I’ve been gearing up for summer by preparing several counseling groups for kids and teens. These programs are all enrolling now, please contact me to learn more or to sign your child up. Click through on the group’s name to learn more:
Girls Power Up: These girl empowerment groups are open and ongoing, meaning that girls are welcome to drop in at any time (space allowing). The groups will begin once we meet minimum enrollment. There are two groups, one for girls 12 to 14, which meets each Friday from 5pm to 6pm and one for girls 15 to 17, which meets every Thursday 6pm to 7pm. Cost is $100/month, which averages out to $20 or $25 a session.
Coping Kids Anxiety Group: For kids 9 to 12, this 6-week program uses cognitive behavioral techniques to help your child gain skills to manage their anxiety. One of the greatest benefits of this program is the opportunity kids have to connect with each other and know they are not alone in their struggles. The group will begin meeting Wednesday, June 10th from 10am to 11am and continues through July 15th. Cost is $225 payable on the first day of group.
Kids Talk Adoption: An 8-week support group for adopted kids ages 9 to 12, participants will be exploring their adoption narratives in a safe space with room to ask hard questions, confront all of our feelings, and space to enjoy each other’s company. We’ll have guest speakers — an adult adoptee and a birth parent — to help us understand all sides of the adoption experience and to give us a chance to ask all of our questions. Cost is $225 and group begins Thursday, June 19th from 4pm to 5pm.
I’m super excited about all of these groups and welcome your questions! Just contact me at (614) 301-8030 or through the form below to learn more:
Some of you know that I have Wonder Woman all over my waiting room. Wait, scratch that. Some of you may know that I have Wonder Women all over my waiting room. I have artist renditions of different kinds of women — fat, thin, young, old, hip and matronly, different ethnicities — all as Wonder Woman. Some of them are very serious and dignified and some of them are silly. They are all awesome.
When I was first decorating my office I went back and forth about hanging them all up. If you’ve been to many therapist offices then you know that most of them are pretty neutral and I wondered if it would be too much of me there in the waiting room. I thought maybe I should go with a tasteful Pottery Barn neutrality or maybe just a touch of Ikea blank hipness. I thought about having, you know, a gentle beach landscape on my wall.
But then I decided that I am not really a neutral therapist. I mean, I crack jokes a lot. I’m not always all that dignified, much to my chagrin. So I figured that since the research says that our success depends on the relationship that we build together then we would all be better off if my clients knew what they were getting right up front and what they’re getting is someone who thinks it’s appropriate to have a comic book character all over her waiting room.
So why Wonder Woman? Why not Bat Girl? Or Buffy? Or some other out-sized heroine of justice and truth? Here is why.
When I was a kid my mom had a Wonder Woman picture hanging in our kitchen. (You can see it in my waiting room now — it’s the one on the wall you’re facing when you are heading into my play therapy room.) I wasn’t much for comic books and if I was reading a comic book it was much more likely to be Sabrina the Teenage Witch but I liked that Wonder Woman picture. I liked the TV show, too, and I liked the Saturday morning Super Friends episodes with her in them the most. I liked the idea of her. I used to run around my neighborhood pretending I was this character I made up, Shadow the Midnight Panther, leaping off my Huffy bike to fight the powers of evil. I’m not so sure that I would have invented Shadow if I hadn’t had Wonder Woman as an example. (The reason I was not actually Wonder Woman is that I really wanted a cape — Shadow had a cape — and I liked cats a lot and panthers are super cool.)
Later when I was a loud young feminist my mom mentioned that Wonder Woman was on the very first issue of Ms. Magazine. That’s when I realized that Wonder Woman meant something to a lot of women — not just to my mother and not just to me. I still liked her only now I liked that she was a touchstone. I liked that she reminded me of the terrible 70s fashion of my youth and of the specific feminism that I grew up with. (When I was little I would read Ms. and flip to the No Comment in back, then the “click” letters in the front and finally to Stories for Free Children.) That specific feminism taught me that it was OK to be angry, to be strong, to be outspoken and to have a sense of humor.
All of that is to say that Wonder Woman is hanging in my office as a way to share that I’m a feminist therapist. Now you don’t have to be a feminist to come see me — that’s the great thing about feminism, it very clearly says that we all get to be who and what we want and need to be — but I want people to know that they’re seeing a feminist therapist because, again, you should know what you’re getting right up front if you’re thinking about seeing me.
Very often clients will tell me that they saw a Wonder Woman thing — the book that just came out, a doll, a t-shirt — and they’ll say, “I thought of you!” But I’ll tell you the truth, I really hope that someday my clients will see Wonder Woman and think of themselves, of what they worked at and what they learned in our time together. I have all of these Wonder Women in my office because I want my clients to see their own strength and power and heroism. I want them to see themselves reflected in the Wonder Women on my walls.
I’ll add that while I do see men in my practice I mostly see women and kids — boys and girls. Someone — not a client — asked me why I don’t have male super heroes on my walls and my answer to that is that we get to see lots of male super heroes everyplace else. We get to see them at the movies and on television and on the shelves in our toy stores. I have nothing against male super heroes — I especially like Spider-Man — and you’ll find them in my sand tray toys. But I like to do my part to even out the representation in the world a little bit, which is why Wonder Woman gets the prime real estate in my office.
Note: I haven’t blogged the last two weeks because as some of you know I slipped on the ice and jammed my finger by sliding hand first into a curb. I think the technical term for what I did to my finger is “stoved.” It was my middle finger, which made wearing a splint super hilarious since just by wearing it I was inadvertently flipping the entire world off. The most annoying thing about it was not being able to type. Years from now when I’m filing away my client case notes I will notice that two weeks worth are all lower case, terse and filled with typos. I will see them and remember, “Oh yes, those were the splint weeks!” And I will once again be reminded to always be grateful for spring.
I have a basket of miscellaneous toys on my shelf and the kids like to rummage through them. Most popular are the real cell phones even though they’re not smart phones. The kids really like the ones that slide out so they can “text”. There’s also a magic wand, some rubber balls and a toy gun. Toy guns in play therapy aren’t as controversial as, say, toy guns in preschool but they are still part of an ongoing discussion that play therapists have with each other.
We all agree that a fully stocked play therapy office needs to include some ways to be aggressive like rubber swords, dragon puppets, lion figurines or guns. Most of us are ok with guns and some of us are not. We have different ideas about what kinds of guns can be used (at the agency where I used to work we had Nerf-type guns that shot spongy “bullets”) and we have different rules about how they can be used (some therapists don’t allow kids to point a gun at the therapist and some do — my decision depends on context).
The gun I have looks an awful lot like the cowgirl cap gun my mom bought me from Sears to go with my red-with-white-fringes cowgirl Halloween costume. I think that was 1975 so this one is a little different — it has more plastic, less metal and it has the orange tip that they started adding to toys in 1992.
I chose this gun because it is so clearly a toy. It doesn’t look like a modern gun (it isn’t black, you have to cock it) and it doesn’t actually shoot anything. Lemme tell you, I got really tired of helping kids dig under chairs for those spongy yellow “bullets” so when I set up my own office I decided no Nerf-type guns.
Some kids are very excited when they find the toy gun. Other kids don’t care one way or the other. Very, very occasionally a child will tell me that he or she is not allowed to play with toy guns and ask me to remove it and of course I always respect this request and we talk about that.
My decision to allow toy guns in my play therapy office is indicative of my belief that kids should have a full vocabulary in the language of play. As a mother I struggled with gun play and it was something my friends and I discussed at length. We all fell on different sides of the decision — some of our kids had full arsenals and some weren’t even allowed to play with figurines that had guns attached to their tiny hands — but we all thought about it a lot. Other weapons like swords, knives, and bows and arrows didn’t cause us as much concern. I suppose there are vestiges of this struggle in my decision to use an anachronistic cowboy gun in my play therapy room. But I never considered not having a gun available to my clients.
Kids are smart. They get that the play therapy office is different then the rest of the world. They understand that the rules I have aren’t the same as the rules that their parents or their teachers have. Children who aren’t allowed to use guns in the rest of their lives but who welcome the one in my basket are OK with leaving it there when they go. (Although they are usually super excited about showing it to their parents — sometimes they even run out to the waiting room with it when they find it!)
Some of the children I work with use the toy gun to work out feelings of helplessness or power by shooting my stuffed dragon or the picture of the guy doing a handstand on a horse that hangs above my couch. Some of them don’t use it at all but keep it near them while they work in the sand tray or color; having the gun nearby makes them feel safe.
Sometimes children shoot my Feelings poster (a grid of pictures featuring kids making faces to illustrate different emotions) often as an indicator of their own frustration at their inability to understand or name their own feelings.
Sometimes kids tell me who they would like to shoot or announce that they’re shooting someone while they aim into the middle distance. This can be upsetting for parents to witness but I liken it to an adult saying in my office, “I could kill my boss!” or “I wanted to throttle my brother-in-law!”
Often children just want to use the gun because they think it’s fun. This includes both the kids who can play with guns at home and those who aren’t allowed to. Some of them include it in their play because it’s part of a language that’s familiar to them. Others use it because it’s novel and they’re excited to explore. Many, many children glance at the gun, cock it and pull the trigger a couple of times and then put it back never to play with it again.
Frankly the cell phones are way more popular.
If you bring your child to see me and have concerns about the gun or any other toys I have in the playroom, I encourage you to bring it up.
Two VERY DIFFERENT bosses
When you look at the ethical guidelines for therapists a whole lot of them are in place to address the power imbalance between therapist and client. In the minds of our clients, the things we therapists do or say hold greater weight than the same thoughts that, say, your hairdresser or mechanic might offer. (Except when it comes to how to do your hair or fix your car.) When we share our reflections about your life choices and relationships then we need to be aware that our clients will likely take those thoughts very seriously, which is why it can be painful and even dangerous to have a therapist get things really wrong with you.
I remember the second therapist I ever saw when I was a freshman or sophomore in college and was in love with a boy who didn’t love me back. (That’s what brought me to therapy although it turns out — no surprise — I had a lot more going on than just that.) Anyway, the therapist just loved all my stories about my super interesting boyfriend and would agree with me, “He does sound amazing! And in a band, too, wow!” which was not what I needed to hear. Now I understand that likely he was just trying to join with me (this thing where therapists go along with you to help build rapport) but at the time I thought, “Well, it’s hopeless. My boyfriend is too amazing for me to ever get over him and even my therapist loves him” and I quit going to therapy. What would have been better is if I’d come back and said, “Hey, I’m sick of hearing about how great you think my stupid boyfriend is” and then we could have had a discussion about it.
Because therapists get stuff wrong. It happens. We’re not perfect and even the best therapist is not necessarily the best fit for any given client. We will get things wrong and it’s up to you, dear clients and potential clients, to help us get it right.
Sometimes we get things wrong because we don’t ask for enough information and sometimes this is because we don’t even know we need it. You say, “Hey, my boss!” and the therapist is sitting there merrily picturing Leslie Knope and really you’re talking about your boss who is more like Glenn Close in Damages only the therapist has already decided she knows what’s going on and so things just get confused.
That happens. Although eventually situations like that work themselves out if the therapist is a good listener and asks good questions.
What’s trickier is when the therapist is wrong only you don’t know she’s wrong because it’s nothing as clear cut as facts. Instead she’s operating with a set of biases that you don’t know about. Like say she is against beach vacations and thinks everyone should go hiking in Hocking Hills and you don’t know this so when she’s discouraging you from planning your vacation to Bethany Beach you think there really is something wrong with your ideas. You wonder, “Is this what’s wrong with me? That I always go to the beach?” and it’s confusing. Because sometimes it’s true — your ingrained thoughts or beliefs are part of the problem — but sometimes it’s not. Sometimes it’s just a matter of different priorities and opinions.
So what do you do?
First of all, if you feel like your therapist is being biased, tell her. Have a discussion about it. Heck, have a debate. Good therapists know their biases (we all have them) and will be willing to engage with you. She will be able to say, “Here is my bias” but she’ll also be willing to say, “My issue with the beach is not because I’m against beaches, it’s because you’ve told me that you are allergic to sand in previous discussions and I want to challenge your assumption that you should go to the beach anyway.”
Or the discussion might help you discover that your boss thinks Glenn Close in Damages makes a GREAT boss and that you should suck it up and let her murder people and violate legal ethics and blackmail everyone because your therapist places a high value on career achievement and that’s just her philosophical starting point. In which case you can decide for yourself if that’s the kind of therapist that you want to have.
Very often you and your therapist won’t agree about things and a lot of the times, that won’t matter because our ethical guidelines state:
Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.
(this is from the 2014 American Counseling Association Code of Ethics)
In other words, even if your counselor would personally love to work for Glenn Close, she ought to be able to appreciate that you would rather work for Leslie Knope. But if you’re not sure, ask her. Have that discussion. Find out what’s going on there if you feel like she’s misunderstanding your point of view or steering you away from your goals. Because even though we are therapists and sit in the big comfy chair (or at least the chair with good lumbar support because this job is hard on your back) that does not mean we know everything or that we’re the boss of you. Sometimes we’re wrong. Call us out when we are; good therapists will appreciate the discussion.
(For the record, I prefer a Hocking Hills vacation as long as there’s air conditioning and obviously I would prefer to work for Leslie Knope because I like waffles a lot more than I like murder and blackmail.)
When our daughter was two she had a standard answer when confronted with angry parents.
“Why did you throw all the baby wipes into the toilet?” we’d ask.
“Because I do,” she’d answer. “Because I did.”
It never failed. Whatever the disaster – water sloshed all over the kitchen floor, her dresser drawers unpacked and the contents strewn across her room, her brother’s micropet collection hijacked and missing – we would ask why and she would answer, “Because I do, because I did.”
And it seemed like a fair enough answer because when you’re two years old how can you have the words to explain such a complicated situation? To explain the lure of developmentally-appropriate curiosity? The driving need to explore?
“I saw the full container of baby wipes,” she can’t say. “And I opened them just to smell but the smell – it reminded me of you and of daddy and then I wanted to feel the cool of them on my skin and wipe them across my eyes the way I’ve seen mommy do it to get off her mascara before bedtime. I imagined myself like mommy, wiping away the dirt of the day and then when the chill of the wipe went away, I tossed it aside and reached for another one. Before I knew it, they were gone and the toilet was clogged. But I didn’t mean to use them all up and I didn’t mean to break the potty.”
No, she couldn’t say any of that, she said, “Because I do” and “Because I did.”
I think about this not just with my kids but also sometimes when I’m working with a client (child or grown up) in therapy. Sometimes we won’t know why. Sometimes we won’t know why until later. And that’s ok because sometimes we don’t need to know why.
Sometimes all we can do — all that we need to do — is deal with the results. With kids, we can involve them in the clean up. With clients, it’s the same thing. We can deal with the results (the fall out, the grief, the anger) and then eventually if we’re patient with ourselves and each other, we’ll start to make sense of the why.
Meanwhile we can get comfortable with the reality of not knowing. We can work on trusting the process — our child’s growth, our own growth — and operate with the belief that learning is inevitable, if we don’t actively try to stop it, but that we can’t control the time line.
Life is a journey, right? Not a destination!
This is Goldilocks. She’s having a tough time.
This is the final post in the 3-part series about helping kids with anxiety. I reserve the right to blog more about it in the future because it’s a big topic and this is so general. Onward! To the helping!
Cognitive Behavioral Therapy or CBT is the counseling modality of choice for kids (and adults) with anxiety. Research on effective anxiety therapies tend to focus on these three areas:
- Understanding and addressing the physical response to anxiety
- Recognizing and challenging the thinking errors that perpetuate anxiety
- Using controlled exposure to the anxiety-provoking situation and practicing the tools
Again this is super simplified and super general. Kids (and adults) have diverse learning styles, challenges, expectations and histories so how this works will look very very different depending on the child. But to help you get the gist, I’ll use Goldilocks as an example. We all know her story, right? On the very off-chance you don’t, you can check out this short version so we’re all on the same page.
So let’s say Goldilocks’s mom brings her to me because she’s gotten very anxious since her disastrous meet up with the three bears. She’s having trouble sleeping, she’s having some bad dreams, she is having tantrums at the drop of a hat and she hates leaving her mom to get on the school bus because she’s afraid the bears will come break into her house. She also can’t bear the thought of eating porridge ever again and will fall apart if her mom serves it at breakfast.
The first thing we would do is talk about Goldilocks’s physical experience of being anxious. We would talk about how being chased by bears would rev anyone up but now we need to help her calm her body back down. We would talk about how since this happened every time her heart starts beating or she starts breathing fast that her body immediately thinks BEARS! even if she’s faced with something much less concerning like shoes that are hard to tie or being a little bit late for school in the morning. We would work hard on helping her identify where in her body she feels the anxiety — is it in her stomach? Does her chest feel tight? Does she make fists with her hands or does her mouth go dry? We would talk about relaxation techniques and figure out which ones work for her. She might start keeping a worry diary or we might make a list of everything that makes her anxious.
What I tell kids is that we’re going to be detectives and we’re going to work together to solve the problem of their worries. I am very strengths based (that means I encourage focus on what’s going right even as we are talking about what’s going wrong) so we would also discuss times they have managed their anxiety in the past so we can figure out what shores them up.
The next thing we would do is look at thinking errors (also sometimes called “negative cognitions”). Here are some super common thinking errors:
- All or Nothing Thinking: If I make one mistake then I’m an idiot.
- Catastrophising: If I don’t turn in this one homework, I will flunk out of school.
- Overgeneralization: I fell down at the roller rink one; I will fall down forever.
- Personalizing: It rained on my birthday because nothing ever goes right for me.
- Discounting the Positive: Sure my best friend likes me but that doesn’t count because she’s my best friend.
- Mind Reading: I know everyone on my soccer team hates me.
- Labeling: I’m taking so long to learn to ride my bike because I’m uncoordinated.
- Should Statements: I shouldn’t have such a hard time learning math. I should know how to wrap this present without help.
- Emotional Reasoning: I am in pain therefore I am right and you are wrong. I feel guilty and that proves I’m a bad person.
There are more but you get the gist and probably these are familiar to you either because your child does them or because you do them yourself. (Some of these are so ingrained in our cultural way of thinking that to confront them can be like wandering around in the dark your whole life and then stumbling over a flashlight and realizing you can use it to find the light switch and actually turn on all the dang lights.)
This is where I think counseling can help. I know in my own family that I can tell my kids something over and over but when they hear it from somebody else they believe it. Part of this is that they get tired of the sound of our voices (I haven’t seen studies on this but anecdotally I can tell you that my children get tired of the sound of my voice) and part of it is because it’s easy to get defensive with our parents. At least it was for me when I was a kid and then a teenager. If my mom disagreed with me it was automatically an opportunity for me to argue with her but if another adult said the same thing, it was an opportunity for growth and better understanding.
Yeah, we parents get it coming and going.
BUT! Let’s not resort to Overgeneralization! Sometimes parents have a lot of success doing this work at home without a therapist and there are workbooks (note I haven’t reviewed these so I can’t recommend one in particular) to help parents help their kids. AND even when kids are in therapy, we really need the grown ups in their lives to help them do the work. (I see a child an hour a week. Their parents are the ones bearing witness to the other 167 hours.)
Anyway. That’s the cognitive part of CBT therapy and it can take awhile. We’re talking about challenging ingrained ideas that make perfect sense to the person thinking them. That’s HARD and it takes practice.
For lots of kids, this is when we’re really leaning on the play part of play therapy because every little step we take needs to be ensconced in trust, respect and acceptance, which means a lot of time just hanging out and enjoying each other. The play therapy space (and the talk therapy space) is a place to safety say anything and be anyone and sometimes anxious kids just need one place where they can come and PLAY away from their worries.
Particularly with anxious kids whose anxiety ends up all centralized in their need to Do Good and Be Good, too much CBT pushing just triggers their anxious need to perform well. So sometimes my office is all about creating an island where they can goof off a little and experience themselves in a new way.
I’m emphasizing the slow part of this time in therapy because sometimes parents get (understandably) frustrated. They want to see change. At the beginning they get some concrete tools (breathing, relaxation, etc.), which feels great and proactive but it’s not a cure all. And then at this point things slow down and they may not see the any progress. But progress really is happening. Not to mention that this is where grown ups start slowing down, too, because it’s one thing to hear about Personalizing but it’s another thing to really get it and see how that kind of thinking is actually impacting your life.
The other thing is that anxious kids (and adults) have had people trying to talk them out of being anxious for a long, long time and that can make people hold on to anxious feelings even more tightly. They don’t mean to do this but being anxious, which many of them see as being concerned or cautious or careful or responsible (“I study all of the time because I’m a good student and if I’m not anxious about it then I’m being irresponsible.”) and often they get a lot of praise for being “good” in other anxious ways. (Oh the perfectionist students I see in my office! The ones who are running themselves into the ground for the praise and academic rewards!) To ask them to give up this way of thinking, well, that’s scary. It takes time.
Goldilocks may say to me, “You know this is all well and good but the minute I let my guard down I’m pretty sure Papa Bear is going to come charging in here, paws waving, and I can’t risk it.”
And so we’d keep working on it.
The next step of CBT is taking it out into the world and confronting those anxieties. Remember we’re simplifying these steps and we’re making them look more clear cut than they are (although they’re presented pretty clear cut in the Coping Kids group because we have a curriculum but we will adjust it as needed).
Goldilocks and I would keep on playing detective, we’d see what’s working for her and where she gets stuck. Maybe her big issue is not being able to eat porridge. Maybe I would get an empty box of oatmeal to have in the play kitchen or maybe we’d pretend to feed breakfast to the dolls. When she’s ready maybe we’d have ourselves some porridge together. We’d go slow and we would be mindful of how it feels. We would see any small move forward as a victory even if she never actually gets the spoon in her mouth for a long, long time.
Maybe I’d ask her mom and dad to take her for a walk in the forest and practice her relaxation techniques and see how that goes. She and I might might write a game plan beforehand that confronts the “what ifs” and has strategies in place for whatever scenarios she can imagine. Again, we’d go slow. She might only get herself out the door the first time and we’d applaud that step even as we think about how to get her off the stoop next time.
Or maybe she’d need to play out what happened, putting the bears in the sand tray and working to make sense of the event by playing out the scene over and over again, trying out new ways of experiencing it and new outcomes.
There are other more specific ways to deal with particular kinds of anxiety. Treatment for OCD, for example, is more complex. Which brings me to medication.
Medication for kids is a tricky thing. Although many family practice and pediatricians will prescribe medication, it’s best to seek out help from a child psychiatrist. But this is hard. Columbus — like lots of other areas — has a dearth of child psychiatrists and parents don’t always have time to go search one out. I encourage parents to have an ongoing conversation with their family physician and to be aware that having a psychiatrist becomes even more important as the child gets older because hormones can make getting the right meds in the right dose super challenging (and things can turn on a dime if someone hits a growth spurt).
Not all anxiety disorders NEED medication but medication can certainly make sense if a child is completely hamstrung by his anxiety to the point that he isn’t going to be able to participate in his therapy. (Some kids are so anxious that relaxation techniques aren’t going to be enough to get them to a place where they can do the cognitive work.) Or if her behavior is so problematic (tantrums, rages, violence) that the rest of her life is at a standstill then medication can make sense.
Ultimately this is a parenting choice and I support parents in making their own informed choices for their kids. I do think, though, that medication alone isn’t enough. We all need to learn how to function as our best selves within the gifts and limits of our particular personality make-up. Medication can help us get functioning but we still need to understand ourselves and how we work. We need to know how to get help.
Eventually, too, our children will be adults and will make their own decisions about how to manage their anxiety (since for most anxious people it’s part of their lifetime experience since our personality can be molded but we are essentially who we are) and getting therapeutic support gives them options.
I like the idea of saying to kids, “Hey, counselors are there to help us when we need it. You need to know how to find the right one for you and how to do the work of therapy and I will help you do that when you’re young so you can help yourself when you’re older.” So we can teach them how to be good consumers of therapeutic support by helping them find someone they like and feel comfortable with (because it all comes down to the rapport in the relationship).
This is a positive way to talk about anxiety and anxious temperaments. After all, some of us more athletically gifted and some of us need more help. Some of us are terrific musicians out of the gate and some of us need more practice. Likewise some of us have more struggles with anxiety or depression and that’s why we have therapists and that’s why we learn about medication options and that’s why we learn to take good care of ourselves.
Have questions? Let me know. Want to sign your child up for Coping Kids? Let me know. (I’m trying to plan summer offerings so if Coping Kids is something you’d like your child to attend then, please let me know so I can email you when I get scheduled and also find out if there are particular days or times that might work for your family.)
First in the series: Anxiety in Kids
Second in the series: Child Anxiety Symptoms