Potty training

Our daughter is 4 years old.  She was born with spina bifida, however it's as if she's not affected by it at all.  She walks without assistance, has no hydrocephalus and no shunt.  She was being monitored for possible bladder/kidney issues and was catheterized at home from the time she was 8 months until April of this year.  She was cathed 4 times per day.  In spite of this, we were able to potty train her.  She has now in essence received a "clean bill of health" in regards to the spina bifida. She has had no need for physical therapy and very little intervention really from the many specialists involved to see her once per year as a check up measure. Our issue is that she has always refused to poop on the potty.  During the day we would encourage her to go, try to get her to go, and she would refuse until she got into her pull-up at night, when she would immediately go. She can go on the potty and on a really good day when she is in the best of modds, she will go on her own, tell me she has to go and then do it.  Her doctors have told us have patience, we do not think this is a physical problem, this is a behavioral issue.  Don't get angry with her, be supportive.  She will go one day and then for the next several days refuse and go in her underwear.  Or hold it until bedtime and then go.  She is not constipated at all, and has never been.  I am at a loss as to what to do anymore.  It's very frustrating.  She will lie and tell us "nope, I didn't go in my pants", even when told that we're coming to check her pants and please tell us the truth before we do check.  Then she's in trouble for lying.  We have tried rewards, punishments and I'll be the first to admit we have probably handled it completely wrong.  What should we be doing?  I'm losing my patience with this.  She attended preschool last year and I held my breath every single day and she never had even one accident, although one day she proudly told me that she went poop on the potty while at school.  I thought for sure that by this time this would be handled, yet here we are a year later and we're in the same place. I used to think well maybe she doesn't feel when she has to go, she can't go, she doesn't know when she has to go, but obviously she does because as I said on a great day she will tell me she has to go and then do it on the potty.  She used to go crouch behind the couch and go.  Any advice would be helpful.  We are at our wits end with this.  She is incredibly stubborn about just about everything and so smart/cunning about things that sometimes it seems like I'm dealing with an 8 year old and not a four year old!

[Kevin Kennedy, Ph.D.]

I agree with advice you have already received - be patient and supportive and try to lower the intensity of your investment in her mastering potty training. I know it does make a difference to you, but it will help if you stop conveying this to your daughter. Schedule times for her to sit on the potty; reward her when she does use the potty. It's actually a pretty straightforward approach. She's on the verge of getting this done; she will do it on her, not your, terms. Don't show distress when she does not go in the potty; show pleasure when she does.