When to Intervene

Timing is Everything: Effective Times to Intervene when Parenting

The Benjamin Franklin quote, “An ounce of prevention is worth a pound of cure,” should be the motto of parenting. No one ever regrets preventing a problem, though they may never know what disasters were averted. We remediate problems presented to us, though no reaction can compare to never having had the problem in the first place. This edited excerpt from our book, Working with Parents in Child Psychotherapy, is focused on the best times to have parents intervene with their children.

Pregame, Game, Postgame

We have identified three intervention points to help parents deal with difficult child situations, the pregame, game, and postgame. Using the analogy of a sporting event can help parents recognize potential points for intervention with their child.

1) Intervene before anything goes awry. This is the pregame, the time before the difficult behavior occurs when caregivers might recognize a problem brewing and intercede in order to avoid it. Just as a coach knows their team’s strengths and weaknesses and makes a game plan based on them, a parent can recognize what situations are likely to be problematic for their child and can plan accordingly. We consider this the most effective point at which to intervene.

2) The midst of a struggle or difficult situation with the child, which we call the game, offers your next point of intervention. Similar to during a sporting event, strategies during the game can be reactive rather than contemplative. Despite its ineffectiveness in creating lasting change, parenting energy often goes to the game because it cannot be ignored when something dangerous, destructive, or hurtful is happening. Though we prefer proactive pregame interventions, we can and often do help caregivers understand more effective ways to manage at the game point.

3) After the situation is over, there may be a quiet time to learn from events, build skills, or create a different outcome in the future. We call this the postgame. During the postgame we can help the parent reflect, with the child or on their own, on events and emotions in order to develop healthier solutions. Thinking carefully through the postgame helps determine a plan to shift the negative behavior, which may, ironically, sometimes include eliminating these reinforcing (wiping the slate clean) niceties.

Example: No Gifts Please

How do these different points of intervention play out? Imagine a child, who has previously had tantrums at birthday parties, is invited to one. The problem is predictable and a plan can be made. The parents tell you about the pattern, which you explore in greater depth. You ask essential questions about antecedents, behaviors, and consequences.. In this example, the parents tell you that their child functions well at parties until gifts are opened, but after that the child tantrums (cries and kicks adults) until “dragged away” from the party. Calming occurs when the child is home and having a snack or playing quietly.

Pregame

Your first step in the pregame is to help the parents recognize the pattern and then proactively make decisions about how to manage it in the future. At this stage of intervention, parents can make environmental shifts, such as skipping the party, if they believe the child will not be successful. They can also remain at the party to supervise, if appropriate. They can choose to pick the child up before presents are opened, since this is predictably when their child melts down. Better than any of these avoidant strategies would be to help the parents plan, with the child, to manage the situation more effectively. The parents can write a social story about parties with coping strategies included. They can alert the child to predictable feelings, behaviors, and strategies to manage their feelings. Together they can practice identified strategies such as rehearsing scripted comments (i.e. “It will be my birthday soon”) or going to another space when presents are opened. If these feelings and behavioral options are previewed, it may be easier for both the parent and child to recognize when things are heading downhill but have not yet fallen apart. Caregivers can also preemptively script de-escalation strategies for themselves, including their own comments to have ready in response to both their child and bystanders.

Game

If the parents did not utilize pregame strategies, the intervention starts at the game. There are many reasons why parents may not have utilized the pregame interventions: maybe they were not aware of the birthday party pattern, they may not have had the time to address it before the event, or they may have exhausted their repertoire of interventions. Suppose the scenario plays out and the child is dysregulated and crying. In the game, anything that exits the family from the situation or returns the child to baseline functioning may be a win. Yet there may be unintended consequences for over-reliance on this intervention point, such as reinforcing and practicing negative behavior, avoidance of the difficult situation if exit is the solution, building a community narrative that the child is difficult, bolstering the belief that it is a disaster if other children get presents, or the child developing ingrained negative thoughts about themself.

Postgame

Parents and children both benefit from processing after the fact in order to gain a better understanding of their own triggers and to develop strategies for future use. Was the problem predictable? Should the parents utilize the same pregame interventions, if they had any, or fine-tune them next time? What happened and why? Self-awareness can be built for both parent and child: “Parties are supposed to be fun but you seem sad when you’re there.” “You have trouble controlling your body when other kids get presents.” These moments of self-awareness can then be linked to planning for the future and reducing distortions.

The postgame can also be used when the child did well and the child and parent can reflect on strategies that they used to cope: “I think we had a good plan about the party” (reviewing the specific parts that seemed to work). The postgame can also involve practicing skills, such as saying, “Thank you for inviting me” (social etiquette) or “It will be my birthday in a month” (self-soothing) or “Parties are fun even when you don’t get presents” (reducing distortions). Thinking about the timing of the intervention with parents helps them generate solutions to build a greater sense of control.

Parents have said that prevention strategies take too much time, neglecting the obvious—how much energy and time it takes to manage problematic situations. Reviewing the “game” with parents will give them a new tool for their repertoire.