If you’ve ever felt like anxiety is the uninvited cousin who showed up to your family dinner and refused to leave, this episode is for you. We often view a child’s anxiety as a problem they are carrying individually, but the clinical truth is that healing happens from the Inside-Out. To change the child’s experience, we often have to change the family environment.

Today, Dr. Courtney is joined by Dr. Eleanore Hall, a clinical child psychologist and specialist in pediatric anxiety and OCD. Together, they dive into the "Anatomy of Anxiety" and explore why our parental instinct to protect our children from distress—known clinically as Parental Accommodation—can unintentionally keep the anxiety cycle alive.

From the "Dirty Fishbowl" metaphor to the "Vending Machine" effect of behavioral outbursts, this conversation provides a compassionate, science-backed roadmap for parents who want to move from feeling overwhelmed to feeling attuned.

In this episode, we discuss:

1. The Anxiety Spectrum: Why anxiety is a "backseat driver" that everyone experiences, and how to know when it’s starting to rob your child of their joy.
2. The Fishbowl Metaphor: Why we can’t just "clean the fish" (the child) if the "water" (the environment) stays dirty.
3. Reassurance vs. Information: Identifying the "leaky bucket" of reassurance seeking and how to stop feeding the anxiety drug.
4. The Bike Seat Metaphor: Learning when to hold on and when to take the brave risk of letting go so your child can learn they are resilient.
5. The "Vending Machine" Effect: Why behaviors often get worse (the "extinction burst") before they get better, and how to ride the wave.
6. Supportive Statements: How to validate your child's fear while simultaneously instilling 100% confidence that they can get through it.

About Our Guest: Dr. Eleanore Hall is a clinical child psychologist specializing in pediatric anxiety, OCD, and challenging behaviors. Her training ranges from acute care settings at McLean Hospital to parent-focused work via the SPACE program (Supportive Parenting for Anxious Childhood Emotions). She is passionate about working with the whole family system to get kids back to the important work of being kids.

Resources & Connect with Us:

1. Pediatric OCD and Anxiety: The International OCD Foundation has several helpful resources on their website.
2. SPACE Program: SPACE stands for Supportive Parenting for Anxious Childhood Emotions and is a parent-based treatment program for children and adolescents with anxiety, OCD, and related problems.
3. Dr. Eleanore Hall's practice: You can find Dr. Eleanore at WholeMind Psychology.
4. Book a Consultation: If your family is ready for expert support, book a complimentary 15-minute phone consultation with our team at Integrated Behavioral Health.
5. Instagram: Join our community @integtatedbh.

Keywords: Child anxiety, parental accommodation, SPACE treatment, parenting tips, emotional regulation, attachment theory, OCD in kids, Dr. Eleanore Hall, Dr. Courtney Lynn, Kids These Days.

Remember: You don’t have to be perfect to be a great parent. We are all learning how to raise kids these days.

Legal Disclaimer: While this podcast may provide information that is educational in nature, it is not intended to be a health care service, psychotherapy, or the practice of psychology. This podcast’s main purpose is to provide educational insights for all stages of child and family development. We will not provide diagnoses or specific recommendations for your family. At no point is a therapeutic relationship established by way of your unilateral participation by listening to these episodes, and we cannot provide advice or privileges associated with a therapeutic relationship. We recommend that anyone who is seeking a therapeutic relationship reach out to Integrated Behavioral Health at info@integratedbhs.com to begin the interview process of becoming a client or receiving a referral. If at any point in your listening or engaging with the content of this podcast, you experience an emergency, please immediately call 911 or go to your local emergency room.

Hi, Dr. Eleanor, how are you?

Well, how are you doing today?

Good,

I'm excited for our conversation.

Me too, I've been looking forward to it.

Yeah,

I feel like you have expertise in such a variety of different areas. But anxiety is something that comes up so often with kids and parents. Even if a kid has ADHD, they often also have anxiety. Or parents have anxiety. It's yeah, it's a common thing. Right? Right. We'll just add it on. It'll just jump in the backseat, always.

Mm-hmm. It likes to come along for the ride. Totally. Yeah. Yeah. It's like

the cousins you didn't invite to Thanksgiving. They came anyway. Yeah. ⁓

Yes. Yeah, it's a great, great way

of explaining it. No one wants it there, but it just shows up anyways. ⁓ Well, let's start with that. because I mean, to your point, it's often part of the picture, even if it's not at a clinical level, right? Everyone experiences anxiety. It's part of parenting. It's part of everyone's daily life. So how do you usually describe anxiety to families?

That's right. Yeah.

in a way that helps them kind of understand what it is.

Yeah, know, anxiety, I like how you put that. It's a spectrum, right, where there are people who need diagnostic criteria, which is where it's really interfering with how they're doing at school or at home. But, I mean, all of us experience anxiety and you're actually supposed to. know, famously, we therapists always talk about, you know, hey, if you crossed the street and didn't look both ways, what would happen, right, if you.

didn't study for tests because you weren't worried about the test, what would happen? Anxiety is really important, and so we all encounter it, and it can be useful. But what can happen for a lot of us, and anxiety is the most common ⁓ mental disorder for kids, I don't like that terminology, mental disorder, it's the most common mental health challenge for kids, is anxiety. And what can happen is it starts to rub the joy from kids in their lives.

anxiety will grow to the point where it's not helpful anymore and it's actually getting in the way. And so some examples of that and anxiety looks so different from person to person which is one of the things that I love about this work is it keeps you on your toes, it's always interesting, but a kid might be, let's take throwing up.

as an example, because that's actually a common one. A kid might be afraid of either themselves vomiting or somebody else vomiting or vomit itself to the point where they can't go to sleep without a parent or ⁓ really struggle to go on field trips because the bus, right? The bus is scary. What if somebody vomits on the bus? We've all been there in our own childhoods. There can be anxiety about performance in school that actually interferes with performance in school. ⁓

about social situations to the point where a kid is avoiding birthday parties or clinging on to parents. ⁓ And gosh, the thing that I love about the work that I do is I'm trained in working with adults and kids and ended up going into the child domain. And part of that is because I find it so...

Gosh, it sounds so corny, but I find it so inspiring that you can approach anxiety not only through the child themselves, but also through their parents. Because the reality is kids are wired in a way where they pull on others.

This is a normal part of development, to turn to your safe people, your safe grownups, and go, help, right? I need help with this. ⁓ And so that's what happens when anxiety is at play and growing and getting in the way for kids, is they go, help, right? Which is so normal. So it's actually a positive thing. I see it as positive, that kids turn to their parents for help and that then their parents have this instinct to help them. ⁓

How inspiring though that we're able to help kids relieve anxiety, not just through work with them, but also through working with parents themselves. I don't know. I try to be careful about this because parents can sometimes go, am I doing something wrong? Right? It's like, my gosh, does this mean I'm the problem? No, but you can be part of the solution. Yes. so what?

Right, of course, of course. Yeah.

Yes, yeah, that's a really good

way of framing it.

What a lovely thing, right? That we don't have to ask a nine-year-old to carry the burden of change all on their own shoulders. What a bummer that would be. Instead, we can all hold a piece of the progress together. I'm jumping the gun here. I'm giving away the fact that I love working with parents as far as anxiety goes.

Yeah, I give a.

Right. Yeah. I

always give a metaphor ⁓ that if we're just working with a kid, it's like taking a fish in a dirty fish bowl out of the bowl and cleaning the fish and putting it back in a dirty bowl. And actually one of my professors ⁓ in grad school gave this metaphor analogy first, but it's true, right? If we're not working with the whole environment and including parents and we're just taking the fish out of the fish bowl and cleaning it.

I

then it's hard to get as much change.

I love that. Yes. So we parents are the, we're the dirty water.

Right? No.

No, but I love that. It's about,

it's not about ⁓ parents having done something quote unquote wrong. It's about you are the environment in which your kid exists. I'm gonna have to steal that. I like that one. ⁓ I calculated at one point in graduate school when I was trying to, I was trying to understand how to really frame this for parents in a way that didn't feel like shaming in any way. And I figured out that when you see a kid for individual therapy, which is lovely.

Mm-hmm.

Please, yeah, yeah.

and can be really effective, right? But you're with them 1 % of their waking hours. That is not a lot. That's not a lot. And so for parents to be able to be this kid's environment, to have the filtered water, right? How lovely, how lovely, yeah.

Mm-hmm.

Yeah, yeah,

Okay, so you said, you know, not only can we approach anxiety from working with the child, but we have this other avenue of approaching anxiety by, you know, working with parents and kind of addressing the environment. Can we talk about parental accommodation or ways that you do work with parents and how we can all kind of get caught in the anxiety cycle? Not, you know, because like you said, it's not anyone's fault, of course, out of

Totally.

love and protection for our kid. We either want to make the anxiety go away because we see them hurting and we see them in pain or I don't know, we're kind of overwhelmed and busy ourselves and we're like, we don't have time to be talking about your shoes. Like we need to go to school right now. So yeah, talk to me a little bit about parental accommodation.

What is this?

Yes, so I love that you named that, that sometimes it's about like, I wanna step in and help my kid. And sometimes it's actually about like, I'm so sick of getting this question. Or like, can we just go already? I'm just gonna answer and we're gonna leave, right? So what we tend to see is there's what you're doing as a parent and also what you're not doing.

Right? Yeah.

And so a kid's anxiety will pull for parents to, here's the most common one in my experience, answer questions over and over. ⁓

I should put a little pin in this, but information seeking is important, right? Sometimes you need information. Reassurance seeking is when you already have the information and anxiety makes you ask again. So I'll say to parents, like, do you feel like this question is almost like a bucket with a hole in it and you keep filling it and then it just keeps emptying? They're like, yes. Like, okay, that's reassurance seeking, right? So reassurance seeking is one thing that can come up, but also doing things. We think about not just what you're saying, but what you're doing.

doing things to help a kid. And so that might be, here's a really common example, really extended bedtime routines, right? Like, ⁓ we need to check the lock on the front door. honey, I'll go check it for you. Either because, my goodness, I want my kid to not be suffering right now, or, ⁓ I'm watching the time that I have to myself slip through my fingers, the post bedtime time. So I'll just do it for you, right? We get pulled to help and participate, but there's also the things you're not doing. And so that

Might be avoiding long drives because your child is afraid of car sickness. ⁓ Not going to certain restaurants that are... ⁓

I'm really on the, I'm on a metaphobe kick right now, that fear of throwing up like certain restaurants where a kid might've had a bad experience and won't eat there anymore. Now the whole family doesn't go to that restaurant. Right? So it can be kind of sneaky like that, where it's things you're doing, but also maybe things you're not doing. Those are accommodations. So we call them, um, I feel like that word has a little bit of a negative loading, uh, but it's the word we tend to use. Uh, you know, it is, but the, the, there's a cycle.

Yeah.

like to map this out and show it to families where, so anxiety spikes, then the child turns to the caregiver. I'm gonna say, you'll hear me use the word parents, but of course I mean caregivers broadly. All sorts of family makeups out there. parents turn, kids turn to their caregiver for relief, and then the caregiver engages in some form of accommodation, doing or not doing, then the child experiences this big feel, right? my

Total relief, but then the anxiety gets maintained. That's the kind of like jargony way of saying that makes it stick around and it creates dependence on caregivers. Almost, I like to describe this to families as like, gosh, if you had a headache and you took aspirin and then the headache went away pretty quickly, what do think you're gonna do next time?

an aspirin. And the other thing I think about is bike, right? If your kid actually knows how to ride a bike and you're holding the seat, and you might not realize they know how to ride a bike because you're holding the seat, right? But you're holding it and they then think that they're only able to do this because of your hand. You also think they're only able to do this because of your hand. You know when you let go that they're going to fall.

Certainly, it's guaranteed, right? But we do that, we're willing to do that as caregivers because we know that that's how they'll learn how to ride on their own. And I think of this as very similar. It's like being willing as a caregiver to take that risk of letting go of the bike seat so that your kid can stumble and learn that they're capable and they're resilient. Yeah, yeah.

Right, right.

OK, I love that. Sometimes what I'm hearing is by accommodating, we aren't giving them necessarily the opportunity to be able to do it on their own and to almost gain that confidence that they can do it on their own. So if we're modifying the environment by, OK, yeah, you're right. Soccer practice is really scary. You don't know anyone there. We're not going to go to soccer practice tonight. It's almost sending that message,

Mm-hmm.

Mm-hmm.

Soccer practice is scary. I guess, you know, I can't go to soccer practice.

Totally.

Yes. I feel like it all boils down to, you know when they're little and they fall and they turn and they look at you to go, am I okay? It all boils down to that.

where sometimes, and this is something I think about a lot with families, and in my own parenting too, it's like, gosh, do my words match my actions? Because I might be saying, oh, you're gonna be great, it's gonna be fine, but then when I step in to reduce a demand, that's basically my kids who skin their knee turning to look at me and going, oh.

Mom is like running towards me, even though she's saying I'm okay, she looks scared and she's running towards me. Right, that behavior of mine communicates this is too much for you. Yeah.

Okay, we kind of, parents maybe identify, yeah, actually we stopped going to that restaurant or yeah, you know, they don't take the bus anymore and I'm driving them to school. We're kind of modifying all of these environmental things. ⁓ What would be the first step after having that awareness?

perfect example. Yeah. ⁓

⁓ it's a good question. I like having that conversation with families because for every family it's really different. I think a lot about what are you motivated to reduce? Because here's the reality. It's gonna be tough. There's this term that we psychologists use, an extinction burst, right? Which is where if you make a change, the person...

who's experiencing that change is gonna repeat what they used to do to get their needs met and they're gonna repeat it more.

And so I think that motivation on the parent side is really important. And that awareness, I'm glad we named it here, right? That awareness that like, man, when you make a change, it's probably gonna get worse before it gets better. And riding that out is so important and not going back to how you used to respond. So the motivation's key. But I also think about frequency. You sometimes families will say to me, what if we go on an airplane trip once a year?

Yeah.

could be super meaningful to a family for whom travel's really important, but it's not happening very often, right? So you're not getting a lot of reps with it. So I prefer to start with something that's happening at least a couple times a week. Some ⁓ item where I feel like parents are emotionally prepared to ride it out, and they have a plan, and you know, for folks listening at home.

You could think this through, like, okay, if my kid responds in such and such way, if she keeps asking me questions, how am gonna answer? So that's part of that preparedness is imagining what am I gonna do instead of the thing that I've been doing. ⁓

what's it gonna look like for me to really commit to this? If my kid starts following me around and asking questions or shouting the questions at me, perhaps I will go run an errand and tap out with my co-parent because I know I'm gonna accidentally answer, so let me go to Safeway in this moment, right, or whatever it is. ⁓ Yeah, so those are the things I think about when choosing an item. ⁓ Yeah.

Okay, so we kind

of would start with one thing. Like, okay, the bedtime routine feels like something that's happening every day, something that's really debilitating. How can we reduce some of the accommodations in this specific moment? And then having a plan because it will likely get worse before it gets better.

Totally, because if you got a soda from a vending machine every day, like every day for a year, let's say, and then one day it just stopped dispensing soda, what would you do?

Kick it, call the number on the back. Yeah, amp it up.

Exactly. Right? I feel like hip checking the machine. Like,

come on. And so I like sharing that image with families because they're like, yeah, that totally makes sense. And the problem that we can encounter sometimes is if you do hip check the machine and then the soda comes out, what are you going to do next time?

You're gonna try the same strategy.

Yep. Exactly.

You're like,

I guess I just have to hip check it now. And so helping families understand, man, when those responses from your kid escalate, as they would for any person. Doesn't mean anything about your kid. When those responses or attempts at getting a response escalate, holding firm is really important so that they don't accidentally learn, my goodness, all I have to do is up the ante in order to get my needs met. I think so much about,

I love kids, I love working with kids so much. They are not the most skilled at getting their needs met. it's not always like a will thing where they're being willful or that word manipulative can come up. It's a skill.

Mm.

challenge, right? It's like, man, I so desperately want to get my needs met and I can't figure out how in this moment. So let me try anything that I can. And that's normal. And so I've had some parents tell me, I just said to myself, vending machine, vending machine, vending machine. I'm like, I love that. It became your mantra, right, in order to ride that wave.

Right.

Yeah. Yeah,

I love that you brought up manipulation. I will often tell parents, I think we're giving their frontal lobe a little bit too much credit to think that they thought this through and planned it and decided that this was going to be the best strategy. Their frontal lobe is not developed enough to be able to do that. It's just the patterns. They don't know how to get their needs met. Yeah.

Yes.

like they're flailing

in the water, like reaching for anything they can grab, you know? Yeah.

Right, right. As you're

saying that, ⁓ I'm thinking, right, anxiety is often, it just takes over the entire family, right? And so it sounds great. All right, we're going to reduce the accommodation. I'm going to ride out the wave. I'm sticking to this. Seeing Dr. Eleanor next week, I'm going to come back and tell her that I was able to do it. And then the parents' anxiety takes over in the moment, right? This is never going to stop.

Yeah.

Yes.

Yeah.

we're

going to be tired tomorrow, and then tomorrow's going to be horrible because the bedtime routine is getting even longer now. How can we, as parents, in the moment take care of ourselves? I know that we're doing the right thing for our kid by trying to stop some of these cycles and reduce the accommodations, but also, yeah, the parent anxiety.

Yeah.

love that question. I think it's not asked enough in our field. You have that experience too.

Yeah. Yeah, I'm always like, can't,

I mean, trust me, I'm the one with the anxiety in the family. can tell you many stories. My step-sons ⁓ very much know about accommodating and they'll be like, court, we're practicing an exposure right now. Like this is all fine. ⁓ But yeah, I'm always like, this is really hard for parents to do when your child is screaming and crying. Not only do you

Is it just breaking your heart? Also, you're thinking about tomorrow and what the day is going to look like tomorrow. Like there's just so many other things I feel like that get brought up.

Yeah,

absolutely. I like to think about that with parents as part of the plan of like, what are you going to say? Sure, that's all well and good. It's very important. But also what's equally important is thinking about what do you think is going to come up for you as far as anxious thoughts or even just like hopeless thoughts that might get in the way of this plan or just might beleaguer you. That's reason enough to think about this stuff, right?

the very good one, to be like, okay, tomorrow we're gonna be exhausted, right? And so I think with families about is there some kind of change we could make in order to allow this plan to be less anxiety provoking? For example, if it's related to sleep, can we do it on a Friday night?

instead of a Sunday night when everybody has school and work the next day. But I also like to get really nitty gritty with parents about like, okay, so you're gonna, let's just name it now, you're gonna have this thought of like, I'm hurting my child. What can we remind you in that moment? Let's write it down. Like, please get out of Penn. Anxiety is painful, it's not harmful.

Right, so often I'll help parents, and this is something I love about our field, is scripting, which is where we line feed for ourselves. And I'm so grateful that you don't have to believe the line feeding. Saying it actually still has an impact. And we do this when we're doing exposures with people and individual work. Here's the great news, you don't have to believe it.

Right?

Isn't that great?

But saying it and saying it over and over actually does have an impact. So knowing what might come up for you internally as a parent, what words can we offer you to hang on to in that moment? But I also, like to zoom out and think about, my gosh, what's your why? Like, why are you doing this? Right? And so this is, ⁓ you may know Lisa Coyne. Seeing her...

in his like church. I love to go to her talks at any conference. She's just remarkable and she does a lot of work around values, what motivates people to do things and what motivates them specifically. Like what do you care about? What does your best life look like? Not my version of a best life but yours. And she, this is an imaginal exercise that she likes to do with parents and what she says is

you

Okay, right, so she has somebody sit and notice their body. It's always a nice thing to get kind of grounded. Actually, can I just walk us through this right now? Let's do it. Okay, perfect. ⁓ Okay, so I'm gonna close my eyes too. Why not? ⁓ We'll close our eyes and it's always a lovely thing when you're going through an exercise like this just to get grounded in the space and in your body.

Yeah, I was like, can we, can I do this? Yeah, okay, I'm gonna do it. Yeah.

And so I'm going to give you a few moments just to take some deep breaths in through your nose and out through your mouth.

And you might notice any ambient noises around you, the feeling of the ground under your feet, the seat underneath you. Just give your shoulders a little wiggle.

When you're ready, in your mind's eye, I'd like you to conjure one of your kids.

And what we're picturing here is your child without anxiety or whatever problem that they carry that's been getting in the way for them. It's gone. It's gone. It's been wiped away.

want you to notice in this image in your head, what do you see, what do you imagine for your child?

What does he do?

Who is he with?

What does his face look like?

surround him.

And as I ask you to think about doing these very hard things, answering differently, not jumping in to take challenges off the table.

What if that is what this is all about?

What if changing the way you respond was for this? For your child to have more of this that you're seeing right now.

Would that help you be willing to take that brave step yourself?

When you're ready, can wiggle your toes and shimmy those shoulders and bring your focus back to us right here.

How was that experience for you?

It was good. actually was, like I said, I'm the one in my family system that needs the accommodating. I've had OCD my entire life. I've done lots of therapy. I know all of the things and do them often. So I was thinking though, like similar, I kind of switched it, like without my anxiety, what it would be like for my step-sons.

Yes.

And so one of my step-sons is 20 and he wants to get matching tattoos. And this just happened like a few days ago. So, I mean, it's taken us a year to like figure out what we want. ⁓ And we get to the tattoo shop and I start asking the guy behind the counter all sorts of reassurance seeking questions.

I love you.

I know that they're unrealistic, am I going to get poisoned? I mean, crazy things. And everyone in my family knows what's going on. Yeah. I'm like, am I going to get poisoned? And he's like, what are you talking about? That's not something that happens. I'm asking all these things. My partner is like, it's fine. We know these are ridiculous questions. But what happened was I kind of stole the joy from the moment because

What? Yeah!

Yes, I was talking.

⁓ he

still the joy? Nah. Nah.

LCD still the joy, yeah, exactly. Because

it actually wasn't fun anymore. Because now I'm anxious, right? And like this fun thing that we've been talking about for a year has now turned into this whole thing. So I actually didn't even get it done that day. We scheduled a different day to do it because anxiety had decided I needed a certain person to do it. So anyways, you get the picture. And like, I know all of these things, right? And my family knows all these things.

Hold on. Yes?

And so, yeah, without the anxiety, there would have been way more joy and it would have been a totally different experience, right? We would have got it done on the same day. It would have been more fun, but yeah, that's not what happened. So it does, I mean, to your point of, I liked imagining that though, like what it would have been like without ⁓ anxiety takeover. Right, exactly. Yeah.

what I do.

Joy connection is another value that I hear in there.

It's like you're wanting to, what a gift to be asked to join in this moment with your staff son. Like, I love he wants matching tattoos with you. knowing you, I'm sure that actually means so much to you. ⁓ And so that's the value, right? It's like the connection, the joy, the spontaneity in a way. Although you said it's been a year or so, but I don't know.

rain.

Right. I know.

Right. Yeah.

I mean, deciding what it was, but it was,

yeah, kind of spontaneous in the moment. I know, I texted my friend. I was like, I'm choosing connection over OCD. Like, we're scheduling it. I'm still gonna do it, but yeah. So, I mean.

Bye.

That's so great. But

what a cool thing to bring that to life in our conversation here of like, that's your why. And I think when we're thinking about parental anxiety that might get in the way of responding to a child's anxiety differently or OCD or whatever it is, tapping into like, what am I doing this for?

Yeah.

Right? I'm gonna ask you to respond differently. Here I am in my chair, my therapist chair. I'm gonna ask you to respond differently so your kid has fewer symptoms. Great. I'm gonna ask you to respond differently so that your kid can have richer relationships and more joy and delight and awareness of the world around them. Wow, which one is more motivating? Right?

Right, right.

Well, and I mean, to your point, those are, it's like the things that the kid fears, right? ⁓ Going, I'm using soccer practice, going to soccer practice, not knowing anyone, you know, so I don't want to go. It's the same thing that the parent fears. My kid's not going to be able to make friends and not going to have connection, right? And then of course it spirals. They're never going be able to have a relationship when they're older. Like, no, they're nine right now. But yeah, those values. I love that.

Yes. Totally.

The exercise was great and I love tying it back to values for both the parent and the child.

Yeah, why are we doing this?

100%. I love, that's so true that in that moment, I think we like up the emotional ante so much for ourselves by going like, he always, she never, this is gonna, I knew it. Right, like the, man, yes. A huge button for me is like watching my kid be excluded for something, from something I should say. It does the same exact, I'm like, ⁓

my gosh, I suddenly picture he's four. He's gonna be 14 sitting on the edge of the recess lawn.

No one's gonna be talking to him. I'm like, whoa, whoa, whoa, whoa, what just happened there? I've actually been, ⁓ heard a fellow provider say, I can't remember who it was, I wanna give them credit, but something about adding right now to the end of the thought. That's been something I'm working on. I think it's a lifelong project, but I found it helpful to be like, okay, shrink the moment.

Right.

What's this is happening right now, right? Sticking to the facts. He's not being invited to play right now versus destitute 25 year old who knows no one, right? ⁓

Bye.

It's true. That

reminds me of like mindfulness, right? And like really being mindful of the moment, noticing our thoughts. This is the thought that I'm having. It doesn't mean they're not gonna have relationships when they're 25. It's thank you anxiety for letting me know that you're still there, but I'm not gonna listen to you this time.

Come on.

Yes.

Yes.

Yes, yes, which is such a, man, what an elegant skill, right? And I think it says so much that we therapists who do this day in and day out don't and will never have that mastered because we're human too.

And so sometimes that frontal lobe just is fully unplugged and we lose access to the skills that we preach, which I think is such a lovely, lovely, humbling experience to have so that we can, as providers, better understand just how challenging it can be. It's all well and good for us to lay out a recipe for success, but using the recipe is another thing.

Totally.

OK, so on the recipe, ⁓ we've mapped out these accommodations. We know, OK, this is kind of what we do. I go and check the locks at bedtime. I give 10 kisses. I put the stuffy in the correct spot. We kind of know what we're doing. We've chosen one thing to reduce. So maybe there's a lot of parts of the bedtime routine, but we're just not going to check and lock the door. Two things. One, how does a

Yes.

Yup.

Mm-hmm. Yeah.

parent let the kid know this is what we're doing and actually we'll stop there.

Bye.

gonna

Fully explored. We didn't have the research behind as many options even 10 years ago. It's really remarkable. ⁓ But so space is a parent focused treatment that in initial really beautifully designed research has been shown to be as effective as treating a kid individually, which is so, so awesome, right? There's that inspiration. my gosh, we can come from all angles and have success. ⁓ And one of the things that I love so much about space is that it

involve something that we call an announcement, as you know. ⁓ It's pretty formal in the treatment. And so it would certainly make sense to do this if you were working with somebody like me, like you, where you would write down, literally write it, print it out, write it in your own handwriting if it's legible, and write, hey, this is where we're coming from.

It's a place of love. We love you so much. We see how much you've been battling anxiety. And we realize that by colluding with anxiety, but you'd want to use a more developmentally appropriate word, by being on anxiety's team, we are actually not helping you. And so we're going to be making these changes and we're going to start on Monday.

Anyway.

And so that's formally delivered by both parents, which is actually an element that I love so much because usually there's just a kind of gravitas that comes with both parents in two-parent households delivering a message like that. ⁓

But I will say, I've really enjoyed borrowing that even, like, if I'm working with a family where ADHD is the primary presenting concern and we're targeting some anxiety, I'm like, let's do a mini announcement, right? It's something that I think is so, ⁓ it's so protective of the relationship. It's so protective because the thing that usually happens, and I should just pause there for a second and say when I mean mini announcement,

What I mean is like, just give your kid a heads up at a neutral time. It doesn't have to be written and printed out, but giving them a heads up that these changes are gonna be coming, and this is why, with the why being like, because I care about you so much. That feels so, so, so important to me in this work, because...

Rigs it. Yeah. Yeah.

Kids tend, this is so appropriate for where they are cognitively, but they tend to blame themselves for things, right? Their world is very egocentric, as we say. They're kind of focused on themselves appropriately as kids. And so they go, ⁓

Maybe I did something wrong, maybe this is my fault, maybe my parent is mad at me, right? And that's so not where we're coming from. So it makes sense to get out ahead of that misperception. ⁓ But also it can feel, if you think about this, it's like, let's slow this down. Your kid's anxious and asks for something and you go, nope, I'm gonna be doing things differently now.

It just kind of feels more punitive than if you were to deliver that message at another time. Plus, there's the element of, man, your kid's probably already anxious, which means they can't really hear you. So your message is not going to get across. ⁓ So very important to do it, you know, like maybe Sunday morning.

Thank

when everyone's feeling really chill in their PJs. I don't know. Just to give that that heads up that change is coming and this is why.

Right, no one likes something to just be dropped on them all of a sudden. And especially if we're dealing with anxiety and then we just remove it in the moment without any heads up, it's a lot. It's a lot for their little nervous system to take it. Yeah. Right. Yeah, we don't want to do that. Right, and to your point, we don't want it to be a punishment, which is what it would feel like in the moment of actually, no, I'm not doing that anymore. It's like, wait, what?

Yeah, it's like, Actually, no, I'm not loving you anymore. my god! ⁓ my gosh. That's so hot!

Yeah. ⁓

you're pulling the rug out from underneath of me. And you kind of mentioned starting with one thing at a time, right? We're not just completely changing their entire life. We would just start with one thing at a time to build up that tolerance.

Is that it?

Yeah.

Exactly. Yeah. Yeah.

OK,

what about we come up with the plan, we do the announcement, and we don't do it perfectly, right? Maybe we tolerate their anxiety for a long time, and then we're like, all right, I am going to go and check the locks. I know that was an example that we give. What would you say to a parent, right? Because we don't want to go down that shame spiral. We're not going to do it perfectly, right? We didn't get here overnight.

Yeah!

This is really hard. It is involving the whole entire family. Yeah. What would you say to a parent who maybe tries it and then feels like they don't have success? Right. Let me give you a hug. Yeah.

Honey, it's okay.

Yes. The thing that I think about, as a parent, you reserve the right to be wiser today than you were yesterday. And so I think that there's, if you're messing up out loud and coping.

out loud with your own mistakes and adapting out loud to your own mistakes, there's actually a benefit there too, right? And how humanizing to be able to go to your kid and say, ⁓ man, I had this plan because I've learned so much about what's gonna help you. And I had this plan and I gotta tell you, I caved and I think it was really about, I...

wanted to make sure that you were okay and I realize now that you were okay and I didn't need to step in and so I've thought about what I'm gonna do to help myself stay strong and we're gonna try again tomorrow, right? To be able to, and...

Here's an important distinction. Sometimes I work with families where I hear parents owning things and sort of coping out loud, but verbalizing a lot of guilt. Like, I really shouldn't have done that. That was terrible of me. This is an opportunity to model giving yourself some grace because that's what we want our kids to be able to do. Again, you might not believe a word, right? But...

Thank

just keeping those guilty self-statements in when you can so that your kids have a roadmap for like, ⁓ okay, I don't have to be perfect. Can you imagine having a perfect caregiver? How intense would that be? my gosh, what a standard to hold yourself to. And so to me, the important part is keeping the open communication. Because I wouldn't want a kid to go, great.

Bye.

My parents not gonna stick with the plan. I'm assuming that's gonna be the case every night. Like I'd almost rather reset with the child and then try again. It's okay. It's okay to not be perfect, yeah.

Thank

Yeah. Right.

It's a lot to make these changes. And as you were saying that, I was thinking it also is really helpful if it has gotten to the point, like you were outlining in the beginning, where we're not doing school activities, we're missing school, we're not going out to restaurants. It's really taking over life. ⁓ It is really helpful to work with a therapist or a psychologist, like you said, like yourself.

Mm-hmm.

Yes.

You know, I think one of the things,

yeah. Yeah.

even the anxiety example that I gave of myself, I have seen so many parents, right, do this exact thing and reduce accommodations as you have. And we have seen so many kids have very big emotions and it'd be really difficult. And we've seen them then be okay, right? Like, you know, I always think of the classic example of going to get a shot and you're like,

Thank

No.

holding your child down and they're screaming and it's like this traumatizing thing and afterwards they're like, are we getting ice cream now? And the parent is like, wait, what? Like you were just screaming and like being held down and now they're like moved on, right? And so like we have that background to be able to share with families and like give that confidence that, you know, we've seen this many, many times and it will be okay. But I imagine for a parent of, you know, N equals one doing this with one of their child, it is.

children, it is a lot, you know, to have to trust the process.

Yes, yes, I think that's such a good point. If it's gotten to the level where it's really interfering with your child being able to do like.

kid things. Go on play dates, go to birthday parties, go to school. That definitely feels like a level at which to get support from somebody like us. We can hold the hope and go, yeah, you're seeing big reactions and that's something that we see. And we can get you there. I love that about our jobs too, is we can work with the school system and have the school be on board with the plan that we're taking one step at a time.

I know that you feel the same way because you have a podcast, but I feel so passionately about like, gosh, I wish that we could disseminate just some of these concepts because anxiety is so pervasive for kids and increasingly so. ⁓ It'd be so cool for families to just know more of this stuff because it's so counterintuitive, right? That like, man, okay, so I'm supposed to comfort my child less and that helps anxiety shrink.

Mm-hmm.

It's very, very counterintuitive. I wonder, do we have time to talk about things you could say in response?

I was actually, that was going to be my next question. was going to ask,

because I know we're coming toward the end, what you would say to a kid in the moment. Because of course, all kids are going to ask for reassurance. And so there is a dance. You can give reassurance sometimes. Of course, it's fine. There is no perfect way of parenting. You know your kid. If you give one reassuring statement, know.

now.

Mm-hmm.

Yeah.

you're going to be totally fine at soccer practice and then they go and then it's fine and they go every single time. Like it's fine, right? It's no big deal. You don't have to not give reassurance ever. But if you notice that you're, ⁓ all right, they're going to soccer practice, but they still ask every single time what, yeah, what would parents say instead of giving that reassurance statement?

Great! Love it! Yes! No! No.

I see you.

mess.

Well described, that's a good distinction.

There's like this one consistent theme where you're like, ⁓ man, I've answered this question 20 times today. That might be a good one to try. I appreciate so much that there's no one way to do it. And so I would love to hear what your thoughts are too. But there's a couple different ways in which I will recommend to families that they respond. It's like a buffet. You can pick which item on the buffet speaks to you most. ⁓

Right?

We love a supportive statement, that's what we call it, from space, from that treatment, where you're validating the fear, like, ⁓ I see how hard this is for you. I see you're so scared, and you're instilling confidence in their ability to cope. And I know you can get through this feeling. I know you can survive this. Tone here is everything, by the way. I caught myself once. I turned to my son and said, I know you're scared, but you can handle it.

Right?

I was like,

man, that sounded so dismissive. Tone is everything, tone is everything. That's an option. I actually really lately, I love using punch cards where if a kid is asking, let's say 20 reassurance seeking questions a day about a particular theme, give them a punch card with, I don't know, 10 punches. And then they get to, right, and then you're gonna continue to wean it down. ⁓

Just to throw a little fun spice in there, it could be that whatever punches they don't use can get converted to points that they can cash in for something. ⁓ I've found that some, especially elementary age kids, can get really into that. saw a kid once go from, he was asking 60 questions a day, to zero, because he wanted so many points. He was so points motivated that he was like, no problem.

Amazing.

I will just sit on these questions. And that, of course, brings up a conundrum for parents where they're like, man, is my kid now just suppressing? Right? And it's a really good question. But the way that we think about it is, yes, they're suppressing this urge to ask you, and then they're tolerating that uncertainty themselves. And that's really the crux of the treatment that we do, is tolerating uncertainty. And maybe they're reassuring themselves, like, okay, but hey, then they're able to do that at school. Right?

of uncertainty is the good stuff. Parents can also prompt a child to answer themselves. Like, oh, did I say last time? What does that make you think I'll say this time? Or like, I know you can rely on the answer I gave this morning.

Or the emoji level, I like that one too, where it's like you are technically giving the answer, but it's less ⁓ reinforcing, we say, like less intense than verbally answering. The most intense thing you can do is like lean in and touch your child and look them in the eye and say, no, Suzy's not coming over, it's gonna be fine, right? But if you just go, like you're actually weaning off the hit of the reassurance drug, so to speak.

Mm-hmm.

And then the idea though always is we're weaning off more and more and more until, and you should see a kid's questions reduce with these approaches. And if they don't, you could talk to somebody like us. Yeah.

Right? Yeah, it's hard

to talk. I mean, it's hard for adults to tolerate feelings, you know, and tolerating anxiety and uncertainty, especially raising kids. Who knows what they're going to be like as adults. It's like every day is just uncertain. And, you know, we're constantly wondering if we're doing the right thing all of the time. But I love the supportive statement. And I think that is useful regardless of if the child has like clinical levels of anxiety, right? Validating the emotion.

totally. No!

Absolutely.

Mm-hmm.

confidence

that they can handle it. I know you're feeling so anxious about your test today, and I am so confident that you'll be able to get through it. just feel like that combination I feel like is really helpful instead of no, you're fine. It'll be fine. You studied you're fine. Which you know sometimes I do, but it's fine. Yeah.

Yes.

Totally, yeah. Yeah, I love that you said get through it too. Because sometimes

I've actually fallen into this trap where I'll say like, I know you can do it. And then my child is like, no, I can't. And I'm like, I'm stuck. But if you instill confidence in their ability to get through the situation or just survive, I mean, the bar is low. We're not talking about like.

Right.

nailing every situation, we're talking about just surviving and getting through. That's the bar that we're going for. Like that's success, you know? So I love that you said I know you can get through it.

Right. Yeah.

Yeah, helpful reframe. Okay, what is one thing for the parents listening today and caregivers listening today that you want them to take away?

Anxiety can get better. think that's, I care so much about the sort of public health side of what we do. You know, I think sometimes families assume like, man, my kid is dealing with this thing and that's just how they're wired or it's their personality and they'll bear that for the rest of their lives. But what we actually know and same goes for OCD, which I have as well. When you treat early, you mitigate a lot of

Mm-hmm.

of the impact that can come from having untreated symptoms. It's 14 to 17 years is the average from first OCD symptoms to appropriate treatment. And so just knowing that we can treat this stuff and kids, I ⁓ love my job so much because I get to see kids feel free again.

Right? And get back to being kids. And so knowing that like you can get help and things can improve, that's what I wish everybody knew. Yeah.

love it. No, that's a great message. Instilling hope that things can get better.

Yeah, yeah, it's the most fun part of our jobs is being like, you don't need me anymore. Right? I know. I know. I'm over here being like, I'm so sad to say goodbye. I miss seeing these people each week. But like, there you are out at soccer practice. You know, I'd rather you be at a play date than in my office. Even though I wish I could like keep you here and we could make beaded bracelets forever, but.

exactly yeah i know it's like a it's a double edged sword or whatever like i you know you don't need me and yeah i've ⁓

Right. Flying. Yes.

But

yeah.

But like go,

go be yourself. You know, that's the call. That's the goal. Yeah, yeah.

Well, thank

you so much. This has been really informative and very helpful, and I'm looking forward to more chats.

Thank you so much for the invitation to come on. I really loved talking through this stuff with you.

Wonderful.