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There is no doubt the “Age of Anxiety” is more upon us than
it was when W.H. Auden wrote his famous poem of the same name in
1947. Every day we hear about more and more things that
generate anxiety. For children the situation is even more dire because
children are afraid of all the things that their parents are, as well
as a host of other highly improbable and impossible things, such as
ghosts hiding in the closet or monsters lurking under the bed.
When anxiety becomes so high that it interferes with one’s ability to
function, then it is called an anxiety disorder, and in childhood and
adolescence the prevalence of anxiety disorders is rising and is
currently higher than that of all other mental disorders. The
prevalence in children ages 9 to 17 in Canada is estimated at 6.5%
(Mental Health Evaluation and Community Consultation, University of
British Columbia, 2002), which means that in Canada approximately
650,000 children suffer from this problem. At the children’s
mental health centre in Toronto where I work, statistics are kept and
they show that the incidence of anxiety-related problems in
children has increased by 50% over the past ten
years. Anxiety now represents 27% of the problems that
clients seek help for at the centre.
Unquestionably, there are a lot of anxious kids who need our
help. In this article I will be sharing with you the work I
have been doing over the past ten years. I have discovered
another way of understanding anxiety-- that it is not a disability but
rather a “gift”— a gift that can be ruthless if it is unbridled, but
when made tame can be a delightful asset. This approach is
achieving remarkable results in helping these children.
Many years ago, Melanie, a delightful 11-year-old girl, (name changed
to protect identity) entered my office. For all the world,
Melanie looked like a happy child, with big curious hazel eyes, a
toothy grin and a scattering of freckles. But Melanie was anything but
carefree. She suffered from debilitating anxiety, which she
experienced in the form of severe and frequent stomach aches. Her
anxiety was so intense that many days it was excruciatingly painful for
Melanie to get herself out the door for school. She also missed many
social events, such as parties and sleep-overs. Yet her grades were
excellent and she had many good friends. She was articulate and more
mature than the average 11 year old.
I really enjoyed my discussions with Melanie. I asked her what else she
liked to do, besides spend time with her friends and family.
Her eyes sparkled as she told me about her art. She painted with
watercolors and oils and described in enthusiastic detail the paintings
of which she was so proud. As I listened, I wondered out loud, “Do you
think there’s any connection between your incredible creativity and
your anxiety?”
Melanie stopped, looked at me, perplexed but clearly
interested. I continued, ”Well, it seems to me you don’t just
have a fear of something. When you imagine something, you
imagine it in full color, with loads of detail and it becomes a very
realistic and elaborate scene.” She nodded
enthusiastically. “Yes,” she said. “That’s how I
see things. I can picture all the details so clearly. It’s
like I’m really there. Doesn’t everybody?” I said,
“No, not really.”
That was the beginning of a new path of research for me. Sitting with
Melanie all those years ago, I didn’t know what to make of this
epiphany -- whether it was a common or unique case. But I was intrigued
and so I continued to ask questions and to search for some
answers.
From that time on, I incorporated new questions into my interviews with
parents of children suffering from anxiety. The response
to “Does your child have a vivid imagination? invariably came
back a resounding, “Wow! Does he ever!” As for my young
patients, they were eager to recount in vivid detail how they flexed
their imaginations, (very different from the typical “shrug of the
shoulders” response one typically gets from children when asked what
they are thinking).
Some kids have extremely imaginative play, making up wonderfully
elaborate scenarios and acting them out with their dolls or action
figures. Older kids write stories, plays or even
novels; some compose songs, often with intricate
lyrics. Other kids express their imaginations
through art, creating detailed drawings and paintings. Still
others build complex structures with Lego®, building blocks or
clay. The realm of the imagination really is
limitless and takes many different forms, but the children who come to
see me for anxiety all typically share one common characteristic: These
are children gifted with highly active and developed
imaginations.
After years of research and clinical observation in my office, I’ve
been able to confirm the validity of my theory that had its beginnings
so long ago with Melanie. Since then, I have dedicated myself
to researching tools and means of helping these children tame and
control their imaginations, so that they can live happy, creative and
less stressful lives. I’ve developed a step by step
process that has changed the lives of many of these extremely anxious
children. I found some confirmation for my
hypothesis from the work of Paul Harris, Psychologist from Harvard who
writes: “Children and adults alike have the capacity for ‘absorption”
in a pretend world…Once we enter that state of absorption, it is the
events occurring within the imagined world that drive our emotional
system”(Work of the Imagination, 2000).
Here are the main stages of the process:
1. The first session is a
critical point in the treatment. Once the
parents have confirmed that their child is highly imaginative, then I
get as close to the child as he or she will permit, and say “Do you
know that you have an
amazing gift?” With my hand gestures, tone of
voice and facial expressions mirroring the importance of my words, I
say “You have an amazing gift
of imagination! This is a wonderful
thing! And when you are in charge of it and it goes where you
want it to go, then it is a joyful experience. You can have a
lot of fun playing with what you make up with your
imagination. But when it goes where it wants to go,
and you have no choice, then it can be a real nightmare!” I
take my time to ensure that the child is with me every step of the way.
I also check in with the parent, to see if they are nodding in
agreement or looking puzzled. If the latter, I slow down and
answer questions.
2. The next step is to
search for a control metaphor that is rooted in the child’s own
experience of learning mastery. For this information, I
often turn to the parent who may have better recall. I want
to find something in the child’s experience where he/she learned to
control something—riding a bike, learning to ski, riding a horse,
training a pet, managing a toddler--something that is difficult and
which required patience and repetition, where anger and frustration
might impede success. Many boys resonate to the metaphor of a
powerful car like a Lamborghini or a Ferrari. In
many cases there are a lot of examples; in others,
only one. You use whatever you are offered. Then
the connection is made—“Just like you learned to ride your bike, to
brake and steer when necessary, you can learn to brake and steer your
imagination. It wasn’t easy to learn to ride your bike, but
you did it, and now look how much fun you have with it.”
I have come to several conclusions about why this approach is so
effective. Probably the main reason is that it creates motivation on
the part of the child to want to use the tools that are
available. Many children are simply not motivated to make
changes. This is perplexing to many professionals, as well as
to parents, because if someone is in distress, then logically
he/she should be clamouring for change. Children, however, frequently
choose a different route. They prefer to try to change the
world rather than change themselves. This often takes the
form of trying to control the parents. For instance, if a
child is afraid of school or something adverse that might be happening
at school, then he/she might try to avoid school, which entails
manipulating the parents to allow the school refusal.
By the time a child comes for therapy, he or she has
typically had a few years of practice and has become quite skillful in
avoidance. This is often the reason the parents seek professional help
-- they are tired of the manipulative tactics and of the price both
they and the rest of the family are paying as a result. How many
vacations, parties, events can a parent cancel without feeling
resentful and deprived? If offered new tools that
require an effort, many children choose to continue using
their old avoidance tactics with which they are more comfortable. From
their perspective these strategies have been
successful.
Current psychological approaches used with children for anxiety,
notably cognitive-behavioural, seem to take the motivation factor for
granted. The children are brought to the therapy and given
tools. This may work for adults, who, usually come to therapy of their
own accord and know the personal cost of avoidance. Children
frequently do not understand this. No matter how much adults
tell them, they do not believe it, because their experience tells them
that the anxiety diminishes the minute they avoid whatever is making
them anxious. Children typically do not look far into the
future nor do they think about the long term consequences to any of
their behaviours. Has anyone ever convinced a 9
year old boy to do his homework because it might lead to a better job
in his future? Rarely! Children focus much more on
what’s happening today. Rarely do they think about ten years
from now.
3. The key to successful
therapy is creating a desire for change. Many
parents come to my office asking me to give the child tools and
strategies. I refrain from giving these too early.
There are many useful tools, many of which can be found in the
excellent cognitive therapy manuals for children (See Kendall, P.,
Friedberg and McClure). But as the saying goes, “You can lead
a horse to water but you can’t make them drink.”
4. Timing is
everything. It is only once the child
understands about being
in charge,
that he/she is ready
for change. You can say to a child
“Your imagination is like a wild stallion. It’s strong and
powerful. You need to tame it. You need to be in
charge. Once you do that, imagine how much fun you’re going
to have with it. If you don’t establish that you’re in
charge, what is that going to be like? You’re going to be
holding on for dear life and, how much fun will that be? Not
much!”
Once this point is successfully made, many children then go through a
significant transformation. Having initially come to the
office riddled with shame, reluctantly dragged by a parent, convinced
that this will be “another waste of time,” he or she is now proudly
sitting up and eagerly engaged in the dialogue.
5. Getting Control.
For the next few sessions we work on how to get control of the
imagination, understanding why imaginations like to create scary
scenarios, how to be respectful of the imagination but still show it
that you are in charge. I also introduce concrete tools for
steering the imagination in other directions. I am
continually amazed at the creativity these children then bring to the
therapy and, once they decide to, how successful they are at changing
their lives. Children who had previously been missing out on
many of the fun activities in their lives are now fully participating
those activities-- school, family vacations and hikes, birthday
parties, eating out in restaurants, swimming at the deep end,
braving storms, and even getting a good night’s
sleep.
References
Friedberg, R.D., McClure, J.M. (2002), Clinical Practice of
Cognitive Therapy with Children and Adolescents, The Nuts and Bolts,
the Guilford Press.
Harris, P.L., The
Work of the Imagination, Blackwell Pub., 2000
Kendall, P.C., Coping
Cat: Cognitive-behavior therapy for anxious children: therapist manual,
2nd ed.
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