After an intro to encopresis (https://bit.ly/EncoIntro) and the necessity of a medical assessment (https://bit.ly/EncoGastro) this post will start to discuss what happens in the consultation sessions themselves.
After getting the necessary information from a doctor and hearing more from the parents about the current situation and developmental history, we’ll usually start with a Tracking Chart.
What is the Tracking Chart? It’s a chart (makes sense, right?), split up into one column for each day, with around 5-7 rows for each day. The parents’ job (given at the conclusion of the first meeting) is to observe and note what is going on with their child from a physical perspective: at what time of day did they have an accident or go to the bathroom? How much was it? What was the consistency and color? If it was an accident and they afterwards went to the bathroom, was there anything that came out after? Was this before, after or during eating? What else was going on: were there friends over, was there a fight between siblings going on etc.
This chart plays an important role in the counseling, and accompanies us throughout the process. At the most basic level, it allows us to know what is going, and to break things down a bit better. This enables a number of things:
a) as time goes on, it allows us to *compare* and *celebrate success*. After two months, parents can look back on the first week’s chart and say “Wow, look at how far we’ve all come!”
b) getting a better understanding of what’s actually happening in terms of *frequency* of accidents. It’s not uncommon for parents to disagree with each other or not be entirely sure how often the issue comes up: the chart helps understand the frequency.
c) gaining a better understanding of the child’s physical system: does the child tend to have accidents more right when they wake up, or right after eating (for example)? Although parents often have a sense of this without a chart, observation allows for a better understanding of the *exact timing*. This is necessary both so that parents can better understand their child and what is going on with them, but also for planning the timing of the behavioral/habit intervention (to be discussed in the next post).
d) at the simplest level, “breaking down” the issue into the specific occurrences means being able to look at *each time the issue comes up*. However, “breaking it down” also has another function: dealing with encopresis (as with many other issues that come up with children) can be overwhelming and frustrating and can create a sense of helplessness and hopelessness. By focusing on specific instances, we (therapist and parents) are working on *kicking self-regulating mechanisms into gear*. When we zoom in, it can be the equivalent of taking a few minutes to breathe (often, the same can be accomplished when “zooming out”, as well, which will also be discussed in the future). Instead of looking at encopresis as a massive problem taking over our lives, it can be helpful to focus on specific instances.
e) lastly, and related to the above, speaking about discrete events helps parents discuss their thoughts and emotions regarding those events. Instead of asking “How does this problem make you feel? What do you think when it happens”, we ask “Well, on Wednesday at 3 PM when this happened, what do you remember feeling? What else was going on? What was going through your mind?” When discussing a specific instance, parents are better able to notice and relate what they feel at each point and how that makes them think and act. This is also an important aspect of emotion-regulation.
These last two emotion-regulation goals help prepare parents for the next stage of the therapeutic process: joining together with their child and helping them, in an emotionally supportive way, (re)gain the toilet training habit.
