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The Role of Imagination in Children With Anxiety | Robin Alter

The Role of Imagination in Children With Anxiety

A girl skipping rope

Photo: Martin Yaffe

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.