Infant and Early Childhood Mental Health: An Interview with Dr. Barbara Stroud
Curt and Katie interview Dr. Barbara Stroud on infant and early childhood mental health. We explore what therapists need to know about working with very young children, including the latest brain science and the very earliest developmental stages. We talk about the importance of children being safe, seen, heard, and helped. We also look at the importance of culture and how to support under-resourced families.
Click here to scroll to the podcast transcript.Transcript
An Interview with Dr. Barbara Stroud
Barbara Stroud, PhD, is a licensed psychologist with over three decades worth of culturally informed clinical practice in early childhood development and mental health. She is a founding organizer and the inaugural president (2017-2019) of the California Association for Infant Mental Health, a ZERO TO THREE Fellow, and holds prestigious endorsements as an Infant and Family Mental Health Specialist/Reflective Practice Facilitator Mentor. In 2018 Dr. Stroud was honored with the Bruce D. Perry Spirit of the Child Award. Embedded in all of her trainings and consultations are the activities of reflective practice, demonstrating cultural attunement, and holding a social justice lens in the work. Dr. Stroud’s book “How to Measure a Relationship” [published 2012] is improving infant mental health practices around the globe and is now available in Spanish. Her second book, an Amazon best seller, “Intentional Living: finding the inner peace to create successful relationships” walks the reader through a deeper understanding of how their brain influences relationships. Both volumes are currently available on Amazon. Additionally, Dr. Stroud is a contributing author to the text “Infant and early childhood mental health: Core concepts and clinical practice” edited by Kristie Brandt, Bruce Perry, Steve Seligman, & Ed Tronick.
Dr. Stroud received her Ph.D. in Applied Developmental Psychology from Nova Southeastern University, and she has worked largely with children in urban communities with severe emotional disturbance. Dr. Stroud’s professional career path has allowed her to work across service delivery silos supporting professionals in mental health, early intervention (part c), child welfare, early care and education, family court staff, primary care, and other arenas. She is highly regarded and has been a key player in the inception and implementation of cutting-edge service delivery to children Prenatal to five and their families; her innovative approaches have won national awards. More specifically, Dr. Stroud is a former preschool director, a non-public school administrator, director of infant mental health services and agency training coordinator. She has held an adjunct faculty position at California State Long Beach and maintained a faculty position in the Infant-Parent Mental Health Fellowship for 12 years. Currently, Dr. Stroud’s primary focus is professional training and private consultation from an anti-racist lens, with a focus on social justice, in the field of infant mental health. Dr. Stroud remains steadfast in her mission to ‘changing the world – one relationship at a time’.
In this podcast episode, we talk about mental health services for infants and young children
Curt and Katie continue to identify gaps in typical therapist training. One such gap is working with children 0-5. We reached out to Dr. Barbara Stroud, expert in infant and early childhood to help us learn what therapists need to know about this age group.
What is infant and early childhood mental health?
“What I often say to parents and providers is, it’s our job to be the bigger cortex for the dysregulated midbrain. So, your little kid is not bad, they’re not misbehaving, their dysregulated midbrain is doing the best it can. And we have to step in and be the cortex that holds that dysregulation and nurtures them through this process.” – Dr. Barbara Stroud
- Looking at big feelings and social and emotional development
- The current brain science that is impacting infant and early childhood mental health
- How adults impact infant developing brains
What are the basics that therapists should know when working with children under 5 years old?
- The importance of dyadic therapy
- Parent training
- Social emotional developmental stages
- The damage of punishment on the development of an authentic self
What infants need to love themselves, have healthy development
“Let me give you something that I give parents and I give childcare providers and I give therapists as a way of thinking about one simple thing you can do and always remember that will support your child’s social emotional health: keep them safe, make them feel seen, heard, and helped.” – Dr. Barbara Stroud
- Infants want to be safe, seen, heard, and helped
- Co-regulation and holding the big feeling with the child
- The impacts of this work on adults
- Transgenerational work – we treat the parent in the way that we would like the parent to treat the child
- How to support parents in healing their own wounds
Therapy Interventions for infants and children under five years old
- Play therapy is complex and advanced and requires training and supervision
- Before children can think symbolically or have words, play is not effective
- Attunement and attachment work
The impact of the pandemic on social emotional development
- Developmental delays seen in research of kids related to the pandemic
- The way children can catch up developmentally
- The impact of parents’ stress responses on availability
- How the lack of interaction with age-mates impacts development
- The responses to stress based on these delays
Cultural impacts on early childhood development
- Questions to ask about cultural and family traditions
- The stories to explore and the importance of stories and practices
- How to explore areas of inequity and disparities
- Understanding our power as professionals
Interventions for families with very young children
“We can take everyday tasks and turn them into not just nurturing moments, but therapeutic moments… take nurturing tasks that parents have to do already (it’s already something they’re going to do) and turn it into a therapeutic moment.” – Dr. Barbara Stroud
- Helping families to identify what they are able to do to make changes
- The importance of predictability for families with a lot of chaos
- How therapists without kids can work with parents
- How parenting is an individual journey
- The importance of loving kids and being emotionally available to kids
Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:
Thrizer
Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client’s insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don’t need to give up your rate. They charge a standard 3% payment processing fee!
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Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
drbarbarastroud.com
Dr. Barbara Stroud | Changing The World One Relationship at a Time
Using Reflective Practice to Examine Microaggressions
The ABC’s of Trauma with Dr. Chandra Ghosh Ippen
https://mcsilver.nyu.edu/ttac-deconstruct-racism/
Facebook: Barbara Stroud Training
Relevant Episodes of MTSG Podcast:
Crafting Your Authentic Message: An interview with Mercedes Samudio, LCSW
Navigating Pregnancy as a Therapist: An interview with Emily Sanders, LMFT
Infertility and Pregnancy Loss: An interview with Tracy Gilmour-Nimoy, LMFT, PMH-C
Field-Based Private Practice: An Interview with Megan Costello, LMFT
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
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Connect with the Modern Therapist Community:
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Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Curt Widhalm 0:00
This episode of The Modern Therapist’s Survival Guide is brought to you by Thrizer.
Katie Vernoy 0:03
Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session just by billing your clients through Thrizer. You can potentially save them hundreds every month with no extra work on your end. The best part is you don’t have to give up your rates they charge a standard 3% processing fee.
Curt Widhalm 0:23
Listen at the end of the episode for more information on a special offer from Thrizer.
Announcer 0:29
You’re listening to The Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:42
Welcome back modern therapists. This is The Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists about our clients, about our practices, about the things that we do and we are nearly 270 episodes in and still finding areas of our field that we have yet to explore and today we’re getting the opportunity to dive in on infant mental health, early intervention, all this kind of stuff and better than just Katie and myself wandering through this, we brought in an expert. So we are joined today by Dr. Barbara Stroud, and infant mental health care specialist. And thank you so much for joining us and wading this conversation for us Dr. Stroud.
Barbara Stroud 1:32
My pleasure.
Katie Vernoy 1:34
We are so glad to have you. And it’s so good to see you again Dr. Stroud. We worked together long ago, and I’ve been blessed by some of your trainings in the past. So, so glad you agreed to come on today. The first question we ask everyone is who are you? And what are you putting out into the world? Well,
Barbara Stroud 1:51
Thank you. Thank you for the invitation to be here. So my name is Dr. Barbara Stroud, my pronouns are she/her and they. I’m a clinical and developmental psychologist, I am a small business owner. So currently, I am professionally doing training, consultation and a lot of reflective supervision. What I’m putting out there currently, trainings and opportunities for a transdisciplinary community, which is mental health providers, which is childcare providers, which are early intervention of folks who do developmental support providers around what is really infant mental health, around reflective supervision, which is the supervision strategy we use a lot in infant and early childhood mental health, and I’m doing a lot of racial equity work and implicit bias work and trying to dismantle the systemic inequities that exist in our child serving systems. So that’s what I’m doing.
Katie Vernoy 2:38
I love that.
Curt Widhalm 2:40
So let’s start with the very basics here. How do you define Infant and Early Childhood Mental Health. Let’s all get on the same page as far as what this actually means.
Barbara Stroud 2:50
Sure, sure. At its most simple level, I would say that infant and early childhood mental health is really social emotional success. The capacity to use your social emotional skills to maintain relationship engagement. And when we talk about social emotional skills, we really have to start with self regulation, which in my world is very, very common. But some folks may not really understand what I mean by that. And it’s the capacity to kind of hold a big feeling, when we’re talking about little kids, we talk about big feelings, you’re holding a big feeling, not becoming overwhelmed by that feeling, and not losing your capacity to be in a relationship. So really what we’re trying to do with little ones, because their emotional self is evolving, their understanding of their feelings is developing in these first three years, three to five years, as well as what is culturally appropriate in their family system, and then the larger community culture, like the culture of school, or preschool, in terms of how to express and share their feelings. As I think about and want to define, you know, what a social emotional success or social and emotional development already looked like, it starts with self regulation, my capacity to notice my feelings, and then share them with others, share them with others in a way that keeps them safe and me safe, because I can scream and yell and punch. That’s the way that I share my feelings. We want to be able to share our feelings in a way that’s safe. We also want others to acknowledge that our feelings are real, and that we have a right to those feelings. And then we need people really at every level of our development to help us through the feelings that are so tough. So for little kids, infant mental health is emotional health, infant mental health is social emotional development, infant mental health is ensuring that kiddos are on the right track to have authority over their own ego, experience and emotional life in a way that’s nurturing and safe and empowering. And if we can do that for little kids, I think we get much healthier adolescents and adults.
Katie Vernoy 4:46
Oh, for sure, for sure. I have so many questions, but one of the things that you had put forward as a question that I think would be really important for us to kind of also ground ourselves in is is the current brain science. How has that impacted the field of infant and early childhood mental health?
Barbara Stroud 5:04
Thank you. I think we in early childhood and infant early childhood mental health are really starting to be more of a brain based system when we think about little kiddos. And when you understand the developing brain, you kind of can see the little folks a little bit differently. And for those who aren’t like brain nuts and love to read neuroscience, like I do, we’ll just do a quick review. You know, our cortex is where all that narrative declarative learning happens and psychotherapy, traditionally, our roots are very cortex heavy, they’re very, let’s explain, let’s tell the story, let’s do you know, talk therapy, that’s all cortex level activity. And little ones really, kids under three are very, very midbrain or limbic system based, they’re all about the experience, they are all about feeling their feelings, they don’t often have words for their feelings, but they’re swimming in their feelings, and our feelings can be very, very overwhelming. And then our survival brain or our brainstem is where we go, that reactive part of our brain, when we our brain really thinks it’s fighting for our lives. So most kids under, I’m gonna say under three, you’re gonna get small glimpses of cortex, and you’re gonna get a lot mid brain and a lot of survival skills. Because the first role of the of the newborn is to survive, and surviving for a newborn means I gained the connection to a strong adult figure who will care for me. Infants do not survive alone. So they must attach, they must make you fall madly in love with them, and then, and they do this with the coos and, and the smiles, and they just they do this, and their amazing smell and all that kind of stuff that it just makes you want to, you know, grab those babies and say, I love you madly because they need to be loved madly. And we notice and understand that cortex level interventions or strategies are really not birth to five appropriate or even successful. We really have to start thinking more about what’s happening in their midbrain and how we help them survive and move through these really big feelings with nurturing supportive adults. So what I often say to parents and providers is, it’s our job to be the bigger cortex for the dysregulated midbrain. So your little kid is not bad, they’re not misbehaving, their dysregulated midbrain is doing the best it can. And we have to step in and be the cortex that holds that dysregulation, nurtures them through this process and literally, that is how their own brain is going to develop, which for me is like, Ah! Your behavior is impacting your child’s developing brain. And that’s like, awesome.
Curt Widhalm 7:33
So what are the basics that therapists should know in going into this kind of work? I’m a marriage and family therapists, come very much from a family systems, I’m hearing that this is a lot of parent work of how to reflect this back to their own kids, because we might get 45 minutes with their kids, they get 100 and some other odd hours with their kids. So they are having a lot more impact. But what are the basics that therapists should know in working with this age group?
Barbara Stroud 8:00
That’s a great question. And I think one of the first things folks should stop doing if they’re working with children under five is trying to work with each other alone.
Katie Vernoy 8:08
Yeah.
Barbara Stroud 8:08
That’s going to be your first mistake. Because as you said, they’re going to spend 45 minutes with you and the rest of their days with their caregivers. You want to do what we refer to as dyadic therapy. So we want to work with the caregiver and the child, because I believe intervention happens outside of my therapy time. My therapy time is to structure the relationship skills that the parent then will use for the next week to really mold this developing child. So I would say: one, work with a parent; two, learn about social emotional development, because really, your therapeutic process is going to model the developmental stages of social emotional support or social emotional development. And there is a stage, there are a set of stages, Stanley Greenspan and Serena Wieder put down these social emotional milestones. They are available through the perfecting website. Or you can just Google Stanley Greenspan, social emotional milestones. Just like any other set of milestones, we move through these and you can begin you can learn how to identify where a child is in their social emotional development, and to build interventions around where they are in their social emotional development. You can help parents support kids exactly where they are. Because when we understand that social emotional success is interpersonal success, we want to support that right? Just like motor development, or cognitive development, all the other developmental skills that kids go through, right? They go through social emotional development. So you want to meet them there, first of all, and foremost, teaching parents to be good enough reflectors of their children’s experience. A lot of parents have been raised in the culture that suggest that punishment is a good teaching tool. We actually know in infant mental health that punishment is not a teaching tool. Punishment shuts down your child’s nervous system and teaches them not to engage or that it’s not safe to be their authentic self. So really what we want to help parents understand is how do you sit with and hold these really big feelings that sometimes scare us. And they are the authentic experience of the child. I’m not sure if that’s been really helpful. But let me give you something that I give parents and I give childcare providers and I give therapists as a way of thinking about one simple thing you can do, and always remember, that will support your child’s social emotional health. Keep them safe, make them feel seen, heard and helped. Safe, seen, heard and helped. You do those four things, and you start with safe, because we all want to be safe in relationships, we all want to be safe in the world. Sometimes what we would call misbehavior or acting out behaviors because my brain and body don’t feel safe. You don’t have to know why they don’t feel safe, they simply don’t. See: identify my authentic self. And those that you know, as therapists, we can see how this supports identity and ego development, that I have a story to be my authentic self. See your child, name your child’s experience, that noise was really scary. I yeah, I can see your flinching. I can see your arms are filled. That noise was really stir. I’m here. I’m here. And I’m going to keep you safe. Right? Hear their story, hear their truth. When your children are verbal. That noise was really scary. I didn’t like that song. I didn’t like it. And that’s ok, let them not like that. It’s okay that they’re scared.
Katie Vernoy 11:24
Yeah.
Barbara Stroud 11:25
I’m angry. I didn’t get a cookie, I want a cookie. It’s not fair. How come I don’t get a cookie? It’s okay. It’s, it’s okay to not like it, it’s okay to have these big feelings. We hold the value, there aren’t good or bad feelings. And sometimes the feelings are really big and feel overwhelming. The most important thing is that we’re safe in our feelings. And then help us not fixing for. Help is offering co-regulation. Co-regulation is where that your cortex comes in. Co-regulation. And your cortex comes in. And it says I gotcha. I’m gonna hold you emotionally through this challenge. So for folks who work with infants, or if you’ve had your own infant, there’s a time when all your infant wants is to be next to you, right? They want to sit on dad’s chest, mom’s chest, grandma’s chest, whoever, and they just want to feel the connection of a caregiver, what you want to do with co-regulation is you want to cuddle or swaddle the brain, the emotional needs of the child, you don’t physically do it, but you kind of hold their emotional experience and say, I’m going to swaddle and hold that big feeling with you so that you know you’re safe in it. Okay, and through safety and heard and helped. And through this, we really want to create the strategy and the experience and the skill set, even at a preconscious level, below the level of awareness that I will survive relationship rupture. How many of your audience who are doing work with adults are handling folks that are still struggling with relationship rupture.
Katie Vernoy 12:44
Oh, that’s what I was thinking about completely. I’m like, Oh, my gosh, I’ve got so many of my clients who did not get this at all. They have such a hard time and interpersonal relationships. And I think about what a blessing this would have been for them to have that safety to be safe, seen, heard and helped. Oh, I love that. That’s, that’s really, really helpful.
Barbara Stroud 13:04
Well, that’s my mantra that I share with folks. If we’re going to help nurture these kids, these young ones, you know, from birth to five to one love themselves, have a healthy ego, understand they share this planet with other people, and that all of us on this planet deserve to be respected, right, we have to respect them. And we have to respect their emotions.
Curt Widhalm 13:26
I’m imagining the therapists who are going to very ideally bring this to their clients, parents, and hearing from parents, but I never got that when I was their age. I don’t know how to do that. Or I won’t do that. Because look at me, I turned out fine. I know that that turns this into parent work. And all right, we’re gonna move some of this family system stuff to stopping intergenerational trauma. Please help me expand on just kind of this shifting from infant childcare to this is a lot of ongoing work.
Barbara Stroud 14:00
Oh, it is. And I think you nailed it when you said transgenerational work. One of the buzzwords in infant mental health or infant early childhood mental health is parallel process. And I think of that as paying it forward. This idea that you do unto others as you would have others do unto others. She is an icon. To recall an icon in the infant early childhood mental health field, I have to say that it’s her quote, that we are really treating the parent in the way that we want the parent to treat the child because we understand that’s that’s the message of dyadic work is we’re holding the parents so the parent can have the emotional capacity to hold the child. We understand that most of us have had parents who did their best and may not have met our needs. And that’s okay, they did their best but they may not have met all of our needs. There is so much more that we’re continuing to learn about development, about the brain, about social structures that are abusive and harmful, institutional inequities and systemic challenges that families are dealing with. So today, you can rewire a relationship. You can rewire relationship including your own, and you can heal yourself by parenting your child differently. So for parents, you know, who kind of want to say I wasn’t parented that way, and I turned out just fine. You are, I would honor the safe seen, heard and help. You’re a phenomenal parent. I would never question your parenting. And I’m curious if you’re willing to try some different things that we know, that brain science tells us, support your child’s capacity to be successful in school? Are you willing to do that?
Katie Vernoy 15:31
I think it would be pretty hard for a parent to say no to that.
Barbara Stroud 15:33
There we go. Because, because socially, there you go, because social emotional skills are school readiness skills. And that’s what I remind folks, and we have if you if for those of you who are working with adolescents, you’re aware of the fact that our educational system is starting to teach social emotional learning, because we have a generation of children who don’t have robust social emotional skills, and they’re not trying to teach it in high school. We can teach this seamlessly in the first five years of life. And this prepares children to sit in the classroom and learn.
Curt Widhalm 16:03
So beyond, you know, teaching kids zero to five beyond play therapy, what can we do?
Barbara Stroud 16:08
Yeah, so I would say in terms of play therapy, be very cautious because I think play therapy is very, it’s very complex, it’s very advanced, and you need training, please get really good training and get supervision.
Curt Widhalm 16:20
Don’t just put a bunch of toys in your…
Barbara Stroud 16:23
…toys in a sandbox and call yourself a place therapist. Please do not. Please do not. This, like doing couples counseling, you know, you don’t read a book and sample couples, counselors, you get training and supervision to develop expertise. So folks think, you know, play is the window. And I love the idea of play therapy. I love the history behind it. Taking Freud’s idea of narrative declarative, and then Anna Freud kind of thinking about the children tell us their narration in play, and they do when they have symbolic thought, or symbolic capacity. And this is where development is so important, and particularly social emotional development. There are a series of developmental skills that must happen before children are capable of symbolic thought. And when we have children who have had trauma in their life, or other emotionally disruptive, chronic kinds of experiences, and often the children that we find in psychotherapy, their development will be delayed in terms of access to symbolic thought, and play therapy will not be very successful. So the question is, well, if I can’t play with kids, what can I do? Alright, so that was Curt’s initial question. Well, here’s what here’s what we do. But below the level of symbolic thought is we do engagement and mirroring of the experience of the other, we do somatosensory kind of body based interventions with kids. And if you think about the first thing you do, when you pick up an infant, whether they’re yours or someone else’s, is you look in their eyes, and you copy their face, and if they open their mouth, you open your mouth, and if you raise your eyebrows, they raise their eyebrows. Think of how that demonstrates, I see you and I acknowledge you. So before the level of words, before the level of the capacity to symbolize, I see you, I acknowledge you. Seeing the experience of a child is a wonderful intervention before they’re capable of symbolic play. That’s just one nugget I can share with you. Again, I would encourage people to look into, I’m going to promote Perfect Them because I respect the work that they’re doing. And they teach DIR floor time, there are other universities and systems that teach DIR floor time, but I don’t know that off the top my head. So I’m sorry. But I would look into some of the pre symbolic interventions that are if you want to do this work, if you really want to do this work well.
Katie Vernoy 18:39
It seems like there’s a lot that can happen within the therapy session. But there’s also it’s the way you described it is that it’s really setting folks up to go back and practice them. The thing that popped into my head, and I think part of it was how you started bringing this up. But I think about all of these kiddos who potentially were just getting ready to start school or all of those things and the world shut down.
Barbara Stroud 19:06
Yeah.
Katie Vernoy 19:06
And I think about all of the social interaction that maybe was lost in some of these critical periods. What are you seeing as far as the developmental stages, I guess, are the social emotional development based on kind of locked down for 2 years for the pandemic?
Barbara Stroud 19:21
You know, it’s interesting, we are seeing some social emotional delays and kiddos and there is some research happening at Columbia University right now. And they’re looking specifically at mother baby dyads and how parents have negotiated the pandemic and the outcomes in terms of social emotional development for kiddos. So we are seeing some delays in social emotional development. However, we know that relationships can make up that difference. We know we know how to repair that. We know that with good resource and good support those delays the kids can recoup that. One of the outcomes of some of this information is that it was what seemed to be the barrier for children’s success was the lack of availability of parents. Parents own stress throws their natural caregiving capacity. And this is not to blame parents at all. But our our own overwhelmed stress response as adults has made us less available to our children. And so as parents were able to feel safer in the world, they were able to give more to their children and support your children’s experience. Now, of course, not being in preschool and not being around age mates also impacted social emotional development. And I think anyone who is working with kiddos who are three, remember, during this pandemic period, remember, they’re currently not three, they’re probably developmentally two. So you have to treat them like they’re developmentally two, I have just some professional and personal concerns about kids heading for academic training after the pandemic, because I am concerned that they have not had the robust social emotional support they needed to jump into the challenge of academic training. So as parents, you make decisions about where you want your kid to be in school. I mean, if kids, you can take kindergarten twice, no one’s going to be particularly upset with you, it’s not going to keep you from graduating, and won’t be on your final transcript. So parents can think about those things themselves. But we have a population of kiddos that didn’t get the robust social interaction that other kiddos get. And so that’s going to, for a temporary period, we can always recruit right repair is always possible. That’s the good news, they are going to look developmentally a little younger than they physically are. And that’s also what we know of kids who’ve had trauma, we know that we know, right, we know adults that have had trauma, we know those of you working with adolescents, because I did start my work with adolescents. Those 16 year olds can look very much like their 10 if they’ve, they’ve had a trauma history, and/or when they’re emotionally overwhelmed, right. And so this what we’re seeing with our kiddos, our four year olds might really be two and when stress when you introduce stress into their world, and stress for a four year old might be I don’t want to wear these socks, I want to wear my green socks. That might be stressful, a four year old, they’re gonna have a meltdown, or what some of us might call a tantrum, or they’re gonna look two. That’s a typical response to stress, that is not a bad child, that is not them misbehaving, that in not them trying to manipulate you, that as a child who’s having an appropriate response to stress. So you respond to the stress, you are stressed, there’s a lot going on today, the socks are just the tip of the iceberg. I’m here. Some days are hard, and socks can be a problem.
Katie Vernoy 22:25
Socks can be a problem. Those darn socks. As you’re talking, I know that there’s a lot of trauma that can happen, especially in communities where there’s even more disparities. And I’m just curious, because I know this is one of the areas of expertise for you as well, like, how can providers support family culture as well as address these disparities within our systems?
Barbara Stroud 22:52
The first problem is pretending that there’s any culturally neutral or cultural free anything experience strategy, what have you, we are all swimming in culture, we’re all swimming.
Katie Vernoy 23:02
Absolutely.
Barbara Stroud 23:03
And so an important responsibility of a clinician is to say to families, I’m interested in your caregiving practices from a cultural lens, if you have emigrated recently to this country, or if your parents are from another country, what would have happened in that country with a two week old, with a six week old, with a six month old?
Katie Vernoy 23:21
Sure.
Barbara Stroud 23:22
Because that’s going to inform a 12 year old or what have you, because that’s going to inform what I know about your family system. So the first thing is to start asking questions, and I’ll tell your audience because these are a couple things that I tell folks to ask as just culturally curious questions to get to know, folks. If you’re working with babies ask what’s the family tradition that you have to do in the first six weeks, two months of the baby’s life? Most family cultures have some sort of activity, and it can be a religious activity, or it can be a very specific family activity that you know, grandma Sally has to come and kiss the baby. And she does that for all the babies. I mean, I don’t know if you have some sort of family practice. The other thing I asked folks is Do you know your family’s immigration story? And can you and would you be willing to share that with me? And then another question is, do you know your birth story? Can you tell me your super story? It’s interesting. Sometimes people don’t know their birth story. So they’ll say something. And then one thing if, if your parents did get married, because not everybody’s parents did, do you know the story of how they met and fell in love. So these are stories that tell me a little bit about their family story, because culture is held in stories and practices, it opens the door to the idea that your story is important to me. So I’m going to give some prompts that say the story of who you are and how you came to be in this world is important to me as part of your journey. So I want to know about that. And then I’m going to be particularly sensitive to areas of inequity, and I invite clinicians particularly if you are white, what we call dominant culture, Eurocentric. You guys can see me. I’m an African American, cisgender female, that’s how I identify and I would encourage all of us to say, you know, if I’m a white person, as a white person, I may not understand the journey of someone who is Latino, African American, cisgender, heterosexual, I’m gonna need some support with the queer community, transgender community, LGBTQ, I’m not gonna understand. So understanding our power as professionals, we have power in the relationship. So because of our power, I think we have to say these issues are important, because folks don’t know what therapy is, they come in and they follow our lead, what do we have to talk about, I’m gonna have to talk about my childhood, I’m gonna have to talk what I’m talking about, well, we have to talk about all these things. And we have to talk about culture. And we have to talk about where you may be feeling disenfranchised, even in this relationship, because I want you to be safe to say to me, that’s not my story, you’re misinterpreting it. And some of it might be because of your bias lens. Because you don’t know what it’s like to have a child with autism, or you’re not a person who is Muslim, or you aren’t, you don’t have a child who’s transitioning to another gender. You’re right. And I want to understand.
Curt Widhalm 25:57
I have to imagine that there’s also a lot of just kind of wealth inequality questions that come up in this kind of work too. Whether it’s access to even things like preschool, and that kind of stuff that impact a lot of these kinds of questions. From your perspective, what kinds of work do you end up accommodating for when these kinds of disparities show up?
Barbara Stroud 26:23
Well, it’s being poor in this country is pretty devastating. And children who in poverty have poor outcomes across the board. And there’s inequity in turn, there’s so much inequity, I mean, there’s inequity in terms of hiring practices and pay structure, you know, I’m a black women, black women make 58 cents for every dollar that a white male makes. So there’s, you know, there’s all these other structures of inequity that also keep poverty nested in certain groups. So you know, we have to think about that as well. The other thing, too, is, I think there are some, I don’t want to get down too much of like social lens necessarily, but there’s some challenges for families, it’s hard to get out of poverty, you know, it can become a trap, your attempts to exit that can result in for example, you losing your WIC coupons, or your childcare stipend, and so on, and so on. So as you try to climb out of poverty, minimum wage won’t cover the resources that you’ve lost, because you are on some sort of subsidy. So it’s a bit of a trap, and it becomes very, very difficult for families. So I think, again, it’s admitting that it’s real, and helping families find their best method to move through that system, exit that system with our support.
Katie Vernoy 27:36
I think the big piece of this is, and this was stuff that I think I learned from you and other colleagues at the clinic is that there are assumptions that folks who have not lived in poverty or who have not engaged in poverty communities and communities that are overcome by poverty, that they make assumptions of the amount of time that can be spent, or the types of resources that families have available. And I think what you’re talking about is that there’s just a reality there. And that’s part of navigating this. I mean, to me, it seems like it’s hard to feel hopeful, and kind of do that parallel process of holding the space for this really huge systemic issue while then these caregivers who potentially don’t have much they have the the 45 minute session, and maybe another hour, one other day this week, that they’re not working their two jobs to really be present for their child. How, as clinicians, can we help families navigate this? How do we hold hope for ourselves that can then hold hope for our clients?
Barbara Stroud 28:38
I hear you and it’s very, it can be overwhelming that that’s the parallel process moving up towards us holding that tension and hopelessness that our families are holding, and I get it. And yes, we have families working two jobs and single parents working two jobs and taking the bus to get to our work thing about to get to our office and being on like an hour bus ride both ways, you know, the commitment to getting insured service, right? And many times they’ll look at us providers and say you do it because you have a doctorate or that the Marriage and Family Therapist degree or you know, you’re the professional, you do it, you’re smarter than me, you fix my child. And so when we sort of say you have the authority to do it, that can what, what me do one more thing. So what I try to do with families in that situation is make one change in their system. You know, I know there’s a lot going on in your day, and I want you to think about one thing you can do. Can you and I usually think about a meal together or bedtime. Can you all sit down and have dinner together. And some families can and some can’t, because one of the parents might be working till 9 and so I want you to spend that time to talk to each other. Share your day. You know, people talk about their roses and thorns. Just have a conversation with your children during that moment. And if they can’t do a meal together, have a bedtime routine, not a bedtime time because I know many of my families who are struggling with who are overburdened we refer to them as overburden. There’s just too much happening. There’s not enough resources. Because I can’t always have a bedtime, but you can have a ritual, what are the things you do before bed. And it doesn’t have to be a story because I’ve had parents who can’t read, it can be a tickle game, it can be a song that you love to sing. But the point is, there’s some predictability and consistency. That’s an anchor. Predictability is an anchor for families for whom there’s a lot of chaos. I know that when I get home, my family and have dinner together, regardless of all the other things that have been happening in my life. I know that before I go to bed, I will get five minutes with my dad, my mom, my mom, my mom to sit and say prayers together, if that’s important to you. Find one ritual that you can support every day with your child. That’s the first thing. And these interventions don’t have to be something that you stop and sit down and special time and play for three hours for 30 minutes with your kid. I know there are interventions that talk about special time and I support that, I’m not saying that’s a bad thing, when you have six children, and you’re working two jobs is very hard to find 30 minutes of special time. So you know, we just have to be realistic.
Katie Vernoy 30:59
Yeah.
Barbara Stroud 31:00
However, you can put on shoes and make that an everyday activity, you can sort of say, Oh, my God, look at your toes, 1234. But in on goes your shoes. So take everyday moments, things that you have to do hair combing, oh, my goodness, hair combing all you guys out there, Google Marva Lewis, Dr. Marva Lewis, she’s done some wonderful research around hair combing as a nurturing activity to support attachment. Better yet, I have a video on my YouTube channel about Marva. But hair coming, this is something you already do with your children, this is a moment you can facilitate attachment with your child. So we can take everyday tasks and turn them into not just nurturing moments, but therapeutic moments, Ah! I’m gonna say that, again, take a nurturing tasks that parents have to do already, it’s already something they’re going to do and turn it into a therapeutic moment.
Curt Widhalm 31:46
I love that. And sitting here reflecting back on some of the moments that I had with my own kids when they were in that zero to five age and also some of the moments that were missed, and just kind of like, Oh, these were things that my now middle aged children do reflect back on as far as like, oh, yeah, I remember doing this with mom, or I remember doing this with dad, that still does bring a lot of this to life. I have the benefit of having my own kids. And I know for a lot of clinicians who don’t that this ends up becoming a barrier to working, especially with very young kids that, you know, I would look at providers for my own kids like, what do you know about being a parent. Like what do you know about sleepless nights and all of this kind of stuff? For some of our especially early career clinicians who might not have their own kids? Do you have special advice for them?
Barbara Stroud 32:39
I certainly do. Here we go, I’m going to help you. You know, you’re right. I have not had the gift or the opportunity, whatever you want to say, to have my own children. And I do know that every child is different. And every parenting journey is unique. Your story is your story. I’m here to understand, I’m here to offer compassion, I’m here to help. But no, I will never know your story, even if I was a parent. And to me, that’s true. Because if you have more than one child, you did not parent them all of them, I only have one child if you did not parent them all the same. Because because there’s a relational interaction, and that is unique to that child. I believe your spouse, your co parent parented differently than you did. So parenting is it’s a very individual journey, just like psychotherapy is an individual journey. So we’re going to co create the parenting story that works for you and your child at this developmental moment. And remember, that story is evolving.
Katie Vernoy 33:36
What else do we need to talk about that we’ve missed so far? Because I think there’s so many questions I could probably add, but I know that there’s we’re running low on time, and I’d love to make sure we we’ve hit all the main points.
Barbara Stroud 33:47
You know, I think the last thing I want to say I think we’ve hit the main points. The last thing I want to say to your clinicians, and it’s going to sound a little bit cheesy, but I think it ultimately is true. Love your kids. Love your kids in the mess. Love your kids in the stress. Take care of your stress response so that you can be emotionally available for your kids. You will not go wrong. If at the end of the day your kids know that they were madly loved by you.
Curt Widhalm 34:16
Where can people find out more about you and your work?
Barbara Stroud 34:21
drbarbarastroud.com Dr. Barbara Stroud, S T R O U D website, you can go there, you can stalk me on Facebook, Instagram, LinkedIn, I’m on all of those. I also have a YouTube channel which is Dr. Barber Stroud. There’s a lot of great free videos on there for you to take a look at please go and watch all of those things. So I’m pretty easy to find.
Curt Widhalm 34:42
And we will include links to all of those in our show notes. You can find those over at mtsgpodcast.com. Follow us on our social media come and continue the conversation in our Facebook group the Modern Therapists group. And if you liked the content and want to support the show, please become a Patreon patron or support us through Buy Me a Coffee. And until next time, I’m Curt Widhalm, with Katie Vernoy and Dr. Barbara Stroud.
Katie Vernoy 35:07
Thanks again to our sponsor Thrizer.
Curt Widhalm 35:10
Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinician should earn what they are worth. Every time you bill a client through Thrizer an insurance claim is automatically generated and sent directly to the clients insurance. From there Thrizer provides concierge support to ensure clients get their reimbursement quickly and directly into their bank account. By eliminating reimbursement by cheque confusion around benefits and obscurity with reimbursement status. They allow your clients to focus on what actually matters rather than worrying about their money. It is very quick and easy to get set up and it works great with EHR systems.
Katie Vernoy 35:50
Their team is super helpful and responsive and the founder is actually a longtime therapy client who grew frustrated with his reimbursement times. Thrizer let you become more accessible while remaining in complete control of your practice. Better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free. You will get one month of no payment processing fees meaning you earn 100% of your cash right during that time.
Curt Widhalm 36:24
Once again, sign up at bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free.
Announcer 36:35
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