Sneaky Poo

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The write-up of a community gathering that took place with the Narrandera Koori (Aboriginal) Community in April 2002 and documentation of the follow-up to this gathering. Also included are a number of songs that were written and recorded during the gathering.)

Urinary symptoms such as daytime and/or nighttime wetting, or urine infections as a consequence of constipation or soiling, can be common. Whichever method is used, once there have been a few successes the problem usually disappears. Even without any kind of intervention, in my experience it is very unlikely that the behaviour will persist past the age of 5. Adequate fluid intake or approximately sixevenly spaced drinks of water or water based cordial a day. Looking like they are straining on the toilet, when they are actually trying to stop themselves from passing a poo.White, M. (1989). Pseudo-encopresis: From avalanche to victory, from vicious to virtuous cycles. In Selected Papers. Adelaide Australia: Dulwich Centre Publications. (pp. 115-124). Original work published in 1984, Family Systems Medicine, 2(2). Some children are generally slower in all aspects of their development, and toilet training is just another example of this. With these children there is no physical problem causing the soiling, and no anxiety about using the toilet. They are quite capable of passing a motion into the toilet, and are happy to do so on request, but sometimes they just don't make it in time. For these children the term "accident" seems to be an appropriate description for the nature of the incidents. The term narrative implies listening to and telling or retelling stories about people and the problems in their lives. In the face of serious and sometimes potentially deadly problems, the idea of hearing or telling stories may seem a trivial pursuit. It is hard to believe that conversations can shape new realities. But they do. The bridges of meaning we build with children help healing developments flourish instead of wither and be forgotten. Language can shape events into narratives of hope. This is done by using daily doses of laxatives, sitting on the toilet 15-20 minutes after meals to make the most of the gastrocholic reflex (which increases colonic motility when food passes from the stomach into the upper part of the small intestine), and using a foot stool to relax the pelvic floor muscles when passing a poo.

Epston, D. (1993). Internalising discourses versus externalizing discourses. In S. Gilligan & R. Price (Eds.), Therapeutic Conversations (pp. 161-177). New York: Norton. We have strong muscles in our large bowel that squeeze poo along (this movement is called peristalsis). As it travels through the bowel, water is removed turning poo into a smooth sausage shape. Standing as an alternative to the diagnosis and treatment of pathology, the focus in an externalizing conversation is on expanding choice and possibility in the relationship between persons and problems. Roth and Epston (1996, p. 5) write:Our stomach then mashes the food into a soupy mixture before it gets passed into the small bowel. The body takes out the good stuff it needs (nutrients) before passing the rest of the waste liquid into the large bowel. A more direct form of intervention is to use either a laxative or a suppository to take away the child's control over the retention and timing of the motion. This avoids the problem of constipation, and makes it more likely that the child will comply with your direction to pass the motion into the toilet because they have less control over the process. One method is to use a graduated approach to the final goal of using the toilet appropriately. The first step is to allow the child to pass a motion as they usually do, but (a) only into a nappy, and (b) only in the toilet area. These requirements are the beginning of "shaping up" more appropriate toileting behaviour. The next step is for the child to defecate into a nappy while sitting on the toilet, then while sitting on the toilet with the nappy held a little distance away from their bottom. Finally, everyone agrees that the nappy is just getting in the way and is no longer needed. a paper and songs by David Denborough. First published in Clinical Psychology, issue 17, September 2002

Epston, D., Morris, F., & Maisel, R. (1995). A narrative approach to so-called anorexia/bulimia. In Weingarten, K. (Ed.), Cultural Resistance: Challenging beliefs about men, women, and therapy . (pp. 69-96). New York: Haworth. Proctor, E and Loader, P “A 6-year follow up study of chronic constipation and soiling in a specialist paediatric service” Child: Care, Health and Development” 29 (2) 103-109 by David Denborough, Carolyn Koolmatrie, Djapirri Mununggirritj, Djuwalpi Marika, Wayne Dhurrkay & Margaret YunupinguViewing the child as facing rather than being a problem is a helpful start to preserving the fluidity of identity formation. Externalization seems a natural fit for many children. It is compatible with the way they typically approach difficulties in the dynamic learning environment of play. In play, along with hats, costumes, and accents, multiple perspectives and roles are tried on during “dressup” and other games. This fluidity allows the child to explore variations of attitude, identity and behavior–to try out the emotional flavor of the moment or day. In fact, when a child’s play is repetitive, ritualistic, or confined in its range of roles and behaviors, we may wonder about abuse or other severe interruptions to developing identity. As therapists, we have been especially trained in the use of words. But practicing the language of externalizing conversations is for us, as for many others, not so much about learning a technique as about developing a particular way of seeing things. As Roth and Epston (1996a, p. 149) write: Epston, D., & White, M., &“Ben” (1995). Consulting your consultants: A means to the co-construction of alternative knowledges. In S. Friedman, (Ed.), The reflecting team in action: Collaborative practice in family therapy. (pp. 277-313). New York: Guilford. White, M., & Epston, D. (1990). Consulting your consultants: The documentation of alternative knowledges. Dulwich Centre Newsletter. 4, 25-35.