Transcript for
Helping children to live their ‘best life’ – part one
Narrator (00:02): Welcome to the Emerging Minds podcast.
Dan Moss (00:07): Hello everyone. My name is Dan Moss, and this is episode one in a series of two podcasts with psychologist, Penny Sih. Penny will be describing practice strategies for work with children and families today. For those of you who follow Emerging Minds, you’ll know that we will be releasing an engagement and assessment practice strategy course that examines some of the strategies practitioners can use when first meeting with a child or a young person.
To develop this course, we worked intensively with Penny, who has offered amazing insight into her practises of working with children and families. Penny works with children to develop an understanding of their best life as a way of developing a functional assessment of children by having them describe what it is that’s important to them in their relationships, their routines, and in the activities that support and sustain them. The best life or whole of child approach is utilised in the assessment and engagement practice strategy course.
So Penny, really glad to have you here today. Maybe we could start by having you tell us a bit about your background as a psychologist, particularly your work with children and their families.
Penny Sih (01:18): So I’ve been a psychologist now for just over 17 years. And all of my work has been with kids and teens and their families, but in a whole variety of settings. So I’ve worked in child protection, I’ve worked in department of education, primarily with early childhood kindy programs, kids with challenging behaviours, and speech and language difficulties. I’ve worked in department of health, working with an early childhood and family programme with kids of again developmental delays and disabilities. And for about the last decade now, I’ve also worked in private practice where I am fully set now in Developing Minds. So we’re a community-based private practice that specialises in working with kids, teens, and their families. I’m also the team leader there, so I provide a lot of supervision and support to a range of psychologists who work in that area.
Dan Moss (02:04): So that’s a really broader breadth of experience. So Penny, tell me in that time what started to shape the way that you see work with children and their families?
Penny Sih (02:16): What has shaped the work? Well, I think I do most of my learning from the kids and their families. And I’ve certainly had some fantastic mentors and obviously I go to the research and the evidence base, but certainly a lot of what’s shaped it is actually the rich experience I’ve had meeting, and talking, and supporting these many, many families over the years and hearing their stories shaping the way I work with them.
Dan Moss (02:40): And in the last seven, eight years, we’ve forthcome to think a little bit differently haven’t we, about children’s mental health in particular? Can you tell me as a psychologist, how has those understandings informed your practise over time?
Penny Sih (02:53): Well things have definitely changed in the last couple of decades, haven’t they? I think probably one of the biggest shifts is that we know a lot more now about brain development. We have the ability now to really understand neurological development and child development in a way we didn’t, when we didn’t have the neuroscience technology that we had two decades ago. And one of the biggest shifts is that we now know for certain how important relationship is in early childhood development. In the development of kids brains, in their emotional regulation skills, in all of their cognitive skills. And that relationships; those warm, attuned, connected relationships, don’t just feel nice but they actually play a really integral part in child development and mental health. So that’s been a really big learning I think and shift away from, I suppose, behaviourism of the past, where it was we teach kids how to behave in certain ways, by rewarding them and giving them boundaries and consequences. We’ve learned that’s important, but also these rich coaching experiences and relationships really make a difference.
Dan Moss (03:57): And I suppose in that time with thought a little bit more broadly about the types of relationships that children need from a very strong attachment theory model where we’ve thought.
Penny Sih (04:10): Mothers, only mothers?
Dan Moss (04:10): Yeah, now thinking more broadly than that?
Penny Sih (04:12): Absolutely, and I think that is that interesting thing that it’s not just about a carer relationship and definitely not just a mother relationship, but about all of those connections. The connections that kids make in the systems that they work in. Connections they have with teachers, and support staff in schools, other health providers, with their peers, with their extended family, with their key carers. All of those relationships can play a role in shape and support a child’s life.
Dan Moss (04:39): And I suppose in the last 17 years we’ve gotten much better at describing or much more advanced at least at describing the types of psychological problems that children might come to you with. Do you see your role in that as eradicating or fixing the problems that children come to you? Or do you think a bit differently about your work with children?
Penny Sih (05:02): Well I think it’s a little bit of both. I think that absolutely children are brought to see a psychologist because they’re struggling with something. There’s something in their lives that isn’t going well or they’re having difficulty coping with something. They might have a disability or a diagnosis or some specific struggle. Or it may be just general coping skills or emotional regulation difficulties with whatever situation they’re living with. So I wouldn’t be doing my job if I wasn’t identifying the problem and saying, “Here’s some skills, here’s a way of understanding this, here’s how we can support this child to cope better in their struggle.” But, I think it’s really important that when we’re thinking about children’s mental health, that mental health is not mental illness. Mental health is about living a rich, meaningful life. And I talk to kids about my job is to help them get their best life. And what that might look like not just coping when things are tough, but also engaging fully in the things that give them a sense of well-being and the things that help them feel alive and living their life.
Dan Moss (06:03): So when you talk about a child’s best life Penny, what sorts of factors might influence a child’s best life?
Penny Sih (06:11): Well I think it really depends on the child of course. But, I suppose we’re looking at relationships are one of the key things. And that can be relationships within families, peer relationships, the relationships with coaches, and teachers, and it’s that old saying of a village to raise a child. So I think helping kids feel like they have a supportive village or they’re connected with a whole range of relationships, we know that positive relationships make a huge difference in a child’s best life. But we also know I suppose, being able to thrive, and explore, and develop their own strengths no matter what that looks like. And we know with neurodiversity now that actually you don’t have to look a certain way or be good at a certain skill to have strengths that you can bring into the world and thrive in whatever it is that really speaks to your heart I suppose. And so helping kids discover what their interests are, what they care about, what their values are, what their skills are, can all be part of their best life as well.
Dan Moss (07:07): Penny, in the practice demonstration that you help develop for the assessment and engagement practise course, we are introduced to an eight-year-old girl, Zoe, and her mom Bridget. Zoe has been referred to a psychologist because she’s experiencing significant anxiety and this is causing her to miss lots of school. Bridget and Matt, Zoe’s dad, are currently going through a separation. And this has brought some tension and conflict into the house. Particularly when Matt comes to visit or comes for dinner. Can you tell me what is important for you when you first meet with a child like Zoe, who might be feeling quite reluctant or ambivalent to meet with you?
Penny Sih (07:47): Sure. Well so, I’m assuming that a lot of kids when they first come to see me, I don’t know what they’ve been told. So one of my first questions that I ask is, “What did mom or dad or whoever’s brought you today, tell you about why you are here today? What I do? What we’re going to do here?” And I ask that question of the kids and or their parents depending on who answers, because it gives me a lot of information about what parents expect. But also whether the kids reluctant to be here, whether the kids initiated asking for help, and that can help me structure that. But I suppose one of the ways I do that is if no matter what kids say to me or whatever parents say to me whether they say, “I’m here for my anger,” or “I’m here because I’m not going to school,” or “I’m here because I’ve been sad a lot.”
Penny Sih (08:31): I will often reframe that to say, “Well sounds like there some stuff we can talk about but, I think it’s important that I tell you what my job is and my job, I’m a psychologist and I have the best job in the world and I get to play with kids for a living. But most of all, I get to help kids get their best life and I’m really sure that mom or dad has brought you along today because what they want for you as well is for you to be living your best life.
Penny Sih (08:57): Now, best life doesn’t mean that I’m going to buy you a fancy car, or send you on a holiday to Disneyland, that would be great. But that’s not what we’re here to do. Is because sometimes our best life means that even though we’re going through tough times, that we can still be living a life that feels good to us, that we’ve still got supports around us, we’re still doing things that matter to us, we’re still engaging in the things that really fill us with a sense of satisfaction and value. So, I want to know about what makes your best life?”
Penny Sih (09:27): And sometimes I’ll say things to kids like, “Most kids who come to see me have got some really nice things or some good moments going on regularly in their life.” Most kids will say, “I have a sport that I enjoy,” or “I really love to draw, I have a great game that I love playing on my tablet, my mom and I like to go for walks together,” or “I really love going and doing this activity at school.”
Penny Sih (09:51): So they’ll have a range of things that they really enjoying. And in those moments they are already living their best life. And I’m sure you are living some of them and I’ll get kids to tell me about a few times that life feels good for them.
Penny Sih (10:02): And then I’ll say, well, and also kids come to see me because there’s often something that’s getting in the way of their best life, there’s something that they’re struggling with. It might be big feelings or a tough situation they’re living in, or difficulties doing something that they feel like they should be doing better. And so, we might start to talk about ways that we can cope better with those things as well. But I need to know what feels good to you first so that we know that everything we do here is really trying to head you into your best life.
Dan Moss (10:30): And that might be quite different I imagine for a child who’s come along, maybe somewhat reluctantly thinking that this person is going to try to fix them or is going to tell them
Penny Sih (10:42): You’re going to see the feelings Doctor, because you’ve got anger problems. And that’s not all kids’ experience of course, but they will come often with a hesitancy feeling like, “I am the problem,” or “I have a problem,” or “There’s something wrong with me, and that’s I’m going to see someone.” And that can get in the way of us doing our work. So I want to normalise help seeking, I want to say to them, “Hey, you’re really brave, I already know this about you because you are willing to come talk to a complete stranger about your life, that takes a lot of bravery.” Or I might notice, “Hey, I can already see that you’re a pretty flexible kid, you’re willing something new a go because you want the best life for you too.” Or “I can tell you’ve got a really caring mom or dad. They’ve come all the way, they’ve arranged for you to come see someone because they can see you are having a tough time and they really want things to be better.”
Penny Sih (11:31): So I’m building up those strengths as I see them right from the beginning to let them know this is a place where we’re not just going to be going, you shouldn’t do it like this, we should do it better.
Dan Moss (11:42): And if a child throughout that first minutes of engagement is still displaying a bit of ambivalence or reluctance. Are there particular activities you might engage in to start to hopefully get the conversation flying?
Penny Sih (11:57): So I think giving kids a bit of choice and control in that makes a big difference. So sometimes it’s as simple as saying things like, “Would you like to talk to me first, or would you like mum or dad to do the work first?” And so give them a choice about who starts. Sometimes I might give them choice around, “Do you want to tell me why you think you’re here, or what you’d like to talk about, or would you like me to ask you a bunch of questions and you just answer them?” So, I might just give them a bit of a sense of being in the driver’s seat, which can make them feel a bit more relaxed. Also depending on their age, I’d be engaging them in fun ways. So I set the rules of therapy up really early in my sessions and quite often I’ll say, “Okay, it’s really important that we know the rules here and rule number one,” and I’ll say, “Look, I’m sorry I know most people don’t like rules.” I make a bit of a game of it. And then I’ll be like, “See really important that my most important rule. Rule number one is we have to have a bit of fun.” And it catches them off guard, we have a bit of a laugh. And I will sometimes say to kids, “I’m going to give you the job of rating my session. We’re going to get to the end of the session and you have to give me a score out of 10. 10 means this session was the most fun I’ve ever had.” And I said, “I’ve never got a 10. I’m not as good as going to bounce but tell me how I’ve done.”
Penny Sih (13:10): And if we’ve had no fun, if I get a zero, we need to have a chat about that, because I haven’t done my job. We have to have a bit of fun here. Because did you know that kids learn better when they’re having fun? I’ll tell kids that. Have you ever noticed that when the teacher’s just teaching you maths, your brain can go to sleep, and you don’t really want to learn it. But if the teacher gets out spaghetti and marshmallows and says, “Let’s make a 3D shape,” suddenly you’re learning and you don’t even realise, because you’re having fun. We’re here to learn and we need to have some fun. So letting kids know that it will be a bit fun, and then doing some fun things, is a way I might relax them.
Dan Moss (13:45): Penny, these are such great examples of how you might overcome a child’s initial reluctance and the anxiety of parents coming into a therapeutic setting for the first time. So in the case of Zoe, our case example from our practise strategies course, how would you continue to use the idea of the best life to engage with her and her mum?
Penny Sih (14:05): So sometimes just asking kids about their best life, and they’ll give me a few things, and that’s enough to relax everyone and have that as our focus. But sometimes I’ll turn the best life idea into a full activity that I do with kids and involve their parents in. And I do that quite often by doing an activity I call, “The Best Life Documentary.”
This is an idea I got off of Russ Harris. And the idea is we’ll talk about, imagine that I had a secret film crew. Who, I have to be careful to make sure I have told them I don’t really have a secret film crew.
Penny Sih (14:37): Imagine that there had been a secret film crew filming everything that you did. They’d been making a documentary about Zoe. So for the last three months my film crew has been filming everything you do, everything you say, everywhere you go, every conversation you have. And of course my film crew can’t tell what you’re thinking or feeling. All they can see is what you’re doing and saying and how you’re doing and saying it. They’ve been filming you for the last three months. And that’s the beginning of our documentary, which is Zoe’s life.
But imagine that what we do here. What you, and me, and mum, and dad, and all the people that we pull in to help you, we work together. And the work that we do here really makes a difference to your life, that we are going to make your best life. And then in three months time, or at the end of the year, we’re going to refilm the second part of this documentary and we’re going to call it, “Zoe’s best life.” And things have changed, things have gotten better, and you’re living your best life.
Penny Sih (15:34): What I want to know is, what would I see on that new documentary? I still can’t see what you’re thinking and feeling, but I’d want to be knowing what will you be spending your time doing? Who will you be spending your time with? What would you be like? What would you be doing or saying and how would you be doing or saying it in those situations?
So some kids can answer that quite freely and sometimes I’ll be fleshing it out. So I might say, “So if you are sitting at school and the work is tricky. In your best life, what would I see you do? What would you be acting in a certain way? Would you be asking for help? Would you be sitting quietly and focused? What sort of student would you like to look like on my best life documentary? At home when mum and dad ask you to do something tricky, what would you look like if you were living your best life? With your siblings or your friends what would that look like? How would that look?”
Penny Sih (16:26): And we’re really just trying to tease out how they’d like to be. With looking at some values, but also what is even included in their best life. Is it sport? Is it school? Is it home life? Is it family? And I’ll include if kids can’t answer, mum’s and dad’s opinions about what will make their best life makes a real difference as well.
Dan Moss (16:45): That’s really great Penny, that’s really useful. Thank you. And when I’m here to listen to you talk, I’m thinking that what you are starting to get to with Zoe is a bit of a invitation for her to talk to you about her day to day functioning, really in the world. The different elements of that in a slightly more engaging or open-ended way.
Penny Sih (17:06): So this is a clinical assessment, right? So while we’re talking about, “Hey, I really love soccer and my soccer team’s really important.” And then you see their face drop. And I’ll say, “Oh, I notice that soccer seems really important to you, but I notice your face drop there for a second. What’s going on?” Then we might explore that a bit. And she might say, “Well I haven’t been to soccer lately.” And we can say, “Oh something’s tricky.”
Penny Sih (17:30): Now I might expand on that right there and then if they feel comfortable. Or I might log that away for her. There’s something that’s difficult in getting out to sport on a regular basis, that’s something that we’ll look into later. But there’s so much assessment that can be going on about what is a functional life for this kid, but also what their parents are hoping and expecting of them. What we’re looking at age-appropriate expectations here, and how busy this child is, and how supported they are to do a variety of activities, or how over scheduled they are. There’s lots of things that I’m assessing just through talking about what would life look like? But kids think here I am doing a fun activity talking about what my best life could be. It’s a really motivating, energising, kind of way of looking at it.
Dan Moss (18:13): Thank you so much, Penny. This has been a fascinating and insightful conversation about how to work with children and families in the assessment and engagement stage. Particularly the practical examples you’ve provided regarding the use of the best life model. As you talk at the almost like we can hear children like Zoe and mums like Bridget breathing a sigh of relief. Realising that this session is not going to be just about their faults or their deficits. And in fact, you are intensely curious about every aspect of Zoe’s life. And in that curiosity, it becomes possible for Zoe to think out her life in ways that don’t only involve the problem.
So that’s all we have time for in episode one. But please join us in a fortnight’s time, when we get to hear the second part of this conversation with Penny. Who is going to continue to describe her work in helping children like Zoe to walk towards their best life.
Narrator (19:10): Visit our website at www.emergingminds.com.au. To access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health, under the National Support for Child and Youth Mental Health Program.