,229 --> 00:00:17,489
and practical support and application for your

8
00:00:17,489 --> 00:00:19,319
work with children and their families.

9
00:00:19,629 --> 00:00:20,340
In today's episode,

10
00:00:20,389 --> 00:00:22,709
I am answering a question from Rachel in Missouri.

11
00:00:24,139 --> 00:00:27,629
About a 5.5 year old that is her client,

12
00:00:28,190 --> 00:00:30,329
and the child will not

13
00:00:30,469 --> 00:00:32,080
poop in the toilet

14
00:00:32,709 --> 00:00:34,340
and how to navigate that.

15
00:00:34,360 --> 00:00:34,750
Obviously,

16
00:00:34,909 --> 00:00:36,939
she's starting child-centered play therapy,

17
00:00:37,189 --> 00:00:39,580
which means it will likely address itself,

18
00:00:39,709 --> 00:00:43,049
but just some thoughts about what parents might do

19
00:00:43,470 --> 00:00:44,159
and just

20
00:00:44,270 --> 00:00:45,590
some processing of this.

21
00:00:45,750 --> 00:00:47,110
So I'll read parts of the email,

22
00:00:47,189 --> 00:00:47,909
then we'll dive in.

23
00:00:48,720 --> 00:00:51,380
I'd like your perspective on a 5.5 year old I'm working with.

24
00:00:51,549 --> 00:00:53,569
This child does not poop in the toilet.

25
00:00:53,630 --> 00:00:56,099
She only uses pull-ups when it's time to go.

26
00:00:56,349 --> 00:00:57,509
Parents have tried rewards,

27
00:00:57,630 --> 00:00:58,150
goal setting,

28
00:00:58,159 --> 00:00:58,779
and practice,

29
00:00:58,830 --> 00:00:59,840
which have not worked.

30
00:01:00,110 --> 00:01:02,869
Mom and dad have been able to redirect responsibility

31
00:01:02,869 --> 00:01:04,779
to their child when it comes to cleaning up.

32
00:01:05,138 --> 00:01:06,339
By setting the expectation,

33
00:01:06,430 --> 00:01:07,800
if you choose to poop in a pull up,

34
00:01:07,910 --> 00:01:09,830
you choose to take care of the rest on your own.

35
00:01:10,400 --> 00:01:12,480
So the client can now retrieve the pull-up,

36
00:01:12,690 --> 00:01:12,959
poop,

37
00:01:13,169 --> 00:01:14,639
empty the pull-up into the toilet,

38
00:01:14,750 --> 00:01:16,139
wrap the pull-up in a bag,

39
00:01:16,410 --> 00:01:19,180
place it in the trash and wash up all on her own.

40
00:01:19,449 --> 00:01:20,139
Oh my gosh.

41
00:01:21,199 --> 00:01:23,709
Her parents set that expectation a year ago,

42
00:01:23,750 --> 00:01:25,110
and it has been successful,

43
00:01:25,720 --> 00:01:28,760
but she still shows no interest in graduating from the toilet.

44
00:01:29,319 --> 00:01:32,449
She is healthy and can pass stools easily and regularly,

45
00:01:32,559 --> 00:01:35,440
and it seems like her mom and dad have done a helpful

46
00:01:35,440 --> 00:01:38,389
job of being patient and removing themselves from the power struggle.

47
00:01:38,779 --> 00:01:41,330
I think the CCPT will be such a wonderful outlet

48
00:01:41,330 --> 00:01:44,000
for her to give herself more autonomy and control,

49
00:01:44,290 --> 00:01:48,239
hopefully displacing some of the need for control she has around bathroom habits.

50
00:01:48,489 --> 00:01:52,029
Do you have any specific parent coaching tips you would provide a family in

51
00:01:52,029 --> 00:01:54,809
these circumstances or any limit setting that

52
00:01:54,809 --> 00:01:56,809
you'd recommend the parents re-engage in?

53
00:01:57,660 --> 00:01:57,680
All right.

54
00:01:58,690 --> 00:01:59,050
So yes,

55
00:01:59,129 --> 00:01:59,410
Rachel,

56
00:01:59,449 --> 00:02:00,160
I agree with you.

57
00:02:00,209 --> 00:02:03,260
I think as this child continues in CCPT,

58
00:02:03,730 --> 00:02:04,550
the

59
00:02:05,129 --> 00:02:06,489
anxiety levels will reduce,

60
00:02:06,559 --> 00:02:08,240
the self-esteem will increase,

61
00:02:08,490 --> 00:02:10,580
and the need for power and control will lessen.

62
00:02:10,669 --> 00:02:13,080
So I think it will kind of naturally sort itself out.

63
00:02:13,330 --> 00:02:15,520
Let's backtrack to something we've talked about before,

64
00:02:15,610 --> 00:02:17,520
but probably not in a while.

65
00:02:17,960 --> 00:02:21,889
Kids have control over a handful of things and they fit on one hand.

66
00:02:23,300 --> 00:02:24,639
Toileting is one of them.

67
00:02:25,220 --> 00:02:26,770
There are a very few

68
00:02:27,539 --> 00:02:30,009
number of options for

69
00:02:30,419 --> 00:02:32,210
what a child has control over in their life,

70
00:02:32,419 --> 00:02:33,369
especially at 5.

71
00:02:34,289 --> 00:02:34,839
So,

72
00:02:34,949 --> 00:02:35,899
for whatever reason,

73
00:02:35,960 --> 00:02:39,139
this child has grasped at this measure of control,

74
00:02:39,750 --> 00:02:43,820
and is perfectly content to keep things the way they are.

75
00:02:44,740 --> 00:02:48,929
You have to keep in mind too that when you have a child that wants control,

76
00:02:49,470 --> 00:02:51,850
giving up control makes them vulnerable,

77
00:02:52,139 --> 00:02:54,539
and so I don't know that it's necessarily that she

78
00:02:54,539 --> 00:02:56,729
continues to still want to poop in the pull up.

79
00:02:57,179 --> 00:03:00,449
I don't know that it's that she continues to not want to poop in the toilet,

80
00:03:00,899 --> 00:03:04,690
but it seems as though she's not willing to become vulnerable potentially

81
00:03:05,419 --> 00:03:08,179
by all of a sudden changing behavior.

82
00:03:09,149 --> 00:03:10,589
That could be a consideration.

83
00:03:10,949 --> 00:03:12,699
So as far as things that

84
00:03:13,419 --> 00:03:16,169
I might provide in the way of parent coaching

85
00:03:16,169 --> 00:03:18,679
or limit setting that the parents might engage in.

86
00:03:18,929 --> 00:03:22,339
I think first and foremost they've already sought CCPT

87
00:03:22,729 --> 00:03:25,279
that will be the most effective approach for this,

88
00:03:25,610 --> 00:03:27,479
but as far as what's happening at home,

89
00:03:28,210 --> 00:03:30,089
one of the things that I encourage families to

90
00:03:30,089 --> 00:03:32,449
do when they're in a scenario like this wherein

91
00:03:32,809 --> 00:03:34,000
it is consistent

92
00:03:34,199 --> 00:03:35,240
and pervasive.

93
00:03:35,449 --> 00:03:35,970
In other words,

94
00:03:36,009 --> 00:03:37,770
it's been going on for a long time

95
00:03:38,089 --> 00:03:38,639
and

96
00:03:38,850 --> 00:03:41,050
it doesn't seem like there's an end in sight.

97
00:03:41,929 --> 00:03:44,039
We encourage parents to

98
00:03:44,369 --> 00:03:46,699
set an expectation of time limit.

99
00:03:47,250 --> 00:03:47,929
In other words,

100
00:03:48,250 --> 00:03:49,089
she's 5 1/2.

101
00:03:49,169 --> 00:03:51,649
Does that mean she is 4 months away from her birthday,

102
00:03:51,729 --> 00:03:53,320
3 months away from her birthday?

103
00:03:53,770 --> 00:03:54,360
We don't

104
00:03:54,690 --> 00:03:56,089
have details specifically,

105
00:03:56,130 --> 00:03:56,759
obviously,

106
00:03:57,050 --> 00:03:58,279
but that might be

107
00:03:58,649 --> 00:03:59,360
the time frame.

108
00:03:59,369 --> 00:04:02,399
It might be the end of summer or the start of school year.

109
00:04:02,570 --> 00:04:03,610
It might be

110
00:04:04,009 --> 00:04:05,410
some other date on the calendar,

111
00:04:05,490 --> 00:04:08,850
but what I would encourage parents to do in a scenario like this is.

112
00:04:09,580 --> 00:04:10,460
Child's name,

113
00:04:10,699 --> 00:04:13,179
you've been choosing to use pull-ups to poop in

114
00:04:13,539 --> 00:04:15,050
for a long time,

115
00:04:15,500 --> 00:04:16,260
and

116
00:04:16,500 --> 00:04:18,209
as soon as you turn 6,

117
00:04:18,820 --> 00:04:19,410
or

118
00:04:19,779 --> 00:04:21,250
as soon as

119
00:04:21,579 --> 00:04:22,850
it's time to start,

120
00:04:23,179 --> 00:04:24,130
maybe 1st grade,

121
00:04:24,220 --> 00:04:26,130
I'm assuming she might be starting 1st grade,

122
00:04:26,540 --> 00:04:28,750
as soon as it's time to start 1st grade,

123
00:04:29,140 --> 00:04:30,850
or by the end of summer,

124
00:04:31,299 --> 00:04:33,890
or by the time we go on vacation in August,

125
00:04:34,140 --> 00:04:36,489
or whatever this future date is.

126
00:04:38,100 --> 00:04:40,089
Pooping in a pull-up is no longer an option.

127
00:04:41,609 --> 00:04:46,000
And you just make the declaration with lots of time in advance of it.

128
00:04:46,799 --> 00:04:47,829
Here's what that does.

129
00:04:48,359 --> 00:04:51,369
The child can begin to work through it.

130
00:04:51,679 --> 00:04:54,850
What am I going to do if I'm not gonna be able to poop in a pull up?

131
00:04:55,119 --> 00:04:56,720
What emotions do I need to process?

132
00:04:56,839 --> 00:04:58,670
What fears do I need to work through?

133
00:04:59,040 --> 00:05:00,549
What questions do I need to ask,

134
00:05:00,679 --> 00:05:02,470
how do I prepare myself for this?

135
00:05:02,640 --> 00:05:04,630
What problem solving needs to begin?

136
00:05:04,799 --> 00:05:06,869
There's all of this stuff that will happen.

137
00:05:07,559 --> 00:05:08,470
But if it's just,

138
00:05:08,640 --> 00:05:08,890
OK,

139
00:05:09,040 --> 00:05:09,399
we're done,

140
00:05:09,480 --> 00:05:10,829
you're not gonna use pull-ups anymore,

141
00:05:11,369 --> 00:05:12,790
that's overwhelming for a child.

142
00:05:13,200 --> 00:05:16,989
So you set a date far in advance of the current date,

143
00:05:17,559 --> 00:05:19,429
but you help a child know it's coming.

144
00:05:20,429 --> 00:05:21,359
And to a 5 year old,

145
00:05:21,440 --> 00:05:23,359
the end of summer feels like an eternity away,

146
00:05:23,399 --> 00:05:24,119
but that's OK.

147
00:05:24,940 --> 00:05:26,250
Because what we're doing is,

148
00:05:26,380 --> 00:05:29,369
I just want to let you know when school's going to start again

149
00:05:29,820 --> 00:05:31,410
and when you become a first grader.

150
00:05:32,410 --> 00:05:34,559
Pooping in a pull-up is no longer an option.

151
00:05:34,850 --> 00:05:37,049
You're a big girl and you can poop in the toilet.

152
00:05:37,850 --> 00:05:38,839
And then you move on.

153
00:05:39,109 --> 00:05:40,739
And as the date gets closer,

154
00:05:40,959 --> 00:05:42,630
you remind here and there,

155
00:05:42,839 --> 00:05:44,320
not like an everyday thing,

156
00:05:44,600 --> 00:05:46,190
but at least once a week.

157
00:05:46,640 --> 00:05:50,230
Just wanted to remind you we have a few more weeks until it's vacation,

158
00:05:50,440 --> 00:05:51,040
end of summer,

159
00:05:51,239 --> 00:05:51,839
start of school,

160
00:05:51,959 --> 00:05:52,359
birthday,

161
00:05:52,420 --> 00:05:52,910
whatever.

162
00:05:54,299 --> 00:05:55,049
And

163
00:05:55,209 --> 00:05:58,489
you know that pull-ups are no longer an option for pooping in.

164
00:06:00,140 --> 00:06:02,059
And over the course of time,

165
00:06:02,269 --> 00:06:06,980
the child is able to resign themselves to the fact that things are changing,

166
00:06:07,489 --> 00:06:09,500
prepare themselves for the change,

167
00:06:09,790 --> 00:06:11,380
and equip themselves to handle it.

168
00:06:12,600 --> 00:06:14,940
And when you do it with far enough in advance,

169
00:06:15,149 --> 00:06:17,619
kids actually usually handle it pretty well.

170
00:06:17,859 --> 00:06:20,480
And with the support of being in therapy with you,

171
00:06:20,579 --> 00:06:21,250
Rachel,

172
00:06:21,619 --> 00:06:25,649
she will also have that benefit of being able to process it with you.

173
00:06:26,260 --> 00:06:27,250
All this is

174
00:06:27,420 --> 00:06:28,970
is habit at this point.

175
00:06:30,070 --> 00:06:32,140
Probably rooted in several things,

176
00:06:32,350 --> 00:06:34,220
but it's a conditioned pattern

177
00:06:34,859 --> 00:06:37,540
and condition patterns can be changed,

178
00:06:38,149 --> 00:06:42,589
but there has to be a time frame in which it's going to change and I agree with you,

179
00:06:42,670 --> 00:06:45,540
mom and dad have gotten themselves out of the power struggle

180
00:06:45,910 --> 00:06:47,459
and they've walked away and said,

181
00:06:47,589 --> 00:06:47,799
OK,

182
00:06:47,910 --> 00:06:48,739
if you're choosing that,

183
00:06:48,750 --> 00:06:51,209
then you're choosing this and kids OK with it,

184
00:06:51,230 --> 00:06:52,140
they're OK with it,

185
00:06:52,179 --> 00:06:53,829
and there's harmony in the home,

186
00:06:53,950 --> 00:06:54,619
good for them.

187
00:06:55,549 --> 00:07:00,420
But there does need to be an end date for this because this isn't an endless struggle.

188
00:07:01,149 --> 00:07:04,309
And that is the way that we typically encourage parents to handle that.

189
00:07:04,390 --> 00:07:05,730
As far as limit setting.

190
00:07:06,480 --> 00:07:07,709
That I would recommend

191
00:07:07,880 --> 00:07:09,769
only in the fact that

192
00:07:10,200 --> 00:07:12,279
we're not going to be doing this after this date.

193
00:07:13,779 --> 00:07:14,540
So,

194
00:07:14,609 --> 00:07:16,029
we kind of get

195
00:07:16,429 --> 00:07:17,029
in that

196
00:07:17,230 --> 00:07:18,119
line of thinking.

197
00:07:18,470 --> 00:07:18,859
Now,

198
00:07:19,079 --> 00:07:22,429
here's what has typically worked really well in that scenario.

199
00:07:22,790 --> 00:07:25,260
You give the child a measure of control

200
00:07:25,589 --> 00:07:26,450
over

201
00:07:26,790 --> 00:07:27,859
what happens after that.

202
00:07:28,730 --> 00:07:29,339
So

203
00:07:29,670 --> 00:07:32,579
child has not felt comfortable pooping on the toilet,

204
00:07:32,619 --> 00:07:34,149
it's not to say that she won't now,

205
00:07:34,190 --> 00:07:35,420
it's been more than a year.

206
00:07:35,630 --> 00:07:37,470
Maybe she is OK with it now,

207
00:07:37,549 --> 00:07:39,320
she's just comfortable with the habit,

208
00:07:40,070 --> 00:07:42,390
but you want to give her a measure of control.

209
00:07:42,429 --> 00:07:42,899
So

210
00:07:43,510 --> 00:07:46,859
now that pooping in pull-ups is no longer an option,

211
00:07:47,350 --> 00:07:49,200
you can choose to

212
00:07:49,670 --> 00:07:50,540
have

213
00:07:50,980 --> 00:07:54,720
A book to read while you go to the bathroom on the toilet,

214
00:07:54,850 --> 00:07:57,320
or you can choose to play music while

215
00:07:57,570 --> 00:07:59,160
you go to the bathroom on the toilet.

216
00:07:59,570 --> 00:08:02,660
Give the child some ownership and buy-in of the environment,

217
00:08:02,769 --> 00:08:04,019
because this is going to be different.

218
00:08:05,100 --> 00:08:07,820
Pooping in the bathroom on the toilet is very different

219
00:08:07,820 --> 00:08:09,899
than grabbing a pull-up and pooping in a pull-up.

220
00:08:10,500 --> 00:08:11,010
So,

221
00:08:11,380 --> 00:08:14,380
give her some control over the environment.

222
00:08:15,399 --> 00:08:20,220
And that typically also has responsibility and ownership built into it,

223
00:08:20,589 --> 00:08:23,670
so she's more likely to abide by the new expectation.

224
00:08:24,720 --> 00:08:25,859
My final thought is

225
00:08:26,079 --> 00:08:27,549
any change is hard,

226
00:08:27,839 --> 00:08:29,690
so it may not be flawless

227
00:08:30,000 --> 00:08:32,750
the first day or 2 days or 4 days

228
00:08:32,960 --> 00:08:33,750
or a week.

229
00:08:34,400 --> 00:08:36,808
You never know how hard a child's going to push,

230
00:08:37,169 --> 00:08:37,630
but

231
00:08:38,419 --> 00:08:40,130
You know that it's temporary,

232
00:08:40,530 --> 00:08:41,210
so

233
00:08:41,419 --> 00:08:42,530
you stick to it,

234
00:08:42,780 --> 00:08:45,049
you say you really wish that you could poop in a pull up,

235
00:08:45,099 --> 00:08:45,570
but

236
00:08:45,820 --> 00:08:47,929
pull-ups aren't for pooping and now you're 6

237
00:08:48,299 --> 00:08:51,369
or it's August or you're a first grader or whatever,

238
00:08:51,700 --> 00:08:52,250
and

239
00:08:52,419 --> 00:08:53,849
then you just stick to it,

240
00:08:54,020 --> 00:08:55,140
the child will adapt,

241
00:08:55,179 --> 00:08:57,570
but there may be some change pain.

242
00:08:57,780 --> 00:08:58,619
It happens.

243
00:08:58,909 --> 00:09:00,169
So you might see resistance,

244
00:09:00,340 --> 00:09:01,299
you might see defiance,

245
00:09:01,419 --> 00:09:02,659
you might see tantrums,

246
00:09:02,979 --> 00:09:03,969
prepare parents for that.

247
00:09:04,099 --> 00:09:05,500
Talk them through that process,

248
00:09:05,619 --> 00:09:06,130
Rachel,

249
00:09:06,380 --> 00:09:07,880
so that they're not caught off guard.

250
00:09:08,700 --> 00:09:09,359
And

251
00:09:09,640 --> 00:09:09,799
you know,

252
00:09:09,880 --> 00:09:10,520
what do we say?

253
00:09:10,599 --> 00:09:11,239
We outwit,

254
00:09:11,320 --> 00:09:11,960
we outlast,

255
00:09:12,000 --> 00:09:12,609
we outplay.

256
00:09:12,760 --> 00:09:13,940
Parents need to do the same.

257
00:09:15,219 --> 00:09:15,780
That's,

258
00:09:15,820 --> 00:09:16,719
that's the goal.

259
00:09:17,099 --> 00:09:18,570
We're not going to give in.

260
00:09:19,140 --> 00:09:21,809
She will eventually go to the bathroom on the toilet.

261
00:09:22,380 --> 00:09:23,650
You just have to stick it out.

262
00:09:24,059 --> 00:09:24,309
All right,

263
00:09:24,539 --> 00:09:25,489
thanks so much for the email,

264
00:09:25,539 --> 00:09:26,090
Rachel.

265
00:09:26,900 --> 00:09:29,070
Thank you for your commitment to kids,

266
00:09:29,239 --> 00:09:29,849
all of you.

267
00:09:29,979 --> 00:09:31,049
Thank you for the,

268
00:09:31,530 --> 00:09:34,099
the concern and the love that are poured into

269
00:09:34,099 --> 00:09:36,570
every single question and email that you send me.

270
00:09:36,900 --> 00:09:37,409
I

271
00:09:37,619 --> 00:09:39,219
very deeply see

272
00:09:39,619 --> 00:09:43,940
how much you strive and long to help kids in the best way that you can.

273
00:09:44,260 --> 00:09:46,780
So I don't receive them just as questions.

274
00:09:46,830 --> 00:09:49,940
I know it's rooted in your love for these kids.

275
00:09:50,469 --> 00:09:51,909
So thanks for caring about kids.

276
00:09:52,070 --> 00:09:52,469
Love you all.

277
00:09:52,669 --> 00:09:52,950
Bye.

278
00:09:53,929 --> 00:09:56,690
Thank you for listening to the Play Therapy Podcast with Dr.

279
00:09:56,849 --> 00:09:57,799
Brenna Hicks.

280
00:09:57,969 --> 00:09:59,960
For more episodes and resources,

281
00:10:00,049 --> 00:10:04,809
please go to www.playtherapypodcast.com.