One of my favorite experiences as a child anxiety therapist is the graduation session, when we all — the kids, their families, and myself — high-five and celebrate the child’s triumph over the anxiety. A cookie cake is often involved.
But even better, from my perspective, is when the parents tell me: “We got as much therapy for our anxiety as our child! We are so much more confident that we can help him manage his anxiety on our own!” because I love helping not just the kid, but also the whole family, and because I love being a bargain.
I am board certified in cognitive and behavioral therapy, which is ideal because CBT is the most evidence-based form of psychotherapy for anxiety. The traditional model of CBT for anxious youth is individual sessions, perhaps with a parent check-in at the beginning or end of the hour.
And so imagine parents’ surprise when we first meet and I explain that my typical policy as a CBT therapist is to have parents present in every session, throughout the entire session.
This is because I believe parents deserve to see how the most potent aspects of CBT unfold and heal their children in real time.
Good CBT is about learning — learning that what anxiety tells us is unrealistic, that simply talking about fears doesn’t really help but that talking back to them does, and that facing fears in a systematic way is absolutely required if kids want to get better. Whether we are practicing hanging out in the dark, petting the therapy dogs, making homework mistakes and moving on, or reading aloud in front of an impromptu audience in the waiting room, the most important thing that parents can observe during sessions is that their kids can function — typically very well, often like heroes — even when they are quite anxious. And that their kids feel exhilarated after having risen to that challenge.
Parents need to see this so that they can coach their child through similar challenges out in the real world. Parents who are new to treatment typically arrive in a crisis of confidence when it comes to their effectiveness as parents. Whether their child fears sleeping alone, taking a test for which they feel unprepared, giving an oral presentation in class, or simply attending school, parents of children who frequently express anxiety have typically grown accustomed to rescuing them from anxiety-provoking but developmentally appropriate experiences. Or parents find themselves stuck in an ever-expanding cycle of over-accommodation so their kids don’t have to feel anxious in the first place. These parents know that they are doing their child a disservice but are at a loss as to how to stop, believing that doing so will somehow break their child or ruin their child’s attachment to them forever. If anything, the opposite is true.
This is why it was no surprise to me to read the recently published study showing that an anxiety treatment for children composed entirely of parent-only training sessions performed just as well as the more typical treatment of individual sessions for children.
Parents are living in what I hate to call the Age of Anxiety, where they are reading left and right that there is an “epidemic” of anxiety disorders, even though the good scientific evidence says this is not the case. That screens and social media are the cause of this, even though high quality research refutes that.
My impression is that parents have forgotten that it is common for children to feel anxious sometimes. It’s as normal a part of development as anger, sadness, and joy. But the near constant message in this Age of Anxiety of “your child is at risk, risk risk!” has left modern parents understandably terrified that any anxietytheir child shows means an anxiety disorder, rather than a rough patch of stress, likely to be temporary, and that parents themselves are perfectly capable of managing using the tried-and-true techniques their parents probably used: distraction, humor, compassion, helping their child develop a plan to tackle a fear, and having high expectations that their child is capable of facing that fear and that it will get easier the more their child does it. And an unwavering belief that children learn self-reliance by doing what is safe, but scary at first, and that the very best kind of confidence is that which is earned.
To my students I exhort: “Never underestimate the power of parents to heal their own children, when you have modeled the right tools and coached them to use them.” To the parents I work with I say: “My job is to train you to become your child’s cognitive-behavioral therapist and therefore make myself obsolete. I’ll be in your child’s life only a short while; you get to be there forever.”
Katherine K. Dahlsgaard, PhD, is clinical director of the Anxiety Behaviors Clinic at the department of child and adolescent psychiatry and behavioral sciences at Children’s Hospital of Philadelphia.