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This column contains a couple of common questions from the parents of my patients about kids during the holidays.

What are your suggestions for helping kids have reasonable expectations for what “Santa” brings (when other kids get expensive stuff)?

There is no one answer to what is right for Santa to bring so please keep that in mind as you read these suggestions. Santa is an extension of family and as such should match your family’s values.

Having family conversations with your children well ahead of the exciting build-up to Christmas can help children have expectations that match what is right for your family. Even though children learn about Santa in many places, the main place they learn about Santa is at home. This is a great opportunity to teach them what Santa means to your family. Having these conversations together before the buildup to the holidays can help teach children many of your family’s values that go far beyond material gifts.

If your child complains that gifts are “not fair” or that another child got a “better” gift from Santa than they did, try to respond with empathy rather than lecturing them for being ungrateful for what they received. In doing so, you are teaching an important value—namely that you care about each other and hear each other out when you feel wronged.

This does not mean that you need to agree or promise the moon for next year. Just acknowledging a hurt goes a long way to helping someone feel understood and loved. Even though we may not think so, showing empathy in this way is a gift that we can give our children and Santa would surely approve.

How do we help our children learn boundaries and ways to stay safe around unfamiliar family and friends during holidays?

Recommendations from pediatricians and child psychologists/psychiatrists have changed dramatically from the “old days” when children were forced to hug and kiss family friends and relatives. The reason for this change is that it corrects a harmful mixed message that may have made children more likely to be exposed to dangerous touching.

The current recommendation is that that you should not force children to have unwanted physical interactions with others. This allows children to decide who and when to hug. In addition, you should help your child set limits if you feel a situation is not appropriate or if an adult is trying to force a hug or a kiss and your child seems hesitant.

It is ideal to have conversations about this as a family before the holiday season. This will give your child plenty of time to ask questions and also to let the ideas you share with them “marinate” before they have to apply them. You can let children know that they don’t have to do the same thing to every person or every time and that is okay. They don’t have to offer explanations to people for not giving physical affection. And importantly, that you support them no matter what.

Monitoring your children at family events is important. It is also appropriate to step in and say, “If Bobby does not want to hug that is okay.” Instead of physical affection, you could have your child help put up guests’ coats or show guests where the snacks are set out. This way children learn about respect and hospitality while also learning that you support them when it comes to setting limits about physical interactions with others.

The Girl Scouts have a parenting article on this topic that has additional considerations: “Reminder: She Doesn’t Owe Anyone a Hug. Not Even at the Holidays.”

Last, try to avoid using labels for your child or giving excuses such as, “Oh, he’s just shy.” Your child may take that label to heart and it could have an unintended negative impact on your child’s self-esteem. It is not “shy” to set a limit and decide not to hug a relative. It is a show of strength and there is no need to make excuses about it. Supporting your child and modeling limit setting is the best way to ensure that your family enjoys the wonderful holiday festivities at hand.

Happy Holidays & Happy New Year!


 Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.

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Common questions that I hear from parents center around the ideas of children not listening or talking back.

Parents ask: Why won’t my child do what I ask? Why is my child always arguing with me? How can I stop the back talk?

The short answer is we can’t stop it completely. The longer answer is we can improve a lot of it but it takes consistent work on our part. Why is this hard for parents to do? First, it is because as parents, we are already working so hard day in and day out for our children. And second, because our natural urge when our children are being disrespectful is to yell and/or “lay down the law” even though the endless punishment/reward cycle often fails to solve the problem.

Often when I talk with parents, they refer to “the good old days” when children listened immediately. They ask, what is wrong with things today that children don’t do that anymore. My answer to that is that things are actually better now. Yes, better even with more back talk. Why is that?

In the past, it was much more common for parents to use harsh verbal and physical punishment with children, much of which is considered child abuse today because we know how damaging it is to child development. Through the use of fear and intimidation, children were more likely to “fall in line.” However, that came at a steep price. Specifically, it came with poorer parent-child relationships and lifelong emotional and psychological scars.

As a society, we came to realize that to raise healthy, strong children and to have families that were loving and connected, we needed to abandon the use of fear and intimidation with our children. The good news is that in doing so, children and families have flourished. That is not to say families are problem free but rates of violence in families have decreased dramatically and school graduation rates have increased substantially since these harsh punishment practices have stopped.

With harsh punishment off the table, what do parents do now to increase children’s listening and decrease misbehavior? Should they reward? Should they punish appropriately? What should be done?

The answer really lies in modeling the behavior you want to see yourself (i.e., Walk the walk. You can’t ask your child not to yell if you are often yelling.) and taking steps to motivate this behavior in your child instead of rewarding or punishing.

How do you motivate?

Instead of saying: if you pick up your toys, then you can ride your bike.

Say: I am really looking forward to going on a bike ride with you after your toys are picked up. Let’s get started with putting them up.

Instead of saying: You better play in the pool nicely or you are going to get a time out.

Say: I can see you are feeling wild. I’m going to take you out of the pool because it is not safe. Then we’ll go to calm down.

No matter how difficult or out of control a situation may seem, there are ways parents can respond to motivate appropriate behavior. In motivating, parents can foster positive behavior that is lasting in a way that rewards and punishments cannot.  The difficult part is that when our emotions are high in these challenging situations with our children, our natural instinct as parents is to engage in threatening or punishing behavior, even though it does not work in the long term.

How do we break the cycle?

There are books for pre-school and elementary age children like Heather Turgeon’s Now Say This: The Right Words to Solve Every Parenting Dilemma.

And for middle- and high-school age children like Anthony Wolf’s I’d Listen to My Parents if They’d Just Shut Up: What to Say and Not to Say When Parenting Teens.

To have solutions that are tailored exactly for your family’s values and circumstances, don’t hesitate to contact the Chrysalis Center and schedule a consultation with me, Dr. Kate Nooner, or one of our other clinicians who have parenting expertise.

You are a great parent and you can do it!


Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.

Online games, music, videos, written content, and various social media have reshaped the ways in which our pre-teens and teens interact with the world. In many ways, this is a scary prospect for parents, who did not grow up carrying a powerful computer in their pockets with the capacity to access (or send videos to) the entire world in seconds. While our initial inclination as parents may be to take technology away, we also know that there are many positives that come from technology and like it or not it is an integral part of daily life.


Controlling internet use can be more straightforward with younger children where limiting access to technology, blocking non-kid-friendly sites, and setting strict time limits are developmentally appropriate. Unfortunately, much of this changes in the pre-teen and teenage years. Adolescents want and need more independent access to technology than younger children for homework, recreation, and socialization—and severely limiting that can be harmful… but letting it be a free-for-all can be harmful as well. So what does a conscientious parent do?


The good news is that there are many ways that we can help our pre-teens and teens learn to be more safe, to avoid perils and to take advantage of positive, age-appropriate opportunities online. Some more good news is that the internet has a lot of great things to offer that will enrich our children’s lives and help them learn key skills for their future. So, how do we make sure that our pre-teens and teens navigate this seemingly limitless online world safely and productively? The answer is us, or more specifically, our relationships with our teens.


The number one thing that we can do to make sure our children are safe is to have conversations with them about their online activity on a regular basis. This engagement likely looks different than what you think. It is not the typical parental grilling: What are you doing? Who are you talking to? Show me everything! Followed by a lecture of why this or that is wrong. This approach often shuts down teens and pre-teens. It can have the negative effect of decreasing communication between parents and teens, which is the opposite of what we want.


Instead, we need to foster conversations that are genuinely focused on teens’ online interests and goals, while also setting developmentally appropriate limits on device types and usage time as well as having parental monitoring of use. This means actively engaging our children in the aspects of the internet that are nearest and dearest to them and may be completely foreign (or boring or trivial) to us as parents. This parent-teen dialog is a vital way to open doors and build bridges that ultimately keep them safe and help them make better choices online.


The purpose of engaging our youth about their online interests is not so parents can start SnapChatting. The purpose is to stay in a parental role while building a relationship that maximally facilitates our teens coming to us for guidance when they have a question or are in trouble. Rather than fearing that they will be punished, we want our kids to know that we are their allies. Developing a foundation built on a positive relationship about online matters will shift our kids’ perceptions from seeing parents as roadblocks to seeing parents as resources.


Exactly how is this done? This is a highly personal matter that differs from family to family and should be centered on your core values. To help support families in this conversation, we are offering seminars for parents and pre-teens/teens ages 12-17 at Chrysalis. Parents and pre-teens will have separate seminars to allow youth and parents to find support and guidance in safe spaces.


The purpose of the pre-teen/teen seminar is to open up the conversation and provide a supportive environment for youth to talk about the positive and negative aspects of being online—this will not be a lecture. It will be fun for your pre-teens and teens, while also providing valuable information. In the teen seminar, we will be asking questions to teens to better understand their online experience. A summary of this information will be shared with parents as a window into what teens and pre-teens are experiencing when they are online.


The parent seminar that follows the teen seminar will be an opportunity for parents to learn specific tools to open and develop the conversation about technology with teens and pre-teens. Parents will also be able to share their own experiences in a private setting as a way to learn what is most helpful and what to avoid. Following these seminars, opportunities will be available for individual family work to address specific needs, challenges or concerns, all with the goal of strengthening families and keeping our teens and pre-teens safe and healthy.


I look forward to seeing you there and starting the conversation! If you are interested you can call the Chrysalis main number 910-790-9500 for seminar dates and times and to sign up.


Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.

This posts shares some information about a supportive, evidence based treatment for trauma and PTSD symptoms: Prolonged Exposure.

What is PTSD?

Post traumatic stress disorder is a common mental health problem following trauma. Individuals with PTSD often have difficulties with emotion regulation, managing symptoms of arousal, and other related symptoms. Co-occurring problems such as eating disorders, substance use disorders, depression, and self-injury are also common. You can read more about PTSD in my prior Chrysalis blog about PTSD.

What is prolonged exposure?

Prolonged exposure (PE) is a well established evidence based treatment for PTSD. It has been shown to yield long term improvement in PTSD symptoms.  PE can be applied with individuals who have co-occurring problems as part of a comprehensive treatment plan.

PE s a form of Cognitive-Behavioral Therapy (CBT) for PTSD, developed by Edna Foa, PhD. PE typically takes 8-12 sessions with at home practice in between sessions. Before working on traumatic memories, the PE therapist teaches the patient various safe techniques for relaxation from anxiety and arousal.  After the patient learns theses techniques, the PE therapist helps the client begin to work on traumatic memories. As part of this process, the trauma survivor intentionally recalls a traumatic memory that is contributing to PTSD symptoms. This is done through the use of verbal or written narratives while under the careful supervision of the PE therapist. These memories are recalled and then the safe relaxation techniques are employed. This is done long enough and often enough to experience a reduction in PTSD symptoms.

Working in this careful manner with a PE therapist, the patient learns new ways for the brain and body to respond to traumatic reminders. This allows the traumatic memories to lose their power to elicit PTSD symptoms. To be successful, PE needs to target the traumatic memories that are most related to PTSD symptoms. However, individuals can experience improvement  without discussing every trauma or all aspects of their trauma.

How does prolonged exposure work?

PTSD can be seen the inability of the brain to stop the fight-or-flight response. Reminders of the trauma trigger distressing thoughts, feelings, and harmful behaviors, even when there is no current danger. Escape and avoidance behaviors develop to provide temporary relief; unfortunately, over time they can lead to PTSD and co-occurring problems.

By intentionally approaching traumatic reminders safely under the therapeutic guidance of a PE trained therapist, new learning can happen to decrease PTSD symptoms. Over the course of PE, the brain starts to learn that traumatic memories and reminders are not dangerous, that anxiety does not last forever and that it is possible to have some power and control over traumatic memories.

What if I feel too afraid to start prolonged exposure?

It is natural to feel afraid at the start of PE. It is common not to feel quite to start PE or even feel afraid. All of that is totally okay. In fact, the first steps of PE address these concerns and give patients tools to decrease these anxious feelings, relax and regain control before working on traumatic memories.

PE should only be done in the context of a strong therapeutic relationship with a licensed clinician who has received formal training in PE. PE is a gradual process where the patient is in control and works collaboratively with the PE therapist. As part of this collaboration, fears about PE should be discussed about openly with your PE clinician throughout the process. This should help decrease initial fears and keep later fears manageable. It is okay to feel afraid and PE will help you gain strength and confidence.

What if I am ready to start prolonged exposure?

If you think you may have PTSD and that PE might be helpful, talk with your primary clinician or  contact Chrysalis to set up an initial evaluation. PE is compatible with ongoing therapy for other difficulties. PE can be added for 8-12 weeks in conjunction with your primary therapist in a collaborative approach to your treatment. At Chrysalis, we offer PE by a licensed psychologist who has been intensively trained in PE.  You can contact Chrysalis for more information about getting started. Recovery from PTSD is possible and within reach!

Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.

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What is traumatic stress?

Traumatic stress and posttraumatic stress disorder (PTSD) are unique mental health problems in that they have a known cause – a traumatic event. Life is filled with stressors. There are typical daily stressors such as a car breaking down or a large bill to pay. There are also bigger stressors such as getting divorced, losing your job, or the death of a grandparent. Even positive events can be stressful including buying a home or getting married. However, none of these positive or negative daily stressors are considered traumatic events.

Traumatic events are different in that they are events in which someone believes that their life or the life of others is being threatened. Traumatic events can be witnessed, such as watching a friend get mugged, or experienced directly, such as being sexually assaulted, fighting in a war, experiencing a serious accident or natural disaster, or being abused as a child. These are the types of traumatic events that can lead to PTSD.

How common are traumatic events?

Unfortunately, traumatic events are common. Statistics from the National Center for PTSD show that more than 60% of men and 50% of women have had at least one traumatic event in their lives. This means that most people have experienced a traumatic event at some point. However, among the people who have experienced a traumatic event, most do not develop PTSD. While about 7% of people develop PTSD in their lifetime, this is actually a substantial number, representing 1 out of every 15 people. So, it is likely that your or someone you know may have experienced PTSD at some point.

What happens after a traumatic event?

After people experience a traumatic event, it is useful to have a strong reaction. Remembering what was dangerous and staying away from that can help you stay safe after a traumatic event. However, once that threat has been removed, it is healthiest for our brains and bodies, if our strong reactions decrease to pre-trauma levels. For most people, this happens within about a month after a traumatic event. But, for people with traumatic stress and PTSD, these strong reactions do not disappear and they start negatively impacting daily life. In fact, if the traumatic stress or PTSD symptoms do not return to pre-trauma levels within a year, it is highly unlikely that they will go away without evidence-based treatment from a professional.

How do I know if I have PTSD?

If you have experienced a traumatic event and are having difficulty in areas of your life or find that you are coping with behaviors that are unhealthy, such has drinking heavily or drug use, self-injury, significant changes in eating or sleeping, or other high-risk activities, you may have PTSD.

To diagnose PTSD, individuals need to consult with a licensed mental health professional who specializes in PTSD. Symptoms of PTSD include experiencing a traumatic event and having specific symptoms that cause significant distress or impairment for more than one month including:

1) intrusion of traumatic memories or uncontrollable reminders of traumatic events

2) avoidance of safe people, places, activities, or behaviors that are in some way associated with the traumatic event

3) negative changes in thinking or mood

4) alterations in arousal or reactivity, which include feeling numb, also called dissociation, or feeling on edge, also called hyperarousal

What should I do if I think I have traumatic stress or PTSD?

It is not a good idea to “self-diagnose” if you think you have PTSD. Self-diagnosis can lead to increase in trauma symptoms and other problematic behaviors. The best course of action if you think you may have PTSD is to seek an evaluation from a licensed mental health professional who specializes in treating traumatic stress and PTSD.

How can I get help for traumatic stress or PTSD?

The Chrysalis Center for Counseling offers compressive treatment for traumatic stress, PTSD, and many co-occurring problems. At Chrysalis we have licensed professionals, who used evidence-based treatments to decrease trauma symptoms and help people live their best lives following trauma.

Future blog posts will describe the specific evidence-based traumatic stress and PTSD treatments offered at Chrysalis. However, you can call at any time to hear about these treatments and to schedule a time to talk with one of our licensed professionals.

You can also find out more about evidence-based treatment for PTSD at the National Center for PTSD: This site has useful posts and videos on PTSD treatment, including many of the treatments we offer at Chrysalis.

Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.

As parents, there is no one who we love more than our children. From the moment they are born, our mission becomes to do whatever it takes to make sure that our children have happy, healthy lives. This can involve going to great lengths to help our children when they are sick or in pain. When our child is sick and not getting well, we are quick to seek help from medical professionals and rightly so. But for some reason that fast action does not translate as directly when it comes to our children’s mental health. Why is it that it is okay to ask for help for a physical health problem but when it comes to our child’s mental health, we are supposed to have all of the answers?

As a child and adolescent mental health specialist, I have found that people often make the mistaken assumption that parents are the problem, which could not be farther from the truth. The parents who come through my door are heroes. They have already done so much to get it right. Unlike some parents who are struggling on their own, the parents who come to me for treatment have taken the important action of seeking professional help when they have reached their limits. They have put aside the myth that they must have all of the answers when it comes to their child’s emotional or behavioral problems.

Really, our children’s mental health is no different than their physical health. If our child has a virus, we take them to the pediatrician to be checked and to receive advice on how to help them get well. Similarly, if our child is struggling with peers or in school, we can do the same by taking them to a mental health professional. Research has shown that seeking treatment for our children not only vastly accelerates the pace of recovery from mental health problems but it also prevents more serious problems down the road.

The majority of mental health problems that adults experience can be traced back to untreated mental health problems in childhood and adolescence. It is a myth that children are resilient and will grow out of their problems. Just like leaving your child’s ear infection unchecked can have serious negative consequences, allowing your child to endure bullying without the aid of professional help could also lead to lasting problems.

To the parents who have taken that crucial step and brought their child to my office door, you have already conquered half of the battle to solving your child’s mental health problem. You are serving as a role model for your child by demonstrating that it is okay to seek help from professionals when you are struggling. For those who are hesitant to do so, I encourage you to think about what you would do if your child had a serious stomach bug and suggest that you take the same action if your child is experiencing anxiety, depression, inattention, bullying, or other changes in behavior that are negatively impacting your family or your child’s day to day life.

As a parent, you are the best expert on your child and you should always let your expertise as a parent guide your decisions for your child. This should include listening to yourself when your expertise tells you that you have reached your limits and need help. By seeking help you are not only putting your child first, you are also putting your child on a path of lifelong mental health and well being. There is no greater gift than that.

Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.

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