S7 E2: Parenting anxious youth w/Dr. Meredith Elkins and Dr. Julia Martin Burch
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Anxiety is a normal evolutionary based emotion that all humans have as a signal telling us that there might be danger that could harm us or impact our well-being. An Anxiety Disorder is not the same as feeling the emotion of anxiety. An Anxiety Disorder is when anxiety is experienced consistently at a high level in a way that is impairing and very distressing to the individual, leading to changes in behavior and ways of living that become maladaptive.
Outside of serious medical pre-conditions, the experience of anxiety is not inherently harmful in of itself, although it can feel as though it is.
Parents often have a naturalistic instinct to want to protect their children when they feel anxiety as a way to keep their child safe. Anxiety, however, can ‘high-jack’ the rational part of your mind as a parent making it difficult to distinguish the appropriate response in a particular situation and context.
It helps to learn about a child’s anxiety and understand and accept it for what it is so that the parent (or any adult supporting youth) can have clarity around how to best respond in a given situation or context. For instance - is it more helpful to soothe the child, problem-solve, encourage bravery and persistence, take space, and/or encourage the child to handle the situation independently.
There can be mixed messages about how to understand anxiety. Some may suggest it’s best to ‘trust your intuition/trust your gut’, which may be helpful at times. However, feelings are driven by thought processes, and our thoughts are not always based in reality or facts. Therefore, it may be more important to understand the thought process and using cognitive strategies to shift thinking rather than to simply interpret all feelings as ultimately true and/or helpful.
Even if the child’s worry is legitimate as in the case that there is an actual problem or concern to address, the encouragement can be to still be brave and continue in the routine rather than avoiding the situation altogether. The more people avoid something (granted it is not truly dangerous), the more imagination and catastrophic thinking can lead the fear to get bigger and bigger. That problem or concern can be addressed in time with patience, and it need not lead to complete avoidance of the situation, which may end up making the fear larger than is based in reality.
Sometimes adults may have good intentions by making statements that are overly-positive, like “You’re going to have the best day ever! You have nothing to worry about. Everyone is going to like you.” This can be invalidating of the child’s actual experience. Coaches can sometimes unintentionally instill unreasonable expectations of their athletes, “You’re the best player, you’re always going to be the best on the field.” The child may interpret this as shame and anxiety when things are not perfect all the time.
Adults need not ‘partner’ with the anxiety and agree with all of it, but the worry and concerns can be validated and understood for their valid parts. It can be followed by what Dr. Eli Lebowitz calls a supportive statement in his SPACE treatment: starting with acceptance and validation and followed by a confidence statement (e.g., “...and I know you can do hard things.”). https://www.spacetreatment.net/
Sometimes kids (and even adults) struggle to verbally express something terrible happening in their life and it comes out in their emotional states and reactions; and in these cases it can be worthwhile to not try to simply persist through anxious moments or push for bravery too quickly, but rather to pause and dig deeper to understand where the anxiety is coming from. This can give time for the child and others in their life to verbalize what is contributing to the emotion of anxiety in order to address those factors.
Exposure therapy is helpful because when we avoid things we are afraid of too often, it can teach the child that 1) they cannot handle this situation, and 2) whenever the child feels anxious, the response to take is to avoid the situation. Avoidance prevents us from learning that we can handle these situations. Exposure can be slow and gradual, not simply pushing a child too far and overwhelming them.
Confidence can often come from doing hard things so the child can learn that they are capable.
Thinking over and over about something can actually make the anxiety persist or get more intense rather than exposure to doing the thing that’s been avoided. The thinking and rumination (and even seeking excessive reassurance from parents/adults) can be a ‘false sense of control’ that may feel like a sense of safety in the short-term but actually lead to more fear in the long-term because it may simply be a form of avoidance.
Parents (or other adults like counselors or school staff) may feel a sense of exhaustion speaking about the child’s worries in the case when it’s rumination, obsessive thinking, argumentativeness, or venting rather than a conversation with openness, problem-solving, and/or support. Kids can be oriented toward how interactions with adults can be utilized differently to make it more useful.
Parents can ask themselves, ‘what is the goal’ of the conversation and interaction? That goal may shift and change depending on the situation and context.
Options can be given, even with a visual aid, to help the child identify what they need in a given interaction - especially when there is little time.
At the same time, sometimes it can help to set aside space to process and talk through things that are upsetting or scary and aspects of life that they truly need to process. This can be especially helpful when the child is in an environment or system where things are rushed with little downtime and quality time to speak openly to process experiences and feelings.
Without a space to truly process important aspects of life, behaviors can have secondary gains, meaning the behavior can be a substitute for something else that they need but are not getting. For example, an adolescent may complain a lot about going to a sport, but in reality they are just feeling burnt out and need a break. Or, a child saying they are scared to sleep alone may simply be wanting quality time with their family if their family has been in a high state of stress without time to slow down and bond together.
Parents can positively reinforce brave behaviors and coping (e.g., “You did great not letting that worry stop you from going to your friend’s house!”) rather than simply focusing on the outcomes.
Kids may not have had enough life experiences to have a larger perspective and the adults can slow things down to help the child to gain perspective and put the pieces together. Otherwise, the child may think that every little experience is a catastrophic event without seeing the big picture. It can help
Continued avoidance can lead to depression because the person can fall into a pattern of not having meaningful, fulfilling, and authentic experiences. It can lead to loneliness, as well, which can contribute to depression. That is a reason why empowering people to be brave can help in the long-run and in terms of self-esteem and developing a sense of self.
“Independence focused therapy” by Dr. Camilo Ortiz is an idea to pick something that is a bit newer or just outside your comfort zone and boundaries, as a way to prove you can be independent. This way the parents can celebrate their child’s independence rather than being involved too much to do everything for the child.
Dr. Jonathan Haidt has suggested that social media has impaired child development because it has prevented independent activities that would otherwise build confidence, exploration, and agency.
At the same time, sometimes kids have unrealistic expectations placed upon them or put upon themselves, leading to pressure-filled anxiety preventing them from trying something new. Back to our episode on perfectionism with Dr. Ellen Hendriksen (S6E3), parents may be getting social media messages (implicit or explicit) that they have to do everything perfectly well and their child cannot struggle at all in public, contributing to parenting fears whenever their child is appearing to struggle in public.
The idea is to try to not challenge a child too much (including unreasonable expectations) but also to not prevent the child from being challenged enough (i.e., ‘being overly fragile’ with the child) so that the child can practice becoming a capable, independent child. This helps the child as they launch after high school into either college or other ‘real-world’ experiences. It is also important for parents to have their own support in cases when parents feel an urge to give up and completely have ‘hands off’ when their own resources and/or emotional capacity is stretched too thin.
It is also important to acknowledge how difficult parenting is, and to validate that for parents; particularly, with ‘parental determinism’ where there is immense pressure on the parent to do everything for the child to allow them to flourish and avoid floundering - which feels like an all-or-nothing and neglects the nuance of what influences a child’s long-term development. In fact, parent stress has been shown to be higher than ever in the past decade (not only due to Covid).
Dr. Donald Winnicott, a psychoanalysis, once encouraged parents to strive for being a ‘good enough parent’.
Therapists can help parents with differing opinions to hash out their differences in parenting approaches, find common ground, and ultimately identify what could work best to move forward in a united way. Additionally, different people in a youth’s life can figure out ways to clarify their roles in supporting the youth. This can help finding a middle path approach and trying to learn from experience when parents get frustrated with the process. Adults can ‘do what works’ - Dr. Martin Burch’s practice’s name - and from the DBT idea of doing what is effective rather than trying to be ‘right’.
Emily Oster, an economist, in her book recommended that families create a ‘family mission statement’ to clarify shared values within the family. This can help guide the actions and decision-making within family dynamics.
Scott Barry Kaufman, a humanistic psychologist, uses the idea of the sailboat as the way of navigating the ‘rough waters’ that may await us.
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Gerald Reid 00:00
Welcome to Season Seven of the ReidConnect-ED podcast, co hosted by myself, Dr Gerald Reid and my sister Alexis Reid. We're a sibling team providing free resources on topics related to mental health, education and sport and performance psychology, with an expert and nuanced perspective from our private practices in various roles as educators, authors and consultants and the wonderful guests that we bring onto this podcast. For today's episode, we are thrilled to be joined by two psychologists who specialize in Youth Mental Health with a particular focus on parenting anxious youth. We have Dr Meredith Elkins and Dr Julia Martin Burch, I will provide a bio to introduce them to you shortly. But before I do let's set the stage for the topic of today's discussion parenting anxious youth. The word anxiety is thrown around so often nowadays, way more than when we were growing up in the 80s, 90s, and 2000s children are given language to describe their internal experiences, whether it be from social emotional learning programs in schools, counselors and therapists andor other forms of media that promote mental health awareness, society as a whole is more inclined to acknowledge and validate anxiety as a real thing as we would any other medical issue. Of course, this may not always be the case across all contexts, while it is true that mental health awareness has seen great progress over the past few decades, it is also true that youth mental health has not really improved too much. It has arguably gotten worse over the past few decades. In fact, the director of the National Institute of Mental Health during the 2000s Dr Thomas Insel, has commented on how the field spent so much time trying to identify brain based treatments, all the while, mental health issues actually declined rather than improving. In a recent NPR interview, in 2022 he commented on how mental health requires the field to effectively utilize and implement psychological and social supports as a critical elements that will help individuals to recover from mental health ailments. Of course, this is not medical advice, and as always, we advise you to seek out professional resources and services to discuss and potentially implement these ideas with guidance, feedback and support in a professional manner. I also want to say the disclaimer that the guests here today, and Alexis and myself, the opinions that we share, do not reflect or represent the institutions that we are part of. So let's get into the interview. Let me begin by providing a brief bio to introduce you to our guest today. Dr Meredith Elkins is a clinical psychologist specializing in the research and treatment of anxiety and related disorders in children, adolescents and parents. She's a faculty member at Harvard Medical School and CO Program Director of the McLean anxiety Mastery program at McLean Hospital, an intensive outpatient program for anxious youth. She also maintains a private practice focusing on anxiety in new and expectant mothers and in parents navigating the challenges of raising children. Her work is grounded in the conviction that supporting parents is essential to helping children thrive. I crossed paths with Meredith through my several years of clinical training at the renowned center for anxiety and related disorders card at Boston University during the early 2000 10s. Dr Elkins earned her PhD in Clinical Psychology at Boston University and completed a post doctoral fellowship at Columbia University. Her research integrates the development of accessible, scalable treatments for anxiety disorders with investigation of the mechanisms underlying anxiety in children and parents. More recently, she's exploring how contemporary parenting culture shapes the expression of anxiety within the parent child dynamic. She has co authored more than 60 academic publications and has been featured in outlets including the Boston Globe, the Wall Street Journal and The Harvard Gazette. Next we have Dr Julia Martin Burch. She is a clinical child psychologist and founder and director of do what works, a group practice based in Boston, also providing virtual therapies in other states, dedicated to providing evidence based therapy to young people and their families. She specializes in the cognitive behavioral treatment of anxiety, obsessive compulsive disorder and related disorders. Dr. Julia Martin Birch is also passionate about disseminating the effective techniques she uses in therapy with the lay community through workshops and consultation with schools, pediatric practices, parent groups and camps. She's a frequent contributor to outlets such as Harvard health and the American Psychological Association. Dr Martin Burch completed her training at Fairleigh Dickinson University, Weill Cornell Medical Center, Massachusetts General Hospital and McLean Hospital, Harvard Medical School. Prior to transitioning to full time private practice and consulting, she worked as a staff psychologist in the McLean anxiety Mastery program and as a trainer and consultant focused on disseminating evidence based practices in schools with the McLean school consult service,
Gerald Reid 05:55
we're so happy to have these two psychologists who have such a great depth and wealth of knowledge to share about anxious youth, and particularly with parents. And it's such an important topic that I think often gets overlooked in mental health, because we often think we have to treat the child, and that by treating the child, we work with the child, let's say, in individual therapy, and support the child, one on one, when the reality is so important to include parents in the treatment and helping anxious youth, not only with prevention, but also with intervention. So what a joy this is to have you two. We're
Meredith Elkins 06:28
so glad to have you. Thank you all so much for having us. It's a delight to reconnect with both the Reid siblings, and, of course, to chat with Julia, who's one of my favorite humans of all time. So this is just a dream. So great. Same,
Gerald Reid 06:40
same, same. Why don't we start with a general question, just to kind of, you know, get the wheels turning here. So what are some influences that really bring about childhood anxiety, you know, just as a general thing, or anything you really want to say about childhood anxiety, just to kind of set the stage for our talk today. So I think it would be
Meredith Elkins 06:59
wise if we started by, like naming the elephant in the room of what we mean by what we when we say anxiety, because you know, when we talk about sadness as distinct from depression, we have two different terms, but the term anxiety is used interchangeably to refer either to Anxiety, the natural, normal emotion that we all have, and anxiety disorders. And I think that actually a lot of what you were referring to at the beginning of the sort of hyper recognition or identification with anxiety, is due in part to this, this language challenge. So you can encounter parents or kids that say, Well, I have anxiety. It's like, Yeah, me too. We all do this is part of the human experience. And one of the challenges that I think we all face in clinical practice is distinguishing what is normative anxiety that represents a challenge to which someone can rise naturally, perhaps with some support, and what's something that could that require some more intervention, some more support? And how do we not over pathologize the former? I'm
Julia Martin Burch 08:09
so glad that you're starting there, Meredith, because, you know, one of the things that we see so much in our social media feeds and in these incredibly like well intended resources, I think, is often, you know, is your child doing X, Y and Z, your child might be anxious. And, you know, anxious as a clinical term, anxious with a capital A is different from, as Meredith said, this actually very necessary emotion that motivates us to action, that prepares us to defend ourselves in the case of danger, and it's hard wired. I talk to my patients about, you know, okay, that's your cave woman self, your caveman self, doing exactly what you evolved to do. Like this is great. It's uncomfortable, but it's great. And so I think we live in this particularly interesting time at the moment, where it really does help to kind of differentiate what we're talking about when we're talking about more pathological and putting that in air quotes, but, you know, clinically significant anxiety.
Gerald Reid 09:00
Yeah, it's such a it's such an interesting point. And I also feel in tandem, there's a cultural shift to feeling like we need to control everything. You know, with social media, with technology, we have at our fingertips the ability to control so many things that it can create this illusion that we have to control or we have anxiety we had to control it. We have a feeling we have to control it, rather than trying to understand and work with it, which I think is probably in line with your, you know, teaching parents how to help children to work through their emotions, right, rather than to kind of pathologize it too quickly, right? And I wonder if we can get better at helping people work through their emotions, then it wouldn't, in turn, turn into an anxiety disorder over the long term. So maybe you can talk a little bit about what is the transition between, oh, I have these feelings. These are part of being human, and how that can, in turn, manifest into a more clinical disorder that could be interfering in their life, highly distressing and kind of maladaptive and create a lot of problems in their life.
Meredith Elkins 09:58
I think that anxiety. Anxiety. You know, small anxiety really hijacks the the normal and adaptive parental instinct to protect our children. When I hear my kid scream, you know, my stomach ties in a knot, and no matter what I'm doing, I am instinctively motivated to do whatever I can to alleviate her distress. And again, anxiety is always an opportunist, and so it's going to hijack this deep seated biological drive and make me question myself about is this something that I need to let her, you know, once I realize that she's not in, you know, absurd danger? Is this something that I need to encourage her to manage independently? Is this something that she actually needs my protection? And I think something sort of swirling in the ether that Julia and I talk about a lot is the the message that parents get in our culture, that that good parents are those parents who are hyper attuned to their child's emotions, and so that it is a marker of being an attuned parent to to jump in, to use this as a teaching opportunity to soothe the emotion. And again, as Julia indicated, this is so well intentioned, but what is the message that then that sends to the child. It sends the message that your distress is the most important factor in this situation. This is the thing to which you need to pay attention. This is to the thing to which all of the other adults in your life, whether parents, teachers, coaches, are going to attend to, and that makes it seem like a crisis. And so that's something that I'd love to hear Julia's thoughts on this as well, but, but we think this is a really under recognized or under explored piece of what we're seeing in the parent child dynamic.
Julia Martin Burch 11:53
Yeah, I so appreciate you pointing that out. Meredith, because I think that I'm thinking about, okay, so on our continuum from more normative, typical part of the human experience anxiety into more kind of clinically significant and impairing anxiety. What are the differences and how might parental responses and kind of, critically, for this conversation, what we coach parents to do, how might that change? And so I think it might be helpful, actually, to take a step back and talk about like, okay, so what does that continuum look like when we're in the more normative, okay, my heart rate is elevating. I'm on this podcast, and I'm speaking to people, and, you know, I notice my tummy is a little bit tight. Normative, helpful, useful. Anxiety. If I start to notice that my distress is so intense, I'm having a hard time focusing, if the severity is really increasing, and then, most importantly, and we'll probably talk more about this today, but if, over time, my functioning is becoming impaired, if my behavior is consistently changing in a response to these anxious feelings, so if I start saying no to opportunities to go on podcasts, or if I start saying no to Other things that I think might activate my anxiety, that's when we start moving down the continuum of, hmm, this is looking like more of a kind of clinically significant anxious presentation. What's interesting, though, is that, as Meredith was alluding to, this like hard wired, natural parental urge to step in, exists at all ends of this continuum. And and I guess you guys, you can't see me. I'm drawing continuums all over the place with my hands here, but it exists at both ends of it. And as your child, if you're if you are the parent or educator or working with a kid who has been anxious for a prolonged period of time, it's tricky because those behaviors, of stepping in, of analyzing, of trying to kind of protect and remove the kid from this stress, can become more and more entrenched and can become bigger and bigger as you move towards more clinically significant
Alexis Reid 13:51
anxiety. I think that's so important, and I work a lot with educators and parents alike, kind of talking about some of the behaviors that they see, and how we have this tendency, as you mentioned, to kind of jump in. And I talk a lot from more of like the animalistic side of things, there's this idea of mama bear who swoops in and saves baby bear from any danger that might come up, and from an executive function perspective, that actually teaches this learned behavior that anytime something seems uncertain or, you know, scary or frightening, that there always needs to be somebody to come and save them. And it actually creates this response, especially in younger people, whose brains are still developing, to not necessarily think critically about the situation, to assess the situation, to see what is possible. So when we do have this natural urge to kind of swoop in and fix the situation, sometimes it actually works against what we're trying to accomplish and to be able to do, to support young people as they're facing these. Challenges from a parental
Gerald Reid 15:01
perspective, that's a really good point. Lex and echoes kind of what Julia and Meredith have been saying. It's like we have to understand our anxiety for what it is. Would you both agree with this idea that part of working with the anxious youth is to try to calibrate what is, what is an appropriate response for particular situations, almost like learning from the experiences that the kid goes through, right? Let's say the kid is being bullied, right? That's a pretty terrible experience that a kid could be anxious about, right? And then part of the parents response, as you're saying, is to fix it, or to soothe or to help, right? And so do you feel like part of the work with the parents is figuring out a plan that they have clarity around okay, this is how I want to approach it. I'm going to stick to that plan, rather than kind of, as you're saying, kind of treat the whole thing as a crisis all the time, or or kind of react so strongly all the time when the kids anxious. But it seems like a lot of your work, and based on, you know, what we did at card and all the you know, work with anxious youth is, is to try to develop clarity for the parents as to, US to here's how to talk to this child. Here's how to keep it simple, and to determine how to either be brave, to work through it, or to problem solve, or to take a step back and regroup and come back. Can you talk a little bit about how you help parents have clarity? Because, as you're saying, when you're anxious yourself as a parent, you just react immediately, rather than react intentionally. So how do you help parents react more intentionally around this?
Meredith Elkins 16:23
I think this always starts with education, and if parents can have the confidence that my child is in distress and this is, this is not dangerous for them, right? They're they're experiencing their emotion, which is a signal that something in their life that they're facing may be dangerous for their life or well being. This has been honed through millennia of evolution and serves a really important function, and if we can help parents to understand why this distressing experience exists in their kids, and to have confidence that it's in and of itself, it is not harmful. Your the feeling itself is not feeling of some it's your The feeling is not actually going to hurt you. You would have to have a pre existing medical condition for the extent to which your heart is beating during an anxious experience to really, really harm you, even though it feels it doesn't feel that way, right? Which is why it's so scary. But if we can help reassure parents that this is their body working the way it should be working if they actually were in danger, but we're in a situation where, you know, we're not facing life threatening danger most of the time, and so your body is having this like ancient alarm that's going off in the context of, you know, by and large, normative stressors. Now, to be clear, there are that doesn't want, I don't want to minimize here when, when there is something really, really, that's an affront to development, that that we should be intervening on paying a lot of attention to or when anxiety has reached a clinical level. But again, this is where Julia helped to distinguish between the behaviors that we do because of anxiety, right the ways that we let anxiety pull us out of our life and kind of erode our opportunities and change our behaviors, which is really where the distress and disability comes, versus the feeling itself. So one is educating parents about that feeling. And I often find it's helpful to ask parents, you know, what is your fear here? If you you know, what are you afraid will happen if you don't intervene, or if your child continues to experience this distress, and this is where we get a whole spectrum of answers, everything from, it just seems insensitive not to respond. It just seems like the bad parent thing to, I don't know. I think they might, like, have a psychotic break, or they might, you know, engage in self injury. And so really, then being able to help the parent identify what is their fear, and then being able to work around the reality of that, do some kind of reality testing, some cognitive work with the parents to say, to be able to assess how normal is this. Is that fear justified? To really validate the fear in the parent, which is prompting them to intervene, but also then kind of to test the reality around that, and then I think you can make a plan for this specific situation. Jules, I'm so curious your thoughts.
Julia Martin Burch 19:27
Yeah, no, you, I think you described that beautifully, and I think that really emphasizing the groundwork that needs to be laid before getting to a plan is so key. You know, I'm I'm also a parent and have a child who can run kind of hot in new situations, like the start of school yesterday in Utah, and my strong urge was to jump in. Okay, I'm an exposure therapist, like, let's do the thing. You know? I know what to do here and and I've learned clinically, but then just through my own parenting process, that if I don't stop and to use the. Clinical term, get my own head on straight before I get to these moments. I'm not able to stick the landing in terms of a plan, and so taking that time to really identify the just the sticky thoughts that get into our heads as parents, as clinicians, as educators, when this kid that we care so much about is having a hard time, it goes a long way. It can feel hard to slow our roll and kind of check in, and that's very important. And so I think doing that, as Meredith said, doing some work around, am I engaging in a thinking trap? You know, I know in the parent coaching I do, I see, and I see this in myself, a lot of catastrophizing, you know, if this day doesn't go well, the whole year is going to be a disaster, and then really pausing in, okay, am I being extreme in my thinking? Is there another way to think about this? Or, you know, my personal favorite thought challenge, if you will, is, can I have this thought and still be the parent I want to be in this moment? Can I follow my values and be values consistent, even while my mind is yammering at me and saying all kinds of scary things? And so I think laying that foundation is really, really key. And for a lot of parents in this is so normal. Sometimes it goes beyond just checking those thoughts. Sometimes it's also putting together your own coping plan. You know, writing on a sticky note. The values are, patience, love, acceptance, you know, whatever your values, North Stars might be having that somewhere where you can see it, taking those, you know, couple slow grounding breaths in the bathroom before you dive into the melee. So really, really laying a strong foundation.
Alexis Reid 21:34
I was gonna jump in. I love how you were just talking about the differences between your thoughts and your feelings. And I think to further operationalize anxiety, you know, I know in CBT, it's a lot about your cognitive reframing. The thoughts that come up when we have these emotions sometimes dictate how the emotions take over in certain situations. And I wonder if we can further extrapolate that a little bit. Because, you know, when I talk to a lot of the people that I work with, it's often, you know, I'm feeling really anxious about this, and I have to help them, you know, pause and check in and say, Is this something that's happening that like you're feeling an intuition that something's off we need to prepare differently, or is this your anxiety kind of taking over and developing in this narrative that might be getting in the way of whatever you're trying to do. Yeah,
Julia Martin Burch 22:22
I think that that's such an important topic, you know. And as we mentioned already, Meredith and I have this particular interest in how culture is interacting and parenting culture, particularly is played out over kind of social media and how we get our advice as parents. And I think that this is something that comes up a lot in that setting about, you know, on one hand, this wonderful idea about, listen to your gut, listen to your intuition, the importance of trusting your emotions, but then also recognizing that feelings are not always. Fact, I think Meredith used the word hijack earlier to describe what anxiety can do. It can really just it hijacks our amygdala, and it rests the controls from us, sometimes in these situations. And so building that practice of noticing, you know, kind of coming back to our basics of cognitive behavioral therapy. What is my feeling? Okay, hard to miss that one. I'm clearly feeling anxious. But also, what is my thought right now? And that thoughts are not necessarily facts, that these are two separate things,
Gerald Reid 23:18
yeah. I mean, I would say the biggest part of doing therapy with anyone is assessment and trying to really dig into understanding what is actually happening. So if you're gonna work with a family in the kid, I mean, my experience, you know, you can work with kids who are anxious is like, you can identify is this anxiety that's indicating that there really is something going on. Like, let's say a kid is highly over stimulated in a certain situation, because they're just a sensitive kid and like, they get dysregulated because there's so much going on, and how can you problem solve around that? Versus the kid is just, you know, it's a new situation. They gotta get used to it. Both things could be true, though, right? They can. You can encourage bravery and to be brave, to continue to do something that you're afraid of, and still problem solve over time. It's kind of like being a therapist. I always tell the therapist in training, when you're sitting with someone, you're not going to help them immediately, like their their whole problem is not going to get solved immediately, right? It's going to take time. And even as a parent, right? If your child, as you're saying, Julie, is going to go to school the first day. Even if there is a problem that the child's afraid of, it's you don't have to pull them away from it to deal with it. They can still go to school, still come back and talk about that problem, but they can still go to school and be brave to not let the anxiety hijack them from continuing their routine. And as we know, with therapy, the more you avoid something, the bigger the problem it gets. It's kind of like the boogeyman under your bed, right? If you don't look to see that it's not there, you're like, Well, you keep thinking about it over and over and over and over again? You avoid going in your room, right? If you avoid going in your room over and over again because you're afraid of the boogeyman, you're going to think there's actually a boogeyman, and it's going to become a bigger, scarier thing just because of your imagination. More you avoid something, you more imagine something, right? If you don't see a friend for a long time, you can imagine they don't like you because you're just imagining things. So, you know, that's. As you're saying, Julia, like, just kind of not catastrophizing that, oh, they're not gonna go to school one day or the next day. Like they'll be okay. They can get through it. And even if there's a legitimate problem, we can deal with it over time. There's no rush. As you said, patience could be a good value.
Meredith Elkins 25:14
I love the I wanna pull on a thread there, because you reminded me why it's so important to always start with validation. So as a parent asking yourself, you know, why does it make sense in the moment that my child is experiencing anxiety right now? So it makes so much sense that on the first day of school a child would be anxious. There's so much unknown, right? What's the classroom gonna be like? Is my teacher gonna like me. Am I going to, you know, know where to go, all of these things, I'm going to be away from mom and dad. It just feels different. There's so much uncertainty. And I know I've spoken with other clinicians about the well meaning attempts of all parents to be like, you're going to have the best day. This is going to be amazing. Everyone's going to love you. You have nothing to worry about. And again, this is, this is one of the prime examples of where trying, well meaning parents can be unintentionally in validation, invalidating
Gerald Reid 26:13
coaches too. The Meredith like coaches will say, Oh, you're going to be the best player on the team. You played so well, you're going to play great next time. You're going to be the best player on every game. And all of a sudden they have this expectation. Like, oh, I can't never make a mistake. It always has to be great. I always have to be happy. I always have to be the best, right? It's
Meredith Elkins 26:29
the hilarious thing well, and it also adds that secondary emotion of shame, because I feel anxious, but everyone's telling me how ridiculous it is for me to be feeling anxious. And so then I think, what's wrong with me, that I feel this way, and so, you know, instead having having your your first response as a parent or as a coach really validate, why does it make sense right now that you'd feel anxious, and that doesn't mean that you need to to, you know, partner with the anxiety and be like, yeah, absolutely like, you're going To be a mess. Everyone's going to think you're the weird kid, like your teacher. I heard they're awful. You don't need to partner with the anxiety, but you can validate the anxiety, and then we can use the skill called a supportive statement, right? So this is a skill that that was has been promoted by Dr Ellie Lebowitz in his space treatment, which I think we'll probably talk about, because it's a parent focused treatment for child anxiety. And he indicates that a supportive statement is a two ingredient skill. The first is acceptance or validation. So it makes so much sense that you feel afraid to go to school today, because you really want this to be a good experience. And there's a lot of unknown. And then rounding it out with a confident statement, something like, and I know you can do hard things, so you have the Mac and the cheese. You can't have one without the other. And this is something, again, this isn't gonna magically make your child not anxious. I really wanna highlight to parents and Julia, I'm sure you do the same thing when you teach the skill is that this is not a magic verbal valium that's going to obliterate your child's anxiety, but it both validates and communicates confidence in your child's abilities, and it becomes a template for your child for how you see them as confident and capable over time. So when parents are looking for what do I do in the moment when my child is expressing anxiety, this is what you can go to, even if you don't have full confidence in yourself. But the validation, plus the confidence and really getting to know the skill and practicing it across situations can be really powerful to help parents, sort of like you said Jules, stick the landing with some in these, some of these hard situations.
Alexis Reid 28:43
I love that you said that a lot of times, when I work with teachers, I often say, I don't expect you to become a psychologist. That's not the goal. But if we can observe some of the behaviors, I always say, very similar to the program and the protocol you were describing. I always say, if you can observe the behaviors, narrate what's happening, validate and then proceed mindfully with the way you respond. It opens up opportunities to build trust, to help them to be more in tune with what's happening around them, inside of them. It's such a beautiful approach to just navigating life in general, especially for young people who are trying to figure this out every
Gerald Reid 29:19
day. Yeah, definitely. Can you both talk about the theoretical understanding of exposure therapy? And I just want to put a disclaimer that I think you know, there are times when kids are really I just want to say this, just to put it out there that there are some times when kids truly have a legitimate problem, and the anxiety is legitimately telling them something because they can't verbalize their problem, because kids sometimes don't have language to express real problems, because they haven't matured enough to say, Hey, this is like something horrible, or maybe they have shame, or maybe there's something really bad that they can't truly verbalize and so so I want to just say that sometimes that in. That case, it's really important to kind of pull back and really understand, you know, if there really is something going on. But that's not always the case, as you're pointing out, right? Not every kid is being, you know, like terribly treated or mistreated or maltreated or being victimized in some way, right? That's not always the case when it is, is important to really try to understand that and help and support, right? Because the kids may not be able to verbalize and sometimes their emotions are the only way they can express it, or their behaviors are acting out, right? Great point, but, and, sorry, not but and, and, so can we talk about how why it's so important to persist through anxiety and to keep those routines through exposure therapy, even though it could feel uncomfortable for the parent and the child from a theoretical standpoint in terms of what the child can learn from the experience, and all those, you know, all those great elements of exposure therapy that we can understand.
Julia Martin Burch 30:51
Sure, well, and Jerry, before we jump into that, I just want to piggyback on your comment about, you know, sometimes kids don't have the words for these things. And I to me, that's actually a really important foundation of exposure therapy as well, because, you know, I know, similarly, I work with trainees, and when people are learning the skill, or it might be in other professions, it can be really tempting to just like, jump in and let's go, you know. And I think that's an awesome attitude to have, but you have to understand what you're working with first, and so really taking the time to assess, like, Okay, I see school avoidance is what's showing up for you. And school avoidance can have so many different functions. There can be so many different things driving school avoidance. You know, it can be everything from i The Academic perfectionism is just making it hard for me to get in the door to I have panic attacks, to social anxiety to perhaps some of what you're alluding to, maybe I'm being bullied, maybe I'm having, like, a really difficult situation that needs a different response. And so I think that kind of assessment at baseline is a really, really key part of working with kids who are presenting with anxious avoidance for exposure therapy. But you know, in terms of what exposure therapy is and why it works. You know, anxiety is hallmark is, again, this is that cave person in us when we are facing something scary, our natural instinct is to avoid it. And so I think perhaps a helpful example that maybe many of us have related to is, you know, some kind of social situation, you know, where it feels uncertain. Maybe it's walking into that classroom the first day of school, or it's going into that birthday party, but feeling some nerves, your body's telling you, uh oh, prepare for action. This is hard, and so the natural response when you're getting those signals from your body is to pull back. And as as Alexis mentioned earlier, a lot of times that's a really helpful thing, right? With uncertainty, kind of pause, check things out. Where it becomes problematic, though, is when that then starts to dictate our behavior, and it becomes a pattern over time, because when we avoid the things that we're afraid of, our brain learns a couple things. So it learns, one, wow, I couldn't handle that. I can't handle feeling anxious. It also learns when I feel anxious, the thing to do is to get out of here consistently, you know. And again, there's nuance here, as we've mentioned, there's times that we want to listen to our brain and to anxiety when it's giving us really important, you know, signal rather than noise, if you will. Or I talk with patients about, you know, is this a junk mail? Is somebody trying to send you, sell you a gold mine? Or is this like, helpful thing about registering for classes, you know, so we have to kind of get good at parsing it. But then the really key thing is, when we avoid we also don't get a chance to learn if we approach our fears that we can handle them and oftentimes, that they're not as bad as we thought that they would be. And so that's the basis that the rationale for exposure therapy, which is, by slowly and gradually, we're not flooding we're not saying kind of dive in the deep end of your fears, but by slowly and gradually approaching our fears, we're essentially rewiring our brain. We're giving it a chance to learn. When I'm scared, I can still stay in the driver's seat, and I can approach this thing that scares me, and when I do that even when it goes wrong, which, frankly, we kind of love clinically when things go wrong sometimes, because then there's really powerful learning that occurs. Kids are really called upon to kind of be resilient and be flexible. But when I'm in the situation, even if something goes wrong, it probably wasn't as bad as I thought it could be. And you know, one of the questions I get most often from parents when I'm doing an initial phone screen, potentially bringing somebody into the practices. You know, I just want my kid to build confidence, to build self esteem. How can I do that? And I'm always so excited to tell them, like it's this, you know, we can't manufacture self esteem in a vacuum. It comes from going and doing the hard thing over and over and over so that you learn deep in your bones. I am a capable kid, like are a college student or an adult, I am capable of managing my fears.
Gerald Reid 34:48
Yeah, certainly. And you know, when we're afraid of something, we can want to control things, to feel better about it, right? To just like, one way of dealing with anxiety is like, let me just control everything. You can even control your parents, right? Yeah, that could be part of it, right, you know. And even thinking a lot and a lot and a lot keep thinking and thinking, and thinking is actually a form of control to deal with that uncomfortable feeling. So to your point, you know, sometimes you have to get out of your head and just do something, because the more you think about it, first of all, it's going to get you probably even more anxious, and you keep thinking these negative thoughts over and over. And then secondly, it's, you know, it's a false sense of control and sometimes obsessive thinking. It can even turn into obsessive compulsive disorder, because the kid just is obsessed with controlling things to deal with what they're feeling, rather than, you know, feeling trust and just taking action and building that confidence through exposure, rather than, you know, you can talk about the reassurance seeking and all the safety behaviors that can go along with that, that could get kind of we can all feed into, maybe mistakenly feed into it, as if it's helping, but it could actually not be helping in some ways, like truly helping someone is really legitimately working through a problem and in a constructive way, and sometimes reassurance, seeking and talking so much about something in a way that's actually not doing anything. It's actually like not helping the problem to get solved or the issue to get resolved, or to the kid to feel better about like, it just kind of, it's like a cycle. So could you talk a little bit more about the kind of the reassurance seeking and the safety behaviors that we can kind of fall into inadvertently?
Meredith Elkins 36:24
I love how you've set up worry as both a symptom of an anxiety disorder and as a as a coping behavior, because it is both and so you know, kids or grown ups will come to our practices and they'll, they'll say, Gosh, I'm just like worrying all the time. I can't control this, and I sort of need to download it in some way, either by speaking with my parent or calling my mom. You know, whether you're an adult or a child, like calling my mom, and it gives us the sense that we were taking some action. We're engaging in some sort of control, to take a step back and kind of do a little stage setting here. You know, Julia talked about how the natural instinct around anxiety is to avoid and how, while that helps in the short term to alleviate our distress, ultimately, it creates learning that we can't handle the situation. So in the in the clinical world, we have a term called accommodation, which is the changes that we as parents make to our own behavior to attempt to alleviate, mitigate our child's distress, or any of our loved ones to stress. And so effectively, accommodation is parent assisted avoidance. So an accommodation might be if your child is anxious about school and you let them skip school, or if your child is struggling with obsessive compulsive disorder around contamination, and so you are spending hours doing extra cleaning around the house so that they're not feeling that distress. And in the context of worries and reassurance seeking, we find that well meaning parent attempts to be here for you to hear all your worries, to get your processing out and help you make sense of it, that can actually function and the same way, as, you know, behavioral avoidance for the kid, in so far as it helps in the short term, the kid feels better when they're seeking reassurance. Getting a lot of it's gonna be okay, you know. Let's talk about, you know, who could you sit with tomorrow? Let's problem solve around this. And sometimes that's helpful, but it's kind of like just, you know, feeding the begging dog at the table. You're giving them the scraps, and they feel better, but they're going to come back. And so it ends up actually maintaining the cycle. So a really hard challenge for parents is like, how do you find the balance between my child is coming to me saying, I want to, like, download all my worries, but you recognize that this is fueling the cycle of anxiety. So how do you pull back in an effective way? And I think this is where there's no one size fits all solution, right? And anyone tells you that there's a parenting hack for this is selling something because it really needs to be considered in conjunction, you know, with your child, with your, you know, with your partner, and potentially with a therapist. Of how do we start to pull back on this reassurance seeking, so that the child isn't completely under supported, but also isn't over fragilized? I think
Gerald Reid 39:33
a good way to for parents to check in with what what it is, because what you're saying is like, what is this? Is this like, constructive problem solving, or is this avoidance is sometimes I'll hear parents say, like, I'm just exhausted talking about this, like, I just like, it's over and over and over. It's the same thing. They keep saying the same thing, right? Rather than it being kind of a real conversation, or even like, the child is not actually looking for ways to solve their problem. They're just maybe being argumentative about it. Or. Just like saying, Oh, you don't understand, right? There's stuck points. And the parent is like, well, I'm literally trying my best. I'm being loving and helpful, and it's not working. That could be a good kind of, you know, Telltale that this might be, like, just ruminative anxiety.
Meredith Elkins 40:13
I think that that's so key. And actually, as a parent, asking yourself, you know, is this behavior? Is the worry getting better or worse despite my help. So in addition to the parent's own like exhaustion with the child's behavior, what is it actually functionally achieving? Is the child getting more and more capable at handling these worries, or are they becoming more and more dependent on the parent as a font for their worries?
Alexis Reid 40:38
One of my favorite questions to ask from the educational psychology world is mostly from Universal Design for Learning, from a learning perspective, but also it plays a role in everything we do. Is to take a step back and just question, you know, what is actually the goal here? And what is the goal of what's happening in the conversation? What is the goal and function of the behavior? And what's my goal in this situation? Because it is so contextual, even when you figure out the right ingredients or the right recipe in one situation, another situation might negate what had worked before. And maybe we need to be a little bit more creative in the next situation to figure out what's needed there too.
Julia Martin Burch 41:19
And I'm so glad that you brought up the educational world as well, because I was just thinking, you know, a good portion of my practice is doing consultation with schools, and this is something that I talk about a lot with school mental health staff and school counselors where, you know, kids are coming down to their office in distress, and it's just one event, as Do we all right, when something's upsetting, I was like, it feels good. I think there is some research that it tends to be less regulating in the long term to be venting. Don't quote me exactly. I don't have my citation, but I you know, but it feels good, right? It feels good to vent. And so, you know, one thing that I talk with school mental health staff about is exactly this. How do we find that balance between making space for the fact that, yes, you're upset, but then also working in this context of perhaps kids have been socialized to hey, I go to the counselor, and I vent, vent, vent, and then I go back to class. And how do we start to nudge them over to okay, I can express my feelings. But also, how do I use this space in a really effective way to get me back to my job in the school building, which is being a student and participating to the best of my ability in class? And so I think this is actually where I often coach folks to circle back to that supportive statement for having you know I hear how upset you are and and I know you can handle it or, and how can I be helpful to you in this moment, you know? And I've got a lot of with a lot of school mental health staff who will kind of create menus where it's a forced choice for kids, for I can listen. I'm going to set a timer, though, for three minutes, I can listen and bend, and you'll return to class. We can do a skill together, you know, or I can give you space to draw or use your own skill for three minutes, but, but putting some bumpers around the reassurance seeking, especially in an environment where there's not endless time there's a line of other students waiting to see you can be a useful thing to consider.
Alexis Reid 43:15
I love that idea of a choice board, you know. I'm thinking about DBT and thinking about, you know, what do you actually need here? Do you want me to just listen? Do you want validation? Or do you want to help problem solving? And you know, especially from an educational perspective, like you said, Julia, there's not always enough time to really go into everything for every individual. But it doesn't mean that we just let one behavior happen over and over again. It's really about teaching these skills of emotional regulation.
Gerald Reid 43:41
Yeah, you know, it makes me think that in society, we're always kind of rushing around. Now we have all these expectations. And it almost feels like if we were to say, like, what is the goal here? What are you trying to help parents or kids with or schools with? Let's create a space to process so that you have that space to process, and let's also continue to encourage, kind of working through the challenges and not avoiding them. Or because I think one of the things that happens is, like, if kids don't actually process, they kind of just do this venting as like a substitute for really processing things that they have to process or assessing. Right? So, for instance, like, if an adolescent is has so many expectations, they're in sports, they're at the high achieving school. They're they're constantly working at three hours of homework every day. They have no downtime, right? If that kid's not able to articulate that they're just burnt out, they're going to get anxious, but they're not going to say, I'm burnt out, because they're a kid. They don't even know what burnout means, right? So if we can have a space to say, hey, let's regroup and process and assess what this kid needs. And as you said, Julia, let's create a menu based on what those needs are, so that when you can, you know, take space to process, you can say, Okay, this is what I need. You can't really know what someone needs until you have that space to process and assess. Like, even a kid who, like, wants this, like, I'm thinking of a kid who, at nighttime, right, is like, doesn't want to. You their parents. It could be as simple as they have no quality time with their parents because their parents are busy and staying in the bed of their parents and saying, No, I don't want to sleep by myself. I'm scared that might actually be they just want to spend quality time when their parent is relaxed and not stressed out of their mind, because they're actually relaxed at nighttime. And so like to really assess that and then give a menu. So when the kid comes to you say, Oh, is this what you need? Oh, let's, like, literally, just do that, rather than the kid just obsessing over something, which is just a substitute for, like, dealing with something. And so I love the idea of the menu. And the menu comes from assessment of understanding the person and taking time to understand the person to then have the menu, and then you can, kind of, you know, make things more streamlined, rather than, as we're saying, Get lost in this obsession and rumination venting that is really not doing much, right? It might be a substitute for something else. Yeah, you
Julia Martin Burch 45:51
know, one of the things I find so interesting in parent coaching is, I've had a number of families over the years, you know, who have who've done treatment before, and they're kind of coming back because their kids maybe move from middle to high school, and small behaviors are popping up. And as I start to review, you know, assessment and psycho Ed, it's, it's funny. I've had many parents go, oh, wait, wait, we know this, you know, like, hang on. I can even find my notes from, you know, 2021 where we learn this thing. And I mentioned that because I think so often in these stressful moments, we have this sense of, I need to reinvent the wheel. You know, no matter what setting we're in, like this kid, this student, this athlete, is in distress in front of me, act and by taking that time to kind of slow down. And I'm a big fan of, like, writing out a menu. I have the families. They have them, laminate it and keep one in the kitchen, put it on the fridge, so that everybody kind of knows.
Gerald Reid 46:39
Alexis loves that as an executive function coach, yes,
Julia Martin Burch 46:43
because I mean, my goodness, when, when we are in high distress, it's really, really hard to access that the information we learned in 2021 you know, so kind of keeping it there and accessible, I think, is often like half the battle. It's amazing to me how often, I mean in my own life as well, like the low hanging fruit is what actually gets the job done. It's often not fancy thing.
Meredith Elkins 47:05
And I think that that really highlights how this discussion, the techniques that we're talking about, the solutions that we're proposing this really can can serve both kids or parents struggling with clinical anxiety disorders, as well as those who are not but are just coping with day to day stressors. And you know, both exposure work, reducing parental accommodation, building independence, these are all things that have meaningful contributions to well being, regardless of whether they're applied in kind of an acute clinical moment or in day to day life. And so going back to the the importance of educating parents about some of this as a baseline, that anxiety is normal, natural and harmless, that it's the behaviors that we fall into that take us out of our lives and let anxiety, put anxiety in the driver's seat. Those are the things that we want to attend to, and that by pushing back against the anxiety, pushing back against the urge to avoid that's really where we find the strength and where we build resilience. This is kind of a mindset shift, and so I encourage parents and educators, you know, not just to sit down with the kid at one point and say, you know, we gotta face your fears, and this is how we do these things, but to integrate it into conversation over time. So identifying when you see a kid behaving bravely, doing something new, engaging in something you know that that makes you proud of them, that makes them proud of themselves, pointing it out and using some of that processing by asking them, you know, how are you able to do that? I know that was something really hard that contributes to their sense of themselves, like Julia was saying, building the self confidence from data from your past experience, and that becomes part of their story about themselves. And so you know, just for the folks who are listening, this doesn't just apply. If you're in an acute clinical crisis, you can start doing this with your with your kids, with yourself, with your partner at any point, and there's real value to
Alexis Reid 49:19
it. First of all, excellent summary. And second of all, I'm so glad you brought that up, because I think I teach a child development course, and oftentimes people think that children are just small adults, right? And I'm frequently reminding folks, educators and parents alike, that, you know, a lot of the young people we're thinking about just haven't had the experiences yet that we have had as adults, for perspective, for perspective, to understand that sometimes things aren't as big, as scary, as detrimental as they might immediately or impulsively think in a moment, that sometimes we need to pull back and slow things down as the adults in the room to help. Do all the things you just described and and to put all those pieces together. I'm so glad you brought that up again, because I think it's really important for us to remember from a developmental perspective, this also kind of makes sense a lot of times when we see some of these behaviors pop up in all different scenarios and levels of significance,
Gerald Reid 50:20
yeah, and if you don't do that, right, if you kind of fall into too much avoidance, the unfortunate consequence is actually turning into depression, which could become a whole nother obstacle mental health wise, right? If you continue to avoid something, you lose self esteem, as you're saying, you lose your confidence, you lose a sense of self you're not doing things that are important to you, right? As you get older, you really want to do things that are meaningful and important to you, as you said, your values and and if you're too afraid to try, you're never going to, really, honestly never, but it's harder to actually live a fulfilling life where you're doing things that are important to you, right? Like, who would have thought that I'd be making music? It's really important to me, and I feel very passionate about it. Obviously I had, like, feel like this is genuine to who I am. It's coming from my heart, my soul. I'm doing it because it's just genuine. And if I was too afraid, if I had too much anxiety, and let that anxiety stop me from pursuing doing something that's meaningful to me, I would never done it. And so what I'm saying here is that, you know, you can fall into a pattern of avoidance unintentionally, and it can have a downstream effect of not only more avoidance down the road, but also a lack of self esteem, a lack of authenticity to yourself, a lack of and even depression, because it can create loneliness. And loneliness is very, very hard to deal with. It's, it's probably one of the hardest things mental health wise, right? You can have hard challenges in life, but if you're not lonely, you can maybe get through it. If you're lonely, because you're avoiding everything and everyone, and you know, That's a thing that's a bad that's not a good spot to be in, right? So what you've got, what you all are saying in bringing this up, is really important, because it's important to empower people, and that's a really good way to naturally buffer against this kind of spiraling of depression.
Julia Martin Burch 52:13
And you know, we've been talking today about kind of this, the continuum of typical normative anxiety onto clinical anxiety. And this, this conversation just makes me think about, you know, if you're listening and you or the kids in your life, you know, are not experiencing like clinically significant anxiety, but if you're human, and there are things that are hard for you, or things that you know, if you're noticing, kind of like you were saying Jerry, areas where you're just feeling less connected, or things like that, one a newer approach that Meredith and my colleague has been working on is this idea of looking for opportunities to basically push your boundaries in different areas. And he's calling it independence focused therapy. But this, the idea is that, you know, for it's kid focused, but I think it works for everybody, is to pick something that might be a little bit newer to you, that you haven't done on your own before. You know, he's got this great clinical example of a child riding the bus into New York City from Long Island, where his clinic is based. But just how these opportunities to kind of push at your edges a little bit and do things that are important to you. Like, you know, Jerry, I would imagine song, or I've never written a song that makes me feel very anxious. I don't feel very motivated to do it. But for you, you feel very, you know, it's this thing that's important to you, just like for this kid riding the train, and how when we push at our boundaries, things that we genuinely want to do, how we can grow and how that can have trickle down effects. And, you know, I know he's still collecting data, but they've been finding, just with these initial studies, that actually, if you bring in kids with more clinically significant anxiety and have them do these growth edge tasks where they're practicing doing things that are hard with independence, it actually seems to help improve their anxiety as well. So I just wanted to mention that, because that's kind of a whole other area that parents, educators, coaches can help to create more resilient kids, to help them or to encourage them to do things that they've always wanted to do, but perhaps, you know, there's always been an adult there, or they've always been supervised, giving them a little bit more agency. I love that
Gerald Reid 54:16
real quick, and I just want to echo what Meredith is saying in relation to that. Is that, is that. And then the parents don't have to be necessarily involved in it, but they can celebrate the bravery and the growth, right? And that is the reinforcement that can kind of create that upward
Meredith Elkins 54:29
spiral. Absolutely, I'm so glad you mentioned Dr Ortiz's work. He's at Long Island University and developing this independence focused therapy, and Julia and I have had the opportunity to do some speaking engagements with him. It's really, really interesting work, and I think so resonant right now, particularly because as part of the broader conversation about the epidemic of child anxiety, you know John height, in addition to indicating how, how deeply challenging our social media landscape for kids can be. He highlights that one of the main reasons that this is so problematic is because it's led to this loss of child independence, independent mobility, kind of independent play. And so I feel like there's so many Venn diagrams here of the reasons why child anxiety is increasing the role that you know, the adults in their lives can play, both to, you know, to empower them to be more resilient, or to unwittingly handicap them by by by jumping in, by over soothing, by minimizing independence, because, oh my gosh, the playground is a death trap, not a fun outing, right? And so so so much of the Independence focused therapy has to include partnering with the parent to say, Well, what's it going to be like for you when your kid walks to the bus stop by themselves, or when you your college student deactivates their GPS so you can't see where they are anymore. What's that going to be like for you? What are the beliefs that come up for you, what are the urges to behave in certain ways that are going to come up for you, and then to come up with a plan around that?
Gerald Reid 56:07
That's great, and also, real quick that I'm going to echo what you both have been talking about, is that with social media, that's such a great point about how it prevents independence and autonomy to kind of go and explore it, which is a great part of development. Also for parents, if they're on social media, as you said, we had Dr Ellen Hendrickson talk about perfectionism here, and she's like, you know, social media tells you, how do you have to do everything perfectly, right? Everything's like, you have to be the perfect Baker of The Perfect cupcake, of the perfect dinner outing for your for your perfect friends, right? Everything is, like, kind of well curated. And so for parents, I think, like, oh, I have to be the perfect parent. Not only that, they're embarrassed, perhaps because, you know, child under stresses could be embarrassing for the parent. Oh, my God, my child's under stress. What's wrong with me as a parent, I don't want my kid to seem, you know, something's wrong with them, and then everything is kind of blown up now, because everything is social media. You feel like someone's videotaping it, or something like that. It's like, it's not just a moment in time. It's like, oh my god, like everyone's gonna remember this, right? Versus like it's just a moment in time, let's work through it. And so to your you know, it's so important, as you said, to work with parents, to help them to relieve their own anxiety and their perfectionism around being a parent, and to kind of let things kind of work through it themselves. I think that's
Alexis Reid 57:19
so important, and from a behavioral perspective, when learners or students or individuals in general are struggling to accomplish a goal, that oftentimes there might actually be a skill challenge, right, especially from an executive function neurodevelopmental perspective, if these skills haven't been developed yet, if it isn't developmentally appropriate for, you know, a five year old to be reading at a third grade level, right? Sometimes there's an expectation that some of these skills should be more developed than they might be presenting for a child. That increases anxiety for families and children alike, versus pulling it back and saying, if this is our goal, if this is what we're working towards, what actually are the skills we need to develop to be able to get there, to be able to pull back and break things down into smaller parts to see what the trajectory is, instead of thinking about, Okay, here's where I am. This is what I want to accomplish. What's the process in between that I think, especially with social media, we see the end goal. We see this like miraculous, beautiful, perfect thing, rather than seeing what the steps and phases are. And I say this a lot with learners, that they look at their teacher or their parents thinking things just magically happen, instead of understanding the process, which often, like, a lot of anxiety bubbles up around. How can I possibly do this?
Gerald Reid 58:45
Yeah, it's kind of like the flow chart or the zone of proximal development by Zygotzksy, which is, like, you don't want to challenge someone way too much that they're just like, this is way too much of a challenge. But you also want to under challenge a kid, because you're robbing them of their independence, as you're saying, to try something. So Lex, it's such a great way you're putting it, kind of like, I'm visualizing that chart, right? You know what? You want to have appropriate challenges and help the child to challenge, to push themselves. I'm thinking of a picture I just saw when I was a kid, and I built this awesome tree house with my friend Jonathan. Like, we just built a tree house because we wanted to. We were kids, like, and it was like, super fun, right? And that was like, a challenge that we just independently took on. And we weren't posting to social media. We weren't like, using AI to make it look like a castle, right? We were just, like, appreciating it for what it was, and we challenged ourselves to go and be independent. But yeah, Lex, I think that the appropriate challenge, right? And sometimes I think parents may push too much or push too little, right? Yeah, sometimes parents could have too high expectations. Like, you need to, you know, be in like, you know, like, a high, like, five levels higher of Russian math, or, like, you have to be the best figure skater in the world, where you have to, like, meet these expectations. And that's just crippling anxiety. That's not appropriate anxiety. That's like, you're putting too much expectation, which is too much. Much you also want you don't want to put too low. So from a practical standpoint, that's kind of a good visual. I think
Alexis Reid 1:00:05
I love a good Vygotsky and reference, and I it goes back to what Meredith was saying about education, right? What are our expectations that are reasonable in the lives of especially children and parents for that month, for that
Julia Martin Burch 1:00:19
totally Well, I'm so glad we're talking about this, especially that last point you just made, Jerry, because I think there's this very natural tendency, and this is one of those cognitive distortions, or thinking traps that we mentioned earlier, to get very all or nothing right, or black and white when we're thinking particularly about something we really care about, like the kids in our lives. And this idea of like, okay, you know, five levels above Russian math. Or, you know, we're in a place of despair. And then where I see this clinically, and I know Meredith, you do as well, is particularly as we're getting into the adolescent and young adult years, and kids are kind of preparing to launch. And these things that, you know, seem simple to us as adults, or, I don't know, maybe not simply, you should see my laundry room, but things like, you know, doing doing laundry, like meal planning, getting groceries, those are learned skills, yes. And I think this is, this is kind of where, to me all these different topics, you know, achievement, parental accommodation and involvement, anxiety, where they all kind of intersect here, because I've worked with so many families over the years with, you know, the most truly, the most loving of intentions, where their kids are in, you know, a very high performing school. They're doing a sport at a very high level. They're taking all these APs. There's so much enrichment happening. And the parents, understandably so, I can imagine saying the same thing in their shoes say, you know, they've just, they've got too much going on for me to really ask them to kind of be doing dinner, doing groceries, even, like taking the time to get their driver's license, like this is not the time, and not always, because I don't want to be black and white about this as well, but, but I see many kids who then really struggle and Flounder when they're in college, you know, And they've achieved, they've done the things, and they've gotten into this incredible school, but some of those basics that I think, give you that self of self self, a sense of self efficacy and self confidence that we've been talking about, the sense that I am a capable, independent person, they haven't had a chance to practice that. And so, you know, I think when we're thinking about preventative measures, that parents, but also educators and coaches, anybody in a kid's life can take it's really it's stepping back and it's giving your kid the chance to get a little messy and struggle again. I you know, my kids went back to school yesterday, and I loved they gave us a parent packet that said, Don't fill your kids water bottle for them. Like ask the kid to put on their own shoes,
Alexis Reid 1:02:41
because he's so happy to hear
Julia Martin Burch 1:02:44
they don't magically get filled. You know, you have, at some point, you have to start filling your kids water, or your kid has to start filling their own water
Meredith Elkins 1:02:50
bottle. And I think it's so important for us to kind of take a step back and acknowledge how hard it is to be a parent. And I think what society has sort of served up for parents in our intensive parenting culture is just beyond grueling. And I think it's driven by, you know what, what some sociologists have called parental determinism, which is that parents are seen as the primary architect of their child's success. And so at any point, it's this, it's this inherently anxiety laden topic, right? At at any point, you could be making a decision at a parent as a parent that is going to, you know, either help your child to flourish, or that's going to condemn them to a life of like psychological floundering. And the stakes feel so high right now. And so of course, parents are going to feel anxious. And actually, the surgeon general last year highlighted our culture, our Western culture, of intensive parenting, as one of the five key contributors to worsening parental health. So you know, I know I feel this myself as a parent of constantly judging like the goat rodeo of a household that I feel like I have and like what that's gonna you know, how is that gonna lead to thriving versus floundering in my kid? Even when I know better, I feel like I should know better than to judge myself like this. But this is the waters in which we're swimming. Julia and I, this is like our soapbox topic, and we could talk about this for hours, but in the spirit of self validation for parents, of how hard it is to know what to do these days. And really, I think what we advocate for is a middle path approach. So we want to try to avoid those extremes of either over parenting or under supporting, over fragilizing or, you know, just saying, Get your skates on and looking for, you know, looking for balance in your response,
Gerald Reid 1:04:52
right? You know, the the other extreme would be, you know, they gotta, they gotta figure it out themselves. And I'm not gonna, I'm gonna have. Hands off and literally do nothing, which sometimes parents, when they have their own kind of challenges, they don't have the capacity to put the energy in, and that's kind of their own coping is like, I just got to put my hands up because I don't have the emotional support. And they may need their own therapy in that way to kind of work through their own stuff. But that report from the Surgeon General, I believe it said that the parenting stress over the past three years is that the highest it's been in a very, very long time, like, parental stress is rated at, like, a very high level. And it can't just be,
Meredith Elkins 1:05:28
you know, attributed to pandemic stress. That's something that's really important.
Julia Martin Burch 1:05:59
I wanted to just add on the idea of parental determinism. Meredith, I'm so glad you brought that up, because I think it's, you know, kind of this, like academic egg heady term that you know, you and I only ran into, like, a year or two ago, even though we spent so much time thinking about this stuff and just to for anybody listening, you know, in addition to the parental validation of like, it's hard, it's hard to be a parent, it's hard to be an educator, it's hard, it's hard to be working with youth in the in 2025 and in this major kind of mental health crisis that our young people are experiencing. But then also, coming back to our CBT skills, to really check the facts here that this idea of parental determinism, that your kids, you know, outcomes and well being are going to rise and fall with you nailing this specific script that you got told to say on Instagram, we're calling Baloney, right? Like it's just, it's nothing. Is that black and white? You know, of course, parents have a big, a tremendous influence on their kids. And you know, we can talk about what the research says about effective parenting and things like that, but, but just for anybody listening to also, take a deep breath and know that if you ascribe to this idea of, like, wow, you know, I have to say it exactly right. I have to enrich in these ways, like, whatever the thing is for you, that kind of keeps you up at night ruminating about if you're a good enough parent, that is a cultural construct. If up Western culture in this particular time we're living in, it evolved out of this bigger picture, intensive parenting that's been happening for a couple decades now. And you can choose if you ascribe to that or not. And so if you notice these thoughts about, like, you know, I think the definition from Sharon Hayes, who coined the term, you know, she talks about parents having a God, like, impact on their kids. And when you find yourself as, I know, I do as many parents do, getting caught up in these ideas of, like, oh my gosh, I really, I blew it when I said X, Y and Z, pausing and remembering, it's not all or nothing. There's a middle path. I'm doing my best, and there are so many other influences in my kid's life. It's not just me. There's the educators and the coaches and the peers and the neighbors. So many people are helping to grow this kid and just give yourself permission to exhale in those tough moments. Yeah,
Gerald Reid 1:08:16
kind of like understanding your role like and having role clarity. It's really good part about these sports teams too as a metaphor, right? If everyone kind of knows their role and facilitates that in the best way they can, and to use the term, you just use the good enough parent. That's Dr Winnicott, who's an old psychodynamic therapist, would say that you just focus on being good enough as a parent, rather than this perfection idea. Such a great, great points that you're all bringing up. I have one more question. As we kind of get to the end of the episode, how about including both parents? If there are two parents involved in terms of this type of treatment, how often do you feel like that comes to play where both parents are involved? I'm thinking of some parents, and I often try my best to bring both parents in so they can kind of hash out their their differences of opinion, like one parent might say, Oh, we just got to push the kid and just keep them going. I did it myself. They're the parents more maybe be more sensitive, like, Oh, we got to try to help and understand better, right? And for me, it's again, that middle ground that you said, Okay, maybe both of you are saying something that has truth to it. Let's find a middle ground, a common ground, and and work with it. So it may not always be the case that both parents are involved if there are two parents, as I said, But how often can you maybe just make a comment on the involvement of two parents being involved in this type of treatment? If there are two parents
Meredith Elkins 1:09:33
involved in kids life? I think in the ideal circumstances, the folks who are most heavily involved in the caregiving roles, you know, we'd love them to be involved. Emily Oster, you know, who's an economist, not a not a psychologist, but in Her most recent book, or actually, I don't know if it's her most recent, has a suggestion called Creating a family mission statement, which I really love. And it's basically Claire. Identifying your values as a family. And I think that this can be a useful exercise clinically as well with parents. So, you know, what are? What do we similar to what you were talking about with goal setting in education settings, you know, what do we actually want here? What do we value? And I think that parents can often unite in coming up with shared values around parenting, particularly in the context of a mental health concern like this, is what we want to see in our kid. And then it's a question of, you know, how do we both think that we should get there? Are there differences here? And then, what has what's what have we tried? What's working, what's not working? So, but I think if you can't identify what your core mission is or your core values are, you're going to be necessarily in a debate situation, so coming together and having the same noble intention as a great starting place, and not just for parents, but aligning, if we have a team meeting that includes educators as well other outpatient providers who are involved in the child's care, and being able to align in a values based way can then help direct, direct the actual intervention steps.
Gerald Reid 1:11:11
Well said, Julie, have a comment on
Julia Martin Burch 1:11:13
it? No, I just agree that I think values are, you know, we think of them as our North Star in treatment, and as long as you are aiming towards those values, of course, you still have to fill in, you know, the and buts and auras and what an actual plan looks like, but, but it really can sidestep some of the, I think, the tension that you're alluding to, maybe Jerry, where there's people coming in with different life experiences and different ideas about how to get where we want to go. And often emotions are really high because it's so painful and hard to see our kids struggle. There's a metaphor from Acceptance and Commitment Therapy or act where, you know, they talk about the values being like the horizon and you're in your boat. And when I do parent coaching, we talk about, okay, you, the two of you, these partners are in the boat, and we're trying to follow these buoys to the horizon. And that the buoys are, you know, kind of, these are the steps in the plan. And when you're kind of CO constructing, like, Okay, what's our next buoy? What's our middle path here, you think we should come in really hard, you know, get your skates on. And I think that we should go a little bit more soft, because they're having a hard time. And, like, what is this shared buoy? Because we know we're aiming for the same horizon, and if we go sailing off in different directions, like we're not ending up at the same place. I think it comes back to shared values and really defining it. I have a family mission statement on my fridge over there, where you write it down so you can come back every day.
Meredith Elkins 1:12:33
And I think that that, you know, recognizing that polarization, going to extremes in any capacity, is unlikely to be successful. I mean, we see that in our politics. We see that in our households. We see that in the ways that we interact with with one another as humans, and so being able to kind of identify, are we sort of ping ponging between extremes? Are we going toward the nurturing, sort of over parenting side, and then feeling so frustrated because that's not working? And so then it's fine. I throw up my hands. You do it yourself. And so then how can we recognize, okay, these are the red flags that we're becoming we're operating in in a polarized way. And can we pull back to the middle, just like Julia was saying, and find a find a middle path approach to
Gerald Reid 1:13:16
this? Yeah, and to echo Alexis with with her approach to learning and helping people to learn. It's all a learning experience. What you're what you both are saying, is, learn from experience. And that's also what exposure therapy is. You do something hard, you learn from it, you adjust, you keep you know, you figure it out. So, as you said, you know, Julia, your your company is called do what works. You know, part the idea behind that, from what I would gather, is that, you know, comes from DBT do what works is that you can learn from the experiences and say, Oh, I don't have an ego here. I don't need to have an ego. Let's just figure out what's gonna work and be open minded to it, you know, and to try.
Alexis Reid 1:13:51
And I love the boat reference that you just made, Julia, it reminds me of Scott Barry Kaufman actually took the work of Maslow and translated it from the marketing perspective of a pyramid that you need to reach one level to the next and turn it into a sailboat, and thinking from like a familial perspective that sometimes, you know we might take the sails as the adults in the lives of the children, but sometimes it's okay for them to take control of the sails or the rudder or the path or The direction, but we chart and map that path together. And to remember going back to what Jerry said at the beginning, too. We can't always control the turbulence or calmness of the waters, but we can figure out a way to collaborate, collaboratively, work together, to navigate the storms, the weather, the waters, right? The big anxiety metaphors. We can't control the waves, but we can learn how to surf them, or we can learn how to sail them. And I love kind of bringing it all together and remembering from a very humanistic perspective, as you all have discussed and described today, if we pull back and remember that we're all on a journey together, and even though we are in it together, our journey. Might look and feel a little different at different parts of our lives, and that's okay, and that we're all trying to figure it out together. And there's these great resources in all of the different mental health approaches and psychological approaches to support the process and to support one another, but sometimes we can just take a step back and listen and learn and get in tune with ourselves, to figure out what the best approach is to move forward.
Gerald Reid 1:15:24
Yeah, such a great summary. Lex, we're all in this boat together, the Zach Brown song, same boat, you know. And real quick question, Julia and Meredith, did you grow up roller skating? You kept using the phrase, get on your skates. I'm like skates.
Julia Martin Burch 1:15:43
I learned that one from there, which Meredith I thought was like a New England hockey thing. Where did you hit me? Now I didn't
Meredith Elkins 1:15:49
even because I didn't grow up in New England. I don't know. I feel my father is from the Deep South, and I feel like there are sometimes these, these metaphors that escape. And I can't imagine that Mississippi is talking about putting on ice skates very much. But, yeah, get your skates on always seemed like kind of like, buckle up buttercup or something, something along those lines.
Julia Martin Burch 1:16:10
Another one I've got from you, Mayor
Gerald Reid 1:16:13
That's great. Well, look, both things could be true at the same time. To take from DBT, sometimes you gotta push and give a push. Sometimes you gotta pull back and understand and if not either or both, things could be depending on the context and the situation. That's why it's really good work with therapists, if you can hash these things out, gain some clarity, do a good assessment about what's going on, and support the parents along the way and to help them with building independence, confidence, building some approach, behaviors, problem solving, if it's needed, and understanding how anxiety manifests. Because, as you said, anxiety can confuse us. Anxiety can make our minds messy, disorganize us. Alexis, you see this all the time with learning. Once you get anxious, your mind is not clear. You're not thinking clearly. And we have to find a way to have inner peace, to have clarity and to figure out, okay, what makes sense right now to maybe they need a push. Let's give them push. Maybe I need to calm myself down and model calmness for the child, and to do what it takes to help them to get over the hump right, or to be patient, whatever it is. But mental clarity is important, so let's all kind of like you said, Lex, we started the episode, taking a deep breath together, find our center, find some inner peace and make a plan to see what can work and that that plan may adapt and adjust over time. But this has been such a great episode. I'm so happy to have you. I love chatting with you both, and you have such a wealth of experience and knowledge and just such a great way of explaining things so clearly and so helpfully so.
Alexis Reid 1:17:39
And I hope we have a part two, because I feel like we can continue on. I have more questions that are coming up that I know would be helpful for us to discuss here, but we're just so grateful for all the work that you both are doing and sharing your perspective and your experiences. Thank you so much for joining us.
Meredith Elkins 1:17:53
We're delighted to be here. Thank you so much. Thank you for having us. Thank
Gerald Reid 1:17:57
you, and watch out for those cognitive traps you it.
Gerald Reid 1:18:05
Thanks for tuning in to the Reid Connect-ED Podcast. Please remember that this is a podcast intended to educate and share ideas, but it is not a substitute for professional care that may be beneficial to you at different points of your life.
If you are in need of support please contact your primary care physician, local hospital, educational institution or support staff at your place of employment to seek out referrals for what may be most helpful for you. Ideas shared here have been shaped by many years of training, incredible mentors, research theory, evidence based practices and our work with individuals over the years, but it's not intended to represent opinions of those we work with or who we are affiliated with. The Reid Connect-ED Podcast is hosted by siblings Alexis Reid and Dr Gerald Reid. Original music is written and recorded by Gerald Reid (www.Jerapy.com). Editing and recording was done by Cyber Sound Studios. If you want to follow along on this journey with us, the Reid Connect-ED Podcast will be releasing new episodes every two weeks each season, so please subscribe for updates and notifications.
Feel free to also follow us on Instagram at ReidConnectedPodcast that's Reid Connect Ed Podcast and Twitter at ReidConnectEd. We are grateful for you joining us and look forward to future episodes. In the meanwhile, be curious, be open and be well.
In this episode, Gerald and Alexis sit down to chat with child psychologists who have expertise in parenting anxiety youth - Dr. Meredith Elkins and Dr. Julia Martin Burch. Anxiety has been a term used more often than ever in the past few decades, with mental health awareness making large strides. However, at the same time, youth mental health has actually declined during this time. It has been argued that psychological and social interventions need to be at the forefront of supporting youth’s mental health. In our discussion, we address topics like what contributes to anxiety coming about in the first place, how anxiety gets maintained, communication patterns, parental concerns about whether to encourage bravery versus accommodating avoidance, problem-solving, societal pressures faced by parents, and much more.
Dr. Meredith Elkins is a clinical psychologist specializing in the research and treatment of anxiety and related disorders in children, adolescents, and parents. She is a faculty member at Harvard Medical School and Co-Program Director of the McLean Anxiety Mastery Program at McLean Hospital, an intensive outpatient program for anxious youth. She also maintains a private practice focused on anxiety in new and expectant mothers and in parents navigating the challenges of raising children. Her work is grounded in the conviction that supporting parents is essential to helping children thrive.
Julia Martin Burch, PhD is a clinical child psychologist and founder and director of Do What Works, a group practice based in Boston (and also providing virtual therapies in other states) dedicated to providing evidence-based therapy to young people and their families. She specializes in the cognitive behavioral treatment of anxiety, obsessive compulsive, and related disorders. Dr. Martin Burch is also passionate about disseminating the effective techniques she uses in therapy with the lay community through workshops and consultation with schools, pediatric practices, parent groups, and camps. She is a frequent contributor to outlets such as Harvard Health and the American Psychological Association.
Be curious. Be Open. Be well.
The ReidConnect-Ed Podcast is hosted by Siblings Alexis Reid and Dr. Gerald Reid, produced by and original music is written and recorded by www.Jerapy.com
*Please note that different practitioners may have different opinions- this is our perspective and is intended to educate you on what may be possible.
