Wednesday, May 23, 2012

Honey, I shrunk the kid

May 23, 2012

We had established a while ago that Mia is having a hard time adjusting to her brother being around and she is showing it in a rather loud and clear manner

Faced with what appears to be self-destructive behavior, we decided to seek some professional help. 

Dr. Raed Mohsen, a well respected expert in interpersonal communication with clinical social work practice and counseling experience, and who also happens to be a friend of the family had previously recommended a child psychologist for a friend of ours and so we figured, why not take that same advice ourselves.

A Lebanese-American friend who lived his entire life in the USA accused us of surely not being Lebanese as such approaches are unusual in our country.

But apparently, we are not the only non-Lebanese Lebanese since we had to wait for approximately a month before we could see Dr. Danielle Pichon! 

This is partly due to the fact that there are very few child psychologists in Lebanon and so the existing ones are in demand and end up overloaded.

Which is a good thing, I guess. We used to think seeking professional help was some sort of a taboo (unfortunately, it still is to some) but the fact that we had to wait for a month before we could see Dr. Pichon is a sign that parents are now aware of the importance of this field of study for their children's education, health and overall well-being.

I am pleased to report, the wait did not extend to the doctor's office as we sat for less than 10 minutes in the warm, colorful, and really beautiful office that served us as waiting room. I appreciate punctuality.

It was refreshing after Mia and I experienced the worst "waiting-time" ever just two days ago when we went for her very first visit to the eye doctor. Our appointment was at 1:45pm. We waited 2 hours before the doctor's assistant did the preliminary exam at 4pm! She gave us drops and we had to wait for another half hour for them to take effect. Mia was sound asleep by the time the doctor could finally examine her!

Actually, everything about Dr. Pichon's visit was as smooth as her punctuality. We found her office without difficulty: she is located in Tabaris, near St. Maroun Church where there is a public parking lot we can use. Then we simply exited that lot on foot, from the small gate at the back and found ourselves right in front of the building we were looking for. It is one of those old Beiruti structures, with no elevators and really high ceilings. Old, untouched and a little dusty. Absolutely gorgeous. Dr. Pichon is on the first floor. 

St. Maroun Church's parking lot
Photo: R. Abouzeid

I stood in front of her door for a moment, wondering if I had made a mistake as it looked like I was about to enter a nursery. Which I was. Dr. Pichon also runs an establishment for special needs children. She told me many parents were now aware of the chances early treatments provide and a large number of her patients end up admitted at regular schools and do surprisingly well following this preparatory time with her. I was in awe when she told me she was treating a one year old with epilepsy! That is how early on parents and their child can begin their journey of recovery and learning. 

I have to admit, the whole place projected a good, comfortable vibe. The rooms were colorful, in a tasteful manner and there was a "film" touch that totally won me over! Black and white framed photos of old classics were sitting on the walls. And Charlie Chaplin was hanging there with his puppet friends, smiling at us while we waited for Dr. Pichon. Mia absolutely loved them!

The Chaplin office
Photo: R. Abouzeid

But we did not have enough time to properly get acquainted with Charles as the nicest lady came over and promptly invited us to cross what appeared to be either a play area or a classroom and into another space where we sat around a table surrounded with bookshelves. She took out a notepad and white papers and crayons and we began our talk.

Dr. Pichon began with the standard questions, mainly "who" and "why" but made sure to look Mia in the eyes first, and let her know we were about to talk about her and even asked for her permission. Another significant detail I truly loved was that she took notes as if she were Mia. So basically, she wrote (in French) "I am Mia, I am a year and a half, I have a baby brother, his name is Jad" and so on and so forth.

And so we put all our cards on the table:

  • Mia is showing signs of jealousy since the arrival of her brother but because she cannot formulate that jealousy with words, she is expressing it with anger and by screaming
  • When she gets very angry she sometimes pulls her own hair, bites her hand or even poke her eye which Dr. Pichon noted as self-destructive behavior
  • She sucks her thumb since birth to express two specific needs: when she is hungry or sleepy but since the arrival of her brother, she also sucks her thumb when she sees us taking care of Jad (some sort of emotional compensation); Dr. Pichon noted it as "regression" although Mia never ended the behavior to go back to it but I guess it can be compared to that kind of "return" as it does fulfill the same type of emotional need (yes, I am being all shrinky myself)
  • Mia can associate words together and speak two-words (sometimes three-words) sentences
As we spoke, Dr. Pichon picked up a paper and a crayon and started drawing Mia, all the while describing what she was portraying: "This is Mia's head, and here is Mia's belly. Here is one leg. And here is a second leg. Look, Mia is wearing shoes. Here is one shoe. Let's draw a flower on it. Here is the second shoe and flower. Here is Mia's arm. And her hand with little fingers. Here is Mia's other arm, hand and finger. And here are Mia's eyes, her nose and her mouth. Here is Mia's ear and another ear. Mia has shiny earrings, here is one and here is the other. And here are Mia's beautiful curls on her head". 

Mia and Jad as per Dr. Pichon's drawing

When we brought up Jad's name for the first time, she also drew a little baby, next to big Mia also describing his body parts as she was drawing them and she ended with the funniest touch: she started to mimic a baby crying and asked Mia "Isn't it what Jad does? Jad cries all the time, no?"

It appears Mia was taken with her and she kept observing Dr. Pichon the whole time and finally picked up the crayon and tried her luck sketching... Something. God knows what was going on through her head at that time, and she may have been trying to draw Dr. Pichon's arm, head and legs too! ;)

At some point, she felt comfortable enough to leave my lap and started to move around the room and observing things. She even spoke a few times.

Speaking. That is the key word we got from that first session.

Our goal, Dr. Pichon said, is to encourage Mia to communicate her emotions verbally instead of screaming or hurting herself.

The first new habit to acquire is to identify a cushion or some soft toy she can use to vent. Whenever she gets frustrated, she can pick up that object and punch it as hard and as many times as she likes and verbalize her emotion by saying "Mia, not happy". It is important that she not only punches but also expresses herself with words. 

Then we should respond to these statements by asking "Why is Mia not happy?" and follow with hypothesis: "Is Mia not happy because Mommy is holding Jad?" "Is Mia not happy because Jad is crying?" "Would you like to go sit next to Jad?" "Let's go sit next to Jad" (only if she wants it of course).

When Mia starts to scream, another tip is to look at her in the eyes and mimic her, without the screaming. So in fact, we pretend that we are screaming, as if we are a mirror facing Mia. And we tell her to pretend with us. And we explain that we do not like screaming. Then we can go back to the first tip which is to take the "frustration object" and punch it while vocalizing the anger. 

We can also explain to Mia that we love her just the same. A good approach would be to draw a huge heart and start placing "dots" for each person we love. "Mommy Loves Mia" is one dot. "Mommy Loves Daddy", second dot. "Mommy Loves Grand-ma", third. "Mommy Loves Grand-pa", fourth. And "Mommy Loves Jad", fifth dot. And we point out how much space there is left. So many other dots can fit, so many other people can still be loved, and no one is stealing anyone's place/affection.

Mamma's Heart

Then we draw Mia's huge heart and we do the same. When we get to Jad's name, we explain "Mia does not have to love Jad. Whether you love Jad or not, Mommy loves Mia and Mommy loves Jad just the same. Do you want to draw a dot for Jad?" and depending on her response, we add the dot or not. It is important that she knows she is not forced to like her brother. And also, that no matter how she feels towards him, it does not change how we feel towards her.

Another noteworthy remark was that at Mia's age, children do not know yet how to be brats. There is no such thing as "spoiling" a baby despite what people might say. When Mia asks for a hug, a kiss or whatever sort of attention or affection, we should give it to her. She is not yet at an age when she can abuse that, on the contrary, she needs that sort of response from us.

So it recommended that when she is angry or throws a tantrum, to be firm when we would like to convey a certain message, especially "No" but still be kind and wrap up the message with a kiss or a hug, even if it does not end her crying.


That led us to discuss Time Out. Now, I know such punishment's duration is proportional to the child's age and that most probably at Mia's age, she cannot comprehend the concept of "consequence" and "penalty". Indeed, she is too young but Dr. Pichon advised to teach her punishment as an "end" to bad behavior rather than a consequence. So if she is doing something wrong, we can remove her physically from that situation and place her in the area reserved for Time Out, hold her firmly and speak the word "Time Out" then count to ten (not more) and move on. She will eventually learn that when she does something wrong, she will be stopped.

I took the opportunity of being there to also enquire about other issues such as potty training and nurseries. Basically, Mia is still too young and we have another six months ahead of us before she is ready to potty train, although she already knows her potty, what it is for and she sometimes sit on it. 

Two is also the appropriate age to enroll in a nursery. Dr. Pichon does not advise taking that step before that age except in unavoidable cases such as when both parents have to work. In our situation, she said it is even more constructive for Mia and Jad to grow up together and near each other at that early stage.  

Conclusion: We have three weeks before our follow up appointment when we will discuss the results of what has been implemented, mainly how Mia has progressed in communicating her frustration and anger with words rather than screams and/or self-desctructive behavior.

Mamma Mia

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  1. Hi,

    Thank you for your post.
    I noticed that lebanese parents are more open to the idea of consulting child psychologists.
    You hear this in conversations during birthday parties!
    But I don't know if many will write about it! ;)
    Thank you for your frankness.
    The topic of sibling jalousy is so delicate to deal with. Wait till your son will be jealous of your daughter!!!
    Have a good day :)

    1. Thanks Loulou! It is indeed very delicate and although Dr. Pichon gave some clear and effective guidelines, it's been very difficult to manage. But I guess it's only been a couple of days since that visit and we need a little more time to see how things unfold. Hoping for the best ;) And praying by the time Jad can express his jealousy with Mia, I'll be an expert on the subject. That is if I am not institutionalized first, obviously ;)

  2. Ben c'est plutôt vachement positif, tout ça!! Mais ça veut quand même dire que j'ai engueulé le Babouch pour rien, moi... :(

    (PS: c'est chiant pour laisser des comms, chez toi!!! faut qu'on règle ça!! je n'ai réussi qu'en mettant mon compte google associé à mon ancien vide-dressing... la lose!)

    1. Ouais j'au vu... Tu dois avoir un compte Google, LiveJournal, Wordpress, Typedpad, AIM ou OpenID mais avant tu pouvais poster en anonyme mais plus maintenant. C'est con ça et je sais pas comment le changer...

      Au fait, t'as un NOUVEAU vide-dressing???????? C'est quoi ce train de vie que tu mènes? :P

    2. Mais nan, j'ai juste changé la déco, quoi. C'est sur une plateforme dédiée aux sites type "commerciaux"....

      PS: le but n'est pas d'être anonymous, mais plutôt de pouvoir commenter en laissant un nom, un mail et éventuellement une adresse de blog/site internet... et je sais que c'est possible sur blogspot! reste plus qu'à fouiller les options. on s'y colle bientôt, si tu veux.

    3. Ah really? Oui, oui alors!!