Over the past couple of decades, children’s behavioral problems have been increasingly medicalized—conceived as psychiatric disorders, diagnosed by medical professionals, and, with increasing frequency, treated with psychoactive drugs. Too often, the results of this approach include not only physical and mental side effects, but the pervasive disempowerment of the kids, their parents, their teachers, and their entire social network. If the child has a “medical” problem, there’s not much that the child, or anybody in his or her life, can do to change it except focus on the pills and follow doctor’s orders. Should the medical model fail to live up to its promises (as it often does), the result can be an even greater sense of hopelessness and frustration. What’s left to do once the miracle drug has “failed”?
Of course, psychotherapy can have its own drawbacks. It’s expensive, often inconvenient, requires a substantial investment in time, and can promote a sense of helplessness in children and parents as they wait—sometimes for years—for the “expert” intervention of professionals to have an effect.
Sometimes, of course, medications or psychotherapy are indicated, but there are many more times than we may realize when kids who get a little coaching and some help from their families, teachers, and friends, show themselves capable of solving their own behavioral problems with a minimum of expert involvement. When children are helped to take charge of changing their own behavior in a way that includes all the people who care about them (and whom they care about), not only can they make astonishing progress, but they develop more self-confidence and greater social adeptness with their peers.
What Is Kids’ Skills?
In the 1990s, I worked as staff supervisor of a preschool in Helsinki, Finland, caring for children with special needs—most with one or more psychiatric diagnoses, such as AD/HD, Asperger’s syndrome, ODD, or pervasive developmental disorder. The special education teachers of this preschool and I developed an effective, practical model for helping these children, which we hoped would appeal to them and their families. Inspired by the therapeutic ideas of Milton Erickson and solution-focused, cognitive, and narrative therapies, we developed a practical, step-by-step program to help kids aged 4 to 12 overcome emotional and behavioral problems while drawing on the support and encouragement of their families, friends, and others close to them. Known as Kids’ Skills (KS) and now practiced in several countries, the model is founded on the premise that most children’s problems can be reconceived not as permanent deficits, but as skills they don’t yet have and certainly can learn.
For example, if a child’s problem is that he shouts or talks too loudly, the skill would be learning to speak softly and quietly. A child who gets into fights needs to learn the skill of keeping cool even when infuriated. Help the child learn the missing skill, and the problem will recede of its own accord! It’s important that the skill be defined not as something negative—”I won’t swear,” or “I shall not hit other children”—but as something positive, which the child can do, practice, and demonstrate.
In addition to being brief, economic, and nonpathologizing, Kids’ Skills fosters an atmosphere of cooperation among child, therapist, parents, and social milieu. Children don’t like being reminded of unpleasant problems, but they do enjoy learning something new and interesting, particularly when they can learn it in a way that’s fun and quickly rewarding, and lets them be in charge. Parents are eager to cooperate in this approach because they’re regarded first and foremost as partners in the process, with an important role in encouraging their children to learn their new skill. While it may look like yet another behavior-modification technique with a clever reward and reinforcement system, Kids’ Skills is designed to focus not only on the child, but on the psychological ecosystem around the child, engaging the child’s entire social network. It can be used not only by child and family therapists, but also by other professionals working with children, including occupational therapists, speech therapists, school counselors, social workers, nurses, and teachers.
Putting Kids First
Twelve-year-old Carla came to therapy with several problems. Diagnosed with AD/HD because of her short attention span and severe impulsivity, she was overweight and so sensitive to perceived criticism that she constantly squabbled with her peers, and then withdrew from them into lonely isolation and hurt feelings. At home, she was often bad-tempered and frequently had hit her handicapped little brother. She’d been referred to play therapy by the school psychologist; but after a while, she refused to continue, saying “I don’t want go there any more; I’m not a baby.”
A child psychiatrist at the family services who’d evaluated Carla came to the conclusion that her concentration problems and impulsivity made her behavior so disruptive in class that medication was absolutely necessary to enable her to stay in a normal class. Nevertheless, her parents refused to medicate her, with the result that she was removed to a special school for children with behavioral problems. There, her problems continued. The parents, still searching for a nonchemical alternative, scheduled an appointment with Christine, a Kids’ Skills therapist, who explained the idea that problems can be converted to skills that children can be helped to learn. Carla’s parents thought the approach worth trying.
The following week, when Carla arrived with her parents, Christine found out that some preliminary work had already been done at home. The mother had told Carla about Kids’ Skills, and together they’d worked out a list of new abilities she might need to develop to overcome her problems. The list included “to learn to let adults complete their sentences without interrupting them,” “to learn to raise her hand at school to ask for permission to speak,” “to learn to be kind toward her little brother,” “to learn to sit still for gradually longer periods of time,” and “to learn to focus better on her school assignments.”
The first step in Kids’ Skills is to get an agreement with the child about a skill to learn that would help him or her overcome a specific problem. Kids’ Skills works best when children themselves think up the skills they want to learn. Obviously, parents, teachers, and other adults always have their own ideas of what the child really should learn first, but it’s preeminently the child who must agree to learn the skill to take ownership of it. So Carla took full part in the discussion with Christine and her parents as they agreed that the first skill she should learn was to control her tendency to act impulsively in social situations and, more specifically, to learn to wait until it was her turn before bursting into conversations or taking action. “I’m simply too impatient,” she admitted.
The basis for Kids’ Skills has been laid when the skill to learn has been identified and agreed upon with the child, but for that to happen, important steps need to be taken to ensure the child’s ownership of the skill and to build her motivation to learn it. These steps include engaging the child in a discussion of the benefits of the skill, asking the child to give a cool name to the skill, letting the child pick an animal (or any other character) to function as a magic supporter, and last but not least (at least if you ask kids!), planning how to celebrate when the child has learned the skill.
“Okay, so now we have a skill for you to learn. What do you think will be the benefits for you of learning that skill?” Christine asked.
Carla earnestly listed a number of benefits. “My friends would respect me more, and they’d like to play with me more. Maybe I’d even get some new friends,” she said. “Also, my teachers wouldn’t scold me and make me stand against the wall so often. I’d be able to listen better to what the teachers are saying. And in dance class, I wouldn’t disturb other people so much.”
“Sounds good, and if you were to give a name to this skill, what would you like to call it?” Christine asked. Interestingly, adults often struggle if asked to think up a name for a skill, but children usually do it easily and naturally.
“It should be called ‘Waiting Tone,'” Carla said gleefully, explaining that when you call a number and are put on hold, often relaxing music is played to make you feel calmer while you’re waiting for someone to take your call.
When asked to pick her power creature or magical helper to remind her of her skill, Carla immediately chose her horse, Cindy, well-known for her ability to wait patiently.
Carla positively lit up when the idea of celebrating her new skill was mentioned. She wanted to have a garden party, inviting her dance group, teacher, parents, and both grandmothers. The event was to be exactly like the parties her parents had for their friends, held in the evening, with a barbecue and drinks. Carla’s parents promised to help her organize such a party once she’d learned her skill.
Creating a Support Network
When learning skills, children need the support of their social network. A practical way to ensure this is to let the child identify who she wants to ask to be her supporters. Children are greatly influenced by other children—for good and bad—and it’s advisable, therefore, to encourage the child to include not only adults, but also friends or siblings in this group. These supporters can support her, for example, by affirming that the skill is an important one to learn, by showing interest in her progress, by offering practical ideas about how to learn the skill, by helping her remember the skill, and, above all, by celebrating with her when she’s acquired her skill.
It’s typical for children to want to have lots of supporters, and people asked by children to support them in learning a skill are usually delighted by the invitation; however, when the problem is of a more intimate character, such as enuresis or encopresis, a child may want to include only his closest family members among his supporters. Rarely does anyone refuse to be a supporter to a child, but should that happen, others are always more than willing to say yes.
“You’ll need some supporters to help you learn the Waiting Tone skill,” Christine said, “so who do you want to help you to learn it?” Carla wanted Christine to be her supporter, and then added her parents, both grandmothers, two of her friends, her teacher at school, and her dancing-class teacher. The following week, she asked all of them if they wanted to support her, and was delighted to find that they were happy and willing to do so.
To acquire new skills, children need to have confidence. In Kids’ Skills, confidence-building is accomplished through making the child aware of why people who know her well believe she has what it takes to learn the skill. Therefore, cooperation with a child’s network is an essential element of this approach. Carla’s schoolteacher was invited to the next appointment. Christine seized the opportunity to build Carla’s confidence by asking the teacher to tell Carla whether she thought she’d be able to learn the Waiting Tone skill. “Certainly she’ll learn it,” said the teacher. “Not long ago, Carla got quite a good mark in her math exam, even if math has always been difficult for her.” Christine turned to Carla’s parents. “What about you? Do you also think she’ll be able to do it?” she asked. “We believe that you can do it,” the parents said to Carla, “because you’re our daughter, and we know you’re a strong girl.” Carla’s eyes were shining with delight.
After this preparatory work, it was time for Christine to help Carla draw up a plan to practice her skill with her supporters’ help. Again, whatever plan is developed, it works best when the ideas it’s built on come predominantly from the child.
“So, tell me Carla, how will you practice the skill of waiting for your turn?” asked Christine. “What can you do to stay patient in situations when you feel really impatient?”
“I’ll carry a picture of Cindy in my pocket, and I’ll look at it while I have to wait for something, and then I won’t put it back into my pocket until it’s my turn,” Carla said.
“That’s a great idea, but how will you remember to do that?” Christine continued.
Carla thought for a moment and then said: “I’ll remember by saying to myself ‘Stop.'”
A plan was made, according to which Carla would start her training at school with small steps. She agreed that her teacher would inform her classmates about the plan so they, too, could support her. She agreed that the teacher would place a diary on her desk where both of them would write notes about Carla’s progress; also, her classmates could scribble down their observations about how she was doing.
“There’s one more thing we need to think about, Carla,” Christine said “and that’s how do you want others to remind you of your skill if you forget it and become impatient again?”
This question has a central place in Kids’ Skills, where what conventionally are perceived as relapses or setbacks are taken for nothing more than instances of the child’s temporarily forgetting her skill. This framing of setbacks as temporary and inevitable forgetfulness opens the possibility of inviting children to determine for themselves how their supporters can best help them get back on track.
Carla came up with the idea that if she became impatient again, her teacher and her two best friends at school, who sat close to her in class, could whisper into her ear the name of her magic helper, Cindy.
Carla set out to learn her skill with her supporters’ help. She practiced her skill diligently. Within a couple of months, her supporters agreed that she’d made enough progress to warrant her celebration. Soon thereafter, her parents organized the garden party they’d promised for her, exactly the way she’d wanted. She was proud of her accomplishment and said that she now wanted to extend her newly learned patience skill to other areas of her life—to dancing lessons, to situations with friends, and even to her treatment of her little brother.
Carla’s teacher was so impressed with her progress that she recommended Kids’ Skills to another teacher, who had a student with problems like Carla’s. This teacher even asked Carla, the current “expert” in Kids’ Skills, to act as one of the girl’s supporters.
The change in Carla’s behavior, in her ability to wait patiently for her turn—or to control her impulsivity, as professionals would say—was so significant that the following summer she was transferred back to normal school, where, according to her teacher, she’s done well.
Eliciting Hope
Empirical research hasn’t been done on the effectiveness of Kids’ Skills, but a wealth of anecdotal evidence now exists in the form of stories like this one, reported by professionals from several countries around the word. The cases all follow the same steps—finding a skill, discussing its benefits, naming the skill, and so on—yet they’re all different; the ages of children vary from as young as 3 to as old as 18, and the problems that have been dissolved include everything from the trivial to the severe, from bad table manners to refusal to eat, and from swearing to uncontrollable violence. The method seems applicable not only to problems with psychological origin, but also to behavioral symptoms associated with neurological conditions, such as AD/HD, AS, and autism.
While Kids’ Skills appears to be effective, it comes with a caveat: it works only when practiced in a way that adheres to its underlying tenets of respect for the child’s self-determination and building true cooperation with the child’s social network. Much can be accomplished by putting children in charge and making sure the rest of us act as their supporters.
Despite the step-by-step structure, the detailed instructions, and even a workbook to adhere to, Kids’ Skills isn’t intended as a protocol to be followed rigorously. It’s rather a proposal for one possible set of guidelines that can help us work with children and their families in a way that elicits hope, involves the community, and recognizes the value of our children’s inherent creativity.
Case Commentary
By Michael Ungar
Ben Furman and Christine Beuer are to be commended for offering us a positive, respectful approach to children’s mental, emotional, and behavioral problems. Kids’ Skills, the program he created, makes innovative use of both strengths-based and narrative practice, and has the potential to build a child’s resilience. By asking the child what she or he can do, rather than focusing on deficits, Furman and Beuer have found a simple way to engage children in an intervention meant to empower them. There’s a great deal of charm to their discussion of Carla and the therapists’ careful attention to developing strengths, rather than searching for pathologies.
Despite having much to recommend it, however, I do have a few reservations about Kids’ Skills. Its approach seems solid with the authors at the helm, but I wonder if it can stand up to broader application, in different social contexts and cultures. It’s apparently been adapted in countries and cultures around the world, but class often trumps culture when it comes to determining which treatment model is likely to work with which client.
Children from middle- or upper-class families in different Western countries are going to have more in common with each other than will children from the same countries living in poverty, or socially excluded because of race or ethnicity. Though I applaud Carla’s effort to heal herself, many of the children I work with don’t have parents with the skills to negotiate contracts with their children, much less the time or the money to organize “garden parties.” I’d be curious to hear from a Kids’ Skills advocate working with a child in a less supportive social ecology. What if the child has no friends at school willing to provide reminders about how to act in a prosocial way? Even worse, what if those in the child’s social network value problem behaviors more highly than positive ones?
My second reservation comes from a worry about Kids’ Skills effectiveness. Furman and Beuer, to their credit, acknowledge the lack of research measuring Kids’ Skills outcomes. Measuring outcomes can be difficult with child-centred interventions that encourage flexibility. While I have no doubt the approach works when competently applied by an engaged therapist dedicated to helping a child find his or her own solutions to problems, it’s less clear whether Kids’ Skills is a distinctive model that adds to good solution-focused or narrative approaches to psychotherapy.
Finally, as much as Carla appears to be setting her own goals, and was remarkably competent articulating the benefits of those outcomes (“My friends would respect me more, and they’d like to play with me more”), I wonder about the authors’ conviction that children truly choose their goals in this approach. How much do Carla’s caregivers influence her choice of therapeutic goals? Certainly many of the children with whom I work might want respect and friends to play with, but they also want people to “shut up,” or to make sure that their siblings don’t get more attention than they do. In other words, some children might choose antisocial goals, or insist that others change, rather than they themselves. Resistance to following the rules or meeting caregivers’ expectations can be the way a child maintains a sense of personal cohesion when treated unfairly. It’s unclear whether Kids’ Skills can help children mistreated by their families, schools, or communities, and those who challenge rules when those rules (and the adults enforcing them) are wrong.
None of these comments should take away from the positive, empowering tone set by a Kids’ Skills advocate. Carla is happier as a consequence of the help she received. Indeed, it seems to have been the first intervention to make a difference in her life. For that, Furman and Beuer should be complimented. The challenge now is to see if Kids’ Skills can create just as much magic, consistently, in other contexts and cultures.
Authors’ Response
Michael Ungar presents some highly relevant questions concerning Kids’ Skills. I’ll start by addressing his question about whether KS is a distinctive model of therapy that adds anything to other strength-based approaches to psychotherapy. When we created KS, our intention wasn’t to produce yet another model of child therapy, but to package the best practices in the field into a simple, user-friendly, step-by-step procedure that would be easy to use not only by therapists but also by teachers and other professionals working with children.
Another question Ungar raises is whether KS works if the parents of the child are unable to participate in supporting the child. This concern is warranted, as KS relies on the idea that in learning social skills, children need the support of the important people in their lives. When asked who they want to be their supporters, most children name their parents, their teacher, and a few friends, but supporters can also include siblings, extended family, and any other persons close to the child. The parents are the child’s primary supporters, but in some cases, as Ungar points out, they’re unable to fulfill that function. In these cases, the importance of the other supporters becomes accentuated. Fortunately, there’s often a caring aunt, grandparent, parent of a friend, social worker, godmother, or perhaps a football coach who’s willing to step in to support the child.
Ungar justly points out that not all children have friends who’d sign up as supporters for them at school. This is one reason why KS is often practiced in clinical settings as a group activity, in which each child in the group is both learning a skill and supporting the other children of the group. At its best, KS is a social endeavor that helps children make new friends and reduces possible feelings of isolation.
Ungar mentions that many parents don’t have the time or money to organize parties for their children. Celebration of learning the skill is an important step in KS, but it need not be anything fancy. It can be a party, but it can also be just doing something fun together with the supporters. The important thing is that the children get to determine the nature of the social ritual by which they’re acknowledged for their accomplishment and their supporters are credited with their contributions.
Finally, Ungar wonders if children may not always be able to find acceptable skills to learn. Finding a consensus about the skill to learn is indeed the most challenging step in KS—or any solution-focused approach, for that matter. It’s a collective negotiation process that takes time and patience, but once an agreement is found between the child and his or her social network about the skill to learn, the main part of the work is already done.
Ben Furman, M.D., codirector of the Brief Therapy Institute in Helsinki, Finland, is a psychiatrist and internationally renowned trainer of solution-focused psychotherapy. He’s the author of several books, including Kids’ Skills: Playful and Practical Solution-Finding for Children and the forthcoming Kids’ Skills in Action: Inspiring Stories of Children Solving Problems Successfully with the Help of Kids’ Skills. Information about the author: www.benfurman.com. Information about Kids’ Skills: www.kidsskills.org.
Christine Beuer, the therapist in this case, practices in Donauworth, Germany.
Michael Ungar, Ph.D., is the author of Counseling in Challenging Contexts (Brooks/Cole, 2010) and The We Generation: Raising Socially Responsible Kids (da Capo, 2009). He’s both a family therapist and a research professor at Dalhousie University, specializing in the study of resilience across cultures. Contact: michael.ungar@dal.ca.
