Nicholas Bakalar in the New York Times Well blog reports that a randomized study of 84 adults with short-term back pain shows that there is no statistical significance in reduction of leg and back pain when comparing steroid injections, an arthritis medicine, and a placebo. “The researchers conclude that steroids may provide some short-term analgesic effect, but that the improvement in all of the patients was mainly due to normal healing.”
It has been just over a year since US Congress Representative Gabrielle Giffords experienced a traumatic brain injury as a result of a shooting in Tucson, AZ. While Traumatic Brain Injury (TBI) is now estimated to affect over 1.5 million Americans each year, with many of those wounded from the Iraq and Afghanistan wars, Giffords case has helped shed some new light on the way the media is focusing on TBI.
A variety of stories were in the media after the January 2011 shooting focusing on Giffords recovery, sometimes quoted as “remarkable.” Her yearlong treatment has come through a mixture of the services of Memorial Hermann Medical Center in Houston, home based therapy, and an intensive therapy program based in Ashville, NC. These programs involved traditional therapy approaches common after a TBI such as occupational, physical, & speech therapy, as well as music and animal based therapy programs. Approximately 4 months after Giffords injury, her doctors placed her in the top 5th percentile for patients recovering from similar injuries.
At a recent vigil to honor the other victims of the Tucson shooting, which killed 6 and left 12 others injured, Gabrielle Giffords recited the Pledge of Allegiance in front of hundreds of people, as they quietly chanted “Gabby, Gabby” in encouragement. In a CBS interview with Diane Sawyer she was asked about her intentions to run for reelection this fall; her reply indicated that she will continue to focus on her recovery. In other interviews her husband, Captain Kelly, has been attributed to saying that some days he thinks she could do it; other days it seems it would just be too much.
Giffords’s ordeal has contributed to an already growing awareness about the need for treatment after experiencing a TBI. Many of the stories over 2011 have pointed out that most individuals do not have access to the same type of intensive recovery program as Giffords. While research in recent years has proved that these treatment programs are valuable in recovery after a TBI, insurance companies still rarely cover these services. “Cognitive rehabilitation services designed to improve cognitive functioning after a brain injury are not supported by reliable scientific evidence of efficacy,” according to a 2008 Tricare coverage manual.
Other aspects of recovery after TBI have been exemplified in the media using Giffords as a model, such as the effects of TBI on marriage, returning to work after a TBI, and generalizations made of persons who have experienced TBI.
While the January 2011 shooting was an awful tragedy which affects the lives of many, a positive side has emerged out of it; more people are becoming aware of how seriously TBI affects not just an individual but a family. Giffords case represents that having more programs to intensely focus on an individual’s recovery yields positive results, and that better funding gives more people hope that they will be able to return to a better quality of life after TBI. Hopefully Giffords example can continue to shed light on how TBI affects so many people each year, and can continue to push for better programs and funding for recovery.
In the early 21st century, when American children reach late adolescence, parents have little control and children often don’t have sufficient self-control. In the responsibility vacuum between late adolescence and early adulthood, problems develop that are a symptom of the absence of intention, living life with a focus and purpose. Most young people grow into intentional adults, but to the degree the transition is prolonged, the parent suffers and is at financial and emotional risk. Too often, the parent and child get locked into their relationship and retard each other’s growth so that the child enters adulthood scarred and misdirected, with the most important relationship available to him/her seriously strained, if it exists at all.
Parental Coaching is based on motivational interviewing and health coaching, two related methods that are effective in bringing about behavior change in people who are recalcitrant to change.
Parental Coaching uses the emerging rationality of the child to identify and develop discrepancies between what the child wants and what is naturally available in society. It takes advantage of this discrepancy and the child’s need to become competent as an adult. The need to become competent is best addressed by the child’s setting and working toward goals, with the parent as a coach.
The goal of Parental Coaching is to complete the job of inculcating the parent’s value system in the child as an emerging adult. It takes advantage of the earlier value training that is there if you look for it and causes the immature behavior in an adult body to be a source of shame and embarrassment for the child.
Parental Coaching helps to create a rite of passage that didn’t used to be necessary because American children’s ascent into adulthood was much more abrupt. Given the contemporary culture, American parents now need to facilitate a change in the Parent-Child relationship as adulthood looms. If the parent can preserve the inherent value in the relationship while stepping out of the earlier parental role to become a coach to their emerging adult-child, the parent continues to be a valued and influential ally. If the adult-child can allow the adult-parent to be coach, the transition into adulthood will be faster and more consistent with the family’s values and a healthy adult-to-adult relationship will emerge.
Parental Coaching begins with a parental attempt to increase the child’s awareness of the costs of immature behavior in an adult body with the parent doing non-judgmental asking rather than judgmental lecturing. This is a difficult step for most parents, especially when the parent has had several dramatic examples of immature behavior in an adult body that have already been handled judgmentally. Often, a professional counselor or relative such as a caring uncle or aunt will need to help model this for both parent and child.
Parental Coaching requires a different emphasis on the age-old parental question, “What the hell were you thinking!?” The question still needs to be asked because it marks the moment and makes absolutely clear the parent’s value system, which remains the bedrock of the child’s, though this seems to be covered up and sometimes invisible. But the question needs to be asked as if it actually is a question, rather than a more sophisticated way of spanking the child for the immature behavior in an adult body.
Parental Coaching is always focused on considering choices broadly and then choosing that which reflects the family’s values and then sticking with the choice in spite of pressures to abandon the earlier intention and acquiesce to peer pressure or laziness.
Through Parental Coaching the child becomes increasingly motivated to achieve a future that requires acquiescence to some semblance of the family’s values because that makes available the rich resources that are only available within the family. Parental Coaching helps children:
Used by professional therapists, motivational interviewing is non-judgmental, non-confrontational and non-adversarial, which won’t work for most parent-child relationships. Parents are naturally judgmental and must at times be confrontational and adversarial. Parental Coaching takes advantage of this by offering the child an opportunity to adjust the parent-child relationship, if the parent is willing to say, “I can help you become a healthy and happy adult if you can be honest with me and yourself about the choices you’re making. I’ll support those that I understand and will give you the benefit of the doubt for those I don’t understand as long as you are honest with me and yourself.”
Parental Coaching takes advantage of the natural ambivalence and sense of inadequacy that the child has about behavioral change focused on a life of competence and independence sought-for by the child.
The parent helps the child take responsibility for emerging independence by setting goals and identifying resources and threats. During this stage of the relationship, the parent and child enter into an “accountability partnership” focused on the child’s valued future. Here is an example of the December 18, 2006 Career Goal List of a 21-year-old, with her career goal statements presented from most important to least important:
Here is her Goal List on July 29, 2008:
Here is her Goal List on October 15, 2009:
The continuing development of this young woman as an adult is expressed through her goal statements, which are increasingly reflecting her parents’ values.
Parental Coaching uses the natural empathy of the parent for the child to develop better communication about the child’s perspective in order to identify the discrepancies between where the child is and where the child wants to go.
The natural resistance to change that will be demonstrated by the child is accepted and new behaviors are encouraged through understanding. Nobody really wants to change themselves, we all want our circumstances to change so that we can be happier without having to change. Resistance to change is natural and needs to become less important to the parent; the naturally developing needs and abilities of the child will instigate change. The child has an urge to become competent, develop self-efficacy, and establish independence that we can trust and foster.
NOTE: This is an updated version of “Parental Coaching: Transitioning from Adolescent to Adult”, published on October 21, 2009. The original post is no longer available.
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