Monday, June 4, 2012

My Clinical Pastoral Chaplaincy training at the Cancer Treatment Centers of America in Zion Illinois

I am thankful for the great team of chaplains at Cancer Treatment Centers of America (CTCA).  

My Clinical Pastoral training experience has added a new dimension to my ministry work.  I am in deep gratitude to Rev. Percy McCray and his staff of chaplains for their time, investment, and accommodations.  The CTCA model of holistic care has inspired me to rise to a higher level of service in pastoral care.  CTCA’s atmosphere of hope, optimism, and competence is the best model I have ever seen.  Their holistic treatment method places the patient at the center of care. 

-   Rev. Isaac James Schaeffer, May 29, 2012

Wednesday, May 23, 2012

Positive Parenting Strategies for Building High Self-Esteem in Children and Teens

Research Paper:  Parenting Strategies for Advancing Self-Esteem in Adolescents

Self-concept, self-esteem, and self-image play a determinative role in the personhood of adults, children and adolescents.  This paper focuses on adolescent self-concept and strategies parents can use to support the emergence and maintenance of a healthy self-esteem.  This report posits three finding.  First, adolescent development is a transition time that seals as valid ecological exposure to the self-concept of the child.  Second, parents often arrive at conclusions that are deductions of traditions and practices that misinterpret normative behaviors of adolescents that are developmental appropriate.  Third, the report examines Positive Parental Strategy as an approach that rewards prosocial behavior and holds accountable adolescent antisocial behavior with appropriate consequences thereby influencing adolescent esteem.  The paper documents how positive parenting is a determinant in the development and advancement of adolescent self-esteem.  Therefore, child maturational health and child outcome is contingent upon processes associated with this style of parenting which includes strong parent teen attachment and relationship bonding projects.  In its demonstration, the paper displays that spiritually integrated positive parental strategy incorporates prayer as an agency of expression and change.  In the concept of Positive Parental Strategies, the parenting model is authoritative, adaptive, consistent, fair, and emotionally connective to the child’s psychological and emotional state of being.  The report concludes that a healthy, engaging, parent and adolescent relationship positively influences the child’s self-concept, and advances self-esteem in adolescents
Key words:  parental strategies, adolescent development, self-concept, self-esteem
Since the initial research work of Abraham Maslow in 1954 (as cited in Fathi-Ashtiani, Ejei, Khodapanahi and Tarkhorani, 2007), who “hypothesized that esteem was one of the five sets of human needs,” (Fathi-Ashtiani, et al., 2007, p. 995) researchers have continued to build upon Maslow’s theory in furtherance of the understanding of human consciousness and development, and its other supportive components.  According to experts, self-esteem serves as an identification marker of intrapsychic experiences that develop maturity.  Self-esteem is “considered to be the evaluative component of the self-concept” (Fathi-Ashtiani, et al., 2007, p. 995).  Other components of the self-concept are self-confidence and self-perception.  These form a “relationship between self-esteem and psychological well-being” (Fathi-Ashtiani, et al., 2007, p. 995).   Together, self-concept, self-esteem, and self-image play a determinative role in the personhood of both adults and children. 
In defining self-concept, Fathi-Ashtiani, et al. (2007), explains it is a “sense of his or her value or worth or the extent to which a person values, approves of, appreciates, prizes, or likes himself or herself (Blascovieh and Torriaka, l99l )” (p. 990).  This paper focuses on adolescent self-concept and the strategies parents can use to support a healthy emergence of adolescent self-esteem and child outcome. 
The period in human development called adolescence is a stage in the developmental process characterized as transitional (Casey, Getz, and Galvan, 2008).  This stage in life begins at the onset of puberty and continues up to completion of maturity which results in developmental autonomy (Casey, et al., 2008).  Adolescence is not merely a separation in development that leads to adulthood.  The adolescent stage is critical to human development as research suggests (Berzin, 2010).  Adolescence represents “intense psychological, emotional, intellectual and social changes that characterize adolescence and make it an extremely vulnerable phase of development” (Vuk Pisk, et al., 2012, p. 27).
In other research on the adolescent brain, Casey, et al. (2008) said, “An accurate conceptualization of cognitive and neurobiological changes during adolescence must treat adolescence as a transitional developmental period (Spear, 2000), rather than a single snapshot in time (Casey, Tottenham, Liston, & Durston, 2005).” (p. 62).  As studies confirm, adolescence is a “critical stage of life, and one during which body image and self-concept are of particular importance for peer acceptance and approval” (Vuk Pisk, Mihanovic, Silic, Bogovic and Vidovic, 2012, p. 27). 
The Adolescent Self
In her dissertation, Michelle Clark (2009), documents what researchers have consistently found that a child’s self-esteem is extraordinarily high during the pre-adolescent stage.  When children enter the adolescent stage, their self-esteem falls by noticeable levels.  Clark (2009) writes, “Research has historically supported a trajectory that shows self-esteem to be highest in childhood to drop dramatically during adolescence, and remain at relatively low levels throughout mid-adulthood” (p. 6). 
Sexual maturation brings new challenges for adolescents and their parents. A theory presented by Casey et al. (2008) points to the evolutionary process of adolescent brain development and social transformation.  Adolescent development is a transition time that seals as valid ecological exposure to the self-concept of the child turning adolescent.  In its developmental formation, familial experiences and ecological systems influence the adolescent’s self-concept (Fathi-Ashtiani, et al., 2007; Clark, 2009).
Concept and theory of the self is a significant part of understanding self-esteem.  Fathi-Ashtiani, et al. (2007) has found that one’s self-concept influences one’s self-esteem.  Citing the work of Abraham Maslow (1954), Fathi-Ashtiani, et al. (2007) concurs with Maslow’s hierarchy of need.  In the model the formation of self-concept occurs in stages development.  In this regard, self–actualization is the pinnacle of development.
Further, self-concept is a system of intrapsychic processes that are measured in self-esteem, self-image, and self-perception.  These are interrelated and interconnected with self-concept being the base influencer according to Gibson & Jefferson (2006).  The self-concept has an effect on the interactional processes of the adolescent’s interpersonal and intrapsychic relationships and experiences.  Research by Fathi-Ashtiani, et al. (2007) has demonstrated that the self-concept affects self-esteem and self-image.  The self-concept is responsible for “organized informational summary of perceived facts about oneself, including such things as one's traits, values, social roles, interests, physical characteristics, and personal history (Baumeister, 1995; James, 1980; Kihlstrom & Klein, 1994; Rogers, 1959; Snygg & Combs, 1949; Wylie, 1968)” (Bergner & Holmes, 2000, p. 36).
Self-esteem is an affiliate of the self’s concept. Individuals with a “low estimating rate of their self-concept are likely to show certain personality characteristics such as shyness, reserved state, seclusion and loneliness (Kaliopusks et al., l99l).” (Fathi-Ashtiani, et al., 2007, p. 997).   Traditionally, focus is placed on self-esteem as a marker of confidence.  Research points to the self-concept as the base of the self. Self-esteem is an important marker of positive or negative intrapsychic activities and actualization (Fathi-Ashtiani, et al.,2007).
While research by Fathi-Ashtiani, et al., (2007) focuses on adolescent self-esteem, self-image, and self-concept with anxiety and depression, it is clear that self-image energizes adolescents, gives them confidence, and contributes to their mental and emotional health.  In adolescence, self-image is a reflection of childhood experience, exposure and the child’s developmental stage (Vuk Pisk, et al., 2012).  Self-image, self-esteem and self-perception in both adolescents and adults are pivotal to a successful navigation of life.  Vuk Pisk, et al., (2012) found an association between a poor self-image and its negative affect on adolescent development and body image.   A poor self-image also is associated with and influences how adolescents see the world around them and interact with adults, parents, and peers.  
Negative Effects on Adolescent Self-Esteem
Childhood Abuse
An increasing number of adolescents have experienced abuse and exploitation during their early childhood formation (Montague, M., Enders, C., Dietz, S., Dixon, J., & Cavendish, W. M. (2008).  One global study of youth ages 15-24 in Europe, Israel and the American continent conducted by Mansbach-Kleinfeld, Levinson, Farbstein, Levav, Kanaaneh, Stein, Erhard, Khwaled, and Ponizovsky (2010) reports a “lifetime prevalence” of “22.5” percent of adolescents suffering from mental disorders (p. 246).  Considering the data, early childhood exposure to abuse might be a significant contributor to adolescent pathology. 
Studies have shown that depression is an active phenomenon in the lives of adolescents according to Wagner (2011).  Not only does self-esteem reach its lowest point across lifespan during adolescence, but depressive symptomology appears to manifest during this stage to the concern of clinicians and researchers (Montague, Enders, Dietz, Dixon, & Cavendish , 2008).  Some depressive symptomology in adolescents include excessive sleeping, chronic anger, excessive argumentativeness, withdrawal from family norms, and suicidal ideation (Bridge, Goldstein, & Brent, 2006). 
Sexual Exploitation and Abuse
Past sexual exploitation and abuse hinders the development of a healthy self-concept, and without forms of intervention emotional damage and pathology would be more likely to result.  Green, Krupnick, Stockton, Goodman, Corcoran, and Petty, (2005), found a correlation between the effects of adolescent trauma and risky behavior in college women.  The report finds that “individuals with sexual assault or abuse histories are likely to engage in risky sexual and other self-destructive behaviors”, (p. 363).  Green, et al., (2005) stated, “Studies have found that a history of forced sex is associated with intercourse at an earlier age” (p. 364).  Sexual abuse is a likely predictor of the number of sexual partners over a lifetime a person will have, not considering spiritual, psychological, or sociological intervention (Green et al., 2005). 
In a study that examined sexually risky behaviors, Green et al. (2005) wrote, “risky behavior was higher in their sexual and physical assault groups than their non-victim groups; multiple assaults were associated with higher levels of risky behavior than single assaults, and sexual trauma was most predictive of risky behavior.” (p. 365).  Also, Fathi-Ashtiani, et al. (2007), calls body image value an important part of esteem, and claims that an adolescent’s sexual self is attached to his or her self-image and self-concept.  Consequently, sexual or psychosexual abuse suffered of adolescents is associated with a high level of suicidal ideation or attempts (Green, et al., 2005).  Furthermore, Green et al. (2005) stated that the association with suicide was “stronger for combined abuse and molestation than for non-sexual abuse or molestation alone.” (Green, et al., 2005, p. 365).
Feeling of Familial Rejection
Researchers have found that many adolescents who struggle with a gay or lesbian identity are prone to suicidal ideation because of the fear of rejection (Kitts, 2005).  A percentage of those adolescents with a gay or lesbian identity are at increased risks for suicidal ideation or completion (Kitts, 2005).  Adolescents with sexual identity issues, or same sex attraction experiences may perceived or view as valid rejection of their feelings by family and friends as a rejection of them (Kitts, 2005). 
Adolescent Individuating Behavior
For the emergent adolescent, members of the adult class are more likely to label their behavior as impulsive, risky, and self-centered (Casey, et al., 2007).  Research on adolescent brain development confirms these terms and labels placed on adolescents as valid, but not for the same reasons as adults tend to view adolescents’ individuating behaviors (Casey, et al., 2007).  Some adolescent behavior categorized as rebellious is developmentally necessary to the successful emergence of the adolescent into adulthood according to Casey, et al. (2007). 
Adolescent behavior as noted often appears offensive and at times strange to the normal sensitivity of members of the adult class (Ormel, Oldehinkel, Ferdinand, Hartman, De Winter, Veenstra, Verhulst, 2005).  Parents often arrive at conclusions and stereotypes that misinterpret behavior that is normative to the adolescent experience according to research on the adolescent brain conducted by Casey, et al., (2007).
Further, in sexual maturation, the brain releases hormones into the blood stream bringing about physiological and psychological changes within the mind and body.  This moves the child into a new phase of development called puberty (Casey, et al., 2007).  Research about adolescent brain development by Casey, et al. (2007) shows the developing brain produces behavior such as risk taking.  Behavior, considered by the adult class as rebellious, points to the need for the family to make adjustment of itself to the emerging adult and recognition of the adolescent need for individuation.
Influencing the Adolescent
In their role, parents wield enormous leverage with their children (Sentse, Lindenberg, Omvlee, Ormel, & Veenstra, 2010).  During adolescence, however, the child may be  seeking to renegotiate the family’s covenant.  A parent’s capitulation to demands may produce a counter effect that diminishes the parent adolescent relationship.  Parental strength lies in the ability of the parent to model the desired behavior they wish to see in the child’s outcome.  Child compliance strengthens the parental influence and the parent-child bond.  Family routine shows the strength of regularity and promotes healthy interactive family time together.  Family structure and activities where the parent and adolescent work together on a project help to create adolescent connectedness, influence child outcome, and stimulate adolescent wellbeing (Bachman, Coley and Carrano, 2012).  
Adolescent Motivation
Research by Casey, et al. (2008), has established that adolescent behavior is driven by maturational changes in the body along with his or her response to the new experiences and feelings.  Parenting in the adolescent stage requires a different set of parental responses than parenting in the pre-adolescent stage (Hardy, Carlo, and Roesch, 2009). 
In adolescence various bio-psycho-social factors are at work including low self-esteem, sexual maturation, and hormonal changes leading to the behavior stereotyped as risky behavior and impulsivity (Clark, 2009; Hardy, 2009; Fathi-Ashtiani, et al.,2007; Alikasifoglu, & O. 2009).  Researchers explain that parenting during this stage in development requires a different approach and emphasis in the parent child transaction.  For adolescents self-concept is questionable.  Members of the adult class tend to stereotype and miss important behavior clues to understanding adolescent expression and needs.  What might appear to the family as bad, rude, crude, insensitive, and arrogant behavior is the adolescent’s way of responding to the various changes he faces (Lee, Ng,Cheung, and Wayung, 2010).  In essence, the adolescent is seeking to individuate from their family of origin (Lee, et al., 2010).  
Mental Illness in Adolescence
Mental disorders, familial dysfunction, addiction, and other types of disease and pathological abuse affects adolescent healthy outcome (Bolland, Lian, & Formichella, 2005; Vuk Pisk, et al., 2012; Clarke, 2009).  African American adolescents face unique challenges that stand in the way of a healthy self-concept.  A higher percentile of African American adolescents faces being sent to jail rather than to treatment according to Robinson, Holmbeck, & Paikoff (2007).  In addition to growing up with certain constraints, their self-concept is affected by the living environment, poverty and a sense of “disconnectedness and psychological distress and contributes to the promotion of perpetuation of feelings of hopelessness” (Bolland, et al., 2005).
Parenting in the adolescent stage can be filled with stress and familial conflict (Brewer, 2012).  Additionally, the parent teen transaction can be tense with rising anxieties on both ends.  Research by Hardy et al. (2009) points to the need of parents to engage the adolescent cognitively because adolescents “expected their parents to respond appropriately.” (Hardy et al., 2009, 85).  Parents can choose to respond to age appropriate behavior that signals the adolescent individuation stage including impulsivity, insensitivity, and pushing away (Hardy et al., 2009).  A harsh parental response sends a mixed message to the adolescent who is told to “grow up” by a parent who tries to control the consequences (Hardy et al., 2009). 
Positive parental practices, however, reward adolescent prosocial behavior with positive reinforcements (Hardy, et al., 2009).  When parents fail to apply consequences to antisocial behavior, the adolescents interprets the message with a message of their own according to research. Messages sent to adolescents by parents are subject to a poor reception if the message is unclear, confusing, and inconsistent.  It is paramount to the adolescent that he or she be respected in the family dialogue (Clark, 2009).  Parent teen transactions are viewed by the adolescent as socializing with members of the adult class.  Research findings support the premise that “adolescents are more accepting of parental socialization when they see their parents as dealing fairly with then in response to their positive and negative behavior” (Hardy et al., 2009, p. 86). However, parents lose credibility and respect with the adolescent if they are perceived as unfair.  
Parenting the Adolescent Self for High Self-Esteem
Consistent, Fair, and Consequential
It is normal for adolescents to test their parents’ seriousness and parental resolve.  Parental practices that are perceived by the adolescent as consistent, fair, and consequential have a lasting effect on adolescent behavior and maturation (Bachman, et al., 2012).  It is within the norms of adolescent behavior for them to voice displeasure and demonstrate opposition to perceived adult control.  Many parental actions are viewed by the adolescent as intrusion into their lives (Vuk Pisk, et al., 2012). Parents, who apply consistent rewards for prosocial behavior and consequences for antisocial behavior, help their adolescent learn to differentiate appropriately and gain better child outcome (Hardy, et al., 2009). 
Listening to the Inner Voice of the Adolescent
Positive parental practices involve the theoretical concept of proactive awareness.  Parents can become good listeners to the inner voice of the adolescent and diminish the sound of loud tones, anger, and cursing.  According to Kitts (2005), Kecskemeti (2006), and Koplewicz (2012) the adolescent message at times are voices of suicidal ideation, sexual identity confusion, and the voice of deep hurts and insecurities.  Parental practices which generate a successful outcome positively engage adolescents affirmatively without a fear of their acting out (Hardy, et al., 2009). 
Affirmation and Issues of Esteem
Carl Rogers, 1961 (as cited in Clark, 2009) advocated for parents to accept their child without preconditions.  He believed in the principle of unconditional positive regard.  The esteem needs are located above the life sustaining needs.  Adolescent needs are not different from adults.  Adolescents are people who need to be esteemed, feel safety and security and to have a sense of autonomy (Clark, 2009; Lyubomirsky, King, & Diener, 2005).  Data shows that during childhood, self-esteem is at a high, but in adolescence, it drops to “relatively low levels” (Clark, 2009, p. 6).  Researchers are unsure why adolescents’ esteem falls and remains low until mid-adulthood (Clark, 2009).  According to Lyubomirsky et al., (2005) frequent positive affect such as touch, affection, praise, encouragement and a listening ear benefit the parent teen relationship and foster esteem. Likewise, parental socialization can be a positive experience for the adolescent (Kerr, Capaldi, Pears, & Owen, 2009).
Familial Stability
Family stability plays an important role for the self-concept and esteem needs of children and adolescents according to research by Manning,( 2007) and Bulanda, & Manning, (2008).  Robinson et al., (2007) found that in homes parented by single parents or homes with significant marital distress or familial dysfunction, adolescents experience instability and anxiety.  According to Bachman et al. (2012), family “stability may become increasingly important during adolescence as youth contend with transitions into middle and high school, shifting peer groups, and physiological pubertal changes (Brooks-Gumn & Reiter, 1990; Eccles, 1999)”, (p. 26).  A healthy marriage and family experience contributes to adolescent esteem-building, and are more likely to serve as a safe place for the emerging adult.  In adolescence, the familial health serves as a life sustaining entity for the adolescent.
Positive Parenting Strategy is Advancing Esteem in Adolescent
Positive parental practices involve doing no harm to the child, emotionally, spiritually, and physically.  Parental encouragement and modeling contributes to the child’s healthy sense of self.   Positive parental practices as described work within the context of a stable home life that rewards adolescent’s prosocial behavior (Bulanda & D Manning, 2008). 
Strategy for Advancing of Self-esteem in Adolescents
According to research, the family of origin serves as the best source for self-concept and self-esteem (Kerr, et al., 2009).  Adolescents gain a sense of high esteem from their family of origin, societal and economic status and parental warmth.  The parents’ marriage and parenting practices by one’s father and mother provides a model to the adolescent so they are better able to function as adults in a complex society (Clark, 2009).  Further, positive parenting models the use of non-judgmental statements.  Positive parent practitioners use reflective listening. In listening, they seek to hear, connect and better communicate heart level messages (Dwairy, & Achoui, 2009).  They also seek to affirm the personhood of the child and genuinely uplift his or her self-esteem.  Positive parenting is a proactive approach to parenting in comparison to reactive parenting.  Societal investment in parental rights grants authority that enables parents to make difficult choices.  However, the power of parent must be balanced against the adolescent’s response to limits (Hardy, et al., 2009). 
Spiritual Integration
A spiritually integrated positive parental strategy incorporates prayer as an agency of expression and change.  According to Weld, & Eriksen (2007) “intercessory prayer had the strongest effects on the cognitive symptoms of depression” (p. 328) and can serve as an effective parental practice.  Prayer takes the parental wish and directs it towards God and not the child him or herself.  This helps to lower strong emotions by the parent and any possible harmful words and actions towards to child.  In the conversation of prayer, God reciprocates as the parental wish for the parent’s patience, grace and yieldedness.  Parental modeling allows the child to learn to exercise autonomy, cognition, and personal spiritual sensitivity (Weld, & Eriksen, 2007).  Another effect of spiritual integration in positive parental practices is a tendency to unify homes and bring the parent teen relationship into healing relationship. 
In this research, I found an extraordinary amount of information about the self and its various components (self-concept, self-esteem, and self-image, etc.).  As I reviewed the literature, I discovered several significant concepts previously unknown to me that led to clearer understanding of family systems, adolescence, parenting and self-esteem. 
My research revealed that in families it is a normative role for adolescents to engage and respond to parental directives with a level of hostility with exception given to ethnicity, culture, and context (Clark, 2009;ACA, 2005;Kerr, et al.,2009).  Based upon these findings, I theorized that the adolescent-parent relationship is caught in a tug of war for autonomy versus authority (Berzin, 2010).  Parents want to keep children close and control the outcome.   Children want to gain control of their destiny.  Innately, the adolescent is seeking to become his or her own person within the safety of the family.  He or she is pushing away any parental control because he or she perceives it as being smothered.  Individuating behavior is also observed in the toddler development stage. 
The parable of the Prodigal Son shows a son in a stable family.  He grew up under the care of a financially secure and highly successful father.  He leaves in order to find himself.  He later returns to realize that his father meant no harm to him.  In the father’s shadow, however, the son felt he could not see himself (Luke 15:11-32).  At the core of this evolutionary development, i.e. child maturation and familial system maintenance, is the familial need for homeostasis.  In the end, an adult will emerge equipped for life in the adult world (Grafton, et al., Eph 4:14-16). 
Introspectively, motivation for this report is based on my own adolescent years and my employment experience.  I was taken back to my career working as a resident advisor for the Job Corps program.  While there, I saw students (adolescent ages 16 -21) who were struggling with themselves, their personal pathologies, disorders, ethnic identity, and society expectations.  Like my students, my sense of self and the future were in question.  Life had fearful connotations.  Further, in working with my own children I was fearful that my pathology and transgressions would repeat themselves in my home.  However, reconciliation with past obligations means taking on the form of prayer narrative in positive confession of faith, grace, divine hope and my need of help.  This prevented many of my family of origin anxieties from affecting my children in the same manner they hurt me.  
Further, this research brings to the forefront principles that have made a difference for countless numbers of adolescents across the United States and the Caribbean.  This study showed the maturational processes and methods to support better parenting with less parent-teen conflict.  Positive parental practices involve doing no harm to the child, emotionally, spiritually, and physically.  Parental talk, encouragement and modeling contributes to the child healthy self-sense of self.   Finally, it is my theoretical assumption that positive parenting as outlined in this paper is an effective practice when parenting the adolescent.  Child outcome may dependent in part on parental styles, adaptation, and principle application.  The status of the parent child relationship and the esteem health of the child rests on what the research suggests are positive.  Parenting models that are authoritative, adaptive, consistent, fair, and emotionally connected to the child’s psychological and emotional state of being will result in a more successful parenting relationship.  

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