children

Treating Parents is Key to Treating Anxious Children

Earlier this week in the break room, Blake and Tracy shared about a recent study they had read.  As one of the rare individuals who thoroughly enjoy reading academic research, I was PSYCHED – not just because I got to hunker down with my highlighter in hand, but in that it pertained to treating children with anxiety.  While these two things alone would bring a smile to my face, the results were tremendously powerful: TREAT THE PARENTS. While this may seem like a simple and maybe obvious solution to a family systems therapist like myself, you’d be surprised how little family/parental work is done when the main client is a young person with anxiety.  It is not uncommon for parents to believe that their anxious child is the one who needs therapy, which is certainly still true. However, if the goal of all involved is to support the child in reducing symptoms of anxiety, treating the parents is very much the key to success.

According to Eli Lebowitz, the associate director of the Anxiety and Mood Disorders at the Yale Child Study Center, parents of anxious children almost always try to accommodate their child. She states, “For instance, if the child suffers from social anxiety, no friends are invited to the house; in the case of separation anxiety, parents sleep with their child or never leave the home. Parents constantly reassure a child with generalized anxiety. While the responses of parents are natural, studies have shown that they also leave children suffering from debilitating anxiety into adulthood”.  Currently, there are only two evidence-based treatments for anxiety, cognitive behavioral therapy (CBT, which I provide and have written about in past blog posts - Embracing Self-Compassion and Let’s Talk About Teen Mental Health), and medication. Of those able to receive these options, however, only half of the children respond to treatment. Because of this, it has been vital for researchers to find additionally effective treatments.

Yale researchers randomly assigned 124 children ages 7 – 14 with diagnosed anxiety disorders to either receive cognitive behavioral therapy, or their parents were enrolled in the Yale SPACE program, or Supportive Parenting for Anxious Childhood Emotions. For 12 weeks, parents attended weekly counseling sessions geared toward helping themselves cope with their anxious child.  While both approaches were equally effective in reducing the child’s stress levels and anxiety symptoms, the “accommodating” behavior parents typically engage in reduced significantly after receiving SPACE counseling.

For example, a parent assigned to SPACE was able to decrease the number of daily text messages sent to their child from “dozens” to about 2 – 3.  Also, parents who repeatedly kept their child out of school because of anxiety-related stomachaches learned to say, “I know you are feeling upset right now, but I know you’ll be okay,” and sent their child to school.

It is believed that the accommodating behaviors were reduced due to encouraging parents to validate their child’s emotions, while also creating and maintaining boundaries and consistent support for the child. In a 2013 study about Space, Lebowitz shared this example script:

“We understand it makes you feel really anxious or afraid. We want you to know that this is perfectly natural and everyone feels afraid some of the time. We also want you to know that it is our job as your parents to help you get better at things that are hard for you, and we have decided to do exactly that. We are going to be working on this for a while and we know it will probably take time, but we love you too much not to help you when you need help.”.


I am very much excited to share that I will now be challenging myself to learn more about the SPACE approach, and will begin engaging parents more frequently when treating their child’s anxiety.  Also, for you parents of anxious children out there, I’ve created a short and quick cheat sheet that may also help you in this process:

  1. Listen to what your child is saying, both verbally and with their body language!

  2. Validate your child’s feelings – “I see that you feel _______”.  

  3. Normalize the feelings – “Everyone feels _______ sometimes”.

  4. Support – “We are all working on this together, and I love you”.

Thanks for letting me share this exciting work with you, and as always, be safe, be peaceful and be kind ☺


ProTip: "Should I Work With a Male Therapist?"

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I want to let you in on a little not-so-secret reality: in the therapy world, male therapists are a bit of a minority.  As a member of this smaller group, I’m often asked if it would be appropriate or effective for a female to work with a male therapist or even why someone, male or female, would choose to work with a man.  Although we are trained to be able to work with all individuals regardless of gender and sex identification, I’ve come to understand that some individuals have trepidation in working with a male therapist, and wonder how I could possibly understand/help/connect with a female client or if I will be as “nurturing” as a female therapist.  There are some preconceived notions about working with a man that can be helpful to unpack and I thought this would be a good opportunity to get some of these concerns and feelings out in the open and talk about them, which is just what therapy is all about after all:

  • “As a woman, I would be more comfortable talking to another woman about my issues.”  While I appreciate and respect the desire and perspective that speaking with a counselor of the same sex provides comfort and safety, I’ve found that many female clients find great solace working with a male therapist.  Some women haven’t been afforded the opportunity to engage in and experience a healthy relationship with a man, or have had negative experiences with men in their lives. Through the positive experience of working with a male therapist, some women are able to experience a totally new way of relating to men and having the healing power of a therapeutic alliance with a man.
  • “I think I’d rather my teenage daughter work with a woman.”  Some parents feel worried about their daughters engaging in a therapeutic relationship with a man, either because they are fearful that she won’t relate to a man or that it will limit what she is able to talk about with me.  My experience, though, has been that many teenage girls find safety and comfort in working with a male therapist.  In seeing a male therapist who is healthy, establishes appropriate boundaries, in tune with his feelings, compassionate, and attentive, adolescent girls often report feelings of empowerment and a great appreciation in being able to challenge their perceptions of men and to get to experience a male role model who they can really be themselves with and feel safe.
  • “Although I’m a guy, I really think I want to work with a woman.  Other guys don’t really know how to talk about this stuff.”  I get it.  Society has taught us that men aren’t supposed to talk about their feelings nor be able to express empathy and understanding to others. Through the effective modeling and authenticity of a strong relationship with a male therapist, men are able to experience a healthy and mature way of interacting with other men. This often plays in stark contrast to the Hollywood depiction of how guys interact with each other which often provides men with a new appreciation and bolstered comfort in engaging with other men outside the therapy room.

Making the decision to reach out to someone for therapy can be scary and makes us feel extremely vulnerable.  With this, it is absolutely understandable that we all want to feel as safe and secure as we possibly can throughout this process, and part of my job is working with all my clients in creating this felt sense of safety and connection. So if you’re wondering what it would be like to work with a male therapist, reach out to me and let’s explore how I can support you in your journey.

Justin works with all ages and genders and currently facilitates a teen Identity and Relationship group for all genders as well as GirlTalk Therapy groups for teen girls. Learn more about Justin here!

ParentTip: Is Playing Important to Survival?

Photo by  Robert Collins  on  Unsplash

As a therapist who works with children, as well as a preschool teacher, I am fascinated by the way children interact with their environment. I love the way children can spend an hour watching a bug walk across a leaf, and in the next moment pretend they are dinosaurs riding on a magic carpet. Watching children play in groups adds another layer, with social rules and norms that are often unspoken but somehow always understood among the children interacting together.

In a recent Ted Talk that I watched, a researcher and expert on play in all forms named Dr. Stuart Brown talks about why play is so vitally important to human development, and even to survival. Lack of opportunity to play has been shown to have far-reaching consequences, even later in life, his research has shown.

Dr. Brown examines play in nature– he shows animals at play that look like they are fighting and how innate it is in all of us.  He argues that children should be allowed to roughhouse– “dive, hit, whistle, scream, be chaotic”– to find their own limits, and learn the boundaries of how far their wildness can go. Dr. Brown says that kids learn social cues, emotion regulation and that they develop cognitively and physically through these experiences.  

Another idea mentioned in the talk is the connection between play and joyfulness later in life. Think back to the experiences in your childhood that were fun, and really resonated with you: did you love playing teacher? Did you love animals and pretend to play zoo? Did you build things again and again? Did you love to dance?  It’s so important to think about how those experiences connect with us today, because it can provide you with a new way of envisioning your life- as not just living day to day in a job that you may have just fallen into, but perhaps finding your way back to a career or a hobby that you really connect with! Additionally, if you are a parent, helping your child remain connected to the things they loved to be around as a child can be a great way to help them hone in on their passions and dreams later in life.

Dr. Brown is a proponent of allowing children to play without interjections, without guidance, or redirection. He says they know what to do and how to do it. Those that don’t know innately, simply haven’t been given the opportunity to do what they are meant to do. It is vitally important that we allow kids to play, unencumbered by us.  And, maybe if we offer ourselves the same playful opportunities, we can see how positively affects the rest of our lives.

A Hard Hit

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This post goes out to the parents of littles, but take note that much of what you read can easily be adapted to fit your own needs or the needs of an older child. Do not underestimate the importance of self-care and self-compassion during a hard time. Even if you have not had a “direct hit” by Hurricane Harvey (i.e. your house may not have flooded, you didn’t have to evacuate, you only had a power outage), seeing friends and family suffer, even seeing strangers suffer, can be downright difficult and exhausting. There’s so much information to digest about how to help, what to do and what not to do that it can be overwhelming. There’s enough information download and processing happening, so let’s stick to some really important fundamentals. Please feel free to pass this along, as our connection with one another is more important than ever!

When something scary and unreal hits, like what Texas has experienced with Hurricane Harvey, our children need support in making some sense of it. Parents and adults can help children in adapting healthy coping strategies. Here are some simple first steps:

1. Attunement: Time is precious right now. There may be a lot going on with you and around you. As a parent, taking some time to connect with your child will have many positive effects on them and on you. This might be the time when you actually need to schedule, yes schedule, special time with your child. Go ahead and do it - carve out about 10 minutes for play time, extra cuddles, fun reading and good ‘ole fashioned one on one time. Perhaps make this a part of your new routine before bed, but slipping it in between phone calls is fine too. Just make sure that you have given yourself a chance to transition to a place of calm and focus before engaging with your child. Providing special connection time for your child during chaos will remind them of the fact that they are loved and safe. It will also give them an opportunity to be just as they need to be - a child without worry and fear.

2. Response: This might be a time when you, as a parent or caregiver, get a lot of questions. “Where will we sleep tonight?” “Why did this happen?” “When can I go back home?” “Why did my friend have to leave her house?” My go-to suggestion for parents overwhelmed by questions and feeling like they need to answer them all and answer them well is this: Pause and Breathe. Make space for you to clear out anxiety, stress and worry. Your child will not think twice if you don’t immediately answer their questions. Next step is to think: Is this an answer now or answer later question? If it is an answer now question, keep your response simple and age appropriate. The information you give doesn’t need to have a lot of detail. You can give a little bit at a time and check to see if that answers your child’s question. If you think this could be an answer later question, that’s okay too. Generally, those are for the real tough ones or when we don’t know what to say at all. Give the question the space it deserves. Respond with, “Wow, that’s a really good question. Mommy needs to think about that one. I’m not sure right now. I’m going to think about it and then answer you later.” Then, actually do think about it and answer it later. You can also ask your child what they think and how they feel about it.

3. Feelings: There are a lot of them right now. And they might not all make sense or seem totally logical. For instance, the feeling of anxiety may come up but bring into question 'why' because your family maybe hasn’t been directly affected or experienced significant hardship. Any feeling is fine right now. If you notice some behaviors or signs from your child that seem unusual to you, do you best to help them put words to their emotions. As Dan Siegel, MD, says, “Name it to Tame it.” It really does help to say the feeling or feelings out loud in order for them to be soothed and attended to. As a therapist, I love to suggest the following phrase, “I wonder if…” “I wonder if you are feeling scared. There are some scary things happening right now.” “I wonder if you are feeling tired right now. I see that you are rubbing your eyes.” “I wonder if you might be feeling lonely. It’s been a few days since you were able to play with your friends.”

Remember, in a time of crisis, much of how we cope is based on the need to survive. If you are seeing some concerning behavior in your child, DO reach out to a mental health provider to learn more about how to best address what you see and ensure that your child is being well taken care of during this time. The first priorities are providing safety, nourishment, shelter and love.

 

 

ParentTip: Childhood Grief - How You Can Help

Grief can be a difficult process for most people, but it can be especially troublesome for children when they can’t put words to their emotions or feel like no one understands them. Teachers, parents, coaches, uncles - no matter the role, most of us have children in our lives that we care for in some capacity.

While grief can lend itself to feelings of helplessness, there are actually some concrete ways that adults can support children through the grieving process. An article in the Huffington Post suggested that one of the most important things being to accept a child’s feelings and avoid the urge to just ‘cheer them up.’ Easier said than done right? But think for a moment, if you’d lost someone you loved and rather than listen to your thoughts and feelings someone just told you to feel better, wouldn’t you feel a bit dismissed? It’s a very similar experience for children. When a child is angry, sad, or upset your role as a loving adult can normalize those feelings and provide a safe space to work through them. The Coalition of Grieving Students has created a manual for helping children work through the loss of a loved one.

 

More helpful resources can be found below:

What Not to Say

Informing a Child of a Significant Death

ParentTip: The Power of Apologies

We’ve all been there: frustrated, loud-voiced, faced with a sudden realization that we are not handling a tough situation the way we intended.  Even moments when we’re coming up short are opportunities to guide and teach our children.

In fact, acknowledging mistakes and making repairs with our own kids provides some very valuable relational lessons.  They too will (and often do) lose their temper; they will occasionally hurt and disappoint people they care about.  Personally demonstrating how to take responsibility for a mistake and care for another person, even when that person is three feet tall and may or may not be personally responsible for the total destruction of a brand new rug, is a powerful way to emphasize the importance of holding yourself accountable and treating others with respect and dignity.  When we apologize to our own children, we allow them to experience the comfort of being on the receiving end of an apology and let them in on the secret that even parents aren’t perfect – everyone makes mistakes and everyone can take steps to recover from them.

Follow the link below for some tips on apologizing to our own children:

http://www.positiveparentingsolutions.com/parenting/apologizing-to-your-child

ParentTip: Engaging the Child Behind the Behavior

When a child is misbehaving it’s easy to assume the worst. Whether it be our own child, a student, or family member, thoughts like “they’re just doing that to get attention” or “he’s just a troublemaker” sneak their way into our heads and actually affect the way we perceive that child’s actions in the future. Adults can have a habit of immediately labeling children without considering the factors that may be contributing to the unwanted behavior. This can result in a child being labeled as “bad” when it’s really the behavior that’s causing trouble. Now imagine how such a label could impact a child who struggles with chronic anxiety or depression which manifests itself as unwanted behaviors in the classroom or at home?

Kids who are struggling with chronic emotional and behavioral concerns deserve the benefit of a compassionate doubt.
— Mitch Abblett and Joseph D'Antuono, Esq.

Psychologist Mitch Abblett suggests that adults try look past the behavior and focus on the emotions that are fueling it. Easier said than done when your seven year old is face down in the kitchen kicking and screaming for a granola bar right? Thankfully, he offers a step-by-step approach to staying calm and becoming curious to what’s causing your little one to completely lose it.
 

Pause & Practice: Kid-Whispering with Kindness

The next time you’re watching a kid struggle to manage their feelings and actions, try the following practice to spark a higher, more helpful perspective.

1. Anchor yourself in your breathing. Feel the sensations of the breath in the body as you inhale and exhale one complete breath.

2. Notice something in your immediate surroundings or bodily sensations (perhaps the feel of air on your skin, your feet on the floor, or the tick of a clock). Just quickly and silently notice something that is “here and now” other than the labels, judgments and blaming thoughts about the child (e.g. being “a pain,” “manipulative,” “just looking for attention”) that are likely surfacing.

3. With genuine curiosity, ask yourself: What might they be “needing” behind this unpleasant, disruptive, angry behavior? What unmet expectation is most important to them? Don’t stop with labels of “attention” or “escaping a demand.” While these may have an element of truth, they still blame the kid in a way. Instead ask: And what might be behind that? (Hint: it will be something along the lines of looking for caring, respect, reassurance, a sense of competence, being connected and belonging to something/someone, etc.).

4. Notice any blankness, push-back, or “but” reactions in your mind and let them pass. Let go of your agendas and desired outcomes. Hold onto the need behind their behavior as if it’s a jewel you’ve discovered—a hidden treasure others have missed in this kid for a long time.

5. Wonder how this perspective on what’s behind things for this child might inform your next action. How might you act from compassion instead of consternation? Perhaps you will lean forward and whisper that you “know things are hard” and that you “want to help them get through this.” Or maybe simply loosen and let go of the scowl or the exasperated eye-rolling.

6. Wonder how this child might benefit from actions from adults informed by compassionate, “behind”-the-behavior perspective? If you in some way reach or, or stay present with them despite their difficulties, what message will that send?

7. Take in another breath and take a leap in the direction this perspective nudges. DO something to talk in a non-blaming or shaming way. Offer choices or solutions. Give them your sincere caring. Certainly make it clear that they are responsible for their negative behavior AND make it clear they are not a bad kid for having used these behaviors to wake people up to the needs behind them.

8. Adults should give kids permission to fail. We shouldn’t avoid talking to children about their problems and “imperfections”—be they emotional, physical or behavioral. The avoidant silence from adults is message enough. Kids struggling with emotional, learning, behavioral, or physical challenges are left filling in the blank stares with assumptions of blame and badness. Joe thinks we should let kids be imperfect. “Just talk to them,” he says. “Have the conversation so that they know you care.”

 

ParentTip: Flipping Your Lid!

Most parents are all too familiar with the phrase “flipping your lid”... you know the feeling; that blood boiling, steam-coming-out-of-your-ears sensation right before you completely lose your cool.  But guess what? You’re not alone! We all experience this, and believe it or not, the concept is rooted in interpersonal neurobiology. Today’s video gives you a quick explanation (that you can also share with your kids, yay!) on what’s actually happening in the brain right before you ‘flip your lid.’

Many people experience times in their lives when they feel overwhelmed and need clarity. Our mission is to provide the highest quality psychological care by honoring the integrity of individuals and families who seek our services. We strive to communicate understanding, instill hope and provide direction for change and wellness.