Need help re advice from DS's psychologist

[robinia]

This isn't really a discipline question but it relates to discipline and I have had so much helpful advice from this forum over the years (I'm a long-time lurker) that I thought I would try here. Also a bit long sorry!

DS, aged 4, has mostly been a happy, outgoing, confident little guy but over the last year, with some life changes and the more complex challenges that go with being a preschooler instead of a toddler, he has started showing some really anxious behaviour. Worry runs in both our families so we both recognise it and wanted to get some tools to help him cope with his worries early on rather than waiting for it to sort itself out or maybe become more significant.

Our GP thought that he was under stress but coping and referred him to a child psychologist with a suggestion of anxiety and adaptive disorder.

We've had a couple of sessions with the psychologist who seems fairly pleasant, not appalled by AP etc. At the last session she was responding to my request for some tools to help him address his worries and in particular my concern that talking things through with him sometimes seems to encourage him to dwell on worries rather than process them.

She did have some helpful suggestions about helping him to label his worry, much like Happiest Toddler, explaining how sometimes alarm bells go off at the wrong time etc.

But the key suggestion was to discourage him from seeking external reassurance by saying "this is worry talking; talking about worry makes it grow; I won't talk to you until you are feeling better".

This emphasis on "self-soothing" and "I won't talk to you until you are exhibiting x behaviour" seems so much like CIO and time-out to me. The hand-outs she gave me reinforced this impression with statements about rewarding and punishing your child consistently, using time-out as the best form of "punishment" - "when your child is building up anxiety and becoming unreasonable or irrational ... set a goal of say 5 minutes away, then the child comes back and explains (in a reasonable tone) what they are upset about". The psychologist did apologise for giving me the 'older' sheet that referred to punishment rather than consequences, but still this seems such a punitive response to a worried child.

Am I over-analysing this because I so dislike CIO and punishment? I'm familiar with thought-stopping for adults and have been able to use it effectively myself, but this seems like an unkind way to introduce the concept to a four year old. Does anyone have experience of using similar techniques for an anxious child, or maybe some other suggestions to help DS overcome worries?

[Ruthla]

I think you can do the "this is worry talking.." stuff without sending him off to his room by himself. You can try to redirect the conversation, or just snuggle and NOT talk, at these times.

[meemee]

can you change the psychologist till you find one you like?

i too would not be comfortable with what she asked you to do.

my dd has anxiety too. depends on the situation. sometimes she needs to dwell in the worry to understand it. sometimes talking talking shows her how silly it is. other times i have to make sure she doesnt dwell in it too long.

however if is a chemical imbalance like my friend's son, then one will need a combo - medicine and talk therapy.

but you gotta find the right one who supports you adn your son.

[BellinghamCrunchie]

The problem, even from a behavioral standpoint, is that it does not teach the child what to do instead. Leaving him in time-out for five minutes while he struggles to get control of his feelings isn't showing him how to deal with his feelings. It does reinforce regaining control over his behavior, but he is pretty much left to figure out how to get that control with no support (sitting alone in time-out).

If you are certain he already knows how to express his anxiety in a healthy way and is not choosing to do so, then I could see how time out might not be a bad choice. But if he doesn't know how to express his feelings in a healthy way, it seems like it would be a bad idea... because without guidance in working through his feelings in a healthy way, he could just learn to stuff them or add feelings of abandonment to the mix (mama doesn't love me when I'm scared so I better not be scared) or some other non-adaptive response.

Instead of time-out, maybe you could get to the same place (where he is able to state his feelings in a reasonable tone) by coaching deep breathing (count to 10, with a long slow breath for each number). This way you wouldn't be isolating him for having feelings but you also wouldn't be inadvertently reinforcing them by giving too much validity to the worry through sympathetic statements.

I don't think you are wrong in your intuitions. I also wonder if the psychologist would respond to you bringing up other techniques - hopefully timeout isn't the only tool she has in her toolbox.

[aran]

No time to write much, and didn't read the whole thread, so sorry if this has already been said.

The psych's advice sounds like a piece from cognitive behavioral therapy, which has been proven to work very well with anxiety. Upon the recommendation of mamas in the gifted forum here at MDC (there tend to be a fair number of anxiety threads there), I recently bought these two books, which would explain that little piece of advice from the psych in a larger context. The first book I list is a workbook, written at a kid's level with space for drawing. It is meant to give tools to deal with anxiety. It is aimed for school-aged kids, but it is fine for my newly-5 yo DS. I skipped a few lines (blacked them out so DS1 couldn't see) about people being angry with him for being anxious, because that's not true here. But in all, it seems like a good resource so far.

What to Do When You Worry too Much. A Kid's Guide to Overcoming Anxiety. by Dawn Huebner.

Freeing Your Child from Anxiety by Tamar E. Chansky

ETA: The "I won't talk to you until you are feeling better" part doesn't sound like my interpretation of cognitive behavioral therapy in action, though for some people it could be. The books I mention have the kid imagine a "worry box" that kid sets aside worries in as they come up, and then there is a "worry time" every day for 15 minutes where kid can open the box (figuratively) and process the worries. But this is done in conjunction with other techniques, and not in isolation...

[Roar]

The two books posted are really good and worth buying.

While I don't care for the therapist's particular wording as quoted here, the overall idea that sometimes kids need to move on from talking about worry is a valid one. Some kids can get to a wallow spot where it does increase anxiety. It can be freeing to give them permission to be done with a worry. A similar technique that is sometimes used is a worry jar or a worry box where the child (obviously a bit older) writes down a worry and then puts it away.

My suggestion would be to be direct with the psychologist. "I''m getting a ton of good information here and I think that this may help junior quite a bit. However, I wasn't comfortable with x suggestion. I'm concerned about y. Perhaps I misunderstood what you were getting at could you clarify it for me..."

What happens next for me would totally depend on the therapist's reaction. I'd like to hear either okay that doesn't work for you, I get why, let's move on to something else. I'd be good with that. Or, perhaps she could explain in more detail what she was suggesting and it would make more sense. If she's a jerk who says "my way or the highway time" to find a new psychologist. If she's seemed reasonable up until now though my guess is being honest about your concerns will lead to more understanding. She doesn't have the opportunity to express respect for your point of view if she hasn't heard it yet.

[robinia]

Thank you all very much for these helpful responses.

It really hits the nail on the head to ask whether DS is capable of expressing his anxiety in a healthy way, as he is absolutely not and that's half the problem. But equally he is not misbehaving - in fact, more often being unnaturally 'good' - so it makes even less sense to engage in a time-out strategy without giving him coping skills.

I think I need to make it clearer to the psychologist that he is not misbehaving and see if I can get more suggestions on naming the worry and active listening, while leaving the CBT-style thought-stopping and worry time ideas until he can identify his feelings for himself.

Thanks very much for the book suggestions, and also for the point about dwelling in the worry to understand it which strikes a chord - more reflective listening might be the answer; I think we may be trying too hard to solve it all.

Thanks again - this has helped me feel a lot clearer about what the problem is with the advice. Back to the psychologist later this week so I'll see how it goes.