Overcoming adult and adolescent entitled dependency and self-isolation

Dates and Cost

13th, 14th, 15th May 2019

Day 1 optional for NVR ‘aware’ professionals.

2 day workshop
£265 + VAT = £318

3 day workshop
£397.50 + VAT = £477

**Price includes full catering**

Venue & Location

Birmingham, actual venue TBC

Type

Specialist Seminar

Additional Info

9am for 9.30am start.
Finish 4.30pm.
1 hour lunch break

Presenter

 Dan Dulberger

Overcoming adult and adolescent entitled dependency and self-isolation

The new approach to improving mental health, psychological functioning and emotional wellbeing in ‘intractable cases’

Often, CMH teams and CAMHS feel helpless in the face of serious crises which jeopardize the autonomy of younger adults or older adolescents. Extreme social withdrawal, suicide threat and high suicide risk, debilitating anxiety, treatment refusal and tensions in the psychiatric patient / staff / family relationships present themselves in the context of what we have come to recognize as ‘entitled dependency’. Hitherto intractable impasses in treatment can however be overcome with an approach based on Non Violent Resistance therapy (NVR), that targets the family interactions around entitled dependency.

Our 3-day workshop on this systemic intervention introduces the basic concepts of Haim Omer’s Non Violent Resistance Psychology, and their application to crises of older adolescent and adult children. The program aims to provide mental health professionals with the theoretical and practical basis to perform effective interventions involving parents and the social network around the family, with the aim of helping the system around the young person or young adult to become ‘unstuck’. Personal supervision will be offered to participants on this course who are interested in further guidance.

What is NVR?

NVR (Non Violent Resistance) is an approach to therapeutic change through standing against harm in a caring way. It was first developed 20 years ago by Haim Omer, Professor of Clinical Psychology at the University of Tel Aviv, who applied concepts from political non-violent resistance to the sphere of interpersonal care-giving, whether parental, foster-care, residential care, medical, or educational provision. Since its inception as an innovative intervention for high level difficulties involving aggression and violence, harmful and controlling or self-destructive behaviour, NVR has grown to cover an entire range of specialised adaptations in areas such as child-to-parent violence in the birth family, attachment problems in foster care and residential care, anxiety disorders, school interventions, ADHD, community- law enforcement, computer addiction in children, supporting families with children on the autism spectrum, crises of the adult-child, diabetic children, working with traumatized parents and children, multi-stressed families, and more.

What are adult-children and dysfunctionally dependent older adolescents?

In the past 40 years, the transition into adulthood is becoming longer. Autonomous habitation, marriage and onset of parenthood are achieved later than before. As the path to adulthood is prolonged, an increasing number of young men and women experience difficulty in completing it. In many cases the transition to fully autonomous functioning does not occur or is reversed after an abortive attempt at independence, leading to chronic failure to emerge from adolescence into adulthood and lasting dependence on the family of origin instead. We call these individuals Adult-Children and Dysfunctionally Dependent Adolescents – young people whose psycho-social development towards normative adulthood has stopped.

The term “Adult Entitled Dependence” (AED), coined by Haim Omer in 2008, refers to a common family dysfunction he found no existing term for: a relationship where young adults or older adolescents cling maladaptively to their families, while the families nourish them emotionally and materially. Many adult-children and dysfunctionally dependent older adolescents suffer from concurrent disorders such as social phobia, OCD, depression, conduct disorder, ADHD or schizophrenia, or live with disabilities such as learning disabilities or are on the autism spectrum. AED’s systemic patterns are surprisingly stable across individual pathologies, and tend to reinforce their symptoms. Some other adult-children manifest no DSM-related disorder, exhibiting only extreme social withdrawal, avoidance of employment and education, entitled dependence on parents and para-suicidal behaviour/suicidal ideation.

Adult children and older adolescents in AED families tend to reverse the day-night cycle. Many live in various degrees of isolation (“Hikikomori”), often their rooms are locked during most of the day, while they immerse themselves in digital media addictions. Entitled dependent young adults and adolescents typically do not work or study, nor develop romantic or sexual attachments. As time goes by, their social existence grinds to a halt. Parents in turn suffer from growing social isolation, damage to their work capacities, lowered ability to concentrate, increased stress and anxiety, exhaustion, marital problems, rage, helplessness and guilt feelings.

As time goes by, parents and adult children or adolescents with entitled dependency become ensnared in a vicious cycle we call the “AED Trap”: the more helpless, dependent and dysfunctional the adult child becomes, the more anxious parents become to protect him or her against the requirements of adulthood, which leads to more dependence and dysfunction on the child’s part. If parents express their wish to change the situation or try to reduce their services, their adolescent or adult child may react violently or threaten that this will only lead to further deterioration, a total break in the relationship, or even suicide. Parents then retract in fear, accepting the status quo as the lesser evil. They still go on hoping that the child will become more independent, perhaps through therapy or by a process of inner maturing. However, when things have gone so far these hopes are usually unfounded.

In most cases of entitled dependence the adult-child refuses treatment, and therefore most existing interventions do not work. Distressed parents come to see a psychiatrist, a clinical psychologist, family therapist or other psychotherapist on their own, seeking “tools” for convincing the adult child to change. These professionals however usually refer onwards, saying they cannot work without the adult child’s cooperation.

What is the NVR intervention for adult children and dysfunctionally dependent adolescents?

The intervention applies the principles and methodology of Haim Omer’s NVR to cope with difficulties such treatment refusal, extreme social withdrawal, and entitled dependence in young adults with and without mental disorders. Systemic change is initiated by a unilateral effort on the ‘caregivers’ part (whether parents or others) to stand against the adult-child’s entitlement to anything they do which helps maintain his or her dysfunction, such as material services, emotional attitudes, maintenance of secrecy or ‘treading on eggshells’ – parental submission under threat of harm or self-harm.

As young dependent adults often say to their parents: “I’m all right! It is you who have a problem. Go treat yourselves!” NVR interventions for AED begin when parents take this advice seriously. They come to treat the situation as their problem, and then learn to re-define the boundaries of their responsibility.

A typical NVR / AED intervention lasts about 10-15 sessions and involves mainly the parents and their social support network. It implements NVR principles such as non-escalating struggle, transparency, no longer maintaining privacy or secrecy over coercive or self-destructive behaviour, documentation, support and self-change, with the goal of unilaterally changing not the adult child directly but the ecology which nourishes their maladaptive dependence.

As with all other adaptations of NVR, NVR / AED interventions can be applied either as standalone, short-term parent coaching, or within the larger context of family or couple therapy. It can be performed with or without the adult child’s cooperation, and can be effectively combined with systemic (family) therapy, psychotherapy, CBT, psychiatric intervention, social work, occupational therapy, coaching and education.

Target group

This workshop has been designed primarily for mental health professionals such as psychologists, systemic therapists, social workers, psychiatrists and mental health nurses in community mental health outreach teams or in early intervention in psychosis teams, who work with adults or older adolescents and/or their families. It will also be of interest to counsellors, therapists or psychologists who work with parents of younger adults or adolescents who show social withdrawal, internet dependency, are lacking in autonomy, or communicate persistent suicidal ideation.

The Training

The course first offers a general introduction to basic principles and methodology in NVR, and then goes on to familiarise participants with the specific adaptation to AED.

Note: Professionals who are well versed in NVR (e.g. have taken part in a 4-day Foundation Level training course and have applied NVR in their own work setting) can take part in days 2 & 3 of the course only.

The 3 day training covers the following topics:

Day 1: INTRODUCTION TO NVR

  • The family as a political place

  • The evolution of NVR from parental toolbox to a model of parenthood

  • The principles of NVR Interventions

  • The NVR toolkit (intake, announcement, support mobilization, relational reconciliation and repair, gestures, documentation etc.)

  • Typical applications in NVR: behaviour and anxiety

  • The NVR family of applications

  • NVR as a setting

  • Coping with suicidal threats and anxiety

  • The typical NVR intervention process

Note: Professionals who are well versed in NVR (e.g. have taken part in a 4-day Foundation Level training course and have applied NVR in their own work setting) can take part in days 2 & 3 of the course only.

Day 2: THE ADULT CHILD, THE DEPENDENT ADOLESCENT AND THE INTERVENTION

The adult child and dependent older adolescent

The adult child or dependent adolescent in the clinic
Socio-demographic context of emerging adulthood
The contexts of treatment refusal, extreme social withdrawal, suicide anxiety and threats, family violence, addictions
Conceptualising Entitled Dependence and Failure to Emerge

The intervention

Settings and model of change
Family and systemic aspects
Technique: step-by-step intervention management

Day 3: NVR INTERVENTIONS FOR ADULT CHILDREN AND DEPENDENT ADOLESCENTS

Technique: step by step intervention management (continued)

Special cases
Case lab (live interview with a family, or discussion of cases brought by participants, or videotaped interviews with families)
Overcoming barriers and parental resistance to self-destructive and harmful behaviour patterns.

Presenter

Dan Dulberger

Dan is a psychologist and family- and couple therapist specializing in NVR-based systemic interventions, with particular emphasis on AED (Adult Entitled Dependence), resistance to family violence, and crisis intervention. He is the internationally leading expert on entitled dependency.

Dan leads the Centre for Non-Violent Resistance Psychology Tel Aviv, a treatment centre for parents of adults suffering from AED and behaviour and anxiety problems, which he co-founded with Professor Haim Omer. Dan has developed and published, together with Professor Omer and the centre team, a NVR-based intervention model for adult-child crises and AED.

He is also founder of an international forum of NVR practitioners and a team member of the School of Non-Violent Resistance. He is a prolific and well known international presenter. Dan holds an M.A. degree in Social Psychology from the Tel Aviv University and is a graduate of the Herzeliyah Shinui Institute of Family Therapy.

Book 2 or more workshops and get 10% off total cost

(workshops must be booked at the same time)