Views From My High Horse…


Anxiety is a term that sadly permeates the vocabulary of not only parents and teachers but also our children and grandchildren. The problem with the overuse of the word “anxiety” is that it often ignores the core emotions related to fear. An example is that of the child displaying anxious behaviors at bedtime, like numerous requests for water, refusing to get ready for bed, or ignoring verbal cues from the parents. Once the parent becomes aware that fear is at the core of these behaviors, they can find different interventions or strategies to discover how to help the child alleviate the fear(s) and decrease the likelihood of escalating the anxious behaviors. Such interventions could be to provide a nightlight, a transitional object like a stuffed animal or blanket, or soothing music that is only played at bedtime. What is important is to broaden our understanding of how we can support a healthy response to anxieties by psychologizing* the symptoms. Too often therapists look at these behavioral symptoms as a medical condition expecting medications to handle anxiety rather than giving both the child and the parent the tools to grow psychologically.

To begin, anxiety by definition runs the gamut from excessive worry about such things as grades, family issues, relationships with peers, and performance in sports to panic disorders, which are a sudden onset of feeling loss of control or as if you are going crazy. Often anxiety is linked to separation disorders, such as extreme home sickness, feeling miserable when not in the presence of a loved one, or terribilizing fears about something happening to parents when they are not together. Social phobia is the intense fear of social situations in class or as simple as starting a conversation with a peer. Specific phobias would include things like fears of storms, blood, or the dark. Obsessive-compulsive disorders, referred to as OCD, are compulsive ritualistic behaviors like repetitive hand washing or masturbating, and obsessions of unwanted and intrusive thoughts. Post-traumatic stress disorders are on the extreme side of childhood anxieties. Intense fear and anxiety, becoming emotionally numb or easily irritable, and the desire to avoid people, places and activities after witnessing a life-threatening or otherwise traumatic event are examples of post-traumatic stress symptoms.

What is common in the above examples of anxiety is that they all represent, at the core, a feeling of fear. Fear, by definition, is an unpleasant emotion caused by the belief that someone or something is dangerous, a threat, or likely to cause pain. A primary pain for the child is the forced awareness that they are not in absolute, total control of their world. Beginning at birth, the infant feels hunger and cries to bring attention to the need for comfort and feeding. This vocal oral dynamic either brings relief or begins an awareness of frustration and later fear that this need for food and comfort may, or may not, be met. From this primitive beginning, the foundations of fear and anxiety are formed. The parent learns over time how to temper the demands of the infant. The seeds of successful self-management begin here. Techniques, such as distraction, are used to delay gratification of these demands as the child grows through various stages of childhood. But sometimes, something goes wrong. When a life event occurs that is disruptive to the child’s feelings of safety and trust — an illness, another baby coming into the family, a move, a separation or divorce of the parents —what was once a healthy sense of separateness from the primary caregiver can regress into elaborate attempts to stay connected, even from a geographical distance.

Instead of learning to delay gratifications and beginning the process of self-soothing (developing an internal locus-of-control), the child starts on an elaborate path of getting others, especially primary caregivers, to meet their most basic needs and demands. This dynamic of learning to self-soothe comes back around throughout the life cycle and, for the child, is again visible with the issues of experiencing the self as separate from the caregivers.  Cell phones, for some kids in the throes of this regression, become a sophisticated “breast or pacifier.” It is not unusual for children in grade school to have cell phones, to let parents know when they are home from school or if there is a schedule change, but some with high levels of anxiety are being encouraged to stay in constant contact with the parent throughout the school day. The separation from the parent is not occurring in the natural boundary of “when at school, it is the school’s authority that the child must learn to answer to and negotiate.” Rather, the parent stays in the dominant authoritative role, usurping a natural societal and psychological expectation of separation between the school, the parent, and the child. Such a situation causes one to question who really is the authority here, the parent or the child?

Some children learn at an early age to control their environment by exploiting their fears in rather sophisticated ways. For this reason, therapists and parents must collaborate on what is most likely the unconscious exploitations of fear in the child and also in the caregiver. In this manner, the recognition of how to intervene with an anxious child AND parent can keep from getting the child labeled in a medical model definition of anxiety. This is in contrast to unpacking the symptoms demonstrated by the child in order to find the meaning behind the behaviors, in that way psychologizing, rather than pathologizing the child.

Continuing to support the anxious behaviors of avoidance of school by physical complaints such as those in the somatic realm, like headaches, nausea, and stomach cramps, rather than providing consequences for acting on these symptoms can feed the pathology paradigm and circumvent the psychology of healthy development.

In addition, this feeding of the anxious symptoms plays into the victim role of both the child and the parent. Anxious symptomatology is often used as an excuse to avoid compliance, a desperate means to control the authority of parents, teachers, and others. For certain personalities, anxieties are used as resistance to being led, to being part of a team. As much as we want unique separate attributes for the child, first there must be something to separate from beside the caregivers, e.g., the child is part of the volleyball team, band, science club, 4th grade class, and so forth.

In seeking therapeutic interventions, it is important to tease out how much the parent’s desire to be the child’s friend is usurping the role of parental authority. Therapy, at its best, is not a method to prove the brokenness of the child, but rather to embrace the support and wisdom of responsible parenting, promoting interventions that decrease the rewards from anxious behaviors in support of a healthy, non-pathological worldview. It has been proven that the single most powerful intervention in providing a safe, secure, non-fear-driven environment for a child, and even for most adults, is that of structure. A predictable routine is paramount, from when we get up, when we go to bed, when we go to school or work, when Mom or Dad gets home, to when we can have play dates, when we must have time alone without tech toys, and when we have meals.

The child, by her/his very nature, wants to be in control, and will have immediate resistance to such structure until it becomes routine. Sadly, many parents are equally, if not more, resistive to healthy structuring of their lives. This resistance to structure by both the parent and the child is fueled by a desire to be responsive to external demands and by being unaware that there are internal needs for growth.  If this resistance isn’t tempered, the development of the internal-locus-of-control, healthy self-soothing behaviors will have difficulty developing. In the adult, some of the same attachments are seen — video gaming, inability to spend productive time alone, binge-watching television, and the use of drugs and alcohol — as the escape from the inward calls for growth. Even the individuation path required by psychological, spiritual, and emotional separation from others is ignored. NOTE – Families naturally make comparisons: “You are so like your Dad” or “You are just like your Aunt Susie.” These comparisons are normal and good, unless there is the omission of highlighting where the child is unique, and not like others they know. How will the child even know to find his own path if he is constantly reduced to being like someone who already exists? This is an amazing dilemma: to provide the comfort of recognition within the belongingness of the family of origin and to sincerely recognize the unique characteristics of the child.

The task of successful parenting is one of recognizing many paradoxical situations. Fear, as stated earlier, is an unpleasant emotion but necessary for safety and survival. Parenting today has developed a bias that it is the parents’ responsibility to protect the child against unpleasant feelings. Nothing could be further from the truth or more dangerous. The focus must be on the acceptance that, in the course of everydayness, there are unpleasant emotions, fear being one of them, that are well within the ability of the child and the parent to learn to navigate.

*Psychologizing – the process of finding meaning in symptoms for the benefit of symptom relief.

© Lois E. Wilkins PhD APRN