The Nurtured Heart Approach

The Nurtured Heart Approach (NHA) is a social emotional strategy that instills greatness and transforms negative behaviors into positive behaviors, increases interrelatedness and connectivity among family members,^[1] couples,^[2] teachers and students and builds “Inner Wealth” more commonly known as character strengths and virtues.^[3] The NHA was created and developed by Howard Glasser who was discouraged^[4] by the lack of positive results when applying the techniques he had learned in graduate school. Glasser intuitively created this approach by specifically attending to the energy in relationships noticing that more energy and attention went to negative behavior rather than to positive behavior. Howard Glasser continues to expound on his findings for the last two decades resulting in the first Global Summit with topics in research,^[5][6] policy, foster care, mental health organizations, workplace, education,^[7][8][9] diverse cultures and religious affiliation^[10] and with specific psychiatric disorders.^[1][11] The Nurtured Heart Approach to parenting (NHA; Glasser & Easley, 2008) is summarized and evaluated in terms of its alignment with current theoretical perspectives and empirical evidence in family studies and developmental science. Originally conceived and promoted as a behavior management approach for parents of difficult children (i.e., with behavior disorders), NHA is increasingly offered as a valuable strategy for parents of any children, despite a lack of published empirical support. Parents using NHA are trained to minimize attention to undesired behaviors, provide positive attention and praise for compliance with rules, help children be successful by scaffolding and shaping desired behavior, and establish a set of clear rules and consequences. Many elements of the approach have strong support in the theoretical and empirical literature; however, some of the assumptions are more questionable, such as that negative child behavior can always be attributed to unintentional positive reinforcement by parents responding with negative attention. On balance, NHA appears to promote effective and validated parenting practices, but its effectiveness now needs to be tested empirically (Hektner, J, Brennan, A, & Brotherson, S., 2013).

The New Jersey Department of Children and Families (DCF) has won a $12 million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to assist with mental health services for youth with complex behavioral health challenges. The grant's award period stretches from September 2015 to September 2019. "The Federal government has provided New Jersey with a transformational opportunity to not only move the Children's System of Care forward, but to make an even greater difference in the lives of youth with complex behavioral health challenges and mentally ill youth," said DCF Commissioner Allison Blake. During the project's first year, DCF's Children's System of Care (CSOC) will introduce two trauma-informed interventions: Six Core Strategies for Reducing Seclusion and Restraint Use and the Nurtured Heart Approach.

The Ubiquity of the Nurtured Heart Approach

NHA is a strategy to support and nourish relationships whether it is being applied to children, adults^[2] or employees. Although its origin was to transform the “difficult child,” NHA has shown its efficacy across various disciplines and industries. When applied in schools^[12][13][14] and workplaces, qualitative and quantitative data reveal an increased performance output, higher achievement, employee retention and positive workplace relations.^[15] When practiced in families increased positive behaviors and “inner wealth,” compliance to rules and more loving family relatedness.^[16][17] The results in mental health organizations to include foster care and residential care centers are emerging with positive outcomes regardless of psychiatric disorder or behavioral challenges. When used collaboratively with other interventions it helps the individual to move away from a fragile core and move toward building internal strength and stronger relationships. Couples report experiencing effective communication, improved sexual relations and stronger relationships.

NHA is a practice that promotes peaceful and compassionate communication, instills “greatness” in the form of values commonly described across many religious doctrines and spiritual practices thereby embracing a spiritual psychology component. It requires the participant to be in a place of mindfulness and to remain in the moment. It teaches and expects practitioners and participants to cognitively “reset” themselves and to teach “reset” to others as a relentless refusal to energize negativity. In refusing to energize negativity, a focus is on the installation of the approach in the form of energizing success, building inner wealth in the form of character strengths, virtues and values.

This teaching has components of physics in that conventional ways of approaching challenging behaviors have shown to be energetically upside down and therefore the reinforcement of those undesired behaviors are instilled escalating responses. By shifting energy in the forms of the response given to undesired behavior the outcomes are controlled. By changing one's view or how thoughts, actions and responses can alter the outcome, a cognitive “reset” of all participants assist with what NHA terms as achieving greatness or transformation. NHA promotes this as a practice that entails speaking from the heart to in a meaningful way that honors the person or child. Communicating and “being” from a place of compassion and to shift from the mind to one's heart is key to applying this intervention.

NHA was not creatively designed to be compartmentalized into one psychological theoretical body of knowledge or modality for practice. However, for the purpose of collecting data and further supporting this data that is moving toward identifying this approach as an evidence-based practice, emerging research designs are currently in place and compare the approach to the following widely known theoretical bodies of knowledge:

• Humanistic Psychology acknowledges the inherent goodness within people. NHA is a way to use language to acknowledge that goodness, or greatness and believes in people's creativity,good will and human potential.
• Cognitive behavioral psychological practice known as “reset” and how that transforms negative behavior to positive behavior – NHA uses resets as a pause to unacceptable choices and a way to reconstruct the next moments to furthering positive growth.
• Positive psychological practice in the building of “inner wealth” known as character strengths and virtues (Peterson & Seligman)^[18] – NHA works toward radical appreciation of valued traits, qualities and skills in an attempt to take recognition to a soul level of greatness, believing that greatness is in the hardware of all beings and merely needs to be reactivated in order to be propelled forward into an use – resulting in Inner Wealth.
• Positive psychological practice that brings optimal experience in the form of “flow” when we are shifted toward higher levels of life satisfaction (Mihaly Csiksentmihaly).^[19] NHA recognizes that “intensity” is a life force and when intensity is nurtured in a positive way, people are shifted toward higher levels of individual greatness which increases more meaningful purpose.
• Positive psychological practice in the form of saturating with the recognitions of the approach support the positivity ratio of 3:1 whereby it has been proven that it takes 3 positive emotions to outweigh 1 negative. (Barbara Fredrickson)^[20] – NHA posits that no criticism at all is ever warranted. It emulates the architecture of the loving universe that upholds that all lessons can be taught through positive messages tied to real moments when problems and issues are NOT happening. NHA believes that the awakening is not from fear or consequences but rather to “who one really is” as revealed through loving and energized messages of gratitude reflecting actual successes.
• Relational psychology in that connection is the key to human nature, rather than individuation. NHA believes that people crave intimacy through energized connection and uses it’s methodology to guide each person to finding that connection in positive rather than negative ways.
• Spiritual psychology (non-sectarian) in the form of mindfulness practice and approaching a person/people from the heart rather than the head – NHA practices foster heart-centered appreciation and gratitude as ways of reflecting greatness to self and others.
• Energetically shifting one's view and creating positive energy that influences thoughts, feelings, language and posture
• Effective and Compassionate Communication through the vessel of speaking from the heart as a gesture of love; not in the romantic sense but rather from a place of caring and compassion. In contrast to several compassionate schools of thought, NHA is exceedingly careful to only communicate such messages at times of greater receptivity – when things are going right and in context of successes – and not accidentally at times when the recipient might perceive that they are getting these heartfelt messages in context of acting out problems or negativity.
• Organizational psychology whereby building positive institutions and workplace satisfaction increases peaceful relationships and increased productivity.
• Cultural Awareness & Competency. Honoring a person's existence honors who they are and embracing uniqueness as something to be celebrated. NHA assists in outwardly noticing differences among people and creates opportunities to launch healthy and informative conversations to that end.

Intra & Interconnectedness: Nurturing Relationships

The primary aim of NHA is to foster intra and interconnectedness and relationship, build inner wealth and empower all concerned toward positive outcomes. Building stronger and positive relationships within oneself and among others are the goals for transformation. Participants are compelled to make choices and decisions that increase their connectedness in whatever setting they choose: familial, school, workplace, partnerships or spousal. They learn to thrive in the energy toward positivity and want “time in” rather than “time out.” – Time-in being in connectivity to one’s greater self and the greatness that life has to offer through others and desired endeavors.

The core components of The Nurtured Heart Approach

The Three Approach Components

1. Refusing to energize negativity
2. Super-energizing success
3. Establishing and implementing clear limits and consequences

In refusing to energize negativity, the practitioner or participant is taught to demonstrate by the use of body language, non-verbal state and responses that there is a refusal to be drawn into accidentally rewarding poor choices or problems by way of energy and relationship. Conversely NHA is always seeking and creating pathways to get the person right back into life in context of positivity and success. NHA teaches people that there is more to be gained by being engaged in life’s successful choices and positive relations rather than the opposite by way of creatively reflecting first-hand experiences of success. Ultimately the person realizes there is no gain to behaving negatively and everything is to be gained by way of making positive choices.

By energizing success and honoring the participant the practictioner celebrates their success no matter how incremental the movement is toward the desired positive behavior. The emphasis is on progressively building inner wealth. NHA teaches that to wait to catch success is not enough and can lead to a sense of disempowerment in waiting for such moments with particularly challenging children or adults. The Nurtured Heart Approach moves through this by taking a creative inclination with methods geared toward seeing the beauty, success and greatness locked inside most any moment when problems are not prevailing and finding reasons to honor and celebrate those choices to not break rules.

When clear limits and consequences are established and implemented fearlessly and consistently, the child or adult not only comes to know what the expectations are but they also come to see how cherished they are for remaining within the boundaries of those rules. Children and adults learn that by following rules, they get more appreciative energy and intense relationship as opposed to breaking the rules and getting de-energized responses. Should the child or adult break the rules, the practitioner resets this infraction immediately and unceremoniously. The practitioner then energizes the success of how positively the child or adult responded to the consequence for the rule infraction and they use this reset as impetus to create even a greater sense of success in the moments that follow by appreciating the rules ensuingly not being broken.

Foundational Principles

1. Intensity is life force and is greatness
2. Medication interferes with intensity, and therefore is a last resort rather than a first resort. NOTE: In instances of severe and persistent mental illness disorders, medication is indicated for psychotic features or to stabilize suicidal or homicidal ideation.^[17][21]
3. Everyone benefits from the development and nurturance of Inner Wealth, which is the inner strength to abide, persist and succeed no matter the circumstances.

Intensity is not a problem to be medicated but a gift to be nurtured. Without intensity there is no life force. In this approach, there is a new definition for a participant what has been conventionally labeled as negative and shift the energy and negative behaviors that have been associated with that intensity to positivity. The participant is taught how to use that intensity in ways that promote success.

This approach calls to professionals to explore other options before merely writing a prescription. Using medication only as indicated to prevent harm to oneself or others or to stabilize psychosis as a last resort rather than a first resort is the message. However, if medication is indicated for psychotic features or the stabilization of suicidal or homicidal ideation, the approach does not suggest ignoring this intervention. The approach believes that symptomatology that is so often diagnosed is merely a call to action and with a powerful enough approach such as this, the same intensity that surfaces in the acting out of problems can efficiently and quickly be shifted to the acting out of greatness. Then intensity is truly a gift.^[11][17]

Inner wealth in the form of character strengths and virtues is developed with this foundational principle and is the pinnacle to application and success. When building and recognizing participants for their greatness the energy in the relationship and the effect changes or shifts.

Three Simple Ideas

1. "Toys R Us" - Understanding that children and adults alike seek relationships suggests the analogy of being a toy to analyze reactions to others' negativity and positivity. Participants are taught to choose to let positivity “push our buttons," rather than negativity, and thereby gain healthy control over relationships in any setting. NHA asks the question when are people most animated? When is the most energy, emotion, engagement in the form of lights, bells and whistles radiated - when things are going right or wrong?
2. Video Game Theory applied to life. In video games, recognition is offered in the various forms of energetic response (positive reinforcement) for positive explorations and attainments and for not breaking rules. When a rule is broken, an unceremonious and short time-out is called, during which the person resets and then it's right back in the game where the default setting is one of gratitude and appreciation. NHA energetically parallels this in the actuality of life. Sports game theory can be applied when using with adults.
3. The Toll Taker View. People learn that the view one has is a choice as to how things are perceived in an individual's world. Two people can be in the same circumstance and one chooses to see it negatively and the other positively, and they thereby create negative or positive outcomes, respectively, as a result of choosing their point of view. This approach posits that the participant is the producer, director and editor of every moment. NHA teaches that employing this attitude to see success by choice.^[22]

Four Methods of Recognition

(Note: Three of the four recognitions are nicknamed after cameras- the Approach seeing these as "photo opportunities." These are also viewed as ways to perceive and acknowledge radical appreciation in self or another)^[22]

1. Active Recognitions or "Kodak Moments". Action and emotion with no judgment attached is described in detail, out loud, as if for the benefit of a blind companion. It has been shown that this helps the person receiving this recognition to feel valued and meaningful.
2. Experiential Recognitions or "Polaroids". A description of the action and emotion and an attached positive judgment of character strengths and values. This is used as a way of interpreting moments by way of attributes of greatness.
3. Proactive Recognitions or "Canons". An appreciation of the rules and values being upheld and notice when there are no violations. Energy, relationship and acknowledgment are given for that choice of NOT breaking rules.
4. Creative Recognitions. Options for non-compliance are eliminated by way of highly directed requests. Subsequent appreciation for following the direction and any attributes and values that align with this act of listening to what was needed are given.

The Approach Components and the Four Methods of Recognition support the Three Stands of the Approach

• Stand No. 1) A refusal to be drawn into energizing and rewarding negativity is required. This is a stand of Absolutely NO.

Refusing to energize negativity is achieved by the technique reset which is a cognitive choice to change the trajectory of that encounter. Once reset the individual moves forward with renewed determination to foster and appreciate success. At times, the appreciation of success requires a radical view to facilitate movement toward choosing to make smart choices.

• Stand No. 2) Purposefully, strategically, intentionally energizing and nurturing success is an absolute in stand two. This is a stand of absolutely YES.

Super-energizing success through seeing and saying what's right and great about a person (energizing positivity)

• Stand No. 3) Clear rules and consequences are required to be identified and implemented with strict adherence. Consistency in providing a true consequence when a rule is broken is a necessity. This is the stand of absolute clarity. By being ever more clear about where the NO is one can better see and recognize the success of rules not broken and see and reset rules that are broken, even when broken fractionally.^[22]

NHA Application

To effectively teach these components and to ensure that knowledge is put into practice, practitioners use a variety of techniques referred to in The Nurtured Heart Approach as precision tools. Throughout NHA program, practitioners help people to set and achieve their personal goals. In home, school, treatment or workplace settings the participants learn how to set goals to succeed. The approach provides a sure foundation for successful relationships at every and any level whereby differences are valued and appreciated, people engage their best selves with one another, and as a result, problems are no longer the focus, but the texture, caliber and magnitude of the progressively greater relationship. People relating to themselves and others in the Nurtured Heart Approach results in positive outcomes and relationships.

Nurtured Heart Approach Misconceptions

When describing the Nurtured Heart Approach there are sometimes misconceptions.

• NHA is not a behavioral management program. Although the approach transforms negative behavior into positive behavior, it is not merely a reward and consequence intervention that which historically has been presented with behaviorism and classical, operant conditioning. NHA teaches that relationships are the most significant reward and once the person is in tune with this concept, they are drawn to maintaining the relationship and subsequently nurturing to greater depths.
• NHA is not a curriculum for character education that can be found on a shelf. NHA is way to approach children and youth that is embedded in our language, posturing and our energetic thought processes. Although schools adopt the NHA as a vessel to instill character in children and youth, it is an approach that becomes part of our approach in all classes and settings.
• NHA is not about "catching them being good" rather than it is about creating success and getting under the radar to create success particularly with children or youth who present with extreme difficulty.
• NHA is not merely about positive reinforcement. NHA promotes the acceptance of strong and intense feelings and healthy negative emotions and it recognizes those feelings and the handling of them in a responsible, mature and safe manner. NHA recognizes and energizes success but also recognizes when things are not going well and reinforces smart choices as it relates to not breaking rules. Consequences are applied however without giving energy to them. Children and youth learn to accept these consequences and NHA practictioners move them to the next level of success.
• NHA is not simply positive psychology. NHA indeed does build positive emotion, positive individual traits and positive institutions, however it is more relational as well as means to eradicate or transform negative behavior and to move the child or person toward positive behavior and strong relationships.

References

1. Barkstall Elementary Bulletin (2010). "Positive Behavior Intervention System (PBIS) and Nurtured Heart. Champaign, IL. http://www.champaignschools.org/schools/09/files/school_profile.pdf
2. Berge, Angela (2009). "Transforming the Difficult Child: The Nurtured Heart Approach". North Dakota State University: Fargo, ND. http://www.ag.ndsu.edu/impactreports/reports/2010-reports/10area-berge2-hdfs.pdf
3. Brennan, A. L., Hektner, J. M., Hanson, T., & Brotherson, S. E. (2016). A nonrandomized evaluation of a brief Nurtured Heart Approach parent training program. Child and Youth Care Forum. doi: 10.1007/s10566-016-9351-4
4. Bustamante, Mary (2007). "TUSD Tolson Elementary School Puts Emphasis on Positive Reinforcement". Tucson Citizen: Tucson,AZ.
5. Csikszentmihalyi, Mihaly (1997). "Finding Flow: The Psychology of Engagement with Everyday Life". Basic Books: USA.
6. Dabhi, Jaishila. "University of Central Lancashire to Deliver Nurtured Heart Approach Workshop". Perpetual Care: Bolton, Lancashire. www.perpetualcare.co.uk. http://www.medicalnewstoday.com/articles/153347.php
7. Eckhart, Jacey (2001). "Addressing ADHD with Nurtured Heart Approach". The Virginian Pilot: Norfolk, VA.
8. Fredrickson, Barbara (2009). "Groundbreaking Research Reveals How to Embrace the Hidden Strength of Positive Emotions, Overcome Negativity and Thrive". Crown Archetype Publication: USA.
9. Heckel, Jodi (2006). "Positive Approach: Program Used at Franklin Jefferson Doesn't Dwell on Negative Behavior". The News Gazette, Inc: Champagne, IL.
10. Hektner, Joel; Brennan, Alison; Brotherson, Sean. (2013). "A Review of the Nurtured Heart Approach to Parenting: Evaluation of its Theoretical and Empirical Foundations." Family Process.
11. Newmark, Sanford (2010). “ADHD Without Drugs: A Guide to the Natural Care of Children with ADHD”. Brigham Distributing. ISBN 0-9826714-0-7. ISBN 978-0-9826714-0-5.
12. Nichols, Dana M. (2009). "Program Hits Heart of Problem Parenting: Methods Help Families Channel Positive Energy". The Record: Stockton, CA. www.recordnet.com.
13. Peterson, Christopher & Seligman, Martin (2004). "Character Strengths and Virtues: A Handbook and Classification". Oxford University Press: USA.
14. Small, Tammy F & Triandis, Louisa T. (2010). "There is Always Something Going Right: Working for Implementing the Nurtured Heart Approach in School Settings". NurturedHeart.net. # ISBN 0-615-33259-5. ISBN 978-0-615-33259-8.
15. Sutton, Terri (2003). "Life Balance: Wild Gift: Is Medication the Only Way To Deal with a Difficult Child? The Nurtured Heart Approach Offers an Empowering Alternative". Experience Life Publications: March/April 2003.
16. Taylor, Janice (2010). "Top Eight To Being Great". HuffingtonPost.com Inc. http://www.huffingtonpost.com/janice-taylor/you-are-oprah-top-eight-t_b_209633.html
17. West Pidkaminy, Wendy (2010). "Parenting Challenging Children with Power, Love and Sound Mind: The Nurtured Heart Approach from a Biblical Viewpoint". Brigham Distributing. ISBN 0-615-33314-1. ISBN 978-0-615-33314-4.

Further reading

1. Bravo, Lisa; Bowlidge, Joann & Glasser, Howard (2008). “Transforming the Difficult Child Workbook: An Interactive Guide to the Nurtured Heart Approach”. Nurtured Heart Publications. ISBN 0-9670507-5-8. ISBN 978-0-9670507-5-1.
2. Easley, Jennifer & Glasser, Howard (1999). “Transforming the Difficult Child: The Nurtured Heart Approach”. Nurtured Heart Publications. ISBN 0-9670507-0-7. ISBN 978-0-9670507-0-6.
3. Easley, Jennifer & Glasser, Howard (2008). “Transforming the Difficult Child: True Stories of Triumph”. Nurtured Heart Publications. ISBN 0-9670507-9-0. ISBN 978-0-9670507-9-9
4. Stafford, Catherine (2009). “Nurture My Heart: Igniting the Greatness of Every Child”. www.nurturemyheart.com. ISBN 0-9842172-0-7 ISBN 978-0984217205.
5. Stafford, Catherine (2010). “Teacher Nurture My Heart: Igniting the Greatness of Every Student”. www.nurturemyheart.com. ISBN 0-9842172-1-5. ISBN 978-0-9842172-1-2.
6. West Pidkaminy, Wendy (2010). "Jimmy and Julia's Rain Forest Adventure: Discovering Healthy Power, Love and Sound Mind Using the Nurtured Heart Approach". nurturinglifeconcepts.com.

YouTube

1. ADHD: An Integrative Take Home Message
2. Genesis of The Nurtured Heart Approach
3. Introduction to The Nurtured Heart Approach
4. Nurtured Heart: Rocky River Elementary
5. Nurtured Heart Approach in Schools
6. Nurtured Heart Approach in Schools Part II

Notes