“Bravery is not…

“Bravery is not a feeling; bravery is how you behave when you are scared. You are among the bravest people I know.” Jonathan Grayson, PhD

I’m currently reading Dr. Grayson’s book, “Freedom From Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty.”  These words could not reflect my sentiments more.

No, That’s Not a Normal Part of Child Development

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Sometimes, I wish my head could keep up with my conversations – that I had the right response at the right moment.   A little while ago someone who rarely asks me about my work asked how my practice was going.  I responded by mentioning how many young boys and girls with some very big fears had recently been brought by their parents for treatment.  Some, I noted, were having full blown panic attacks.

Now I was fairly certain my conversation partner would say something like, “Wow.  What do you do in situations like that?” or perhaps, “It’s good that they are getting help now.”  Instead, what I got was, “Parents can be so over-reactive.  They take a normal part of child development and turn it into a problem.  If they would just leave it alone, it would pass.”

This is where my spinning head could not keep up.  In part, my professional ego was a little bruised (“Don’t you think I can tell the difference between a child who’s going through a normal phase and one who is truly suffering?” ).  At the same time I was feeling a little defensive about the parents who had the courage and the sensitivity to bring their child for a consultation.  Frankly, I think it takes a lot of guts to admit that something is going on with your child and to reach out for help.

Yes, sometimes parents do overreact about something that is a childhood phase.  They love their kids.  They want to see them happy and healthy.  It’s part of what they do.  At the same time, too often children’s and teens’ emotional issues are overlooked or not attended to.  According to the Child Mind Institute[i], more than 15 million children in the U.S. have diagnosable mental health or learning disorders, yet less than half of them will actually get help.  In addition, the National Institute of Mental Health (NIMH)[ii] notes that the results of a large national survey indicate that approximately 8 percent of teens have an anxiety disorder.  Their symptoms appeared around age 6.  However, less than one-fifth of these teens ever received mental health care.

What’s sad and concerning about this is the loss of potential and the unnecessary suffering – for both parents and kids.  There are effective treatments available that can help get these kids back on track and the whole family functioning better.  But how does a parent know when something is normal childhood development and when it is time to seek help?

Anxiety is a normal part of life for us all.  For a child, there are certain worries and fears we can expect at different ages.  For example, very young children may be afraid of strangers, the dark, imaginary monsters, costumes, being separated from parents and getting hurt.  Older children may worry about school performance or making friends.  If we provide reassurance and are supportive as children learn to deal with these things, in most cases they will eventually resolve.  When a fear or worry persists, creates great distress for the child and interferes with the child’s functioning at home, school or with friends it has crossed over to becoming a problem.  This is when it is time to seek help.

But when you seek help aren’t you just pandering to the child’s fears and making them an unnecessary focus?  Well, the truth is that when adult anxiety sufferers are asked about the history of their symptoms, a high percentage of them actually have symptoms dating back to childhood.  Their symptoms did not go away .   So treating children for anxiety may not only help the child from spending needless time suffering, but may help prevent anxiety disorders in adults as well.

Getting back to my conversation, if my head had been working at the proper speed, I would have said something along these lines:

“At times, you are correct, we as parents do overreact, but we also frequently under-react. Actually what’s going on with these kids isn’t part of normal child development and these parents aren’t over-reactive at all.  I admire them.  They recognized that their children were suffering and that this was not going to go away on its own.  They were forward thinking enough to reach out and get help.  Hopefully we will be able to prevent a lot of suffering now and in the future.”

I can’t make time stand still and give a well-composed answer.  For now, at least I am on the record.  Children with anxiety disorders deserve their suffering to be recognized and they deserve the opportunity to get better.  Bravo to the parents who have the courage to reach out.

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[i] “Why Speak Up.”  Speak Up for Kids: Child Mind Institute.  Child Mind Institute. Web. 16 July, 2013.  <http://speakup.childmind.org/why_speak_up/&gt;.
[ii] “Anxiety Disorders in Children and Adolescents (Fact Sheet).”  National Institute of Mental Health.  National Institute of Mental Health.  Web. 16 July, 2013. http://www.nimh.nih.gov/health/publications/anxiety-disorders-in-children-and-adolescents/index.shtml.

An Ending at the Beginning

As I write what is to be the first blog entry of my new site, I find myself compelled to share a story about an ending.  Not too long ago a young patient who had struggled with anxiety came in for session full of energy, family in tow.  I sat ready to set an agenda for the day’s session.  Instead, my patient told me with a smile to sit back, watch and listen.  So all of us sat back in my office and were treated to a 20 minute, one-person show (complete with props) about how to defeat the “Worry Monster.”

In case you’re wondering, the Worry Monster is a generic term some therapists use to helpIMG_1687 younger patients conceptualize their anxiety.  We talk about anxiety or worry like it’s a bully who keeps coming by to boss you around.  Defeating the Worry Monster means learning how to boss back and put him (or her) into his place.  Many of my young patients quickly latch onto this concept and delight in doing some bossing around of their own.

So…back to the session.  This play was so thorough, so complete in its understanding of anxiety, its description of how to overcome it and the breadth of tools it employed to be victorious that I was completely giddy.  I immediately congratulated my patient, and the whole family, on becoming so well informed and on understanding how to implement that knowledge.  What I knew, upon seeing this play, was that we were at the beginning of the end of treatment.

This was not the first time that I’ve been schooled by a patient in the ways of dealing with anxiety.  Hopefully, it will not be the last.  What it represents for me is what treatment is all about – getting patients to the point where they don’t need to be seeing me regularly anymore.  No matter what goal treatment starts with, there is one underlying goal that is common among the people I treat – to get their situation to the point where they intrinsically know how to respond to potential struggles and they no longer need me in order to cope well.  When I am working with anxiety, parents and patients often ask me how we will know when it is time to stop treatment.  One of the things I tell them is:  “We will know it’s time to stop treatment when you (or your child) start coming in and telling me how to intervene, and you actually are able to go ahead and successfully use the interventions you come up with.”

When I work with anxiety, a good deal of what I do is to teach.  I work to educate children and adults about what anxiety is, what maintains it and what puts it in its place and makes it manageable.  I find that when people have a way to understand their struggles, a frame to put it in, that treatment makes much more sense.  Even my youngest patients can understand anxiety when I put it in their terms.  When they understand, they feel more powerful…and they delight in taking charge of their lives.

When my young patient arrived for treatment and taught ME how to deal with anxiety, I knew we were at the beginning of the end of treatment.  I’m not sure who was more delighted at this prospect – me or patient and family.  We had strived together to get to this point.  The payoff was a child who had emerged from fear, who felt powerful instead of powerless and who felt ready to take on what anxiety might dispatch.  I think that this experience, and others like it, is what I bring into the beginning of treatment with each new patient.  I bring the belief that with each new beginning, each first step into treatment for people who are struggling with fear and worry, there is hope for a more empowered ending.  And it is my honor to be told to sit back, watch and listen as they move forward to live their lives.