About half of my practice is with children and teens, and many of the people who I provide case consultation to also see kids. Those of you who work with kids probably know what I am talking about when I say this first full week of the summer has been a long week, and it is only Tuesday. I love my work, I love providing case consultation and hearing about children who get well from anxiety. But the road to wellness isn’t always smooth, and for children with anxiety and their loving parents, this is a week when the goals we have been working on sometimes change dramatically. Though we have been anticipating the changing schedule by setting goals in session to building social, self-care, and resilience skills to get ready for the new situations like camp and travel, anxiety can still cause surprises.
Jennifer’s mom emailed me frantically on Friday. Jennifer, 14, had worked hard for six months with exposures and social skills work to make friends at a new school, and had asked in January to go to a sleep away camp for the first time in her life with one of those new friends. She and her mom saw this as a huge sign of success, and we completed treatment with excitement about this new opportunity. Last week, four days before the camp was to start, Jennifer calmly told her mom she would not go. She had many reasons she felt it was impossible. I could not fit Jennifer and her mom into my schedule for an appointment. In a short phone call, I reminded her mom about many of the skills Jennifer had practiced. I asked them to get out the notebook we had made together of all the skills and exposures she had done, and also to watch the video I posted last week. Jennifer’s mom said reviewing the work and watching the video helped her realized she herself had to buckle her own seatbelt (which is a line from the video) and take a hard line with Jennifer. She told her daughter she had to go to camp, that it had been her choice to sign up, that her family had paid, and that her friend was counting on her. She held her breath. But guess what? Jennifer accepted it. She shed a few tears, but very few. She left on Monday morning without fuss. Success!!!
The change to a summer schedule can be a wonderful opportunity to try new activities for all kids, and especially for anxious kids because they cannot just fall back on the regular schedule. It is almost a given that it is a time to try something new. Of course that gives anxiety more subjects to work with, as was the case with Tom. At 17, he was homeschooled and from a very Christian family. Tom, his mother, a psychiatrist and I had worked hard for five months on his serious social anxiety. Tom practiced new social skills, and did exposures like going to the gym every day on his own, returning an item to a store, and going to a movie with a friend from church. Two weeks ago he was excited to start working as a lifeguard. After his first day of work, Tom returned home shaken by the bad language his co-workers used. He had overpowering feelings that he had said these words himself, and that God was angry with him. After all the work we had done with social anxiety and building social skills, we were starting over with a new topic: scrupulosity. I fit Tom and his mother into my schedule quickly, and scheduled 3 follow up sessions with them. All that cognitive-behavioral work will pay off for Tom, even though this seems to him and his mother like a totally different problem, but we need time together to allow them to see how to translate exposures we have done before (like making small talk at a party) to the new work we will do creating loop recordings of blasphemy.
If you are feeling this summer transition in increased stresses from your practice, remember that growth, for us as therapists, as well as our anxious clients, takes hard work. Embrace the uncertainty of how this will all work out, learn some new ways to help your clients struggling with a recurrence of symptoms or emergence of new symptoms, and find the excitement of growth for yourself and your clients.