What do parents get wrong about child anxiety counseling?

child anxiety counseling

This question is a bit of a trick because no one’s actually asked it but I wanted to answer it anyway because I want to help families get help. 

The biggest misconception that parents have about any kind of child counseling is that the counselor is going to fix things. What things? Well, that depends on why the parent has brought their child to counseling. Maybe it’s the child’s behavior, or the relationship the parent has with the child, or the child themselves. But this is not how counseling works.

Counseling works by creating a relationship between the therapist and the client — in this case the child — and then leaning into that relationship to explore and guide. By explore I mean learning who that client is. What motivates them? What are their strengths and challenges? What beliefs are holding them back? What beliefs are serving them well? Who is in their support system? How can they tune into that or how can their support them get better at helping?

By guide I mean giving information and teaching skills. Counseling works by metaphor. Therapists are trying to find a way to explain ideas and concepts in a way that makes sense to the client and gives them greater insight into themselves and into how things work. And they are working to connect the client with skills to make their efforts more effective.

Counselors generally don’t tell people what to do. Ok, sometimes they do. Sometimes they say, “You need to quit drinking” but that’s not very useful if they haven’t done a good job of connecting with the client, given them insight into how their drinking is impacting their functioning and relationships, and helped them identify the resources that are available to them. 

There is a lot of repetition in the therapeutic relationship. People need to hear the same things over and over again, often in new ways and in a new context because what doesn’t have an impact one day might have an impact on another day because the client is finally ready to hear it.

With children it’s even more complicated and the younger they are, the more complicated it is. So let’s talk about some of those challenges.

Generally it’s not the child who has decided that they need counseling; It’s the parent. Therefore the counselor needs to work a little harder to get the child’s buy in. The child doesn’t necessarily think anything needs to change. If a parent brings their 7 year old to counseling because they want the 7 year old to start sleeping alone, the 7 year old probably doesn’t agree that this needs to happen. So they’re not even interested in the goal of their treatment plan. 

Instead the counselor needs to work in a round about way to discover more about how the child’s functioning not just at bedtime but at other times, and figure out what skills are lacking. The counselor needs to understand child development in general and this child’s development in particular. This might mean a lot of ruling out. What else is going on for the child? What’s the family’s sleep hygiene like? What’s the child’s physical health like? 

At the same time, the counselor is trying different metaphors to help the child learn skills that the child may not be interested in. The younger the child is, the more likely this is going to be done through play. Therapeutic play is sometimes directive, in which the therapist is doing an activity with the child with a specific intent to pass on skills or information. Or it may be non-directive where the child is choosing and managing the play and the therapist is either observing or joining in to better understand the child and to connect and build rapport. There are benefits to both kinds of play and different scenarios and relationships require different interventions.

Very often the issue will not be with the child, it will be with the parent because the child isn’t the one making the decisions. For example, perhaps the bedtime routine is inconsistent or disruptive. Well, the person who’s going to need to change that is not the kid; it’s the parents. So the therapist needs to also get the parents’ buy in.

Now this isn’t the same thing as blaming parents. This is not about blaming parents. This is about recognizing that in the family system the parent who is bringing their child to counseling has demonstrated that they want things to change and so they are really the ones who are going to have to change. When the parents change, the child will be required to change.

Let’s go back to that 7 year old. Let’s say the child is very sensitive to light and the parents leave the blinds open. I’m deliberately choosing something very obvious and clear to make this point. The 7 year old is not going to be able to go to Target and get black out curtains and then install them. That’s up to the parents. If the parents don’t do that then the light-sensitive 7 year old is likely to continue struggling no matter how often they go to the therapist.

This is how anxiety treatment works, too. In lots of ways parents act like training wheels on a bike. They are there to support their child while their child builds new skills. Eventually the parents need to remove their support and let their child learn to ride on their own. 

Anxious children will not necessarily want the parent to stop being training wheels and yet the parent needs to stop anyway. This is often the point where the parent will bring the child into counseling, which is wonderful, but they will continue acting like training wheels. What they want — and I understand this — is for the therapist to talk their child into wanting to change. The parents are waiting for the child to say, “Please stop being my training wheels.” 

This may not ever happen. There is a large body of research that says that when we do it this way — waiting for the child to ask for the training wheels to come off — that we’re doing it backwards. 

And if the parent doesn’t understand that things work this way, they may continue to be training wheels even when the child HAS asked them to stop because the parent doesn’t realize that’s what they’re doing. 

It’s common in families with anxious children for the parents to have anxiety, too. And as the child begins to grow and stretch and confront their anxiety, this might trigger the parents anxiety. Then we have a child who is ready to go without training wheels and a parent inadvertently getting in their way by checking in repeatedly. “Are you sure?” “Are you sure you’re ready?” “Do you have a plan if you fail?” “Do you want to go over the plan again?”

This is another reason why parents must understand how anxiety works and be a part of the intervention even if the child is the one asking for change.

So in a nutshell what parents get wrong about child anxiety counseling is believing that it’s up to and the responsibility of the child to do the learning and do the changing. No, it’s a family affair. 

Parents need to understand anxiety — how it works, how it’s perpetuated, the different ways it shows up

Parents need to identify their own anxiety — knowing when they are projecting, knowing when their worry is interfering with the intervention, and learn how to care for it

And this ultimately is why I built Child Anxiety Support. Because even if the child is in counseling, the parents need to do their own work. As a counselor, I would only see a child once a week or once every two weeks but parents, of course, are with their children every day and so the parent can effect real change in the family and in the child’s functioning. As studies show, empowering parents to support their children is what makes a real different in anxiety treatment. Child Anxiety Support is my effort to make that more accessible, less expensive, and more convenient. I hope you’ll check it out.

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