Parenting Under Pressure (PUP)

Starting your PuP Journey begins with working alongside the parent or carer to indentify areas of strength and areas of challenge. The goal is to arrive at a shared understanding of the family's current concerns, strengths and areas of difficulty. This is the basis for working together to make family life better.

Starting your PuP Journey is about a conversation where the child (or children) are placed centre stage. There is a key focus on understanding who provides the nurturing and sense of safety for this child (children) in order to understand both promixal and distal factors influencing family wellbeing. The ultimate goal is to help children achieve optimal development by having a family and wider network that supports all developmental outcomes.

Module 2 provides feedback on the assessment, arrives at shared goals to work towards, and develops a way of monitoring progress towards goals. This module also looks at the potential involvement of partners or other carers in the PuP program.

Module 3 of the Parents Under Pressure program aims to help parents reflect on their view of themselves as parents and help find and believe in evidence of their parental competency.

Many parents who are in contact with child protection agencies or drug and alcohol services feel as though they have failed in their parenting role. Bringing about a shift in this negative view of self as a parent requires time and support.

The module includes exercises that help the parent believe "I am a good parent". Parents are helped to understand that no one is a perfect parent. The concept of the good-enough parent is useful here. Specifically, a good-enough parent is one that helps a child develop to their potential (physically, socially, emotionally, behaviourally, and cognitively).

Parents may have  unrealistic expectations of their child and expect greater maturity than the child is capable of. An important component of this module is to find out whether the parent's expectations of their child are realistic.

Parents who have suffered adversity during childhood (abuse and neglect) are often very clear that they do not want their child to have a similar childhood but may not be able to provide alternative models of parenting.  This module encourages parents to consider the impact of childhood adversity on their current parenting and to consider alternative strategies.

In addition to the specific exercises in this module, realistic goals are identified and worked towards throughout the PUP program. Part of the therapeutic process is to acknowledge that each step towards goal attainment provides evidence that the parent has the strength to make meaningful changes.

Module 4 is aimed at promoting a positive parent-child relationship. This involves encouraging sensitive and responsive parenting to provide the maximum opportunity for the development of a nurturing and loving relationship.

A secure attachment to at least one primary care giver is one of the most important factors in ensuring positive outcomes for children (i.e., promote prosocial behaviour, interpersonal skills, high self-esteem, academic achievement etc). A secure attachment develops when parents are sensitive and responsive to their children. The module, then, aims to identify specific techniques a parent can use to promote a positive relationship with their child.

However, child-centered play techniques can be done somewhat mechanically, without sincerity. Child-centred behaviours are most powerful when a parent learns to really connect with their child, when they are genuinely pleased, interested, or proud of their child. Unfortunately, parents who are under a lot of stress may not experience these positive emotions often, or feel them inconsistently. Negative emotions (feeling frustrated, angry with the child) may overshadow the positive emotions. While it is unrealistic to eliminate all negative feelings, most parents accept that the child needs to experience something positive from their parents.

To facilitate a more genuine interaction with their children, this module applies the use of mindfulness techniques as a means for parents to get into a state of mind that facilitates positive interaction with their child.

Module 5 address trauma and loss. Many people, including children from an early age, have experienced difficult life events. At times children may have felt scared, lost, abandoned or unloved. Maybe they have lost a parent or caregiver through death or separation. Maybe they have witnessed violence or been involved in violence themselves. 

These feelings may result in a reaction called "traumatic stress". What is most important for parents, is to feel confident that they are reacting appropriately to their child's situation. 

Module 6 is designed to open up a discussion on health, hygiene and nutrition. These are often difficult topics to raise with parents but all are really important to the well being of children.

Basic health care, hygiene and nutrition are key aspects of providing an environment that is good enough for children. Often parents who are feeling overwhelmed have simply forgotten to ensure that the basics are in place.

Areas of some sensitivity can then be discussed within the context of  "health checking" your kids. Issues relating to cleanliness, overcrowding, poor nutrition and hygiene, dental health etc are broached with sensitivity and respect. Specific goas are set to remedy immediate health and hygene needs. The bottom line is that all children need to have these basic needs met.

The aim of Module 7 is to teach and encourage the use of emotional regulation and self-soothing skills.

A fundamental assumption of the PuP program is that the pressures parents face in their day-to-day lives impact on their ability to be effective in the parenting role. This module provides information on a range of strategies that help parents cope more effectively under pressure.

There is an emphasis on the use of there is an emphasis on mindfulness-based strategies, although other techniques such as relaxation training using muscular relaxation training, use of imagery, and other self-soothing activities are included. 

Mindfulness skills aim to help parents let go of any preoccupation with the worries of everyday life, at least for short periods of time. This mindfulness skill of refocussing the mind on the present moment and letting go of negative thoughts can, at times, help a person to shift from a severely negative mood state or feeling of anxiety, to one that is less overwhelming.

An important first step in emotional regulation is to recognise one's emotional state. A negative emotional mood state should be a signal to take some active steps to alter one's current emotional state. Therefore the module starts with exercises on recognising emotional states.

Promoting a healthy diet and regular physical exercise is an important factor in enhancing emotional well-being more generally.

It is not realistic to promote a positive mood state when a person is under considerable and real stress. When this is the case, it is necessary to consider techniques that might minimise the distress associated with that situation. Distress tolerance skills are an important skill for parents to use when under pressure.

Module 8 is aimed at providing parents withe strategies they can use to improve their child's self-regulation. There are many times when young children have trouble settling and focusing their attention. It is likely they will misbehave-all children do at times. Children also have difficulty managing their emotions. All this can affect other people and sometimes breaking rules puts your child and other people at risk. 

Children need to learn how to develop self-regulation. This means supporting children to 1) focus their attention, 2) learn how to follow rules, and 3) manage their emotions.

This module builds on managing emotions under pressure: it can be difficult to support a child when we are feeling angry or overwhelmed. Mindful management of our own emotions is key to supporting children to learn self-regulation.

In this module parents are helped to see the relevance of mindfulness skills to discipline. Specifically, in being mindful of their emotional state (and therefore their immediate tolerance threshold) and in using mindfulness skills (such as mindfulness of the breath) to create a small, but important shift towards greater emotional control when they are with their child.

Module 9 aims to ensure that parents are not drinking at risky levels or at risk of developing substance abuse problems. The module looks at the skills needed to avoid this and helps build confidence to avoid substance use problems. For those who have already developed a substance use problem, strategies are discussed that help ensure that potential lapses to use do not become relapses.

Parents may present with concerns regarding recent non-prescribed drug use or fears that they may begin using substances at the outset of treatment.

There are now a number of comprehensive manuals and clinical guides on the use of relapse prevention techniques in the substance use field.

It is important to recognise that parents who have a substance using past may be using currently. There are many reasons for this. Substances are used as a way of coping with stress. Use also helps people feel better. We need to assume a non-judgemental attitude to ensure we don't alienate the parent whilst increasing the likelihood of educating the parent on using safely with protection of the child being paramount.

It is important when working with parents who use drugs to help them manage their use so it does not get out of control and does not impact dramatically on the lives of themselves and their families.

Module 10 is about connecting with family, community and culture. Support can come from extending social networks. Beyond this, a sense of connection is a source of strength and important in developing a sense of identity as a member of community and what that may involve culturally.

A 'social snapshot' is taken that tells the parent's family story and identifies important people in the parent's life (or absence of a support network). The social snapshot helps the therapist identify the people in the parent's life who could be viewed as supportive and who could be viewed as a potential risk factor.

Module 11 aims to teach parents practical life skills where these do not exist. Life skills include budgeting, nutrition, health care, obtaining housing etc.

There are many people who do not have adequate skills to seek out services that may help them meet some of their most basic needs.

Some common areas of need (this is not an exhaustive list) include:

• Financial Planning - budgeting
• Diet/ Nutrition/ Health/ Exercise/ Hygiene
• Employment and Education - Resume writing, cover letters, applying for secondary or tertiary education
• Housing - finding appropriate places to live with children
• Welfare support (forms and entitlements)
• Emergency accommodation
• Clothing
• Food
• Furniture
• Dentist/ Medical (bulk billed or government)
• Childcare

Module 12 addresses issues around communication skills and other problems in adult intimate relationships. This moduleis used when the parent would benefit from learning how to communicate effectively with their partner or when their relationship is experiencing difficulties.

Having a supportive and responsible partner is a major factor contributing to success in parenting. On the other hand, an erratic, demanding or violent partner, or a partner who is still using drugs detracts considerably from a person's ability to parent. Improving relationships for distressed parents is an important goal.

However, it is probably unrealistic to believe that all relationships can be improved. For some parents the goal of this unit may be:

• to leave a destructive relationship,
• to use the skills learnt in other sections on PUP to learn to tolerate a partner's erratic or demanding behaviour,
• to learn to say no to a drug using partners invitation to use drugs.