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Text Transcript: Anxiety in Individuals with Autism Spectrum Disorder (Part 3)

- Welcome back.

I'm just gonna jump right in.

So the next point I wanna make is about unintentional anxiety signals that come from the caregiver.

And I've got some listed here, you know, questioning, checking, overprotection, reducing independence, all of these are messages to the kid or the person that they're just not okay.

They can't handle it.

They're just not quite right.

And that's a powerful message to get on an ongoing basis.

What I'm gonna recommend, I'm not to the point where I'm gonna recommend treatment yet, but I'm kind of alluding at treatment is a shift in perspective, not necessarily in practice and the perspective could lead to changes in practice.

And this is, again, a tricky concept to communicate.

Maybe I'll say it badly and try and clean it up.

It's like, where are you coming from on this?

It's like a come from, not to get to.

And so some caregivers have a get to kind of stand about those for whom they provide care, that one day the kiddo or the person will get to a point where they're okay and then the caregiver can treat them like they're okay once they get there.

The come from is that they're already okay.

That they're okay, just the way they are.

Now that doesn't mean they don't need to learn things.

It means they need to learn things.

It means as a being, they are okay.

You would come from there that they're fine.

It's hard to find that to come from a caregiver.

There's two very, very powerful commodities, some of the most powerful commodities that that can come from human beings to children.

One is unrelated to this conversation, but I'll mention it, is physical affection delivered by a masculine man to his son, very powerful commodity and kind of rare, actually.

You know, so if you, you get a bunch of men together and you ask the group, you know, tell me about your father holding you.

And you'll find that not very many men can answer the question with any vivid memories.

But the second commodity is even more powerful in my opinion and it comes from mom and that is the stand by a mother that her child is okay, but that's her stand.

That doesn't mean the child doesn't have disabilities.

It doesn't mean the child got a 36 on the ACT.

It doesn't mean they're getting straight A's.

It means just that the child is just the way that they are, okay, and they have problems and they need to learn some things and they have deficiencies and they're okay.

That stand is very, very powerful and also kind of hard to come by, because there's anxieties everywhere and we're anxious about our children and we're not certain that they're gonna be okay.

And that certainty that the child's okay coming from mom that can get down inside a person's psychological, emotional DNA, and live there throughout the rest of their life.

But by the same token that they're are not okay, that stand, which is not uncommon, can also get down inside a person's emotional and psychological DNA.

So people have this underlying sense that they're not okay the way that they are.

Maybe one day they'll be okay, but not yet.

So I promote that stand anyway.

So here's some dilemmas for parents and caregivers.

This is a really, really abbreviated list I've got in front of me.

So the dilemma is between how much do you encourage, you know, participation, exposure and bravery, versus how much do you allow avoidance or withdrawal?

And the caregivers are always gonna be balanced on this dilemma, you know, going to either side of it.

So how much noise, you know, do you allow in the house?

You know how they are about noise.

But you ever go into a house, you visit somebody and you come in the front door and they're like, shh the baby's sleeping, shh.

And you know, that kid's in for it, you know.

Because infants form sleep associations, you know, and if they associate silence with sleep induction, then they'll have to have silence in order to induce good sleep.

And apparently, I didn't give this lecture to my mom.

So I gotta have absolute quiet to fall asleep.

But my dad, he was an air traffic controller, so we had these odd work shifts, he'd go to work at 11 o'clock at night and get off at seven so he's have to sleep during the day, but he wouldn't sleep in the bedroom, he'd sleep on the couch.

And my mom would vacuum all around that couch and he'd still sleep right through it.

So apparently his mother, had a whole different approach to teaching him to sleep when he was very young.

So I got a bunch, a list of other things that are, you know, how much homework do you require them to do, you know, cause you force them to do an unpreferred activity and they are locked on to a preferred activity and it's pretty rare for kids to have homework as their preferred activity.

Oh, you know, you're gonna get some guff over that.

And what about animals?

Can you have animals in the house?

Because maybe you can have the house where they're living animal free, but the houses where they visit won't necessarily be animal free.

So we are preparing them for the world and if the environment where they're being raised is absolutely hygienic when it comes to any causes of distress for them and we plan on having them leave that place to go out into the world, they're gonna go into an unhygienic world and the world is gonna be more distressful than it needs to be.

And you know what foods do we allow them to, or have them eat?

And you can't have them just drink chocolate milk, eat chicken tenders and cheese curdles for the rest of their life.

We got to expand out their food preferences, but you can't go too far too fast.

Do you do the play date?

Because you do the play date, you know, you might get the call, 'cause he had a meltdown, now you gotta come over and pick them up.

How much competition do you allow into their lives?

You know how they are about losing.

But if they get to win every time in the house where they live, they're not gonna get to win every time in the house where they don't live or at school.

Do they allow them to go on outings?

Because again, things could go badly.

Their perfectionism weird, you know, you've got your typically developing kid, you spend your whole time with them trying to get them to get it right.

Your autistic kid, you spend time with him trying to get, you know, wrong.

So they have the experience if they get it wrong.

And their compulsion's, what do we do with those?

And I'm gonna talk about those in a while.

I have kind of a counterintuitive perspective on their compulsions.

And change, you know how they are about change.

So this is just parents and caregivers are constantly faced with the problems that these kinds of dilemmas present for them.

And for caregivers, for professionals too, again, it's participation exposure, bravery, or allow avoidance or withdrawal.

So you've got, again, playtime, competition, school assemblies, field trips.

The most dangerous places in schools or times in schools are these; one is the bathroom, one is the hallway, one are the assemblies and one are the field trips.

Now, why are they dangerous?

Because it's so much more difficult for teachers to supervise these activities.

They can't always be in the bathroom and there's too many kids in the hallway to see what's going on.

The assemblies, they keep pretty good order when they're managing the assembly, but a bully can get away with a lot with nobody's seeing it.

And school outings, you know, they can get away with a ton of stuff.

And it's not that the autistic kid is the target.

The different kid is the target.

Young children are hard on kids that are different in any way.

So if they're overweight, or if they have a disability, or if they got a weird personality, or lord forbid they engage in some kind of problematic behavior like thumb sucking or pants wetting in school.

They're really gonna be a target for that.

Or different ethnic groups, or if they don't have the proper standard of hygiene, you know, the smelly kid is in for it.

And it's just the nature of our species it seems that they're kind of after the kids that are different.

There's a differential approach to problems that they view as controllable.

So if a kid is different and they're different because they have a problem and the other kids view that problem as a controllable problem, then they're much harder on them.

So they're harder on kids who suck their thumbs or wet their pants, 'cause you should be able to control that, than they are on the kid that has a disability.

Doesn't mean they're not hard on the kid with the disability, they're just not as hard.

So addressing that in part, let's go to strategies.

First, I don't know how to phrase this so that it sticks in your minds.

Catch them being good, I guess, that's a good phrase.

Now you have to remind people to catch them being good, whoever them are.

I'm not just talking about ASD kids here.

You gotta catch your spouse being good, you know, and your colleagues.

And if you happen to be a supervisor, you've gotta catch your supervisees being good, 'cause you will catch them being bad, we are wired for that.

We're much more attuned to problems than we are to successes, because successes by and large don't have a lot of survival value like identifying and responding to problems does.

So we are biologically predisposed to look for problems and we find them.

We ignore shirts that are tucked in, but if the shirt's untucked in the hallway to school, where you've got a dress requirement, well everybody catches the untucked shirt.

Nobody says anything about the tucked shirt.

So you wanna praise and attend to brave behavior and ignore non-brave behavior.

But you've gotta watch for the brave behavior.

You gotta watch for it.

You saw some brave behavior at the very beginning of this presentation, probably didn't even notice it.

(clapping) I wasn't talking about it, but thank you, I'll take anything I can get.

But I was talking about Shelly.

So Shelly had to make a decision before she came up here.

And I don't know if you noticed it or not.

She didn't have any notes.

She has notes, she just didn't bring them up here.

That is bravery, because now she's gonna rely on her capacity in front of you to remember everything she wanted to say.

Now she could have had that piece of notepaper here and then she'd have a backup.

And that would be a safety signal if she did it.

But she went without the safety signal and courage, courage doesn't mean being fearless.

You don't need courage if you're fearless.

You know, if you're fearless, you don't need bravery.

You don't need courage, 'cause you're not afraid.

Courage is doing it when you are afraid.

Courage is doing it when you are feeling very, very frightened.

That's what bravery and courage are.

And so that was an example of courage.

But you know, it was so fluent.

She was so natural at it, you didn't notice.

That's what I'm saying.

You don't notice sometimes brave behavior and you gotta kinda tune yourself into it.

And there's all kinds of accidental conditioning that goes on all the time.

I'll give you a couple of examples.

One involves a make this one up and the other one will be real.

One involves like a mother of a three-year-old and a five-year-old.

She's a stay at home mom and she's been with the kids all day.

It's like 3:30 p.m.

in the afternoon.

She loves her kids, but she's just had enough of Slap Jack, Crazy Eights and Hide the Money, that's what she's been doing all day.

And the phone rings and about now she'd talk to, like a telemarketer, because she wants to talk to an adult for a change.

And it happens to be an old friend she hasn't talked to in a long time, so she is really pleased by this.

But first, where are the kids?

And there they are on the couch sitting apart from each other, the three-year-olds nodding off and the five-year-old's thumbing through a book.

So they're completely handled, perfectly behaved.

Now, what does that mean?

That means she can talk to her friend.

What do they get for their perfect behavior?

Well they get nothing.

Why would you anybody do anything about that?

It's like they're fine.

But what if the five-year-old lights the three-year-old's hair on fire?

You know what happens to that phone call?

Well, that phone call's over and that mother is going to attend to those children.

It'll probably be unpleasant.

It'll be a negative, but it'll be delivered in the context of nothing.

And something delivered in the context of nothing, even if it's a negative can turn into a positive, because something's better than nothing.

Now you wanna test this out?

Tomorrow about this time, no maybe a little later in the afternoon, think up somebody you know who's a stay-at-home-mom who's got a couple of kids.

Call her up on the phone, keep her on the phone and listen to what happens in the background, because the kids will start to cycle, because it's almost like that phone is like a Pavlovian bell.

And it sets the stage for the kids to misbehave, because they know two things kind of inherently, not that they're doing it purposefully, but inherently, that either they can get away with it 'cause mom's on the phone, or they're gonna have to misbehave abundantly in order to get her off the phone.

I'll give you a different example and it's a little more, I don't know, unpleasant for me, it was unpleasant for me, but it turned out well.

Years ago I worked with a big group of teenage mothers in Kansas City and they'd had their children taken away, their young children, the children averaged about one and they'd been taken away by the state because of allegations of abuse.

And before I met the women, I thought I wouldn't like them when I did, because I thought maybe they were, you know, immature, narcissistic, selfish didn't care about their kids.

I was wrong in every count.

These were lovely people.

They were young women, average age was about 17.

They had abundant love for their children.

What they lacked was skill.

They didn't know what they were doing.

And they were accidentally causing the problem that brought them to the attention of the authorities.

So they were teaching their children to misbehave, but remember their children were only about one.

So how much misbehavior can a one-year-old engage in?

You know, they can't do very many things competently.

Well, they're good droolers, fantastic.

They do wonderful things with saliva.

They can do a lot of interesting things with bodily products of every sort.

But beyond that, you know, they can't really do much.

But there is one thing that they do that is a problem and that is basically find danger, get into it.

And this is what was causing the problem, 'cause they are like danger-seeking missiles.

Like you're gonna buy a house and you wonder whether it's dangerous in any way, you want to have it inspected.

That's gonna cost you money.

What I recommend is don't get it inspected.

Just find a friend that's got a one-year-old, bring them over to your house, release them into the house.

They will show you where the dangerous stuff is.

So here's the scenario like you got the 16-year-old mom.

She's doing the dishes.

Her one-year-old's right below her playing with Tupperware, stacking and unstacking and everything's cool, so mom keeps washing the dishes.

What does the one year old get for playing right there where mom can see him or her?

Nothing, it's handled.

Why mess with a good thing?

So pretty soon the kiddo gets tired of the Tupperware and wanders over to the stairs leading down into the basement and starts to head down those stairs head first.

All of a sudden, mom stops washing dishes, goes over, grabs the kid, picks him up, no, honey, no, don't go down the stairs.

Oh, let's do this instead and gives them something else to do.

Well, you know, we're gonna talk about this later, but children learn through repetition with contrast.

So they do something and it either produces a pleasant or unpleasant outcome.

If it produces a pleasant outcome, they're more inclined to do it again.

So they're getting nothing, they go to the stairs, now they get something.

What?

Mom and from mom appreciation and something interesting to do.

Connection is being made.

The stairway is like, you know, the lever to press to get mom to do fun things.

So the kid keeps going back to the stairway and mom keeps going back to get the kid and finally she gets frustrated and ultimately (hands slapping) smack.

That's one thing she knows how to do, probably was done to her.

Leaves a mark.

She's a good mom.

She takes her child in for the well-child care visits.

The mark is right there.

The pediatrician that sees the mark, she's gotta report the case and what do you know, kid's gone.

So it just is an example of attending to the wrong stuff and teaching a child to do the wrong stuff, because of that attention, that's my point.

You wanna catch these kids being brave.

We'll catch them not being brave, that won't be a problem.

And then model brave behavior and use role reversal.

What does that mean?

It means let them in on that stuff is difficult for us, so they can see that we're not a different species than they are.

So we don't show them our difficulties.

We're more inclined to go, no, it's easy watch and no, it's not easy for them.

And we'd be better off showing them that it's not easy for us and letting them in on the fact that it's not easy for us.

So here's a scenario you might consider.

Like you're going to do something that you don't wanna do, you know, go over and meet the new neighbors, or go to like an organizational meeting in your neighborhood that you's just as soon not go to cause you don't know anybody or go to a dinner party or a cocktail party or a gathering of your spouses and fellow employees.

And you know, you'd go to the kid, look, I gotta go do this thing, honey.

I gotta go next door and meet the new neighbors.

I'm just not good at meeting strangers.

And I don't know what to say, you got any ideas?

The kid might go, well don't go.

Or go over there and kill them.

But you bring the kid out in on the fact that what we're dealing with here is human stuff, not autistic stuff.

And there's difficulty everywhere when it comes to social stuff for human beings, there's just more of it on the spectrum, but it isn't qualitatively more, it's just quantitatively more.

And if we let them know that it's difficult for us too and together, we can work this out, so what will work for me will work for you, what works for you might work for me, then you kind of bring them in more into we're all alike here, we're all the same on this bus.

Allocate responsibility, encourage independence, allow mistakes.

I don't know what, let them play soccer.

You know, they're gonna blow up when the other kid cheats or they're going to blow up when somebody on the other team commits an infraction and the ref doesn't see it, kid gets away with it.

This is gonna get underneath their skin.

They're probably going to blow up.

So what, I mean, let them make mistakes.

Let them erase the board, give them some school-based responsibilities.

Let them call a friend, even though they might blow it.

You know, sort of like how you teach business people.

You're not gonna find a really, really successful businessman or a woman who hasn't had a lot of failure along the way.

You know, they'll tell you that success is built on failure.

They have to embrace failure on the way to success.

If they absolutely have to succeed, they're not gonna do very well in business.

And it's the same thing with these kids.

They're going to fail at various situations, but that will be the foundation for their ultimate success.

Ever heard of Albert Ellis before?

He was the founder of a school of psychology called Rational Emotive Therapy.

And he's a short guy, short, Jewish intellectual guy, Wasn't particularly handsome you might say far from it, but I'm not a good judge.

But he was incredibly successful with women and this is before he was successful as the founder of RET, and he had a formula for it.

He decided that what he had to get over, and remember he's Rational Emotive Therapy, so he's the kind of guy that talks people out of their irrational fears of doing things.

And so he took a rational perspective on dating and thought, you know, rejection will never kill me.

And so what I need to do is increase my rate and be ready for lots and lots of rejection.

And the chances of getting a success are increased by the amount of chances that you take and as I do this, I'll get better at it, because I'm willing to take those chances.

And he did indeed get really, really good at it.

And as he explained why he was able to be hanging out with these statuesque model-like women that are, you know, a foot taller than he was without heels, was because he had the formula, He was willing to fail in his quest to succeed.

That's again, my point.

Emotional acceptance, now what does that mean?

Well, you wanna see a good example of it?

Go to YouTube type in the words, Carl Rogers, and then watch some of his sessions.

And what you'll see is what he called, which was he had this whole therapy called Client-Centered Therapy.

But the medicine inside the capsule called his therapy was primarily one ingredient and it was called unconditional positive regard.

In other words, no matter what his client said, he just sat and listened in an accepting fashion.

Where do you find that in your life, where you can just sit and talk to somebody and they don't try and help you?

They don't try and fix their, you know, your problem.

They don't judge your problem.

They don't tsk tsk your problem.

They just listen and you get the sense that they get it.

They really get where you're coming from in that moment and don't do anything with it.

Think of how valuable it would be just to have a source of that in our lives.

Well, that's what I'm suggesting here.

We could be a source of that in their lives.

But they are gonna have things to discuss that we know we could correct.

We could advise them.

And if they only did it differently, that wouldn't happen and we have to bypass that from time to time and just kind of get that it was upsetting and that they are upset and allow them to communicate that without trying to fix it, so that they get that it's okay to be upset.

You don't have to always be all right.

Set reachable goals.

This is probably something you're pretty familiar with.

There are a lot of examples here.

Backward chaining is probably the best example I can think of.

So I used to work a long time ago with persons with developmental disabilities in a institution in Montana and we had to teach adaptive skills.

You know, for example, making the bed.

And so we used backward chaining for that.

So I was teaching Gary, I'll use his name, Gary, how to make his bed.

I made it all the way, except I took the cover off the pillow.

Then I bring Gary in and go, Gary, make your bed.

He puts the cover on the pillow.

I go, fantastic, Gary, you made your bed.

And we do 10 of those.

And he followed me, you know what this is?

And then you take it off both pillows.

And then you work your way backwards until finally all the bedding's on the floor.

And you tell Gary, make your bed.

And he makes it because he's done all these steps that were very completable along the way.

So you set up, you know, your program, so there are very completable steps.

You don't have much failure built in.

Like I work with people and I work for people who periodically get overwhelmed.

Anybody ever get overwhelmed before?

(chuckling) And there is a solution for overwhelm, absolute solution, 100% success on this.

Start something you can finish.

And then when you get done, start something you can finish.

And when you're done with that, start something you can finish.

Don't start anything you can't finish.

If you've got something big, slice it, chop it, divide it up into things you can finish, then finish them.

And as a person does that, you build up momentum then you gather energy.

If you start something that you can't finish, you diminish momentum and lose energy.

No it's the same thing.

Put, you know, reachable goals in the program.

Create opportunities for change that are everywhere.

I have a couple of clients that are adults and they are, I don't know if Asperger's is still a term that's used widely, but they're very, very successful people.

They're also Aspergerish and probably fit the criteria.

And they have a way that they think things are gonna be.

But in my office, there are a lot of places to sit.

So I've got chairs.

I've also got a couple of couches, you know, I'm a psychologist.

And so I get them going, they sit in this one chair and I sit in this one chair.

We face each other that way for a couple of sessions.

The next time they come in, I'm sitting on the couch and then they're like, they don't say anything, but they wanna like nudge me over to the chair with her heads.

You sure you want to do this?

(chuckling) I'm just trying to change up a little bit.

And I do that also with my perfectionistic clients.

And you've got kids you're working with, they're either perfectionistic, or they've got some commitment to sameness and introduce change into their life.

They won't necessarily like it, but it'll be good for them.

Schedule worry time, take the valence out of worrying.

I have a lot of clients that are anxious.

Most of my clients are adults, but not all of them, but I recommend that they worry.

I don't tell them not to worry.

I recommend that they do worry.

I recommend that they get into it and they look at it from every angle.

Not just that the plane will go down, but if it goes down, it's going down in flames.

People are going to be screaming and burned alive on that plane.

You are not going to be able to get out of that plane.

I explained what conditional probabilities are.

Cause, you know, people say, when you fly, the odds of going down are so minuscule, why even think about it?

Well, yeah, that's probability, but there's such a thing as conditional probability, which means under certain conditions, then what's the probability?

So the conditional probability for flying is if the plane goes down, you are going to die a flaming death.

So have them think about that or whatever their fear happens to be, get into it man, get into it.

Look at it from every angle.

And they set up a time to do that.

And we put it at an inconvenient point in their day and then that's their time to worry.

And if I can get them compliant, well then the rest of the day is kind of freed up from the rest of the worry, because I have them do other things.

What I wanna take out of the equation is this sense that you shouldn't worry because I'll tell you what people who don't worry are, they are in a coma.

(audience laughing) And incorporate intense or unusual interests.

Now this is where the compulsion's come in.

So they got that stereotomy, you know, we don't like that.

But is it harmful?

Is this harmful?

You know, or is that harmful?

I mean it may be hurting them socially, but it is hurting them physically?

No, it's not maligning them in any way.

It's benign behavior and they love doing it.

Right?

That's why they do it all the time.

So are you gonna take that off the table as your potential reinforcing activity?

I would say don't do that.

Include that in your programming.

And so you wanna get a bunch of stuff they don't wanna do.

You got something, you know, they do want to do, make a deal with them.

If they do this stuff they don't wanna do, but you want them to do it, then let them do what they wanna do that you don't want them to do.

Did you follow that?

So if it's social that you're concerned about, have them do it privately.

you know, okay honey, you did your homework, go in and flap.

You know, you get 15 minutes.

Why not?

Better than a video game.

So I go over to my well, somebody at Boys Town's house.

I go over to his house one afternoon and we're sitting in the living room and there's a football game on, the Notre Dame, this guy's a Notre Dame fan.

And in the next room I can hear (repetitive groaning).

I go, hey Dan what's that?

And he goes, oh, it's Luke, he's in there doing his thing.

What the heck is his thing?

(chuckling) He goes, oh he likes to rock.

And so can I step in?

Cause I know the kid, you know.

So I step in and he's watching the game too.

He's really excited by Notre Dame.

Cause they're a little bit down, so, you know, threat based stress responses, he's flapping back.

(repetitive groaning) I go out to Danny, what the heck?

And he goes, Luke cleaned up the whole backyard.

I told him if he did that, then he could do his thing and watch the game.

I thought, well, what a brilliant use of his thing.

Who's gonna know.

I mean, he's out there on the ranch all by himself, in a room, flapping in front of the TV.

Who cares?

Are you gonna tell me that you guys don't have any habits?

You know, nobody knows about them, but you know.

(audience laughing) You get a high frequency behavior you know that they love and it's not dangerous.

It's not risky in any way.

Why take it from them?

Use it, that's cause you know, people are always saying, I don't know how to motivate the kid.

Well, yes you do.

You just don't know that you do, watch what they do.

And whenever they do a lot of, I guarantee you is some way motivating.

So find a way to make that contingent.

And then finally, exposure, extinction, desensitization, basically words for the same thing, which is the kind of the core of a successful treatment.

So, but first as we go through treatments, we've gotta pay some attention to medical treatment.

So the primary types of medication that are used, there they are.

They don't cure anxiety.

There isn't a medication that will cure anxiety, but they will reduce its symptoms and allow a person to function more optimally.

And sometimes that's what we need.

Have you ever been to an ER before anybody?

ERs aren't about cure.

They're not in business to cure the people that come in.

They are in business to stabilize the people that come in, so they can be cured, now there's a stabilization.

And for the most part, medication for anxiety is stabilization medication.

Now sometimes people need stabilization for long, long periods of time.

But in other cases, we just wanna get the person stabilized so they can function and participate in treatment.

And the medication will allow them to participate in treatment, which will cure anxiety or at least make it symptom-free, relatively symptom-free.

And then we can wean them off of the medication if need be.

So in-treatment and some of this, I don't have to tell you all of you, some of this I do have to tell all of you and that is when you're gonna to start on an autism treatment program, you pretty much wanna start the way I started today.

And that is educate the people that you're working with or the person that you're working with about anxiety.

Because remember the conversation so far has been dominated by the laid back crowd.

And the laid back crowd has convinced everybody that being anxious is abnormal and wrong and bad.

And we want to get that off the table, there's nothing wrong with being anxious.

There is something wrong with doing anything so excessively that it impairs your life and being afraid is one of those things, not the only thing.

You can do the same thing with M&M'S.

I mean you eat enough M&M'S and believe me, you're gonna have to pull yourself out of life for awhile.

Not in anything inherently wrong with M&M'S, but eat a pound and a half of them you're gonna pay.

And there's nothing inherently wrong with anxiety, but if you like surrender to it abundantly and it impairs your life and diminishes the quality of it, well, yeah, then you're gonna pay.

So we wanna educate them about anxiety.

What is it?

And for my kids, even for some of the adults I work with, I want them to give it a name.

So we have a third party in the room basically.

And back when "Lord of the Rings" was popular, the three movies came out.

Most of the kids that came in to see me then named theirs Gollum, does that ring a bell?

I mean it's the slimy character that was in "Lord of the Rings," the epitome of evil, whatever.

I mean, I let them pick their own name.

I just encourage them to make it a silly name, an insulting name, something that's a little bit disparaging and that's who we're going to talk about.

And so instead of me talking about the kid to the kid, I'm talking about the name to the kid.

How is Gollum?

Who won this last week?

Did Gollum get the best of you?

Or did you get the best of Gollum?

Or what's the score on you and Gollum, 'cause you guys are competing with each other, like that.

Now I think, unless I'm wrong, you're gonna get some training on exposure later.

So I'm just gonna briefly allude to it here.

I think part of the stuff that's happening tomorrow will involve relaxation, so I don't want to spend a lot of time on it.

But it is part of my treatment package and it comes in many different forms.

So one is progressive muscle relaxation, pretty easy.

Basically it just involves tightening and holding the tightness and then relaxing, relaxing the tightness in all the muscle groups in the body.

So you tighten the muscles of the face, hold for say a count of five and then relax for a count of five and then move down to the neck and the shoulders and the back, upper arms, lower arms, chest, abdomen, buttocks, thighs, calves, feet.

And what it is is just your ringing tension out of the body.

When you're all done, you've run all that tension out.

And it's a form of relaxation.

Focused breathing is, I don't know, lazy man's, poor man's meditation.

And it's also probably the entree to most meditation programs it's what the person that's training somebody to meditate trains them to do is put their attention on their breathing and keep it there.

And when I do it I do this one.

I count my breaths to 500 that's 20 minutes and allows me to get 20 minute meditative practice in.

I always do it when I fly.

And you wanna try this, it'll solve a problem for you that at some of you, many of you have called insomnia.

So whenever somebody's got insomnia and it's not due to substances like caffeine or really, really bad sleep hygiene, then it's always due to this one thing, always, thinking.

It's what people are thinking in bed.

You don't wanna think in bed.

It's not the place for thinking, 'cause thinking is an active process.

And when you start thinking about stuff, you are sending a message to your body saying, I need cortisol, I need epinephrine and I might need a little adrenaline.

And all you need to have that need appear for your body is to have an active thought process.

And your body will supply the chemistry, 'cause the body has gotten the message that it's going to be needed.

So it's getting ready to help you with those thoughts.

That's why one thought leads to another and you can get cognitive hyperactivity.

Then we happen to have a tendency to think about problematic thoughts, more than we do successful thoughts.

So all the element of danger, or failure, or problem starts to surface into thinking, which activates the body even more.

And after you've done that for a couple of minutes, your body's ready to go.

You wanna to sleep.

And now you're probably upset because you can't feel like sleeping.

You look at the clock, do the math.

Now you've got another upsetting thought to think about, 'cause you're gonna miss out on all that sleep tomorrow and you got this big thing tomorrow and you're gonna be really tired.

And that's more thinking.

So what's the advice Dr. Friman?

Well, obviously it's not don't think.

When you stop thinking, well, that'll be your funeral.

So there is something else to do and that is give your mind something very, very simple to do, like focusing on breathing.

And when the mind is focused on something very, very simple, like that, a message is sent to the body.

And that message is I don't need you right now, you can go offline and it starts to go offline.

Active thinking, increases blood pressure and heart rate.

Focusing on something simple, like breathing, decreases blood pressure and heart rate.

So it's a way of relaxing and it's very good for sleep induction.

If you get good at it, you'll never have insomnia again.

It doesn't mean, like it's difficult.

I'm not saying focusing on your breathing is easy.

You start focusing on your breathing, thoughts will tap you on the shoulder so to speak and say, have you thought about me lately?

I really think you should.

And it'll seem so important.

And you'll be tempted, like Ulysses was tempted to wreck his boat because of the Sirens.

You'll be tempted to really reflect on that thought.

The thing is recognize that's part of the process and then go back to your breathing anyway.

So meditative practices, I've talked about those.

Mindfulness in general, the thing about mindfulness is you don't have to meditate for mindfulness.

I mindfully ate my breakfast this morning, 'cause I forgot to bring a magazine to the table.

And I thought, now what?

Because I usually read while I eat, that's not mindful eating.

That's not even eating.

That's reading and food is being put into my body.

So it's sort of an unconscious process, but I thought, you know what, I'm gonna talk about mindfulness later.

Why not mindfully have your breakfast?

So I did.

I thought about eating my breakfast as I ate my breakfast, really unusual for me.

It was a very pleasant experience and was somehow calming.

And that's what mindfulness is, is you put your attention on what you're doing while you're doing it.

And these are things you can teach kids.

You know, you can talk to them about their mind and what they do with it.

And they kind of like thinking about like that and talking like that, not all of them, obviously some of you folks are working with kids that have pretty serious disabilities and that's a level of conversation they wouldn't necessarily be able to apprehend, but for lots of kids, you can have that level of conversation.

And again, this wouldn't be relevant for all your clients.

It's not even relevant for all anxious clients.

It just, if there seems to be a susceptibility to what you might call cognitive therapy, and cognitive therapy isn't nearly as useful as it's been touted to be, but it isn't useless either.

Sometimes it can make a difference.

Then you target the irrational thoughts behind the irrational fears, or the tendency to think irrationally.

And even these ways of thinking, aren't just behind anxiety, they're also behind divorce.

This kind of thinking leads to divorce.

You know, you get caught up in an argument with somebody that's using all or nothing thinking and they're using words like always and never and they're talking about you, you know, you never, or you always, and you're over there going no, no, not never, I do sometimes or no, yeah, I do, I do, or no, I don't, sometimes I don't do that.

I mean like that.

And you can't get the person out of that track.

So magical thinking, it's the standard of truth most of us have.

And it's just magical.

It's something to be suspicious of.

If you see it clearly and you feel it intensely, it's true, right.

Gotta be, you see clearly and you feel it strongly, gotta be true.

But I'll tell you something, the conservative people in your culture see clearly and feel strongly that the liberal people in your culture are wrong.

And the liberal people in your culture see clearly and feel strongly that the conservative people and your culture are wrong.

They're both looking at the same stuff.

How can they both be right?

You follow what I'm saying.

Seeing something clearly and feeling it strongly is not a standard of truth that you want to abide by ongoingly and people that are anxious, tend to see clearly the danger and feel intensely the danger and they're not right about it, but they absolutely feel like they're right.

It's a method of thinking they're using.

Filtering means focusing on the negative stuff, which people have a tendency to do and they don't focus on the positive stuff.

Overgeneralization, making hasty generalizations based on very little evidence.

One little meltdown and we've got a tantrum-prone kid.

Nah, we had one meltdown, that's all we had.

And magnification, giving proportionally greater weight to failure then to success.

Success was a fluke, failure is a standard that we can expect.

And emotional reasoning is presuming that negative feelings expose the true nature of the feelings or negative emotions expose the true nature of life like that.

So exposure-based treatments; exposure, response prevention, systematic desensitization, escape, extinction, behavioral and emotional inoculation and flooding, all the same thing.

They're all basically the same thing.

It's just putting people in the presence of the thing and having them stay there rather than escape from it or attack it like they ordinarily would.

If you happen to be a behavior, how many behavior analysts in the room?

So escape extinction is the deal.

Now it didn't win though, because it's an unattractive term.

Exposure and response prevention won, but the people, how many behavior therapists in the room, because behavior therapy won that one, 'cause they have a more attractive way of talking about stuff than behavior analysts do, that's all.

Same stuff, behavior analysts discovered it first, but behavior therapists used it best.

So real life examples.

So some people in the world are terrified of cats.

It's an irrational fear of cats.

And they engage in really, really inappropriate behavior whenever they're exposed to a cat.

You know, so we gotta, we gotta work with it.

And in our program we do a distal exposure and then we do proximal exposure and the terminal step of our programs, if the people complete this step, we always achieve success and they have to survive the step of course, Some kids are afraid of falling into the toilet.

You know, they've seen that stuff goes in, it never comes out.

They would fit into the aperture.

I don't wanna sit there.

So we'll hold them over the aperture give them support.

And then we let them sit on the aperture with the closure down and they can bring a friend.

And then we have them sit over the open aperture and distract them with reading.

And then if they complete the terminal step of our program, we always always achieve success.

Some kids are afraid of creepy crawlies and in our program, we expose them to small, creepy crawlies, then bigger creepy crawlies, then we increase the proximity and then the terminal step, again, if we achieve this terminal step, we always succeed in our program.

So some actual examples.

So here's a obsessive-compulsive disorder in Tourette syndrome.

Now you know what obsessive-compulsive disorder is?

Not quite right syndrome.

Maybe you don't know what Tourette syndrome is and maybe you do, I don't know, Tourette syndrome is the granddaddy of all the habit disorders.

It's a lifelong neurological disease, hallmarked by vocal and motor tics that progress cephalocaudally.

This is your ceph, this is your caudal.

No, no wait, this is your ceph, hello, I wasn't using my ceph.

This is your ceph, and this is your caudal.

So the tics progress that way.

They become bigger and more robust over time.

So the kid involved here for these data had Tourette syndrome.

We didn't know that.

He also had obsessive-compulsive disorder.

We didn't know that either.

What we did know is that he had been, according to the clinical staff at Boys Town, groping our girls in the breast area.

So they're gonna terminate him from Boys Town.

That's a bad deal, getting terminated from a residential care program.

See kids come to us and they're metaphorically speaking, coming to us on an escalator, that's going down.

You know, it's going down.

They step off into our program.

So the question is, where was that escalator going that was going down?

Oh yeah, it's going to hell.

A hell you and I have a hard time even imagining.

A hell where dog eat dog and survival of the fittest are the philosophies of the day.

A hell where livings are earned through petty crime and drug sales if they're earned at all, mostly theft.

A hell where there are no friendships.

A hell where there's no hygiene.

A hell where there's very, very poor diets.

A hell where lives are foreshortened.

They're on their way there, but they step off into our program and our plan is put them on another escalator going up.

Where's that one going to?

Up to the bright lights of the life that you and I live, that's our plan.

But if they get terminated, they go back on the escalator going down.

So we don't want that to happen.

So when I find out about a termination, I'll train some of my staff onto the files of the kid being terminated, to find out what we can find out about his psychological status.

And nobody knew about the Tourette syndrome or the obsessive-compulsive disorder of this kid.

It explained a lot.

See Tourette syndrome is hallmark by different kinds of tics.

One you may know about, it's called coprolalia, which is obscene speech.

Another is called copropraxia.

You may not know what that one is.

That's obscene gestures.

And one is called palilalia, which is a tendency to repeat yourself, repeat yourself, repeat yourself.

Echolalia, which has a tendency to repeat the other person.

And then echopraxia, which is a tendency to repeat what the other person did with their body, to mimic them.

And this kid had echopraxia and these types of tics aren't part of the diagnostic criteria.

But if they're present, they confirm, because they are so weird that there's only one way to explain them and that is Tourette syndrome.

So as soon as I found out he had echopraxia, I knew he had Tourette syndrome.

And then I found out through our diagnostic interviewing that he also had obsessive-compulsive disorder.

And then in interviewing him, he explained what was going on.

He said, "I just am, when somebody touches their chest, "I just have to touch their chest." So it turns out it was not just girls, it was girls and boys, but the boys weren't complaining, they were handling it themselves.

The girls were complaining, but not just 'cause he touched their chest, because that's Tourette syndrome.

But remember he's got obsessive-compulsive disorder, so he touched their chest and he didn't quite do it properly, so he had to touch their chest again and he didn't quite do it properly, so he had to touch their chest again.

Oh, that one wasn't right either, so he had to do it again and again and before long, this looks an awful lot like groping and that's why he's being terminated.

So what these data reflect is me having one of my interns, my psychology interns sitting in front of him touching her chest.

And then when he went to touch her chest, she would block him and prevent him from touching.

So it's exposure to her touching her chest and response prevention.

He can't touch her chest back and over time he just lost interest.

Now on the front end, watching the first couple of data points, he reminded me of, this isn't gonna sound as disparaging as it is going on the front end, as it's gonna sound on the front end, it reminded me of a dog I trained years ago when I was living in Montana.

I trained my Labrador to hold a biscuit on its nose.

Now that dog wanted that biscuit because that's what he would get for holding it on his nose, he gets the biscuit.

So he wants the biscuit and he's not taking it, 'cause I've trained him not to take it.

But you could see every fiber of his being wants that biscuit.

And that's what this kid looked like on the front end, is every fiber of his being wanted to touch that chest, 'cause these Tourette syndrome folks, they'll tell you the urge to commit the tic is like the urge to sneeze.

Imagine, you're right on the cusp of a sneeze and holding that back.

That's what they have to hold back.

But over time it diminished.

And these data, those of you that are research bent were published in the premier child psychiatry journal in the world.

Now, why am I saying that?

Because those of you that have a research bent realize there's no control on these data.

I mean, they're not even A, B data.

It's just B.

There is no confirmation of this result in these data and they published it anyway, why?

Because it was a such a unique case report that it might lead to more research, which it did for us.

We got another kid with a similar problem.

It wasn't touching, but it was obsessive-compulsive disorder and Tourette syndrome.

And in that study, we used a research design and verified that we had the result and published it in our premier journal.

Now, this is interesting.

What we showed here is that talking about tics, increased tics in a couple of kids that had Tourette syndrome.

So just talking about the tics, increased the rate of their tics.

Why is that important?

Well, because the kids that have Tourette syndrome are frequently on anti-psychotic medication and they have to go in for med checks two or three times a year with our psychiatrist.

When they're in for the med check, they have to talk about their tics and the psychiatrist talks about their tics.

And in talking about the tics, if the psychiatrist is magnifying the tics right in front of his or her eyes, then the psychiatrist is gonna be prone to providing more medication.

When we're not seeing an increase in tics over the long haul.

We're just seeing it in that one situation because of the conversation.

So it was useful and it just turned out that talking to Tourette syndrome kids about their tics makes them anxious.

And then they tic more when they feel that way.

Here's a handsome young man.

Looks like he's going for a job interview, delightful looking.

Here's his clinical description.

He's got above average IQ, he's suspicious of adults, socially anxious, pervasive failure, public failure, uncomfortable with attention of any kind, that was a giveaway and he's controlling and manipulative.

And in his psychological evaluation, the two psychiatrists that did it said that this will become a lifestyle for this young man if this doesn't get taken care of fairly early.

It wasn't taken care of, not early, not at all.

And so he grew up to be this man.

Now, I don't know if you recognize who this is.

This is Charles Manson.

You know who that is?

One of the most notorious serial killers in the history of the United States and he was a resident of Boys Town.

That's why I have his psychological evaluation.

That was years ago, obviously not one of our poster children, but that was before the programs that we now have were in place.

That was way back in the late 50s.

But I have psychological evaluations from then and I have them from his current prison stay, because people at "60 Minutes" have been trying to get me to go on camera and talk about our treatment programs that are derived from his case, which I'm gonna talk about here, which I refuse to do.

But in an attempt to get me to do so a producer for "60 Minutes" actually went to the prison where Manson is housed, got an interview with him, 'cause I said, I won't do a thing unless you get permission from Manson for me to talk about him, otherwise it's HIPAA.

You have HIPAA?

Yeah, I can't talk, it's confidential, unless I get a release.

I don't have a release to talk about him that publicly.

So he got in the prison, he got the interview set up, but Manson is always under threat.

And the way he deals with threat is either to burn his cell or to flood his cell and the day the guy was in the prison, he flooded his cell, so he was put in protective custody, never got the interview, but he bribed the guard and got his evaluation, gave me a copy.

I probably should have said no, but well, I didn't.

(chuckling) That's my story and I have to stick to it.

So I have that.

So basically he's a guy that had two problems.

He had social phobia and he had conduct disorder.

And his conduct early on was an attempt to control the symptoms of the social phobia.

And he became an incredibly controlling person until he controlled all those people that live with him and he didn't kill anybody.

He wasn't even at the scene.

He was convicted of murder because he manipulated people into killing for him and he was able to do that because he got so good at controlling people that he got good at controlling people because he was controlling them early on because of his interior anxious state.

So yes, now he's a monster.

He wasn't always a monster.

Nobody's born a monster.

He was born a kid.

He was born a kid with psychological distress, very easily experienced.

And had he gotten some kind of treatment I wouldn't be talking to you about him now.

Anyway, so here's data from another kid who had a similar problem.

He was, well, basically he was assaulting our teaching family staff.

You wanna leave Boys Town.

All you need to do is hit a family teacher, you know, and then you're out.

Only I do everything I can to keep kids in our program.

So this kid was taking swings at his family teachers.

They were gonna terminate him.

I looked at his psychological evaluations, did some of my own, found that he was highly socially anxious.

And that the way he dealt with his social anxiety was to lash out.

He was a really big kid, one of our best athletes.

And so that's probably why he was thought to be dangerous.

So I found out that all his, you know, I used the token economy and all of his token awards and all of his token fines were done publicly.

And we do that with, you know, adolescents.

You know, we'll do stuff with them publicly.

We don't do that with adults publicly.

You know, you're gonna give your an employee a raise, you do it privately.

You're gonna get a letter of warning for one of your employees, you do it privately.

But with a teenager, I guess it's okay to do it publicly.

It seems like that's the case.

Like we think they don't have any feelings, like their feelings about this kind of thing are much greater than yours and mine are.

They're much more vulnerable, I guess at that age and stage.

I remember when I was in high school, I was in his English class and I would periodically act up just for attention.

But I had this teacher, English teacher who would just lash out to students publicly.

So I'm joking around in the back of the class.

He goes, "Mr.

Friman, if I want any crap out of you, "I'll squeeze your head." Right out loud in front of everybody.

It's like if I don't do something about this, I'll live with this for the rest of the year, you know, people will be yelling in the hallway Friman I'm coming over there, I need some crap, gonna squeeze your head.

So, see the thing about Mr., this guy's name was Fry, he couldn't say his R's very well.

So he said it was, "Mr.

Friman, if I want any cwap outta you "I'll squeeze yo head." And I said, awight Mr.

Fry, I'll be vewy careful.

So I got three days suspension, but I was like a hero in the hallway.

Legend actually.

But the thing is, in retrospect, I think he kind of deserved it for doing that with me publicly, that's my point.

So they were doing stuff with this kid publicly, both the good stuff and the bad stuff.

And he was acting out periodically, so I persuaded the program to save him and just do everything privately.

If they're gonna give him an award, points, privately.

If they're gonna give him a fine, do it privately.

That's why we got that reduction in those acting out sessions.

This kid, he's taking a diagnostic interview on a computer.

I walk by, blood is coming out of his mouth.

You know, diagnostic interviews are unpleasant, but they don't cause internal bleeding, so I have questions.

So what's going on here?

He tells me whenever I take a test, I get really nervous and I bite the inside of my lip, that's what's happening.

So we taught him to relax and we gave him an alternative behavior to use instead of biting his lip, which was chewing gum.

And the title of this paper was, "Just Relax and Try This Instead," and it worked really well.

This is insect phobia.

And the kiddo involved here was terrified of LadyBugs and crickets, so much so that he would disrupt his entire class if one of the other students even said there was a ladybug or a cricket anywhere in the room.

And he was a big kid, so it was very disruptive.

They were gonna terminate him from the program.

I did my assessment and told them this is a phobia, I think we can fix it.

So I don't know what the story is in Canada.

You can buy ladybugs in Nebraska, but you have to buy a thousand at a time.

So that's a lot of ladybugs.

With crickets, you know, you can buy them one at a time 'cause people buy them to feed to their tarantulas, so I got them in a pet store.

My thought is with crickets, you and I think of the cricket as a pretty benign little creature.

We're not afraid of them.

But when he thought of crickets, he had a different perspective.

His crickets kind of looked like this to him is my opinion.

And so here's our graduated exposure steps.

And work backwards with me here.

I wrote these backwards.

So we go from, pick up a cricket with a gloved hand.

We started there and he helped us with these steps.

You know, he picked the steps.

We use a discomfort meter to do that and then work all the way, pick up a cricket with a tissue, close eyes for 60 seconds in room with crickets, going all the way over to hold a cricket in your hand, in each hand for 20 seconds, which would be a challenge for me actually.

I mean, crickets are harmless, but they're really ugly and they got this.

So that's our exposure program.

That's the scale that we use to decide the steps.

We included him, that's my point.

If you're gonna do one of these programs, you wanna include the person in the selection of the steps.

And then back to these data.

So, I wonder if I, I don't have the red light with me, so where it says bugs, the measures here are math problems.

I'm not working on anxiety here.

I'm working on him behaving in the presence of anxiety.

So he's doing math problems that were given us by the math teacher and that's the rate of the problems.

So with the no bugs condition, in that condition I went into the room, I examined every inch of it and turned to him and said, there's no bugs in here anywhere.

Please now do your math.

And so he began to his math problems at a high rate.

In the same bugs condition, I went into the room, I looked around.

I said, you know what, buddy?

I'm pretty sure there's some bugs in here somewhere.

Please do your math.

And so his performance goes down.

And then in the bugs condition, I went into the room.

I have two crickets.

I let them go in the room right in front of him.

And I go, okay buddy, do your math.

He hops up on a table.

You know, his feet are on the table and his hands and he's doing his math like that and he's so freaked out.

I mean, he agreed to do this, but it terrified him.

And that made it harder to do those math problems.

But then in that graduated exposure section in the middle, that's where we started doing treatment and all of a sudden his performance starts to improve and then it plummets.

And you know, why?

Well he tells us he's sick of doing math.

(laughing) It's a good point, you know, I never paid him anything for doing the math.

And so I said, well, what if we give you points for doing math, he's all over that.

So that's, we put in an incentive and his performance skyrockets and we got a very nice result.

And this is very fortuitous or serendipitous, whatever the right word would be that my co-author on that little study was over visiting the classroom a couple of weeks after the study was over.

Kid doesn't know he's there, he's in the back of the room.

And so he watches our target kid, get up out of his chair, go up to the teacher's desk, get a tissue, walk back to his desk, bend down, grab something off the floor and put it in the wastebasket.

And so after the class leaves, the guy that works with me, goes over and checks the wastebasket and inside the tissue is a dead cricket, so completely fortuitous, but it indicated, clearly he'd lost his fear of these crickets.

That's just an example of what you can do with exposures.

So typical treatment is what I recommend including in your treatment of this problem, which is so common is demystify it if you can.

Like some of the kids with whom you work, aren't gonna benefit from the demystification process because their language apprehension isn't gonna be that great.

But when it is that great, then I recommend going down that road.

Externalize the problem, if again, as you talk about it, talk about it as if it's something separate from them.

And establish exposure steps.

Address disconfirmation, that's a little tricky.

What that involves is assumptions that people have about what's going to happen.

And I guess it's a tricky step to include.

Do you have, I don't know, relaxation rooms or whatever, you know, at the schools or places where the anxious kids can go as a refuge?

Is that unusual?

You have that here?

You know what I'm talking about?

That's not always a good idea.

Now it can be a good idea, but bear in mind, learning occurs by kids doing stuff and having what they've done followed by a pleasant or unpleasant outcome.

For a kid that's distressed over something that's not harmful and they exhibit their distress and you take them to a very nice place where they get away from class and are very secure, then you run the risk of magnifying their distress.

Am I making sense here?

And we've also given them a safety signal.

Now this is a sophisticated approach to anxiety, but all the research that's coming out of the major labs in United States are pointing this direction.

What we wanna do if we can, if we can get away with it, is eliminate the safety signals, magnify the person's assumptions about what horrible things are going to happen and then nothing could experience that it didn't happen.

Disconfirm their assumption, That turns out to be as powerful as anything we've got.

At some point, the person who will, wait geez, I knew it was gonna happen and it didn't happen or whatever they do in their head that's what we're starting to work with.

Rather than making it really, really safe, like I did with the cricket study, we're starting to make things a little less safe, because we wanna magnify the unpleasant experience that brings with it the assumption that something terrible is gonna happen, then let it play out, so they see that it didn't happen.

And then talking with them to establish memory consolidation afterwards, by saying, you know, it didn't happen.

I know you really, really, really thought it was gonna happen.

I know, I watched your pacing and then you went in there and it didn't happen.

What do you think about that?

Right, that's what I mean by, is this making sense?

Yeah, so that's what I mean by address disconfirmation.

Then establish incentives.

You know, this is difficult for them, so they need a motivation to participate in the program.

And as you saw with the crickets study that worked for us.

Change parenting practices, relaxation practices and then sell it.

The sell it part, that's tricky.

And you know, psychologists, they're not that good at selling stuff.

And behavior analysts, they're the worst.

I'm not kidding you.

I mean I am one, we got the best stuff, no kidding, we got the best stuff and we are the worst salespeople I've ever met.

You know, so we're like, we're out there like establishing and operationing and tacting and manding and auto clicking.

And it's like nobody understands what the heck we're talking about.

We've got this technical language.

We're trying to tell people how great the stuff is.

We use language, nobody ever heard of it before to tell them about the greatness and it doesn't go anywhere.

So these procedures, they need to be sold 'cause people don't wanna do them.

That kid that you wanna work with isn't necessarily gonna wanna go into that classroom, wanna get in that car, or go on that job interview or be in the room with a cricket or whatever it happens to be, they're not gonna wanna do it.

You're gonna have to sell it to them.

That's a big part of our work is now we know what to do.

We know why to do it.

We know how to do it.

But can we get them to do it?

That's where salesmanship comes in.

Does that make sense?