. . . and it's not their genes either. – Dr. C

Posts tagged ‘medicine’

Children’s Temperament Traits

“Human action can be modified to some extent,
but human nature cannot be changed.”    – Abraham Lincoln

Medium Shapes

I developed Children’s Temperament Traits (CTT) in the mid-1980’s.  By then I was completing my doctoral dissertation.  I was also running the first of three different treatment facilities for children and I was training my staff in temperaments and techniques.  I’ve also used this material to train thousands of professionals and parents in workshops throughout California.  Most of the professionals were licensed therapists, interns, school teachers and aides, and child-care counselors.

Though I knew he wouldn’t remember me – I had one class from him while I was a student at Cal State Fullerton – on the outside chance I might hear back, I mailed CTT to David Keirsey for his critique, sometime in the late 1980’s.  He was long retired by then, and I hadn’t seen him in several years.  I wasn’t sure if he would reply.  Thankfully, he did, in a manner of speaking.

Dr. Keirsey sent back my entire essay, with edits hand-written in the margins, other words crossed out and replaced, and other changes.  He added no other comments, other than a “good job!” on the very bottom of the last page.  The edits he made were all gems, and I quickly made the changes.

I’ve made a few more since, though not too many.  Now that I have time, I’m primed to do some long overdue research, writing and lecturing about children, temperament, and techniques.  I also hope to find people who are adept, and so inclined, to take on this endeavor.  It’s never been done, as far as I know.

Sorters
I experimented 30 years ago with a children’s “sorter” of my own.  I didn’t like it, and I don’t like children temperament sorters in general.  I’ve reviewed a few on different websites.  The ones I found seemed to “miniaturize” adult sorters.  It’s really not that simple.  Children aren’t merely smaller versions of their adult counterparts.  In Keirseyan temperament theory, children arrive whole, already equipped.  Our job then, as child managers, is to understand who they are and to help them unfold.

More important, a sorter for children relies on adults to give answers to the written questions, so it’s fraught with the bias – and temperament – of the adult.  Too much “mind-reading” occurs and, when discovering a person’s temperament, “mind-reading” is not allowed.  Observation – watching what children do – is, as far as I’m concerned, the most accurate way to understand what makes a child move.

Child Management Techniques
The specific techniques we choose as parents, teachers, coaches, and counselors to manage troubled or troublesome children is temperament dependent.  To follow is a list of techniques that I’ve collected, used, and trained on over the years.

The majority of the techniques (except for Amnesty) found in Reactive and Proactive sections are gleaned from Keirsey’s little known yet very useful work, Corrective Intervention:  A Manual for Casualty Reduction Specialists in Pupil Personnel Services, copyright, 1972.  Though I’ll write more about this later, this small, obscure handbook may have had the most impact on my career – and the children in my care.

After I post the four portraits – the next blog will be about the STARS –  I’ll provide a description of each technique, as well as how they are best used with STARS, SQUARES, SPHERES and CUBES.  For now, the list of techniques include:

1.  Therapy Techniques
•  
Reflection (Client Centered Therapy):  Carl Rogers, Inventor
•  Psychodrama:  Jacob Moreno, Inventor
•  Rational-Emotive Therapy:  Albert Ellis, Inventor
•  Gestalt Therapy (NOT to be confused with Gestalt theory):  Fritz Perls, Inventor
•  Behavior Modification:  A generic term, behaviorism began with the writings of John B. Watson and B.F. Skinner
•  Reality Therapy:  William Glasser, Inventor
•  Insight Therapy (Psychoanalysis):  Also a generic term and used by many, the inventor of this technique is Sigmund Freud.

2.  Reactive Techniques
•  Restriction         •  Abuse         •  Restitution        •  Deprivation      •  Amnesty

3.  Proactive Techniques
•  The Easy Task   •  Blackmail       •  Bribery        •  Defusing           •  Distraction
•  Frontloading     •  Moratorium  •  Rehearsal    •  Sidetracking     •  Signaling

4.  Group Techniques
•  Adolescent Interactive Group (AIG)       •  The Truth Chair           •  Challenge
•  GIDE (Group Interaction and Drug Education)
•  GIVE (Group Interaction and Violence Education)

5.  Other Techniques
•  The Baldy Maneuver•   Logical Consequences
•  Active Response Training (ART)  –
           ~  Regardless & Nevertheless                       ~  The Sponge
           ~  The “You Win” Proposition                         ~  The Takeover Maneuver
(ART is pre-esclation training for school, residential care, and other mental health facility personnel.  Considered “basic training” in my facilities, ART began in California as Alternatives to Restraint Training in 1989.)

CTT Portraits
Each of the four portraits will include a description of the four shapes.  In addition, each portrait will conclude with a section on:
(1) Dislikes/Complains About
(2) Worrisome Behaviors
(3) Enjoys
(4) Praise for/Responds to
(5)  Intervention Techniques, for each of the four shapes.

I’ll start with the STARS, the most troublesome of the four shapes.

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Next Blog:  CTT Portrait:  STARS – “Do your own thing!”

Why Shapes?

Large Shapes

I’ve been asked a few times where I got the idea for the four shapes I selected to represent the four Keirseyan temperaments.   As a reminder, they are:

    Star Shape  STARS (Young Artisans) 

  Cube Shape  CUBES ( Young Rationals)      

Sphere Shape  SPHERES (Young Idealists)

Square Shape  SQUARES (Young Guardians)

About 25 years ago I started doing CEU[i] workshops for therapists, social workers, counselors, teachers, teacher aides and parents in child management techniques and temperament.  They go hand in hand, by the way.  A technique that may be useful for the Square may have no effect on the Star, and sometimes may make things worse.  The name of the workshop was “Kids Come in All Shapes.”  Participants learned about the four temperaments of children, and left after 6 hours training with some new techniques for each temperament.

Back then, I was a maturing student of Gestalt psychology, thanks to David Keirsey.  Gestalt is the German word for form or shape, and it designates  “wholeness,” a fundamental concept for this long forgotten and much more humane theory of human psychology.

By the way, for those who may be interested, Gestalt psychologists believe “modern” psychology isn’t so modern.  We believe the “elemental psychologists” (the other 99%!) look at human behavior and personality inside out – literally.  The “elementalists” see human psychology as made up of different “parts” or “elements,” and it’s the parts that make up the whole.  Holists (Gestaltists), like me and Dr. Keirsey, believe wholes are fundamental, and much, much more than the sum of it’s parts.

More than that, the current psychiatric elementalists believe that the cause of poor behavior can be understood by looking through a microscope, whether it’s measuring “neurotransmitters” (chemicals), or by “decoding” a persons “genome.”  It’s all nonsense – and I’ll be writing more about this soon – however, it is today’s “modern science” for most professionals, and lay people.

Anyway, I wanted to develop a temperament metaphor using the wholeness idea.  At the time, there were a few other temperament metaphors for children, usually animals.  They included beaver and bear for Guardians, dolphin and unicorn for the Idealist, the owl for Rationals, and the fox (and monkey) for the Artisans.  They were okay, but I didn’t use them too much.  Both kids and parents often liked or didn’t like one animal over another, regardless of temperament.  Instead, I came up with the idea of geometric shapes.  They are unique from one another, and each alone has no particular meaning or value.  Shapes are neutral.

So, I started with the Artisans, about 40% of all earthlings (I was still calling them “SP’s” way back then).  I thought of a star almost immediately for the Artisan.  There are an abundance of stars in the sky, no two the same, but all of them must shine, each a little differently.  While the star symbol I chose is yellow, Stars come in all colors.  The most stylish of all temperaments, Stars also need a stage and must have an audience to appreciate their art – even the quiet ones.  So, without much ado, young Artisans became Stars for me.

Squares, about half the Earth’s population, came to me quickly too.  A square has a solid foundation, and all right angles. Two squares next to each other make a rectangle, rectangles make foundations, and foundations are the building blocks of our society.  I used black and white for the Square because there is very little “grey area” from the perspective of the Guardian.  Right is right, and wrong is wrong, period, so says the Square.  Also, though a little outdated, the slang use of the word “square” seems to fit for the work first-play later, serious minded, routine oriented, industrious, diligent Guardian.

The quest for self-actualization by the Idealist lead me to the Sphere (I made a silly choice in the beginning and used the term “Circle” instead of Sphere because I thought sphere was too hard to pronounce!).  The Sphere must be whole.  A Sphere is symmetrical, symbolic of many Idealists yearning for authenticity.  There’s also a “glow” to the Sphere not found in other shapes, and points to the natural warmth these rare individuals provide.  Though I chose red to signify the heart they tend to wear on their sleeves, Spheres can glow in different colors when engaged with other people.  Keirsey has said that the world could use more Idealists.  He was right about that too.  Only about one in twenty among us are the imaginative, harmonious, people-loving Spheres.

The cube took a long time coming, for some reason.  I thought of a few geometric shapes including a triangle, a pentagon, a cone, a pyramid, even a cylinder.  I settled on the cube, after a while, for the often odd young rational.  Some of you may remember the “Borg” from the 2nd generation Star Trek series.  This half human, half machine, impeccably logical, emotion-free entity traveled the Universe – in a cube.  Ironically, a cube has the unique property of “changing shapes” right in fromt of you.  That is, if you stare at a three dimensional cube on a two dimensional page long enough, you’ll notice that sometimes the cube points to the left, and then, just as quickly, it points to the right.[ii]

Once I decided on these shapes, the rest was easy.  At my workshops, attendees where expected to know their own temperament when they arrived, or soon afterward.  I gave them a nametag with the appropriate shape, and for the next six hours we had some fun, had some great discussions, and the participants left with new ways to interact with their children, and a new perspective about themselves too.  I did this, off and on, for the next 20 years in dozens of foster care and residential facilities in California.

Then, a little more than two years ago, David Keirsey and I went out to lunch.  It was our first meeting in nearly 30 years.  I told him what I had been doing, I gave him some of my material, and I told him about the shapes – or forms – that I had been using for each temperament.  I was a little nervous, as you might imagine.

He didn’t like Star, in the beginning.  I told him the metaphor was about the star on stage, and their need to shine.  “Oh,” he said, “that’s what you mean.  I like that.”  He liked the Square for Guardians, and he really liked the Cube for the Rationals.  I told him I was using the term “circle” for “sphere,” and my reasoning to do so.  He found my reasoning – that sphere was hard to pronounce – rather weak.  “It’s not so hard to pronounce,” he said with a grin, and a little sarcasm, “listen.  Sphere.”  So, sphere it is.  He also said:  “Am I the first to notice that the Cube and the Sphere are three dimensional?”  He was, other than me.  “The extra dimension,” he said, “is imagination.”  Right again, Dr. Keirsey, right again.

I had his blessings, finally, and that meant a great deal to me.  I also went over the slogans I created for the four shapes.  His son Mark was with us for that, and they both approved.  They are:

STARS – “Do your own thing!”  

SPHERES – “To thine own self be true”

 CUBES – “Looking for a better idea”

SQUARES – Longing for belonging”

So, to the point, what are these “techniques” that I’ve been talking about, and how are they used with temperaments?  Well, first, I’ll give some details about the observable behavior for each of the four shapes.  I’ll start with the Stars, the most “troubling” of the young temperaments.


[i] Continuing Education Units – This is required annual training for most professionals.  More here.

[ii] This phenomenon is called – fittingly enough – a “Gestalt.” You can see more Gestalt images here, and you can read about Getalt principles here.

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NEXT TIME:  Temperament Traits – STARS

Star Traits Page

Note from the Lone Arranger: About “The Horrible Kid”


Lone Ranger JPEG

For a number of personal and professional reasons, I’ve been away from my blog for much too long.  I’ve heard from a few of you, wondering if I was going to finish “The Horrible Kid.”  I did.  It’s  longer than the other chapters however, I wanted to finish the story.   Thank you for your patience, and your interest.

For now, to follow directly after this post, please see “THE HORRIBLE KID – Chapter IV:  A tale from the Lone Arranger.”  Thanks.

Dr. C

YKAS 5: A Most Valued Customer – Your Child

First Contact – Someone is “Concerned”
It usually starts like this for parents of active kids – especially parents blessed with very active kids.

There’s a call from your child’s teacher.  You were half expecting it.  About two weeks earlier you met with her about your nine year-old’s behavior in the classroom.  She said he’s a nice enough boy, very cute, however, he’s inattentive and easily distracted.  That, and he’s much too active during classroom hours.  Oddly enough, you’ve seen him at home when he’s using the PlayStation III.  That too active, inattentive kid can be so focused on the TV screen he won’t budge – even if it’s pizza for dinner.  He seems intensely attentive, to the point you have to pry him away from the game.

Nevertheless, this time the teacher tells you “. . . your child still isn’t paying attention and he continues to be up and down all day long, and we are concerned.”  She said “we,” so now you know there’s at least one other person at the school who’s concerned, and that concerns you.

The teacher said she would like to refer your child to the school psychologist for an “evaluation,” with your consent.  Your concern increases so, of course, you consent.  After all, these are the experts, you reason, and you must trust them.

They know best.

The Disease Model Indoctrination Process
You have a meeting with the school psychologist.  She’s a doctor of some kind, and you’re a little intimidated.  While you were expecting her to test your child, you’re given a behavioral questionnaire to complete too.  You didn’t expect that, but that’s good.  At least something is being done to help your son, and the experts are being thorough.

You’re beginning to learn about the process, and you’re impressed.

In a week or so, you’re informed the evaluation is done, and you’re asked to attend another meeting.  You’ve been worried and you’ll be glad to get an answer.  Then you get your answer.  The psychologist recommends you seek medical assistance for your child because he likely has “attention deficit disorder” with, God forbid, “hyperactivity.”  She uses the term “disorder” for the first time, and it unsettles you.  She tells you she can’t treat him because “this is a medical problem.”

A doctor of psychology recommends you seek help from a doctor of medicine.

Enter the MD – With Chemicals
By now, you know this is serious.  You have to inform your family too, and that won’t be easy.  You’re a conscientious parent, and you’re persistent.  You want the best for your child, so you search for a “child psychiatrist,” as others have suggested.  Maybe someone you know, or the school, makes a referral. If you’re “lucky,” you’ll find one.

You do, and you make an appointment.  The nurse takes your child’s vitals, you provide a family medical history, and they’re done with your child.  You’re a little surprised.  You were expecting something more “medical.”  Maybe an x-ray, a blood test, a “scan” of some kind, or another medical procedure that can be measured or weighed or looked at – something.  After all, that psychologist told you “this is a medical problem.”

You’re learning a little more about the process.

A Family Changing Event – The Diagnosis
You meet with the doctor and, for the most part, you do most of the talking.  You tell him about the school’s concern and the tests from the psychologist.  Maybe your child is asked a few questions, maybe not.  It doesn’t matter.  He’s not there to talk.  He really doesn’t need to be there at all.  The doctor is there to make a diagnosis based on the information you give him.  The doctor’s only function is to do nothing, or prescribe a chemical – and he can’t prescribe a chemical without a diagnosis.

Within 10 to 20 minutes, the child psychiatrist has heard enough and says “. . . I’m prescribing a chemical to help with your son’s Attention Deficit Hyperactivity Disorder.”  Maybe he calls it a “mental illness, or a “mental disability,” or “mental disorder,” or “psychiatric disease” or just plain “disorder.”  It’s what you expected.  You’ve talked with family and friends before this meeting. Still, hearing it for the first time from an MD makes it much too real.

There’s a brief explanation of the “disorder.”  He says something about “brain chemistry” and some sort of “imbalance,” and you know he mentioned “dopamine.”  You know you’ve read about dopamine somewhere.  It all sounded so “medical.”  The special chemical he’s giving your son, you’re told, helps to fix all this, so that your son will sit still in his chair during school hours, and so your son will do his school work when the teacher tells him to do his school work.

You’re anxious to get the treatment part of the process started.

How Soon Will It Work?
Well, you first have to know it will take some time – a few weeks, maybe more, maybe less –  for the chemical to begin to have an “effect” because it has to “build up in his bloodstream.”  Once in his bloodstream, you may begin to see some improvement, although there will undoubtedly be some “adjustments” along the way due to unpredictable yet very common “side effects.”  It’s been made clear to you:  there will be good days, and there will be bad days.

Strangely enough, you’re still a little relieved.  At least the medical doctor knows what your child “has,” and you leave the office confident this new chemical will help your child in school, and that’s all that matters.  You privately fret your child has a “disease” or “disorder,” and you’re not clear how long your son will have to take this chemical – the doctor was vague about predictions – nonetheless, you’re reassured, and optimistic.

The teacher is pleased you are taking steps to help your son.  The school is happy too, and, to some degree, so are you.  You find comfort when you hear, over and over from friends and professionals, “it’s just like diabetes.”*  That means, thankfully, your son’s “ADHD” can be “treated,” with the right chemical.

He’s Just A Little Flawed
About your child, well, at some point you have to explain to him he has a “handicap ” –  or “disorder,” or “disease,” or a “mental illness” or, maybe, “an imbalance” – and that’s why he’s not sitting still, and that’s why he’s not paying attention to the teacher in school, and that’s why he needs this chemical to help him.  It’s tricky, but with the advice of others who’ve gone through the same thing, you do it.  You make sure he understands he’s not responsible for his unwanted behavior in the classroom.  You make sure he understands it’s not him, it’s not you, it’s not his teacher, it’s not his school – it’s his “disease.”

Four months go by and you’re disappointed.  Yes, the teacher said she saw “some initial improvement,” but a month later, she began to complain again.  You’ve had two “follow-up” appointments with the doctor to “review” your son’s chemicals to find out how they are helping or not helping.  At the last appointment he increased the dosage of the chemical.  Now, at this appointment, he’s suggesting a change of chemicals “that has less side effects, and better results.”  Of course, this means this new chemical will have to “build up in his bloodstream” too, and there will be new “adjustments” to make along the way.

By this time, you’ve done research, so this wasn’t unexpected.  You’ve surfed the web for the past few months, read dozens of articles, and you’ve talked with other parents who also have children with “disorders.”  Changing chemicals, up and down doses, extra chemicals for the “side effects” is the rule – not the exception.  You’ve talked with some parents whose children are taking 3 or 4, or as many a 5 different chemicals.  You hope you don’t get there.

Don’t Worry – It’s “Normal”
You’re troubled too.  He’s not sleeping well.  His appetite comes and goes.  He’s not doing any better in school either – maybe a little worse – and now they’re talking about special classes, and you have to make some decisions.  On top of that the doctor says he can give you another chemical to help with the “side effects” of the first chemical.  You have to think about that one.  You do, and you agree.

Your child seems to be a little more distressed too, a little more unhappy, a little more frustrated, maybe a little more angry.  You are too – all of it.  It’s going to be a longer road than you expected, but you’re going to stay with it and do whatever is necessary.

You know by now from your doctor, through your research, and by talking with other parents, all of this is a “normal part of the process.”

And It’s Done
You and your child are now willing, all-in customers of the disease model of “modern” psychiatry.  You can’t stop the “treatment” now.  It’s been made clear to you, and you know it as fact, your son has a “medical condition.”  Now you’re the one who educates others that “it’s just like diabetes,” and you wouldn’t dare stop treating diabetes.

You now know everything you need to know about the process.  You’re indoctrinated.  You’re an advocate.  You’re an expert.  You’re fully prepared to indoctrinate another parent.

And so it goes.

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For a very real, very recent example of the indoctrination process, read a mothers story about her experience with her 8-year old son – and how he’s doing now – in her article in the NY Times:  “Raising the Ritalin Generation” here.

* See “It’s Just Like Diabetes” in the forthcoming essay:  Psychi-Babble – Psycho-Babble’s Evil Twin

NEXT:  How’s Business?