What I Tell Parents about Kids and Anxiety

When I’m wearing my therapist hat, a good bit of my time is spent working with, or talking about, anxious kids and their parents. I frequently get calls from parents who would like me to work with young children and anxious behaviors. I don’t generally work with children under 11, but I do work with tweens, teens and the parents of young children. I also talk to local schools about kids and anxiety, trying to help parents understand and help kids overcome irrational or excessive fears.

Not surprisingly, this process often shines a light on the parents’ own anxious tendencies and challenges them to change in order to best help their children. Easier said than done. The truth is, most of us would much rather treat our kids for something than to change ourselves. It’s human nature. But when it comes to anxiety and children, a big part of the treatment involves changes in the family, especially the way parents respond to their kids’ worries.

In the past I’ve done play therapy with young children, but I found it wasn’t a great fit for me. I do have many peers and colleagues who are play therapists, and it can be a powerful, wonderfully healing process for children and their families. I’m a big advocate for play therapy as a way of helping kids heal.

While play therapy is the very best modality for treating lots of issues in children, it is not always optimal for anxiety disorders by itself. Anxiety is more often than not being unintentionally reinforced by the child’s family. As long as that dynamic continues, the child will have an uphill battle with fear.

For starters, there is an inherited component to anxiety (whether genetics or environment or both we’re not sure), so anxious kids are often living in households with at least one anxious adult. Anxiety is also self-reinforcing: Any parent who has experienced the pain of watching a terrified child scream, cry or vomit in fear would do just about anything to take that fear away. Even if it means avoiding anything and everything triggering. Even if it means (unintentionally) making the anxiety much, much worse.

In order to heal, anxiety has to be confronted head on. This is true whether you are six or sixty. Running away from fear only leads to more fear. Unless we stand up to our fears, the circles of our worlds get smaller and smaller. More and more things go on our “can’t” lists. As parents, we work hard to give our children opportunities, but when we give in to their fears (and our own), we create only limitations.

The good news for parents is that anxiety is much, much easier to confront at six, when the brain’s neural pathways are still soft and pliant. Given the right structure and encouragement, a child can often change his or her way of being in the world far more easily than an adult can.

After building rapport and establishing trust, a play therapist in private practice can generally provide those essential ingredients for 30 to 50 minutes, once or twice a week. A parent, however, can provide them far more consistently, every single day, in the child’s regular environment [hint: that's where the real anxiety happens, and where it can be confronted directly].

That’s why I offer the alternative of parent consultation. When anxiety is the primary issue affecting a child, I can often teach parents how to handle things at home without the little guy or girl ever having to set foot in my office. Parents can learn to stop reinforcing anxiety by avoiding or accommodating fears. They learn to support with empathy, while firmly encouraging their child to confront the things that scare her. They become aware of the anxiety cycle in the family and themselves.

During our first meeting, I work with parents to evaluate their family situation and determine whether anxiety appears to be the main issue with their child. If it is not the main issue, or I can’t get a read on the child through the parents, I may refer them to a professional who works with children for a more thorough evaluation. Even in this case I can sometimes be helpful as a parental support.

If anxiety is prominent and our relationship feels like a good fit on both sides, I will work with the parents for a few sessions, usually around six, to teach them how to better handle anxiety at home. We conduct experiments and discuss results. We explore the roots of the child’s anxiety, and talk about the parents’ own fears. We talk about parenting styles and whether the two — or more, if there are step- or grand-parents in the picture — are working as a team.

Very often, when parents have the education they need about anxiety and come together (with support) as a team, there may be no need for a child to be in therapy himself. If this doesn’t resolve the issue, however, or if it turns out there is something else going on, my role is to help parents find the right helping professionals for the next step. In any case, I work hard to help families break free from anxiety and reclaim their lives.

It’s Nice to See You!

Welcome back to the blog! It’s been a longer than expected hiatus, but I feel refreshed and re-centered after a long break. On a personal note, we’re enjoying our newest addition and are thrilled to be a family of four.

If you’re a regular reader, you’ll notice that I’ve made some adjustments to the way the blog looks. I’m also working on updating the categories and structure to make it easier to navigate, and more relevant to both my counseling and executive coaching practices. Often the state of my blog reflects the state of my life, so I’m hoping that cleaner, simpler and more organized is a sign of things to come in general. With less neglect all around.

As always, I welcome feedback about the blog and enjoy reading your comments. Look for upcoming posts about kids and anxiety, ‘invisible’ hoarding, getting hired, and much more.

In the meantime, happy 2012!!

 

A Little Summer Mountain Climbing

Whew! What a busy spring it has been! In the last few months, I have moved my practice location (just down the street, but a move nonetheless), prepared a workshop for clinicians in another state on Obsessive Compulsive Disorder, and taken on several big personal projects. We are also expecting our second child, so that keeps me distracted and tired as well — especially during those hours I spend outside the office.

The end result is that when I logged on today, I realized I haven’t updated this blog since March (a substantial lapse, even for me). I’m noticing that it’s hard to write the next blog after such a long time away. The perfectionist voice inside me is applying pressure to make this ‘return to blogging’ something BEYOND spectacular.

Do you ever feel that way? If you have faltered in your resolve toward a goal (or even in a relationship), do you feel that your next move has to somehow exceed all expectations to make up for imperfections past? I know I often feel this way, and like many other forms of perfectionist thinking, it’s more paralyzing than useful.

I’ve worked with couples in which there has been infidelity, for example, and the ‘offending’ spouse can often feel that once he or she has slipped, nothing will ever be good enough again. This feeling can be mirrored by the wounded spouse, who in his or her anger and hurt affirms the idea. Unfortunately, this pattern can lead a couple to abandon their efforts to heal a marriage before they’ve really even started.

The same thing happens when clients ‘relapse’ in their treatment. They have a bad week, or go back to unhelpful behaviors, and then end up feeling that they’ve failed entirely. It is as though they have not only slipped on their difficult climb, but that they have rolled all the way back to the bottom of the mountain they were trying so hard to scale. It’s a frustrating feeling, and it can keep even the most motivated individuals from taking the next step toward growth.

It’s natural to feel guilty or disappointed after we’ve let ourselves down, or let our family or partner down. But the reality is, our mistakes are usually not as bad as they seem in the moment. We might feel like we’re at the bottom of the mountain again, but if we look closely, we’ll see all the amazing progress that is still behind us on the trail. And wherever we are on that mountain, the next step is the little one right in front of us.

We all have moments of weakness, in which we are not what we hope to be — as parents, as friends, as spouses, as people. It’s important to notice these shortcomings so that we can try to improve for next time, especially when they occur in patterns that are less than helpful to us or even destructive in our lives.

It can be anything. Having an affair, over- or under-disciplining a child, saying something we regret to a close friend. Cheating on a diet, forgetting to do therapy homework, smoking a cigarette even though you’re trying to quit. Letting go of a blog for three months. Whatever it may be, it’s so critical that we forgive ourselves for being human and try to keep these lapses in perspective. That forgiveness honors us for our strengths and gives us what we need to start the climb again.

Self-Help, Tragedy and the “BS” Meter

I’ve been following off and on this week the news about the trial of James Arthur Ray, the ‘self-help guru’ charged with manslaughter in the deaths of three people in a sweat lodge near Sedona, AZ, in 2009. This tragedy, and the resulting search for responsibility, brings up several issues for me that I thought I’d share with my readers.

The crux of the court battle seems to be around whether the three people who died from heat-related illness (two on the scene and one nine days later post-coma), were autonomous adults who had a responsibility to leave the lodge if they were not feeling well, or were under psychological pressure from the leaders of the retreat to remain despite illness and burns.

One thing I will say about the trial is that I am glad I am not on the jury. All my life, I have believed strongly in personal responsibility and personal power. We all make choices in life and must live with the consequences of those choices; as adults with free will, we cannot hold others responsible for our well-being.

And yet, we do. Every day we trust doctors, nurses, police officers, pharmacists, restaurant employees and countless others with our health and safety. We do this without thought, in complete trust of those who have earned a particular role in our lives. We have expectations that those in power or authority will follow the rules and protocols and do their personal best to make and keep us healthy and safe.

But what is the power and authority of a “self-help guru” or “philosopher,” as James Arthur Ray is known? What kind of training did he have, what license did he hold, to what traditions did he turn when leading this group in an ancient, spiritually fulfilling, and potentially dangerous activity? Other than sheer charisma, what qualified him to hold the trust of all those people? How does the fact that extreme heat can blur one’s judgment and thinking abilities play into the question of responsibility?

As a professional counselor, I have been extensively trained in my trade, and the ethics that go with it. Whenever I am with a client, I am always aware that I hold a certain amount power in that relationship and need to approach it as such.  We therapists are ethically bound to inform every client of their rights, the risks of therapy, the always-present option to exit at any time without shame or consequence.

Not only do we inform clients at the beginning of the process, we help to support their autonomous decision-making every step of the way and never, ever encourage a client to do something for which he or she is not psychologically, emotionally and physically ready. Our power in the relationship comes with a responsibility to monitor clients and assist them in the process of working in their own best interest. And if we fail in that responsibility, we can not only lose our professional licenses, we can be held personally liable as well.

But how do you hold someone accountable for their psychological power over others when they have no written code of ethics, safety guidelines, professional standards, or regulated license? It’s a great question, and one that returns us to the question of responsibility.

While the government may or may not decide to regulate activities like sweat lodges and spiritual retreats (I rather hope not); ultimately I think we all need to be better consumers of ‘self-help’ in whatever form it comes. Seminars and retreats like this one are a popular and lucrative industry calling people from all walks of life. Bookstores, too, are overflowing with all the latest self-help books, on topics ranging from business leadership to bipolar disorder.

Many are based on rigorous scientific research and evidence, others grow from personal anecdotes and spiritual philosophies. Both can be useful, but I think it’s important to know which book you are reading (or seminar you’re attending), and take it with the appropriate grain of salt. Problems occur when people who have interesting ideas and lots of personality become known as ‘experts,’ despite their lack of scientific training or ethical accountability.

One of my favorite examples of this is an absolute pop culture sensation from the last decade, “The Secret,” by Rhonda Byrne. Now, about 100 of my friends and colleagues are about to be horribly offended, but while I think that book is an interesting read and has some great nuggets of truth, it’s about 80% garbage. Why? Because it extrapolates from a few basic good ideas and unknowable spiritual phenomena (not to mention testimony from famous people – always a plus), and tries to pretend to be science.

I read that book a few years ago because so many of my respected colleagues recommended it, and I’ll be honest, Byrne lost all credibility for me when she compared the “Law of Attraction,” an interesting idea that could lead to more positive thinking and increased happiness, to the Law of Gravity, an actual scientific law documented by thousands of years of undisputed evidence and quantifiable equations. I also have some other fundamental problems with the “Law,” but perhaps another blog.

For me, that’s when my “BS meter” went off. Do I think the whole book is useless and that my colleagues who love it are idiots? Of course not. There are some great concepts in there, and the book definitely challenged me to see the world differently, in a positive way. I didn’t suffer from reading that book, but I was also aware as I was reading it that Byrne has no formal training in psychology, theology or anything else that I know of. No one checked her book to make sure it passed scientific rigor, or questioned whether it was ethical to sell all these concepts to average readers as Truth.

With no academic reputation or professional license at stake, Byrne and others like her really have nothing to lose when they publish. Self-help authors and speakers fall along a bell curve that includes well-qualified, highly educated researchers at one end; and modern day snake-oil salesmen at the other. And many, many, many in between.

Certainly I am not saying that one needs a master’s degree and a professional license to write a book or lead a seminar… far from it. Some of the world’s greatest leaders and thinkers have had little or no formal training. What I am saying is that those of us who choose to follow the lead of another person — whether it’s by reading a book, attending a retreat, listening to a sermon, or sitting in the therapist’s or doctor’s office — should not check our own common sense at the door.

Too often we see someone as an “authority” and raise their judgment above our own in our minds. We’re afraid to ask about someone’s training or experience, nervous to question our doctor’s conclusions, shy about raising red flags when we feel them. But the truth is, no matter how many inspiring stories, excited followers, or expensive degrees (ahem) someone has, none of that beats your own gut instincts.

I love it when my clients ask about my training and expertise — it shows that they’re invested and want to build trust with me. My favorite supervisor always tells his clients, “You are the expert on you.” It’s so true.

Degrees, ethical codes, regulations and licenses help us to decide where to put our trust. So do online reviews, references and testimonies from satisfied and dissatisfied customers. But ultimately, the instrument we have to trust most when deciding what’s in our own best interest is our very own brain. Listen to experts, sure, but always trust yourself first.

5 Mistakes Couples Make During Fights – #5

This is the final entry in my five-part series on couples and conflict. You can read the first four articles here, here, here and here. I want to add a note of thanks for all the great feedback I have received on this series. I will certainly consider doing another one like it in the future. Thanks for reading!

The last mistake on my list is one that is common in long-term relationships: Stockpiling.

Basically, stockpiling means saving up complaints and grievances about our partner or relationship over time; and then when the moment is right (e.g., in the middle of a heated discussion), unleashing them like cannonballs over the walls of a fortress.

Some of us are “venters,” and when that final straw breaks the camel’s back we are ready to rattle off a list of everything that’s bothering us, from the socks on the floor last Friday to feeling romantically rejected today…. and everything in between. Maybe we process emotions by talking about them, or maybe once we get going it’s hard to stop.

On the other side of this deluge, however, our beleaguered partners don’t know which problem to start with; and as the discussion goes on they feel completely overwhelmed and helpless. This overwhelming feeling of being hit by cannonballs or mired down is what John Gottman calls “flooding.” Too many emotions, too many complaints, too many turns to the conversation, and our little brains melt down under the pressure.

Often, my clients who complain about their partners “shutting down,” or “withdrawing” during an argument don’t realize that it’s actually because they are flooding the other person with too much at once. The second partner shuts down because he or she has no choice: the ego cannot withstand this kind of onslaught for long. Unfortunately, the shutting down behavior often triggers the first partner to increase the volume and frequency of the attack, which only makes both people feel frustrated and ignored.

You could say that stockpiling – quietly saving up little grievances – is the predecessor to flooding. They go hand in hand, and neither is very productive.

This habit also has a passive-aggressive flavor to it, because instead of addressing little issues directly as they come up (or, Heaven forbid, actually overlooking them!) we fool our partners — and even ourselves — into thinking that everything is fine. Sometimes we even paint ourselves in a kind of saintly light as we do this. “I’m not even going to mention the fact that she didn’t do the dishes as we agreed. I’m just going to be nice about it and do them myself.”

Which would be fine, except that while we’re doing those dishes, we are also putting a note in our little mental filing cabinet for later. Then it becomes ammunition for a future argument (“You never do your part around here! Last week I had to do the dishes for you, today it’s this…..”). Hmmm. Not so saintly after all. It would have been much better to address the dishes when that issue came up, resolve it, and move on.

So how do you know if you’re a stockpiler? Here are some common phrases that are benchmarks of this bad habit: “It’s not just this,” “This is about more than just today,” “You always/never….” “And another thing,” etc. Stockpiling is one of the key reasons I recommend that couples have an agenda for their discussions and try to stick to it.

To curb your stockpiling habit, try this next time you are annoyed with your partner and debating whether to start a discussion. Ask yourself, “Is this big enough to mention or small enough to let go?” If you’re not sure, give yourself an hour to decide. If you’re still not sure, then it may be worth bringing up [remembering to be respectful and use your 'I-statements.'].

If it feels small enough to let go, say to yourself in your best courtroom drama voice, “I am choosing to let this go. This case is dismissed, and this incident may not be used as evidence in any future trials or conversations.” If you hesitate on this one, then chances are you’re either not very good at letting things go, or you’re kidding yourself about it not being a big deal.

Contrary to popular belief, it’s okay for little things to be a big deal. The question is why it’s a big deal, and that’s something to explore with your partner in the moment, not to fire at him/her like a missile two weeks later.

Which would you rather respond to?

A: “You have been so inconsiderate lately – you work late all the time, you forgot to do the laundry twice this month, I’ve had to walk the dog every day, you leave your shoes in the hallway…”

B: “I don’t know why, but I’m feeling really angry that you stayed at work late today without calling me. I guess it shouldn’t be a big deal, but for some reason I’m having a hard time letting it go. Can we talk about it?”

B, right? Exactly. You can be honest about your feelings now without bringing in evidence from the past. No one likes to hear a long list of everything they’re doing wrong, and your partner is no exception. (Yes, even if it’s you, and even if everything on the list is true.) Sorry, stockpiler.

10 Great Ways to Show Love for your Spouse or Partner

Happy Valentine’s Weekend, everyone!

One thing I have learned in my years of counseling couples is that it’s often the little things that really make a difference when it comes to nurturing a successful relationship. These suggestions are based on the principles from Gary Chapman’s 5 Love Languages and John Gottman’s research on marital success.  Have a love-filled February!

1. Just for today, try listening 80% of the time and talking 20% of the time.
2. Surprise your partner by learning something about a topic that interests him or her, but about which you know very little.
3. Without being asked, suggest an activity, type of music, or TV show that is your spouse’s favorite.
4. During an ordinary activity or at the dinner table, take your partner’s hand unexpectedly.
5. Buy or make a special gift for your spouse. It doesn’t need to be big or expensive, just something that reflects his or her personality, hobbies or interests.
6. Do a household chore or task that is either normally your partner’s responsibility, or something you know he or she has wanted to have done for a while.
7. Make a list of your five favorite things about your partner. Write each one on a sticky note and leave them around the house where your spouse will find them throughout the day.
8. Set out to make your partner laugh; don’t give up until both your sides hurt.
9. Take an afternoon or a day off from work and do something you don’t often get to do together – take a long walk, see a matinee, or just go window shopping.
10. Share something about yourself – big or small – that you’ve never told your spouse before. Learn something new about him or her, too. It could be a funny childhood story, an old heartache, or even a dream for the future you’ve never shared aloud.

5 Mistakes Couples Make During Fights – #4

This is the penultimate (love that word!) entry in a five-part series about couples and conflict. You can read the first three entries here: #1 – Not Knowing When to Shut Up; #2 – Forgetting Map, Compass & Clock; and #3 – Improper Use of Time Travel.

The fourth bad habit I want to address is a personal weakness of mine, one that I’ve had to work hard to manage over the years — criticism.

For some reason, when we’re in an intimate relationship, some of us begin to feel that our closeness with another person gives us license to tell that person not just everything about ourselves, but also everything we think could be improved about him or her. It often starts with the normal frictions of living together, like leaving clothes on the floor or dishes in the sink. And then it expands to the way someone eats his soup, how she drives, or more fundamental things about who we are, especially in the relationship.

Perhaps being in the relationship and binding our fate to the other person makes us feel entitled to give input on everything we see wrong. Maybe focusing on what our partner is doing ‘wrong’ keeps the focus off ourselves. Unfortunately, whatever the reason we criticize, the result is that it usually backfires.

According to the widely respected marital research of John Gottman, criticism is one of the big no-no’s, the serious relationship killers he refers to as the “Four Horsemen.” When we criticize our partners, we are far less likely to  have lasting, healthy relationships. And yet I seem to see this ugly little pattern almost constantly when I work with couples.

So, what exactly is criticism and how do I know if I’m doing it?

Criticism means passing judgment on the behaviors, words or personality of another person — usually with the underlying intention of making one person right and the other wrong. This isn’t always a bad thing. Many of us are required to offer and accept criticism as part of our jobs, for example. As a therapist, I have to dish out criticism as part of my job, to help clients notice their self-destructive behaviors so they can improve them. As a writer, I have lots of experience (some of it painful) accepting criticism in the form of big red marks on things I have written over the years.

In both of these cases, however, criticism takes place in an environment of trust and purpose. Both sides know that both negative and positive feedback – constructive, hopefully – is part of the work we are doing together. And in both of these cases, everyone knows that it’s not personal.

On the other hand, there is almost nothing in the world more personal than getting feedback from your spouse or partner. When that feedback is frequent and negative, it can wear away at the loving feelings between two people and ultimately, the stability of the relationship. When criticism targets sensitive emotional areas, our character and values, or how we behave in the relationship, it can be even more damaging.

It’s important for each individual in a relationship to remember that our partner is, first and foremost, a human being. He or she was flawed when we met them, and will continue to be flawed until our last moment together. (The person doing the criticizing is flawed, too, and boy, do we hate being reminded of that!)

We are entitled to loving, respectful relationships with partners who listen to our concerns and care about our feelings. We are not entitled to perfection. Our role in life is NOT to help the person we chose become more like the ideal person in our head. If our partner annoys, embarrasses, or worries us on a regular basis, maybe we need to ask ourselves why we chose him or her.

Better yet, instead of trying to create a perfect partner, those of us prone to criticism are much better off trying to become the best partner we can be. It is much more within our power to change our own attitudes and behaviors than those of someone else; and by doing so, we might inspire our other halves to work harder to please us, too. If nothing else, focusing on our own behaviors might make the little things that bother us about someone else less noticeable.