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S4E4 - Why Does My Child Hold Their Pee? · Play Therapy Parenting: Real Parenting Questions Answered by a Child Therapist

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  You're listening to the Play Therapy Parenting Podcast
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  with Dr. Brenna Hicks.
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  Hi,
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  I'm Dr. Brenna Hicks,
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  The Kid Counselor.
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  This is the Play Therapy Parenting Podcast
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  where I answer real parenting questions about behavior,
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  emotions,
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  and the parent-child relationship.
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  In today's episode,
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  I'm answering a question from Joy
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  about struggling with toileting issues.
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  And gosh,
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  is this a common scenario.
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  So,
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  I'm happy,
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  Joy,
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  that you emailed and we'll be able to dive into this together.
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  And just for those of you that may have
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  just found out about the podcast or you're new,
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  welcome.
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  Really glad you're here.
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  This is season 4.
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  So,
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  if you are unfamiliar with the 1st 3 seasons,
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  please feel free to go back and check those out.
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  And
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  there are all different kinds of process for each
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  season.
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  And so,
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  season 1,
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  lots of CCPT content.
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  Season 2,
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  lots of questions and rules of thumb about the model.
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  And then season 3,
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  the Parent Companion for Play Therapy.
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  So if you are considering play therapy and or
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  you have your child in therapy,
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  that's a really helpful season for you.
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  And then season 4,
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  all about y'all,
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  your questions,
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  your concerns,
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  and the scenarios.
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  that you email and we tackle them together.
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  So,
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  thanks for your emails.
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  I'm getting to them in order of arrival and I'm tackling them as fast as I can.
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  So,
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  I may eventually end up going to 2 a week
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  if I end up getting 2 backlogged.
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  So keep sending them and I'll answer them as soon as I'm able.
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  So let me read parts of Joy's email and then we will dive in together.
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  My 7-year-old has struggled with pee withholding
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  since she potty trained 4 years ago.
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  She will hold her pee hours and hours past when she shows signs of needing to go.
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  Throughout the day,
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  one of her hands is almost always on her crotch,
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  and she's wiggling.
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  Eventually she will make it to the potty,
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  but only until she is absolutely desperate,
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  screaming,
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  crying,
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  moaning,
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  and can't stand up.
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  We've tried scheduling potty times,
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  giving rewards,
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  reading and playing games with her on the potty,
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  and even ignoring it or letting her do things her way,
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  but it continues to be an issue.
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  I just listened to your podcast episode about control,
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  and I want to know what my next step should be.
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  What are some ways
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  I can give her more control in daily life,
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  so she isn't so compulsive about holding in her pee?
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  I feel like my husband and I are very easygoing parents,
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  and we let her do what she wants with her free time.
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  We offer her different foods at dinner,
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  but don't require her to eat anything she doesn't want to.
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  She gets to weigh in on family outings and weekend plans.
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  I don't know how to offer her more freedom than she already has,
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  and how can I help her be less controlling about peeing.
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  OK.
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  So,
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  I think one of the most important components,
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  you already addressed it,
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  is we know that children only have control over a handful of things,
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  and toileting is one of them.
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  So,
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  we will have children that will either refuse to go
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  or they will
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  go in their underwear and shorts and they have accidents.
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  They will withhold.
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  They will continue to
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  struggle with toileting related things long past
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  the typical potty training era of childhood,
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  so on and so forth.
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  So,
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  we understand that
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  often there is a conditioned response in a scenario like this,
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  as well as what originally would have been an organic response.
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  Let me make sense of what I'm trying to say.
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  At one point,
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  I suspect
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  she was probably playing.
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  She was excited.
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  She was with her friends.
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  She was right in the middle of doing something that she felt was really important,
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  and she made the conscious decision,
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  emotionally,
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  of course,
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  not cognitively.
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  She wasn't going to think about it,
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  but she felt
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  that,
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  you know what,
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  I'm just going to hold it.
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  I don't want to go right now because I'd rather do
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  what I'm doing.
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  So,
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  that was probably a very natural,
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  genuine happenstance kind of moment
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  where she said,
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  I don't want to go.
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  Over the course of time,
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  what ends up happening is it becomes a conditioned or habitual
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  behavior.
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  And this is true of lots of maladaptive behaviors in childhood.
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  It starts off very innocently and naturally,
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  and then it just becomes something over which they really are not even aware,
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  and they just tend to kind of behave in this
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  pattern
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  of this is how things go,
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  and they're not even cognizant necessarily
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  that it's a willful choice that they're making.
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  So that's how you have kind of the conditioned response
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  as well as what originally happened
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  in one moment in time that was isolated,
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  and it easily becomes a pattern of behavior.
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  So,
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  whether now it's just such
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  a standard in her life,
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  she's so used to holding it,
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  she's so used to not going,
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  that has become standard.
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  And or
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  it sounds as though possibly there's a little bit of anxiety worked in here,
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  and we know that often.
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  High levels of anxiety manifest themselves in high
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  need for control in children
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  because control is the antidote to the levels of anxiety.
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  And here's what that looks like.
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  What if
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  I don't want that to happen.
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  I need to control something.
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  That could be scary.
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  I need to control something.
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  I don't want that to happen.
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  I need to control something.
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  I can't handle that.
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  I need to control something.
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  All of the unknowns and the fears.
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  are anxiety driven and therefore the response
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  that a child
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  eventually falls into
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  is,
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  well,
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  I'll just control it and then I feel that things are under my control more.
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  So if we have anxiety playing in here,
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  she might actually
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  be
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  caught up in an anxiety cycle
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  where
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  I usually just did this because I didn't want to go pee,
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  but now
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  I do it because I'm scared of what might happen.
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  Fear of the unknown is overwhelming for high anxiety kids.
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  Fear of a new outcome,
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  very overwhelming.
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  So it could also be slightly anxiety driven as well.
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  We know that somatic issues,
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  somatic is
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  the body's.
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  Response to emotions.
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  So we get butterflies in our stomach,
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  we get racing hearts,
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  we get sweaty palms,
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  we get lumps in our throats.
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  All those sensations we feel in our body,
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  they're physiological,
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  but they are rooted emotionally.
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  So,
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  it sounds like this could have a somatic component because
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  toileting issues are very often also tied to the somatic,
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  which means they're emotionally driven.
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  So all that to say,
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  Joy,
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  that's kind of the backstory,
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  and those are things that I wanted to share for everyone's sake
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  to help put things in perspective.
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  First of all,
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  this is very common.
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  children have toileting issues
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  very consistently and even much longer into
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  childhood than most parents would think.
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  So,
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  you're not alone.
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  This is something we deal with all the time in child-centered play therapy.
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  So,
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  I think now to answer your kind of second part of it,
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  which is
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  you were listening to the control piece and you're trying
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  to figure out how to provide her with control.
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  I think one of the most important things you
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  can do is be very intentional with choices.
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  Because
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  it sounds as though
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  You said we're easygoing parents.
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  We let her do what she wants with her free time.
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  We offer her different foods,
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  but don't require that she eats them.
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  She gets to weigh in on family outings and weekend plans.
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  It sounds as though you've given her freedom.
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  But it sounds as though you haven't given her choices,
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  and that might be an incorrect assumption.
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  So please feel free to email me and say,
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  no,
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  Brenda,
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  I do in fact give her choices.
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  But
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  I'm not hearing based on what you've written
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  that they are tangible,
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  clear choices.
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  And what that looks like is we give empowerment choices
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  as often as possible
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  so that she feels a measure of control,
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  consistency,
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  and consistently
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  in her daily life.
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  So,
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  Daughter,
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  you can choose
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  carrots for dinner,
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  or you can choose broccoli for dinner.
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  Which do you choose,
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  assuming she likes both.
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  You wouldn't want to give a choice that she doesn't like.
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  But if she likes carrots and broccoli,
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  you can choose this vegetable or this vegetable at dinner,
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  which do you choose?
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  This weekend,
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  you can choose for us to go to the beach
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  or you can choose for us to go miniature golfing.
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  Which do you choose?
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  For getting ready
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  for the day.
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  She's 7.
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  I'm assuming that means 1st or 2nd grade.
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  So,
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  when she's getting ready for 1st or 2nd grade,
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  you can choose to wear your tennis shoes today
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  or you can choose to wear your sandals today.
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  Which do you choose?
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  And what we're doing,
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  it is not the same thing if we say,
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  what shoes do you want to wear?
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  What do you want to do this weekend?
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  You don't have to eat that if you don't want to.
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  Those are not choices,
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  and what we're doing when we give choices,
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  we say choice,
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  we say choose 3 times.
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  You can choose A or you can choose B.
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  Which do you choose?
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  What we're communicating is you have control,
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  you have power,
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  you have a choice.
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  You have the acceptance of the consequence of that choice,
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  and you have responsibility for the outcome.
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  And over time,
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  the more empowerment choices a child is given.
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  The more they realize
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  I actually do have quite a bit of power in my life.
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  I do have quite a bit of control
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  on a daily basis.
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  I don't have to fight for control and power,
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  and this is not a quick fix,
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  Joy.
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  I want to be clear.
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  If you start giving choices today,
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  obviously you won't because you won't hear this episode for a couple of days,
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  but
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  the,
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  the second you hear this episode,
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  if you start providing choices.
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  It's not going to immediately solve the problem with the peeing issue,
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  but over time what happens is
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  she realizes
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  I have measures of control consistently.
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  I'm constantly able to make decisions.
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  I'm constantly in a position of power over things that happen in my life.
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  That gives a child a sense of freedom
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  to not have to fight for control
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  elsewhere.
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  So it is a slow process.
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  It's something that happens over time.
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  And the goal ultimately
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  is
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  she reduces anxiety
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  as well as feels more in control.
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  Those two things together means the toileting
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  issues will likely reduce or resolve.
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  And let me be clear on the empowerment choices,
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  because I don't ever want to give the impression or the misperception
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  that when we provide empowerment choices,
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  that just means that the child is in charge of everything.
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  The choices that we offer are always mutually acceptable to us as well.
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  Let's go back to the broccoli and carrot scenario at dinner.
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  I don't care whether you have broccoli or carrots,
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  I'm OK with either one.
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  It's not
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  which vegetable do you choose,
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  and the child says eggplant,
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  and you don't have any eggplant,
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  and so then you're stuck either going to the store
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  or saying,
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  no,
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  sorry,
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  eggplants,
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  eggplant's not one of the choices.
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  That's not the scenario.
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  It's not
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  kid gets carte blanche whatever they want.
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  You are providing choices that you're OK with.
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  Sandals or tennis shoes are perfectly OK with you.
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  The beach or miniature golfing is completely OK with you.
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  You are providing choices
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  under your parameters.
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  So this is not kid just gets the freedom to do and and have at it whatever they want.
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  It is very clearly
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  I'm giving you a measure of control.
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  I'm empowering you to understand what it feels like to make a choice
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  and have some power in your life,
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  but ultimately parents are still in the position of power and control
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  because if you weren't OK with broccoli or carrots,
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  you would not be offering that choice.
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  So I wanted to make sure that that's known.
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  I don't ever want there to be a misunderstanding
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  of what an empowerment choice functions as for a child.
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  It's very clear parents still have authority
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  and children are given power under the parameters of parental control.
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  So Joy,
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  thank you so much for the email.
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  I'm really glad we were able to tackle that.
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  I appreciate you bringing that up.
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  If the rest of y'all would like to hear from me or have me answer a question,
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  please reach out,
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  brenna@thekidcounselor.com
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  I'd love to hear from you.
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  I love y'all.
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  Have a great week.
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  Keep loving on your kids.
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  We'll talk again soon.
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  Bye.
• 12:19
  Thank you for listening to
• 12:20
  the Play Therapy Parenting Podcast with Dr. Brenna Hicks.
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  For more episodes and just subscribe to our newsletter,
• 12:28
  please go to www.playtherapyparenting.com.