Therapeutic Interventions

1. Meet with the family as a whole to observe and assess the family dynamics that may contribute to the child's negative attention-seeking behavior.

2. Explain to the parents and/or the family as a whole that some children and adults seek attention through misbehavior because they lack the skills to acquire necessary recognition using positive strategies and behavior.

3. Assign the parents to read literature that explains negative attention-seeking behavior (e.g.,

2. Arrange for testing to identify causes for low self-esteem in the attention-seeking child. (5, 6)

3. Use reflective listening techniques with the attention-seeking child to encourage expression of feelings and opinions concerning unmet needs for recognition. (7, 8)

Children: The Challenge by Dreikurs and Stoltz or Raising a Responsible Child by Dinkmeyer and McKay).

4. Refer the parents to a class that focuses on helping children develop self-confidence and responsible behavior (e.g., Systematic Training for Effective Parenting (STEP) by Dinkmeyer and McKay or The Parent Talk System: The Language of Responsible Parenting by Moorman and Knapp).

5. Administer a normed, self-reporting assessment scale to the child (e.g., The Coopersmith Self- Esteem Inventory or The Youth Self-Report by Achenbach) to determine specific areas of social/ emotional concern.

6. Assist the parents to identify the child's current misperceptions that may be motivating inappropriate behavior according to Dreikurs' theory of misbehavior (see Children: The Challenge by Dreikurs).

7. Process the results from the child's self-assessment scales with the parents and the child to begin the task of reframing and building a more positive self-image in the child.

8. Help the parents to remain open and nondefensive when listening to the concerns of the attention-seeking child by teaching them the strategies of reflective listening (e.g., engaged listening without judgment as explained

4. Implement strategies for recognizing and reinforcing positive attempts to seek attention. (9, 10, 11)

5. Implement strategies for extinguishing negative attention-seeking behavior. (12, 13, 14)

in Parent Effectiveness Training by Gordon).

9. Instruct the parents to implement "special time," a short, 10 to 20 minutes, child-directed play activity between parent and child at least once a day (see When Your Child Craves Attention—A Parenting Strategy from

10. Ask the parents to brainstorm with the attention-seeking child various positive methods of seeking attention and recognition (e.g., complete homework, clean room, assist in a household chore).

11. Assign the parents to develop a plan with the attention-seeking child that satisfies the child's need for recognition using positive strategies (e.g., build a model car, learn to play the guitar) which involve an interactive activity between parent and child.

12. Use role play to help the parents prepare for ignoring negative behavior; emphasize that this behavior may escalate during initial attempts to ignore it; however, it will diminish as the result of consistent and sustained lack of reinforcement.

13. Instruct the parents to prepare the attention-seeking child for being ignored while engaging in negative behavior episodes by explaining to the child that positive behavior is the most successful method of gaining recognition.

6. Assist the attention-seeking child in developing and implementing positive strategies for gaining recognition. (15, 16)

7. Determine and list the individual strengths and special talents of each family member. (17, 18)

14. Assist the parents in listing their reactions that may be reinforcing negative attention-seeking behavior in their children (e.g., responding to whining, allowing tears to influence a decision). Help them to develop techniques that diffuse the negative attempts to gain recognition.

15. Meet with the attention-seeking child alone to explore any dynamics in the family situation and relationship with parents that may contribute to the need to gain attention in desperate ways.

16. Brainstorm positive statements of encouragement that the family members could use to affirm one another during the following week.

17. Discuss the theory of Multiple Intelligences with the parents (e.g., every person has unique abilities and talents in specific areas of functioning as explained in Intelligence Re-framed: Multiple Intelligences for the 21st Century by Gardner); indicate that recognizing and affirming these talents in their child is the key to the development of mature, appropriate behavior and healthy self-esteem.

18. Instruct the family members to brainstorm a list of the various strengths and abilities of each family member and to record the list in a family journal.

Implement strategies for affirming the talents of each family member. (19, 20)

Acknowledge the siblings' positive attempts to interact with the attention-seeking child. (21, 22)

Articulate, prioritize, and implement family values that emphasize empathy, inclusion, and appreciation. (23, 24)

19. Help the parents to develop and implement strategies for recognizing the personal strengths of their children and each other on a regular, ongoing schedule (e.g., verbally recognize accomplishments using the words, "I noticed that you . . . [fill in the personal strength]," discuss proud feelings within earshot of the child, write a note of affirmation and give it to the child).

20. Encourage the parents to acknowledge the accomplishments of the attention-seeking child and other family members by arranging a family celebration.

21. Instruct the parents to verbally express to the siblings their desire for family harmony and positive interaction among all family members.

22. Assign the parents to watch for positive sibling interaction and to acknowledge it verbally by saying, "that's cooperation" or "I'm seeing some real collaboration," or "It's so good to see you guys getting along well" when it occurs.

23. Assist the family in creating a family mission statement that lists all of the family's values and prioritizes the merits of inclusion, empathy, and appreciation of/for one another.

24. Instruct the parents to read stories and select movies and TV programs for the family that emphasize the values of family

11. Develop a family plan for mutual support and encouragement. (25, 26)

12. Implement strategies that encourage the attention-seeking child to become self-reliant, organized, and self-confident. (27, 28, 29)

cooperation, inclusion, and appreciation and encourage them to initiate a family discussion of how love and support was demonstrated in each case.

25. Ask each family member to list several personal jobs or obligations that would benefit from assistance from another family member (or assign the "Family Job Support Checklist" activity from the Parenting Skills Homework Planner by Knapp).

26. Instruct the family members to begin writing notes of appreciation for support and assistance in meeting personal challenges and monitor the notes written and received by the attention-seeking child to ensure participation in this process.

27. Request that the parents use the phrase "Act as if' to encourage the attention-seeking child to make an effort despite fear of failure (e.g., "Act as if you know how to draw that tree;" "Pretend you can jump rope;" "Play like you've done this before;" or "Fake it till you make it" when attempting to bake a cake). (See Parent Talk: Words That Empower, Words That Wound by Moorman).

28. Ask the parents to substitute the phrase "Next Time" for "don't" in order to shape positive future efforts from the attention-seeking child (e.g., "Next time you make your bed, make sure the sheets are flat and smooth,"

Attention-seeking child, siblings, and parents identify significant others who communicate love and care. (30, 31)

Keep a written record of all family members' progress toward engaging in positive attention-seeking behavior. (32, 33)

versus "Don't pull up the blankets when the sheets are such a wrinkled mess.") (See Parent Talk: Words That Empower, Words That Wound by Moorman.)

29. Encourage the parents to give age-appropriate chores and responsibilities to the attention-seeking child and to implement a consequence when the job is not completed satisfactorily and to use affirmations when the responsibility has been accomplished.

30. Ask the attention-seeking child to make a list of significant others and rate the degree of support given (or assign the "My Love and Trust Support Network" activity from the Parenting Skills Homework Planner by Knapp).

31. Assist the family members in writing a definition of unconditional love (e.g., complete and constant love given regardless of personal attributes, attitude, behavior, or performance) and list significant others who give their love unconditionally.

32. Instruct the family to create a family journal that will contain the family's counseling worksheets and serve as a record of progress and suggest that the attention-seeking child be the family secretary.

33. Help the parents to develop a chart that records the child's negative attention-seeking interactions compared to the

15. Model positive attention-seeking behavior for all family members. (34)

16. Engage in inclusive activities currently enjoyed by all family members. (35, 36)

17. Research additional options for positive family interaction and goal attainment. (37, 38)

number of positive attention-seeking interactions during the week and implement a reward each week when the positive interactions exceed the negative ones.

34. Ask the parents to review their own family interactions and identify those behaviors that model positive attention-seeking behavior and those that are negative examples to their children; encourage the parents to target one or two negative behaviors to be eliminated from their repertoire.

35. Brainstorm with the family a list of activities that are currently enjoyed and participated in by all family members.

36. Instruct the attention-seeking child to paste pictures of positive family interactions in the family journal.

37. Instruct family members to develop a plan for a major family project or quality time experience (e.g., family vacation, home project completion, visit to or from relatives) by choosing a specific activity and assigning each family member a specific task or responsibility to ensure its successful completion.

38. Each month assign one family member to assess the family's progress toward achieving its goals of empathy, inclusion, and mutual appreciation by writing a short paragraph or drawing a picture in the family journal.

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