Good afternoon. Thank you for joining us today for the third webinar in our Unlock Emotional Healing with Springer Publishing's EMDR webinars. My name is Lee Montville and I'm the Director of Special Sales and Business Development at Springer Publishing. Today we are presenting a contemporary approach.
to treating school refusal behavior in children and adolescents with EMDR therapy in 2024 with Carolyn Settle. Carolyn has over 44 years of experience working with children, adolescents, and adults who have experienced abuse, trauma, and or loss. She is an EMDR International Association approved consultant and an EMDR Institute trainer.
Before we get started, I wanted to mention that this webinar is being recorded, and if you miss any portion of the presentation, you can find the video on springerpub.com, five to seven business days post-event. If you have any questions today during the webinar, please type them into the Q&A box on your Zoom control panel. I'll bring them up at the end of the presentation. And if you forget... to ask a question, there'll be a brief survey sent at the end of the webinar, and you can include your question there.
Now, without further ado, we will turn the time over to Carolyn. Welcome, everybody. I am so excited to be able to present this information to you in the webinar today. This is a really important topic. And I know many of you may be struggling with this with your clients.
I have over the years worked with a lot of kiddos that have struggled with school refusal behavior. I've been a clinical social worker here in sunny Scottsdale for 45 years. And back in the day, you know, we used to call it truancy.
But over the years, working with school refusal behavior has always been a consistent theme with some of the populations of my, some of my kiddos that I work with. And since the pandemic, this has surged unbelievably. So I know when I'm doing consultation, a lot of my child therapists that I'm working with are struggling with this issue.
So I really want to... kind of give you a great overview and how I utilize EMDR in this process. So we're going to be talking about how to look at school refusal behavior and look at the potential causes. We're going to talk about evidence-based interventions for kids from 4 to 18. And then we're going to talk about strategies for using a multimodal approach.
in identifying and assessing what the actual causes are and then how to effectively treat school refusal behaviors. And we're wanting to do that so that our child clients really are achieving good mental and social well-being and academic success. And school refusal behavior remains a really complex issue. there's been a growing recognition of the role of trauma and anxiety and contributing to school avoidance.
And so that's where EMDR comes in. And that's a real boon to working with kids. And I've really found this to be super helpful in the 26 years that I've begun using EMDR therapy with all of my clients, because I work with children, teens and adults.
But it's a powerful tool in addressing those underlying factors and supporting children and teens to overcome that school hesitancy and the refusal behavior. So let's get to it. So school avoidance and refusal behavior refers to that reluctance or refusal to attend school or a child having difficulty remaining in school for the full day. And that can cause significant problems for the... kids, for teens, for parents, and for educators.
As I mentioned earlier, school refusal behavior has existed long before the pandemic, but with the increase in concerns about COVID, with concerns about, you know, going back and forth between school and online, and then we have school shootings, all of this has amplified. school refusal and avoidance behaviors. So understanding school refusal behavior means that you as a therapist have to think about a variety of factors.
And that's including things like academic pressure, social stressors, family dynamics, along with all of the things that are happening globally and locally. Kids today are experiencing even more heightened sense of anxiety, trauma. and or adjustment difficulties and that's what is leading to avoidance behaviors and challenges in regular school attendance.
Over the years, you know, parents and educators and therapists have typically worked together to support students in struggling with regular school attendance. But as I mentioned, this has been a particular time of upheaval, isolation, loneliness for our kid clients, and just languishing. Kids, you know, when the pandemic hit, kids rapidly went from in-person school to online school, and they missed many significant landmark moments in their life. You know, things like sports and club activities, and in bigger celebrations like graduations and proms.
And now, most of the kids that I work with are excited about returning to the classroom. But many others are ambivalent, and they're resisting in-person school. And this is causing that surge in school refusal behavior.
The social isolation that many students have experienced has impacted them academically and socially. And that's led to that decline in self-esteem, self-confidence, and an increase in teen and child anxiety and depression. So left unrest, school refusal behavior can have real negative consequences for kids, both emotionally and socially in their development, as well as in their academic performance. School refusal behavior can be a manifestation of a variety of underlying factors.
And it is crucial and key for you as a therapist to understand what's going on for that child. And this is where you're looking at things like, you know, anxiety disorders, depression, family dysfunction, any academic difficulties. bullying and social anxiety and understanding that multifaceted nature of school refusal behavior will help you develop those effective interventions.
And don't forget, you know, some of our kiddos may be struggling with learning disabilities before this, the avoidance of school has occurred. There may be things going on at home, like conflict at home, substance abuse issues with parents, or you may have a parent that's just overprotective. All of those things can really affect how our child clients feel about going to school. And then, of course, with those...
diagnostic issues, you really want to make sure that you've done a thorough assessment of that because depression can affect that sense of hopelessness, low self-esteem, and just can impact their desire to get involved in activities. And then, of course, there's the super important issues of social and cultural issues. and gender identity issues that can really impact our child clients in terms of feeling discriminated against, bullied, intimidated, excluded, and marginalized.
So you want to be a detective here. A comprehensive assessment is essential. That's where you want to do interviews with a parent. as well as the child or teen. And you're going to be asking questions about the onset and the duration of the avoidance behavior.
Again, you're going to... do a good thorough middle status assessment, and then you also want to get information regarding their academic record and their school conduct. And then, as I mentioned before, evaluating those family dynamics and that social, cultural, sexual, gender aspect of it. Evidence-based interventions are that we all know about, we all use, and we want to integrate into this process. Things like cognitive behavioral therapy, relaxation training, family therapy, involving the family in the intervention process can really help improve communication, resolve any conflicts, and support.
both the child and the parent or guardian in this process of getting them back into school. Collaborating with school personnel is like super essential because you want them to be able to be somewhat flexible in implementing accommodations, modifying schedules, having academic support systems for them, and then providing individual education plans when it's needed. That can help facilitate a smooth transition to school for your kid client.
And occasionally, in the case where school refusal behavior is accommodated by severe anxiety or depression, then pharmacological interventions like SSRIs are worth considering along with a consultation with a psychiatrist. And these are some of these good therapist skills that we all need to have in all of our sessions with our clients. Those are those practical strategies.
That's, you know, having that supportive non-judgment environment where a child can feel comfortable talking to you about their fears about school. You want to encourage. regular communication between the parents and the school and with you as the therapist.
And then we want to implement a gradual integration plan of how to get the child to return to school at their own pace with gradual increases in attendance and the support that they need in that process. Providing opportunities for the kid to develop social connections and engaging with extracurricular activities that align with their interests and their strengths is really helpful and it's motivating for kids. And then monitoring the process and monitoring their progress and then adjusting those interventions whenever necessary based on their... their responses.
I always say just monitor and adjust, monitor and adjust. It's that fluidity, that flexibility that you need to maintain as a therapist. Okay, so EMDR therapy is one component of this process, of this multimodal approach. It's an integrative therapy and it integrates well with other therapies and interventions and strategies.
But here's the thing that EMDR can do that really no other interventions do, in my experience of being trained in lots of other modalities. EMDR can eliminate the school refusal anxiety and distress, and it can eliminate it completely, which is remarkable and super helpful. So EMG therapy offers a unique solution for clinicians to resolve the behavior by integrating it into family therapy, utilizing it with resource development, combining it with behavior modification, and then utilizing the strategies that I just talked about. So blending all of this together can create a really good plan. or getting your kiddo back into school on a regular basis.
The theoretical foundation of EMDR therapy was developed by Francine Shapiro, and it is rooted in the adaptive information processing model. This model posits that distressing experiences, when they occur, if they're inadequately processed, that's what leads to our clients'symptoms and behaviors and their maladaptive beliefs about themselves. So what EMDR is meant to do is to facilitate reprocessing any of these maladaptively stored beliefs and symptoms by addressing the traumatic memories that are associated with those negative beliefs and doing that through bilateral stimulation. Many of you may have heard of EMDR. Maybe you are EMDR therapists.
But. That's that dual attention of having them move and follow your fingers moving their eyes back and forth. It's not hypnosis.
Or you can do it with tapping back and forth. Or you can do it with sounds going back and forth. The result in this is an adaptive resolution and emotional healing for the child or teen.
In other words, it's lowering the client's anxiety. It's derousing them. And it's helping them access their executive functioning so that they can think about and incorporate successfully returning to the classroom and to eliminate that avoidance behavior.
So EMDR is based on eight phases. I'm just going to go over really quickly with you the first four. History taking is where. You're identifying the treatment goals that the client's presenting with, with their current symptoms and behaviors, and you're developing a treatment plan.
Preparation involves explaining EMDR to the client, demonstrating the mechanics of the bilateral stimulation, and making sure that your child, teen, or teen client is resourced and ready for reprocessing, that they're stable. And then the assessment phase is where... The target memory that's related to the current symptoms, this is where the therapist is activating that memory by asking questions to stimulate the memory, asking questions about the image they have associated with it, the negative thoughts and emotions and body sensations.
And then you do some baseline measurements. And you also have the client identify the positive belief, what they would like to believe. That's when desensitization starts, once you've activated that memory.
And that's where you combine that memory with the bilateral stimulation, with either the eye movements or tactilely or auditorily. And you process that event so it is no longer upsetting. In the installation phase, that's where you're checking that positive thought and making sure it still fits. And then installing that with the bilateral stimulation along with that desensitized memory. The body scan is where you're checking the positive cognition and making sure that there's no any residual tension in the body that might be related to a kind of a cognitive dissonance with that positive cognition.
And then closure, that's where you're just ending the session. containing anything that might be remaining, making sure that the client is ready to move out of the session, and then just letting them know what to expect in between sessions. Re-evaluation, that's where in the next session you're going to re-evaluate the work that you've done and assess where you're at now and make decisions based on the treatment plan.
When you're working with kiddos, EMDR is taught primarily with adults in mind, but with kiddos, you want to change up the language a little bit where it's more developmentally appropriate, especially for young kids. Oftentimes with young kids, too, you're using more expressive therapies like play therapy or art therapy, sand tray therapy, and there's all kinds of trainings that show you how you can incorporate that. There are books.
Embryo.org has a lot of really good information on how to do that. And then you want to be able to adjust the bilateral stimulation in creative ways with young kids. Like I have little finger puppets. Here's a little bunny that we go back and forth with for the young kids.
For older kids, you can just use your hands. And then, of course, you want to assess parental involvement when appropriate in the sessions. In history taking and treatment planning, This is where the therapist inquires about the specific aspects of the child's anxiety and their avoidance of school in a curious and non-judgmental way. Then you're going to explore with the parent their perceptions of the student's school avoidance and ask what methods that they've already tried to solve the problem. And then you'll want to know what has been helpful.
and what hasn't and then with that information you're also going to be listening for any possible secondary gains and then asking questions about um any residuals from the pandemic any kind of isolation issues grief and falling behind academically from an AIP perspective, the adaptive information processing model, the first order of business is figuring out what's contributing to the school hesitancy. And you do this by following the three-pronged approach of EMDR protocol. This is where you're exploring the student and parent, with the student and the parent, the past and the present school avoidance, and then what future apprehensions they might have.
Past events to think about are related to things like previous school avoidance behavior, any suspected obsessive compulsive disorder, social anxiety, academic failures, any kind of bullying, either in person or online, and other issues. that are affecting that school refusal behaviors. And they may have grief related to the pandemic, grief over loss of friends, activities, related illnesses, and even friends or families death.
So these potential targets may be feeding the current anxiety and may need to be addressed. When a student is not able to identify specific past experiences, then you can ask questions like, when you think about returning to school, how does your body feel now? And then asking them to float back to an earlier time that they might have felt that feeling in their body.
And then ask them, what do they notice? Then next, you want to identify... Any kinds of pleasant triggers that's related to the school hesitancy, things that the student might be experiencing that's causing anxiety. You know, things like seeing other teens, being worried about falling behind, feeling concerned about just going back into school or continuing in school. And any recent.
triggers for resisting school. And then you want to create a positive template for the future. What do they want to be?
How do they want to be? How do they want to think? And spending some time asking those questions. In the preparation phase, this is where the therapist is educating the client on anxiety and calming skills. You know, it's just anxiety.
Nobody died from anxiety. and teaching them the good mindfulness stuff that you do with all of your clients, right? This is also where you want to incorporate family therapy in terms of any secondary gains. You know, maybe the child has found that it's easier to stay home and avoid the challenges that they faced previously at school.
This might be true. If the student has struggled with social anxiety or OCD, Or it might be that the child is just escaping discomfort and vulnerability of growing up. Teens oftentimes experience that.
Or just that feeling of they just don't want to attempt anything harder academically or harder with the social structures and the struggles and the challenges that they might have. And many kids have just found that staying home is more comfortable, safer, and quiet. during the pandemic and that has become their go-to to avoid stress.
It's also important for you to look at and listen for with parents or caregivers, are they enabling the child to stay home by not having high enough expectations about returning to school, making it too easy to stay And maybe it's just easier for the parent to just ignore the problem and don't want to, you know, struggle with hustling the child out the door. And then, of course, many parents and caregivers are dealing with their own struggles and their own stress regarding work, home, and family, their own addictions, which make it overwhelming to deal with the child or teen. Sometimes you have a parent or... caregiver that is over-identifying with the child, where, you know, school is just too hard for them, or the expectations are too unreasonable for the child, and certainly you want to evaluate that.
But that's where you want to make some decisions about when to do more education, collaborate with the parent, and setting more firm explanations, expectations, creating meaningful rewards for achieving. um, little successes in getting back to school and, um, discouraging that avoidant behavior by removing the fun activities that are at home when they should be in school. And this is where you want to incorporate that behavior modification system where you're giving them meaningful rewards, small, meaningful rewards when they start to make, um, gains towards going back to school.
And so you're developing a strategy of little segments of success that they can have and small rewards leading to a bigger reward of when they're actually back in school. And then a possible roadblock for getting students back into school might be that lack of school involvement. That's when easing the school, easing them back into school.
The school personnel are really stretched to the max with all of the absenteeism with kiddos, resignations of educators. So reaching out to them is really important to fold them into this process. And then doing resource development and installation. And EMDR has some really lovely resourcing techniques that you can use. to strengthen and focus on positive qualities that the student already has, to build those up and reinforce those positive experiences and thinking to get them back into school.
The assessment phase is, for kids in school refusal, it's just the same as the standard EMDR therapy protocol. The only thing that might be different is the themes that you may hear from kiddos. Loneliness, social anxiety, bullying, shaming or judgment from teachers, parents, or peers. Any kind of sense of academic or social failures and any fears that they might have.
And these are some of the negative beliefs that you might hear from your child clients. And here are some possible positive things that you might be seeing. You know, something like I'm stupid.
A positive belief could be I can figure things out. Another one is no one cares. The positive is I matter.
This is a really common one. I can't handle this. A positive is I got this.
So these are the things that we're listening for so we can process out those negative beliefs. with the goal of achieving 100% whatever they've picked in terms of a positive belief that they would like to think and believe. The future template, this is where you're having them imagine a positive outcome. And then you want them to process through any anxiety that's related to that future experience.
Once you have processed out that small segment, then you're going to have them practice it in real life, go do it, and then reward any small positive change. And to... you know, label any difficulty, but it's only feedback.
It's not failure. It's just monitor and adjust, monitor and adjust. So here's a six-year-old. This is a case, and I always change things up so there's no identifiable information. But these are some of the areas that you're going to want to consider that I just presented, okay?
So this six-year-old was brought in for refusing to go to kindergarten after mom had been away to help a family member. The child was crying, refusing to get out of the car to school, and they had been going to school previously. They weren't sleeping at night, and they were having nightmares. After getting the history information, and one of the negative beliefs that that six-year-old had was, Mommy's not here. She might die.
I'm alone. With taking that information and exploring it further, it was clear, and the child even remembered some of this, that when they were three, mom had been in the hospital and was very ill. Dad was working a lot. And at that time, the kid was having a lot of tantrums and nightmares.
So that was something that we needed to process first before moving on to the present triggers. The future template was... They wanted to go to school by themselves. And so we processed the past. Then we processed the trip that mom took to take care of the family member.
And then we processed future things like the drive to school without crying. So that was a little future template that we did, imagining to go to school. And then I would have them in between sessions, just drive to school without crying.
and then they would get a little reward. Then the next session we would process getting out of the car to the teacher and without crying. And then we had walk to class with the teacher without crying.
What mom had tried previously is she tried staying in the classroom with the child, she tried walking the child themselves, tried having dad take them, but none of that had worked. An important aspect of this case was that I had noticed that mom was a particularly anxious person herself and she was, she kind of, I don't want to use baby the client, but the child had been very colicky as a baby, so she was overly anxious about how this child functioned today. So I just did that educating them about anxiety.
Nobody died from anxiety. Taught this six-year-old some tummy breathing, how to blow bubbles to make them more relaxed. And then I had some sessions with mom regarding her anxiety and coached her to be firmer. And then I actually did some collateral EMDR with mom on her anxiety around the colic, which helped tremendously.
Then when we did those little segments of reprocessing, we rewarded them with Ninja Turtle cards. the child with the extra video game. And then ultimately when they returned to school, they got a trip to an amusement park.
I also did some resourcing of the child was really good at T-Ball. So we resourced that. And then we got the teacher involved and we As I said, we just did those little reprocessing of the past, present, and future, and did some resourcing.
All right, so this is my 16-year-old. I'm going to zip through this really quickly, too. This kiddo was very upset about going back to school after the pandemic. He was just freaking out about going into class.
In the past... The client had already kind of been avoiding going to school before COVID. things that triggered him from the past is kids just looking at them, teachers asking questions, and they also were not doing their homework, so they weren't feeling prepared.
That client's negative bleep was, I don't like school, and I'm smarter than the teacher. And the future, what they wanted to do was to be able to go to school and walk around campus okay. That's what they said. So the future template was just going to school and walking around. We process the future.
So we process the past, kids looking at them, and teachers, incidents of teachers asking them questions. Then when we move to the future, we imagine them walking to school and reprocessed any anxiety around that. And then we had the kid practice that.
And then we would reward the child. And then one of the things that we did to address that secondary game component, the parents had been allowing the kiddo to just play video games when he was supposed to be at school and not having them do homework. So we addressed that where they had to do chores at home. I did the anxiety and I taught him about the call map, which they liked very much.
I had family therapy where video games were not allowed during school time and that the client was supposed to do homework and chores. And worked with the parents on being firmer and then addressing mom's enabling of him like, well, maybe he's too smart for the school. and just encouraging her to nudge him forward. And we addressed her anxiety around doing that.
And then we built in some little rewards, like going to the science museum. And ultimately, he was able to earn a graphic design software. We did some resourcing around successes that he'd actually had, like he got some acknowledgement at a science fair and time spent with a friend. And then we worked. with the school to get the school counselor to meet with them on a regular basis and set up having the counselor there on a few of the early times of getting back to school.
So school refusal behavior, as you know, every client is unique. It's a very complex issue and it requires that comprehensive multidisciplinary approach for an effective intervention. by understanding those underlying causes and conducting those thorough assessments, that you can truly help your kids overcome that school refusal behavior and have that academic success and achieve that mental well-being.
And that's all through your knowledge and skill and support and also your connection. attunement and flexibility in this process. So EMDR really offers that holistic integrative framework for supporting our kiddos in dealing with that school avoidance, school hesitancy, and refusal. And so using EMDR in this process and blending it and integrating with all these different ways.
different components of therapeutic interventions can really help move our clients towards a more positive future. That encouragement really gives them a sense of empowerment and working through this really helps build our clients resiliency. Okay. We have questions.
Yes. Yes. Thank you so much, Carolyn. And thank you everybody for for joining and obviously for all your questions. So the first question we have today is from Lauren.
Lauren was wondering what strategies would you employ to re-engage the student when you have an incomplete processing and have to resume at the next session? Have you found that re-engaging younger children when the reprocessing resumes does not always go smoothly? That can happen for sure. One of the things that I would want to know is how they were, how they felt after the session.
I would be asking the child that as well as the parent caregiver. And I would want to be looking for were they overwhelmed in that process. Oftentimes with young kids, you can't fully tell. They don't really show emotion during processing.
So finding out if somehow or another that was overwhelming for them. For young kids, sometimes they just like to play. So bribery can be involved. And that's where you're saying, okay, if you don't feel like they're super, have been super overwhelmed or you need to do some containment from the last session, then you can say, well, let's do a little bit more of the processing. And then let's do some play.
Let's play with Connects 4 or all of those nice things that we do with our kiddo clients. And sometimes kids just sort of, sometimes I pace it where we do processing. We do a different kind of form of therapy the next session, and then we do some processing.
So it's staying in the dance to keep them engaged in that process, but figuring it out. is really helpful. Sometimes you don't figure it out right away. Hopefully that's helpful.
That's great. The next question was from Jennifer, and she asked, do you have any tips for kids who started school in the middle of the pandemic and did not have school experience prior to the pandemic? Yes, isn't that a problem, right? Again, what guides should be guiding us in all of our thought processes, that AIP perspective.
So for some kids, that may not be an issue. You're like, who cares? Doesn't matter to me.
Other kids, that's sort of an issue for and causes them anxiety. So you want to know what's the negative belief associated with that or negative thought, like I miss something or I'm dumber than the other kids. And for other kids, it just might be. that they're academically behind and socially behind. And that's where you need to see if there's ways of folding in more experiences socially or academically so they can feel like they are more up to speed.
And it's a combination of, could be a combination of all of those three. Excellent. The next question is... Melissa says, I work in a location where physical or actual rewards or incentives such as small gifts are not allowed. Many of my clients are very low income.
What type of rewards do you suggest that don't have a monetary value? Yes. So, you know, there's always the three areas of resources, material, which is monetary, right? social and privileges.
So relying on those two areas, social rewards and privileges are really helpful. And so it can be things like social things could be, mom will play bingo with you tonight. Or do you get dad's attention for 15 minutes all to yourself with none of the other siblings.
You could stay up an extra, privileges are like staying up an extra 15 minutes, watching a special show, or picking where the family goes for a meal, or picking the family's dessert. Like when my kids were young, their reward was that they would pick would be going to Wendy's for dinner. We ate at Wendy's a lot on Saturday.
So finding something that is in that social or privilege. reward. Excellent.
The next question we had was from somebody named Anonymous. What about teens that don't provide trigger for school refusal and shut down whenever the topic of school is brought up? It has been extremely challenging to provide treatment when the client does not provide the information but refuses to attend school. Right. So it sounds like this question is coming from somebody who understands EMJAR as an EMJAR therapist.
what I would explore is there's probably a blocking belief in there. And oftentimes you may need to process through that blocking belief, which is I can't handle talking about not going to school. It's too emotional.
Feelings are not good. I might be judged if I tell you what's going on. So it may take a little bit of finessing, but figuring out what... is the blocking belief that won't even allow them to discuss this.
Great. The next question we had is from Joshua. How long do sessions tend to last? Is there a set amount of sessions that insurance typically allow?
Well, I certainly can't speak to insurance companies. Because it's such a wide range, right? You know, over the years, I don't, I don't, fortunately for me, don't take insurance anymore.
I'm a fee for basis, but I did for many years. And so, like, when I worked with the EAPs, I only had six sessions, whereas others would allow 10 sessions and 20 sessions. So you want to work within the timeframe that you know that you are given.
And then you want to... narrow down your focus. Sometimes you have to just focus on present triggers, not go to the past because you don't have enough time. And you know that maybe you're not completely resolving it out, but that you're at least making some progress in that area. And I think the other part of the question is how long are the sessions?
So again, many people have, you know, the 45 minute hour, the 50 minute hour. So, you know, you go what you have. Right.
For young kids, very young kids, oftentimes they process in 10 to 15 minutes. With older kids and teens, they may take longer. And depending on the processing, you know, you may need two or three or four or five reprocessing sessions to address the past, the present and then the future. So hopefully that gives you somewhat of a framework. Thank you.
That was very helpful. The next question is from Caden. Caden asks, how can we support parents who are frustrated with their kids for not going to school?
I have a mom who struggles to set boundaries because the child is very sensitive, but is feeling very frustrated. She is feeling very frustrated with him. And I see him internalizing it.
Right. Well, you know, and it is frustrating for our parents. clients, right?
So that's where your rapport with the parent is so important and being supportive in that process and finding a way in to help build for them that sense of your child is struggling and in pain and tapping into that so that they can have that more patient aspect of it. Then there might be other things going on for the parent as well, right? What's going on in the home?
What's causing them to be so frustrated? You know, are they dealing with work issues themselves? Are there things that you can help strategize with them on? And then, of course, our parents have their own triggers, right? So are there things the child is doing that reminds them of themselves, that reminds them of their own childhood?
And if it really becomes a huge problem, that's where you may need to refer out to have them. get their own EMDR therapy and support. And, or like I said, do maybe sometimes I'll do collateral EMDR therapy where it's just focused where the parent isn't my client, but we're just focusing like on the frustration and processing that out.
Wonderful. We have a couple more questions, Carolyn. Thanks again for taking the time to answer all these questions. I love these questions.
Um, Christina asked, or Christina said, She would love to learn more about how secondary gains can play into school avoidance. She has a 12-year-old that has missed 47 days of school, about 21 of them with doctor's notes. The ailments have been varied, usually respiratory. Wow.
So they're getting the doctor in on, and of course. We, as therapists, need to also respect what the doctor is saying. So, you know, there may be a real physical component to that.
But I'm assuming since you're asking that question, you sort of... have kind of ruled that out, but I want to reinforce, you know, our respect for what the doctor is saying as well. And that's where you can also target and process any kind of medical illness or injury or trauma that they may be having. And obviously you can't get rid of an illness, but you can reduce the anxiety that is related to an illness. And there's a...
whole protocol on working with medical illnesses and injury. So I encourage you, you can go on the EMDR website and look up some of the workshops. Certainly the EMDR Institute teaches that protocol if you've ever gotten their basic EMDR training.
And that's a really helpful protocol to know. And I obviously can't teach you in two minutes here. Bye. Thank you, Carolyn. And we've provided, just so everybody knows, we've provided the links to EMDR or EMDRIA and the EMDR Institute and to Carolyn's own website, personal website in the chat.
So, Carolyn, we have a couple more. Let me get the next one was from Diana. Diana asked any tips to pass along to a parent for a child, six year old, who does well in school, no negative comments from teachers. But the mornings before school, the child refuses to get ready into the car or out of the car for school.
And that is exactly what I was just talking about. You know, that's where my, you know, six-year-old client was at. So something's going on for that child.
And so that's where... as child therapists being really patient and seeing if we can find out what it is that's going on for that child that they are resisting going to school, that they're avoiding it. There's something going on for them that we need to tease out. And sometimes it's weird things we don't even really think about for a six-year-old, sometimes having them draw a picture of actually going, you know, well, when you think about going to school, what's the bad thought?
Draw me a picture of that. What's the good thought? What do you want to think? Or have them acted out in play with you or doing a sand tray exercise.
And what I would say is spending some time figuring out what that is. And even if it's a word or two that you can get from the child, that's something that you can use as a target to process out. You guys are asking great questions. Yeah.
And I promise it's just a couple more. Mary asked, quite a few of my adolescent patients often cannot identify a touchstone memory of why they got the disturbance of going to school. I will often have them process for the physical disturbance of the thought of going to school.
It works, but takes longer when not having a specific event target. Any suggestions on a better way to work with this? I mean, I think you're doing a beautiful job with that, and it might take longer.
The simple question is, and they usually can answer this, it's like, well, when's the first time you remember it happening? And maybe it was last week, or maybe it was the beginning of the school year. So you may not have to go back far, far, far.
But as far as they remember, you can only do what you can do. And indeed, the next step with that is, you know, where do they feel that in their body? Is there a sound associated with it?
Is there a smell associated with, you know, going with that tactile component of it and reprocess? And yeah, it might take you a little bit longer, but it sounds like you're doing what you need to do. Carolyn, we just have two more questions, but if you can move to the last slide so that people can see about ordering your book, because several people have asked about ordering a single copy of the book. So there's information there. But let me get back to the questions.
So Hassen Chun said, thank you, Carolyn. Do you have any resources, books, psychoeducational material for parents about truancy? and or school refusal?
That is a really good question. I, off the top of my head, I do not have that. You know, like even for this presentation, and I've written an article about this as well, is I put in Google Scholar. I use that all the time. You just bring it up, Google Scholar, you put in what you want, EMGR or whatever, school refusal behavior explanations for parents.
And you'll get great research on that that's really helpful. So I do encourage you to look that up. I don't have anything. specific to school refusal behavior.
I thought you were going to ask about explaining EMDR. And in Robbie Tapia, Robbie Adler Tapia and my book that we co-authored, this is our third edition here. In this book, we have a brochure in it that's meant for clinicians to copy, print up, and use as a brochure to give to parents. explaining EMDR therapy. So that's what I thought you were going to ask.
Google Scholar is your friend if you want information on anything, really. Sure. And then also people can always look at springerpub.com. And we have all of our EMDR titles available there. So there may be some applicable titles there as well.
So the next question is from Cadence, who asks, and you've alluded to this already a little bit, but... Cadence asks, how can we support parents who are feeling frustrated with the child refusing school? I'm working with a sensitive kid who's been bullied and his mother is visibly frustrated, which he's internalizing.
Right, right. You know, and that's where maybe even having a separate session with the parent is really helpful just to let them vent and to be listening for. what's going on for them. So you want to provide them with some support and then figuring out what is getting triggered for them because they're being triggered.
That's what that is. If they're frustrated and what is happening with them in their day-to-day life, as well as what's being triggered for them internally. And then you can make appropriate recommendations based on that information. And the last thing I wanted to bring up was Maureen.
just made a comment. She said, you made the multimodal approach very interesting for me. Thank you so much. So I thought I would share her comment.
So we appreciate, Maureen, your kind words. So it looks like we've covered all of our questions, Carolyn. And we want to thank everyone who has spent time with us today. And thank you again to Carolyn, of course, for an amazing presentation. As you can see here, if you're interested in purchasing the book, EMDR and the Art of Psychotherapy with Children, third edition, you can receive 25% discount code using webinar24 at checkout on springerpub.com.
If people have questions about bulk purchases, I put my information in the chat. It's Lee Montville, L. Montville at springerpub.com. So we also wanted to let you know that all of you will receive the recorded session. and it will be available on springerpub.com within five to seven days.
So feel free to share this with people. And we want to wish everyone a great afternoon, and please stay tuned and look forward to joining us for future Springer Publishing webinars. Thanks again, Carolyn, and have a wonderful afternoon, everybody.
Thank you. Take care.