S3 E3: Caregiver Involvement in Psychotherapy w/ Dr. David Langer
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Dr. Langer's research, in collaboration with students and colleagues, explores the efficacy and effectiveness of psychosocial treatments for youth psychopathology and the processes through which psychosocial treatments work. With funding from the National Institute of Mental Health, he is currently developing novel approaches to personalize psychosocial treatments for youth by supporting active collaboration between clinicians and families throughout the treatment planning process (i.e., shared decision-making). Of the many practices and processes to investigate, focusing on treatment planning is highly promising because: 1) the treatment planning process is relevant across disorders and other presenting problems across the lifespan, and 2) improved treatment planning provides an opportunity, at the start of treatment, to address treatment-related issues which have been important to the field of clinical child and adolescent psychology for decades (e.g., utilization of evidence-based treatments, patient engagement in clinical services).
ABCT, Association for behavioral and cognitive therapies
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Getting your child set up with therapy may not feel like a straightforward process. It can help to gain information about what therapy is and how it might help your child and support your family.
Youth mental health has been in "crisis" for the past few decades. Challenges that are both unique to youth and also seen across development in society.
Youth can certainly be resilient; however, it's important that we all find ways to help and support youth to stabilize and improve their mental health.
Covid made mental health worse but the issues have been present much before Covid.
The stigma of mental health has been reduced over the years.
There can be a lot of ways to support mental health of a child. It helps in therapy to identify aspects that impact a child and then determine aspects you can address.
Identifying issues with mental health can tricky, but it's important to look for signs and have conversations if the child not enjoying things as much, having challenges in making or maintaining relationships, etc.
It can be overwhelming to not fully understand why an individual feels the way they feel, but exploring and understanding one's emotional life can be grounding and helpful in the journey toward supporting youth mental health.
Emotions are not "bad", they are important information of what's going on in our bodies and our lives. Emotions are part of being human.
Mental health challenges occur when the emotions become especially strong and persistent and require attention to better understand, regulate, and work through the emotions.
Emotions are not always simple and can be quite complex.
We can learn to control or change aspects of life we can control and also sometimes change the way we experience aspects of life we may not be able to change.
It helps to be curious about the emotions and experiences that are beneath behaviors of youth.
As a parent/caregiver, it can be tricky to find the balance of encouraging a child to move forward and toward their goals (setting limits and creating structure), and when its more helpful to acknowledge the emotional experiences of the child. It's a nuance and takes time to figure out when which approach is useful and in what contexts.
Parents/caregivers (and others like teachers, coaches, instructors, etc) have their own emotional reactions that can influence how they respond to a child.
Resources to find a therapist include asking your health insurance for providers in network, websites like EffectiveChildTherapy.com
There are various therapies that a child and family can engage in. Some are more skills based. Some are more supportive, explorative, and validating. Some are focused on the family structure, patterns, and dynamics.
There's not one therapy that everyone should be doing. Families could be involved in learning about and considering therapy options.
A prospective therapist could explain their approach so it is clear and transparent. They should be licensed. You can ask where and how they developed their approach to therapy.
Whatever problem or symptom that a family comes to a therapist for ro address may evolve through the therapy process. Underlying processes may be identified and addressed that can in turn improve a symptom or problem.
Families can start therapy by finding common group between the caregiver and child to identify goals for therapy.
Dr. Langer's research focuses on collaborative shared decision-making approach to planning therapy.
Therapists can learn common factors and also integrate effective aspects from different therapies that can be incorporated appropriately to their therapy with an individual.
Therapy is a collaborative process. What works for an individual can be identified over time (and even evolve over time) rather than expecting a quick fix. It takes work on both sides.
Conceptualization is a way of theoretically understanding the factors that impact an individual's mental health. The therapist should be able to communicate their conceptualization. Doing so collaboratively with the child can be therapeutic in nature because it enhances self-awareness and flexibility.
The parent/caregiver may have very helpful perspective and wisdom to share with the child. The child may also have their own helpful perspective and wisdom through their unique experiences. Both can learn from each other.
Education is a term that means to draw out something in someone, much is therapy.
There are many things that can be therapeutic even if it is not therapy, perse, like journaling, using music, having a mentor, joining groups or activities, developing competencies and skills, etc.
Exposure therapy is not for everyone or every therapy situation, but it is meant to help individuals confront the things the person is afraid of to learn 1) are the expectations of what will happen accurate (and to what degree)? and 2) even if something unpleasant happens, how can you cope and be supported through it so its not a neverending catastrophe? It can create a positive upward spiral for the person's life. Note, exposure therapy is done with full consent of the patient and family. The therapist provides a full rationale and conceptualization of how and why it can help. The patient should be motivated.
Anxiety can lead individuals to lose perspective.
Parents and caregivers can be like emotional coaches. They can learn how to understand their child's emotions. Learn what challenge is too much or too little for the child. This takes time to figure out the nuances.
Decisions often come with either short or long term benefits, although some can be both. Therapy can feel challenging and uncomfortable in the short term but healing, empowering, and strengthening in the long term.
There are different parenting styles to learn about.
Longstanding mental health challenges most likely will not be a quick fix. Some challenges may be more short term and require less sessions and intensity. Asking and collaborating with the therapist helps to clarify the process of therapy and what to expect.
Motivation for change and for being in therapy can fluctuate. Talking about the ambivalence can help to resolve it, as well. Motivation is a very important aspect of therapy.
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Gerald Reid 00:10
Welcome back everybody to the Reid Connect-ED podcast. Throughout season two, Alexis and I have interviewed a diverse range of individuals to discuss their individual paths of excellence, knowing that everyone's path is unique and nuanced in their own way. And as we've alluded to over the course of the entire podcast, regardless of one's talents, opportunities, successes, achievements, we're all human. And therefore each and every one of us may at some point in our lives experience challenges with mental health for various reasons, and diverse reasons. In the first episode of season one, Alexis and I discussed why someone would want to seek out supportive a therapist, and in this episode, we're going to be discussing the experience that families can have as they seek out mental health services for their child. For some gaining the support of a therapist can really feel like a lifesaver. And despite this progress that's been happening in society, we're all kind of more open to therapy as an idea. And as something that people can utilize to support them in their lives. There are many out there for whom seeking out therapy can really feel like an insurmountable hurdle to jump over. And this could be due to the fear of the unknown, it could be difficulties with trusting someone else with such personal matters, could even be a sense of this stigma that seems to you know, could still be there for sure. And maybe they have even seen therapy depicted in the media in a certain way that could have been off putting or so forth. But there many reasons why people may feel positive or not so positive about seeking out therapy. So we hope that in this episode, we're going to shed some light on the process for parents who might be considering getting their child set up with a therapist. So joining us in the studio today is Dr. David Langer at Suffolk University here in Boston, Massachusetts. David is an associate professor and program director of the clinical psychology doctoral program. He's also a licensed psychologist with his own private practice providing tele therapy and Massachusetts. So happy to have David here with us today. He's extremely knowledgeable in the field of child and adolescent psychotherapy. And his research he studies the effectiveness of youth psychotherapy and how families and clinicians can work together to plan therapy in a way that fits each family's values, preferences and goals, very individualized, which is important in our field. I've known David for about 10 years now. And we've crossed paths while I was doing my training at the renowned center for anxiety and related disorders known as card at Boston University, where David at the time was the director of the child therapy clinic, David's intelligence, his positive energy, his leadership really made for an incredible three years during my clinical training at Carleton. And we are so grateful to have you join the reconnected podcast today. And by the way, David is also an avid reader, he is a marathon runner, and a budding pianist as well. And he's just a great dude, great to have you here today. David.
Dr. David Langer 03:01
Thank you so much for having me. And I hope I can live up to the introduction you just gave.
Gerald Reid 03:06
So David, you know, we have so much to discuss here in this episode. And, you know, I just want to open up the conversation, probably in a more general way, kind of like when we do assessments and therapy, we want to kind of start general and then kind of narrow in as we go. So let's start general today. Let's just talk about the state of youth mental health. You know, at this stage we're in, let's say right now, the day of recording, it's June 1 2023. So where are we you know, when we're thinking about the research of youth mental health and what the status is at this point?
Dr. David Langer 03:43
It's a great question, and it is a very important topic and a timely topic. Over the past few decades, our society has been increasingly recognizing that youth are facing challenges that are both unique to youth, and also that are reflected across the lifespan, anxiety, mood disorders, depression, risk of suicide and self harm, attention issues, social issues, and that these have gotten worse, unfortunately, over the past few decades, culminating in recently even the Surgeon General issuing a landmark report on the challenges youth are face facing and youth mental health. And fortunately, youth are resilient. And we have a lot of systems in place to try to help youth and to help youth help themselves. But it is really important that we are paying attention to this thinking about this and each thinking in our own roles, whether we are youth, teenagers ourselves and supporting ourselves supporting our friends, educators, clinicians, parents, caregivers, working in organizations, what we can do to help youth grow up in a healthy and safe environment?
Alexis Reid 05:05
Can I just rewind for a second, because you said over the past few decades, and I think there's a lot of misconception around mental health declining since COVID. But this really has been something that has been coming up for years before COVID even happened.
Dr. David Langer 05:20
That is a great point. And it is true COVID brought in a whole number of new stressors with both the separation from people, the shift to a lot more online interaction or lack of interaction, fears of an actual family member's health declining and deaths from COVID loss of jobs. But the youth mental health crisis, and I think it is fair to call it a crisis has predated COVID by a lot COVID is has made it worse, but is by no means the only reason or the only timespan through which many of our youth in this country have been struggling.
Alexis Reid 06:05
Yeah, I find myself saying that it's it's shown a brighter light on the issue, because we see a lot more of it coming up and bubbling up both in our schools and our households, on athletic teams in a lot of different different areas.
Gerald Reid 06:19
It's amazing to hear patients just talk about mental health as just part of life, you know, like mental health is something that we have to prioritize. And I think we're all trying to figure out what that means to you know, what does it mean, to take care of your mental health? I think there's a lot of people who talk about it, and a lot of different ways. And, and to be frank about it, you know, there are a lot of ways to support your mental health. And you know, there's not one thing and I think you alluded to this too, before David and Alexis, we always talk about this, there's so many factors that can affect a person's life, it's usually not one thing. Sometimes it is the one thing you know, there's something traumatic that happened, this one event, but a lot of times, there's a lot of different versions of it. And as a therapist, my favorite part of the job is get to know the person on a holistic level to say, Okay, there's all these factors involved in this person's life. Let's see what we can address what can you control? What can you not control? And how do you, you know, how do you navigate that with the person collaboratively? So David, let's, let's get into you know, what is it like for a family this considered Hey, my child, whether they're young or young adult, let's say they're a young child who all the way young adult college age, even right after college, when that tough transition out of college when you lose the structure of college, and it's like, wow, like all this uncertainty, again, how to deal with that. But let's talk about like a parent, you know, obviously, there's, there's parents who really care about their kids well being and they may not know how else to help, or they feel like therapy could be a good resource, or they're questioning whether it could be or not, you know, tell us a little bit about your ideas and your research from, you know, this topic. Yeah.
Dr. David Langer 07:48
So I think having whatever communication is, is possible and regularly checking in with your child, if you're a parent or caregiver, or just thinking about it yourself, if your youth listening to this or adolescent, college student, emerging adulthood, kind of in those 20s? How, how have things been? Are you feeling fulfilled to some degree in your life? Are you able to enjoy the things that you typically are enjoying? Are there emotions, or feelings that are getting in the way in your life that are keeping you from doing the things that you would like to be doing, from having the relationships that you'd like to be having? Things like that? And that, in that in those reflections in those conversations, and for caregivers, especially of younger children, and those observations, really paying attention to? Are there big shifts? Are there any changes and how someone's feeling that it seems like there's just a more down a lot, that they're having trouble doing what they had been doing before, or they're not engaging in the types of things or not enjoying the types of things that they were before, or any other kinds of emotions or behaviors that are really getting in the way of their life? And that's a time that I think it would be good to think about what might be helpful? How might we? How might we help them understand what's going on, and get help to to move past it to learn some skills to address it?
Gerald Reid 09:26
Yeah, I think the hardest part for a kid growing up is when they're struggling with the emotionally or with their mental health. And they don't know how to make sense of it. And they can blame themselves. They can blame other people. They can just feel hopeless because it's just overwhelming. And there's like, you're younger, this is the world this is your life that you don't know any better. You don't have a context or frame of reference or feedback about why it's happening, what the factors are. And so to your point, yeah, to be able to help the child to to make sense and the parents to make sense of it, too is really grounding and helpful I think
Dr. David Langer 09:59
and I think oftentimes our we could kind of jump to a an assumption that, Oh, these are the good emotions. And we want these emotions. And these are the bad emotions. And we want to get rid of these emotions. And I don't see emotions as good or bad in themselves. I think emotions develop for purpose. There. There's reasons we feel sadness, there's reasons we feel anxiety. And I think if, if, for me, at least, and when talking about it with people with whom I work, if we have the choice of being able to experience fear, or anxiety, or not being able to experience fear or anxiety at all, at all, it's helpful, to be able to feel scared, it keeps us safe. It's our body's alarm system, sadness could help us recognize when maybe we're not having the relationships that we need, when we're experiencing a loss when we need to take some more time for ourselves. And experiencing these emotions doesn't mean something's wrong at all with a person or with any particular person, it is more I think of it as helpful information of what's going on with our bodies with our lives. And if one emotion becomes much stronger, or we're is being experienced for much more of the time, then that's really helpful information about what's going on in someone's life, and what might be helpful.
Gerald Reid 11:32
Definitely, yeah, and it's so important that we're trained to listen really well. Because we can try to understand those emotions, not just in simplistic form, like, Oh, this is happening, you're anxious about it, but what about it? Are you anxious about and, you know, through the training that you did, you know, with me, during Charles card was, you know, a lot of that, like, get into the experience that they're having, like, what is it about this situation that they are afraid of? What are the consequences they're afraid of. And even further, you know, as I continued my practice, just learning more about the relationships that they have, and like the nuances of it, that there could be mixed emotions that you have about a relationship with someone. And that's really hard to deal with, it's hard to navigate and to figure out what to do with it, let alone to understand it.
Dr. David Langer 12:15
Yes, it. emotions aren't always simple. In fact, they're rarely simple. And that one's experience of emotions, it could be pretty complex. And it is, you know, we spoke earlier about primary versus secondary control, changing situations, changing the way we feel about situations, that when thinking about how we're responding to our own emotions, it could be very similar, what are the things we want to do to try to shift our emotional experience, experience new emotions or different emotions at different times, and what part of it is accepting that, as humans, we are going to have an emotional experience. And sometimes that's going to include fear and anxiety and sadness, and that is part of being human.
Gerald Reid 13:01
Yeah, Alexis just shared a really good example earlier about the, the young person who jumped into her office chair and started spinning around. And I think Alexis is very perceptive to say, you know, he said, I have to spin I have to spin I have to spin you're like, go have it, you know, go go ahead and go spin. And you were perceptive thing, hey, maybe this is not just kind of restlessness that could or impulsivity, it could actually be anxiety, because it's like, you know, he's getting used to a situation. And you made such a good point, Lex that like, over time, he didn't do so much spinning as he got more comfortable in the environment, in the relationship he has with you, and so forth. So to pay attention to like, what's happening underneath the surface is hard to figure out sometimes,
Alexis Reid 13:39
yeah, want to go back to that point, but through an educational perspective, because so many educators might notice these big behaviors and think, Oh, they're just not behaving the way they're supposed to. Or they're not caring about the work that's happening. But oftentimes, there's something more complex than that, actually, at the root of what they're seeing. So again, I always say not that all educators need to become psychologists, but just to recognize that every, every human shows up with some range of emotion or some range of experiences that they're bringing with them into the classroom into the learning environment. I just was sitting with my college group yesterday and talking about how each and every one of them has gone through an experience where they had something big happened in their life, whether it's anxiety related, whether it's a life circumstance that they had no control over, or something just got in the way, like a health condition. And the professors that they were interacting with, sometimes kind of just shut them down. They empathize for a moment, and then sort of penalize them for going through those experiences. And oftentimes, you know, as educators, we have certain goals, we have certain benchmarks that we need to meet in a certain timeframe. And the stress of that is palpable, it's real. And at the same time, we need to be flexible. ourselves to teach and train younger learners, especially who haven't had these experiences, to understand that they too need to be flexible, or ask for support or advocate a little bit more for when these things happen. And as adults in their lives, especially in as educators in their lives. It's it's, I don't know, I think it's it's very difficult I can I have a range of words I can use in this moment. But I think it's, it's a disservice to the students, by not understanding or asking good questions to find out what's actually happening in their lives, that's leading to some behavior, or a lack of engagement, or perhaps not even showing up to class or school, because oftentimes, there's something else going on in their lives and in their worlds. And the more that we ignore, that these emotions are coming up, and that these experiences may have happened for these learners, the more we're kind of pushing them out of the realm of being curious about learning, being engaged and learning. Because we're totally invalidating their experience by not saying, hey, you know, what, what's coming up for you? What's happening? How can I best support you to be able to get through this moment? So we can see you to the other side of this?
Gerald Reid 16:15
Yeah, let's, I mean, this gets at the core working with families for a while, that, I think it's, I want to take the perspective of the parents, as we're talking about the grandparents, it's such a good point, because, in my opinion, I always had to take the perspective of everybody involved in the patient I work with parents included. And I think the heart one of the hardest things, fundamentally for parents is to know how to navigate the I have to set limits and keep the structure and move the child towards whatever goal or value or like, you know, character building, whatever it is, versus, I need to understand what's underneath it, as you're pointing out. And I need to nurture the emotions and ask and be empathetic and try to try to try to work with them. And I think especially when life gets busy, and it's hard, I think it is nuanced, because sometimes you do you know, even in CBT, you know, you have to learn how to set limits, in some ways as part of creating structure. But other parts of CBT and other therapies is also to as you're pointing out, understand the emotional part, I think it's really hard. It's even harder as therapists sometimes to navigate that level on the parent, let alone being activated yourself as a parent when you're stressed. And you're feeling maybe guilty as a parent, because you feel like you're not doing a good job, or we're stressed or anxious about the child's failing. And then as you get anxious as a parent, you know, you could lean in more to the limit setting and, and you know, pushing some sort of force towards something when the opposite might be important. I think it's a nuanced, and it's really hard to figure out what to do and when in, in what context. I think that's where the nuance of therapy comes in. And that's why you know, David, the collaboration that you really emphasize is so important, I think in therapy.
Dr. David Langer 18:00
So many good points here. And I think the fit together in the way of we're talking about how each person navigates their emotional experience, and how an instructor at any level at a college level or earlier, will have their own emotional experience when their students are acting in the way that they think they should act or shouldn't act and what those expectations are, and how sometimes our emotional experiences could get in the way of us seeing and appreciating someone as a full person with their own emotional experiences and causes of behavior. And of course, it's, we can expect that we're going to be able to do this perfectly at any time as instructors or as as parents, because we're going to have our own experiences, we're going to have the times when we're frustrated and maybe are not going to be able to have that calm conversation, understanding the cause of a tantrum, or have a refusal to do something. But I think through reflection and through working on that, it could help us figure out what we are able to do, when we might want to take breaks how we may structure in some more communication at times when it will be more effective. And, you know, coming back to where we where we started on this. That's some of the times that I think it could be most helpful to think about it. Would it be helpful to have someone help us with this, the support of a therapist, and you asked a bit ago about what parents might do or caregivers might do when thinking I think my kid could use some help or we as a family could use some help with this. And there are a number of different ways to take those first steps towards therapy or towards any kind of of mental health care. One way is connecting with that child SC Will, sometimes teachers will have helpful feedback and things that they're observing. And there may be mental health resources in the school that are part of the school system that may not be provided as as high of an intensity is the services outside of the school, but are already built in and maybe more readily accessible. So I think that's one place to reach out. pediatricians office because kids, most kids do fortunately, have a pediatrician. And they often know the resources in the community. Beyond that, I think reaching out, you know, with insurance agencies have lists of therapists who are on the, on their insurance panel, or they may take insurance. And I think resources such as info about kids.org, effective child therapy.com ABCT, Association for behavioral and cognitive therapies has lists of therapists within each area. And if it would be helpful, I could give some thoughts about what I might look for. In that, please do so there are a whole bunch of different approaches to therapy. And a lot of times when talking with with parents who are just starting to explore what therapy might be like and whether it'd be helpful for their child, they the overall categories, categories are, well, there's talk therapy, and there's medication. And that is true. But just like there's lots of different medications, there's also lots of different ways of engaging in talk therapy. And some types of of talk therapy would be are more skills based working on cognitive skills, behavioral skills, that's one of the charity that's what we worked on a lot together at the Center for anxiety and related disorders. And it is one of the approaches that has the most research support techniques that are most common in in therapy trials and the research. that's been, that's shown to be most effective. And there are other types of therapy as well. More client centered therapy focused on relationship building, validating, having helping someone feel heard and explore what's going on in their life therapies that are more family focused working on family structure. There, there's a lot to be offered in a lot of different types of therapy. And I don't think it it serves anyone well to say, Well, there's only one type of therapy that everyone should be receiving. And in fact, that's a big part of what got me into the research that I'm doing is instead of a therapist saying, Oh well, or a doctor of any kind, saying, Oh, well, here's the type of here's what we're going to do. And here's the type of therapy that families should be involved in saying, Well, what's going on? What are our goals? What are the options, different types of treatment techniques, different approaches? And what works best for us? What makes the most sense for our family? Just like, for when seeking mental health services for myself, or loved friends or loved ones? How I would think about, well, what how does this person practice? What kind of work do they do? And is that a good fit? And I think everyone should have that opportunity, even if they don't have background and expertise in in therapy and mental health care. As such
Gerald Reid 23:27
a good point, David, I love it. In some ways, it's validating the the evolution of my practice. And you know, when people come to me and they say, their symptoms, the more I get to know them, I can see it's a it's a bit different than what they come to me in the very beginning with and it evolves into something, maybe it's maybe it's related to their symptoms. But, you know, the underlying process of what we got to work on is a bit is a little bit different. And it could be actually a different symptom that's important to work on rather than what their presenting complaint might be, or with apparently think the problem is because a lot of times, you know, in the research, you'll see this, the parents ratings of things and the child ratings of things, in terms of how the child's doing functionally or systematically could be different sometimes, right? That's accurate, right?
Dr. David Langer 24:16
It is accurate, actually, a research that has not been published, but one of my doctoral students, Juliana Holcomb is just about to publish, hopefully, on this, that there's a lot of talk and a lot of research showing, especially the research of nd DeLoss race, showing disagreement among parents and children and different reporters. And one of the questions that Juliana and I were asking is looking at what the disagreement is if you ask them separately, what their top goals are their top problems and how much they agree if you actually talk about it some and what we found is the disagreement if you ask them separately, what's going on, is pretty high. They'll have different pros perspectives, if you get them in the same room, and have them share their opinions with each other, there's actually much more agreement. And some of that may be different perspectives, but kids saying, oh, yeah, you know, I do see that parents saying, Oh, actually, you know, I don't see that as much. But if that's what's important to you, like, we should totally focus on that, you know,
Gerald Reid 25:20
it's funny, that is actually therapy. That little aspect of what they did the research that I mean, understanding each other perspective, taking that as therapy a lot of ways.
Dr. David Langer 25:30
Exactly It is, it is, it's working on that communication and finding those areas of common ground. And that families, I think, are, you know, when creating this protocol to try to help families and therapists collaborate, based on all the research, I thought, like, Oh, we're gonna have like full out arguments. And like, I made this entire appendix of flowcharts of what to do when the parent wants this, and the kid wants to navigate all these disagreements, and we never used it. Why in the entire trial, because every time when we got together, and this was a small trial for him, there were only 20 People in the condition 20 families in the condition that did this collaborative shared decision making approach to treatment planning, but in all of those, that the caregivers were listening to the kids and saying, okay, and or maybe the same? Well, I don't think that but maybe we could do both. If it were just naturally working on finding common ground together.
Gerald Reid 26:31
That's amazing. And you know, the role of the person to facilitate that is so important. I once had a patient say to me, you know, therapy doesn't help me, he was very averse to thinking that he's in therapy. And he goes, you helped me? Yeah, that was really nice.
26:46
Oh, that is such a powerful statement. And I love that because it really is kind of identifying what to him was the key ingredient. And it sounds like for him that was, or at least, perhaps it was that relationship. And that, well, it's not any particular technique. It's what we do together. It's on that personal level.
Gerald Reid 27:10
Definitely. And I'll share a little bit about this. But over the years, I'm so interested in therapy and the concepts and the theories. And I tried to I mean, I read so much in graduate school, that people don't even know how much I read, because I was doing it just by myself. I wouldn't get the manuals, I would like create my own flowcharts, like you said, outlines because I wanted to understand it. And something that I really found in is that like, there's such great ideas from each theory, each therapy. And I feel like sometimes I got to pull from that therapy, because that aspect, just like you said, maybe it's communication, maybe we all gotta get on the same page. And if I'm not flexible enough to realize that or, you know, if you've experienced something stressful in the idea from internal family systems therapy, have you developed coping mechanisms to deal with traumas and stressors that help you to survive it, but then they become obsolete, as time goes on, you have to replace them with the healthier coping mechanism to the new circumstances, stuff like that. I feel like there's such rich, great ideas that have come from people in the field. And for me, I'm like, it's like a catalog of songs. I'm like, let me get this playlist going.
Dr. David Langer 28:21
Right, exactly. And for any therapists listening, or therapists in training, I encourage you to look at different ways of integrating different approaches this Cepi society sounds like it's SETI for extraterrestrial investigations, but Cepi society for the exploration of psychotherapy integration, a lot of that work is thinking about how could we help providers instead of saying, Oh, I only do this or only do this, it take the effective, the helpful parts of different therapies. And what I'd say in terms of picking a therapist in terms of thinking about if this person will be a good fit for you. I would want anyone meeting with a new therapist, I'd say one check if they're licensed, check that they have the education that fits with what they're saying that they're going to do. Do they have a degree that's related to therapy? And are they licensed, so have they passed whatever examinations within the state and and met state's criteria for practicing therapy, and then when talking with them, that I encourage everyone to ask the therapist to describe the work they do. Any therapist or other any good therapist should be able to say this is how I practice. This is the approach I use and to be able to describe that in a way that's understandable to someone without any background in therapy who's never studied this before. Both caregivers and kids, and describe how will how Only you figure out together what the focus will be? Who's going to be included in the treatment? If what the framework is for treatment? Is it based in creating a safe space? And, and being a supportive presence? Is it based on developing certain skills? Like a more cognitive behavioral approach? And to ask, Where have they, where they got into practice? In doing this? I think, you know, any therapist I'd want to refer to, or would want to use to myself, would welcome those questions and enjoy them. I personally, when I'm talking with a caregiver who's thinking about therapy for their kid, and they ask questions about, oh, have you worked with this population? Or how do you do this? Or what about that? Or what's the support for that? I love that. I think like, oh, this is I'm like, so excited to talk about this, and that someone's interested in, in learning about that, and getting me thinking, especially the questions that maybe I haven't been asked before, it's, it's fun to think about these things, and to work on this collaboratively. So ask, so when you're looking for someone, if you find a therapist, and they're wanting to talk about this with you wanting to take the time, to help you understand and be involved in the decisions, and you say, you know, like, Ah, this is the work we're going to be doing, and that this person has a way of understanding what's going on in the family or for this child, and they have the education and the experience to help. Great. If, on the flip side, if you call someone and they go all, you know, we just kind of see what's going on. Or we you know what we chat and we meet weekly, and you know, that's or says something like, oh, you know, that's my job as a therapist. So you don't need to worry about that. For me that that would give me pause, that I'd I'd want someone and I think it's good to have someone who could explain the work they do justify why they're doing what they're doing, and talk about how they'll know if it's how everyone will know, is it working? Is it reaching the goals that you
Gerald Reid 32:15
want to reach? And communication is essential for our jobs, too. So it's a good segue into what would be like to work with the person, you know, like, clarity and communicating as a therapist is essential. So it's a good, it's a good point you made, I would say
Alexis Reid 32:30
that the psychoeducation side of it, just understanding what the process is how you're coming into it, and becomes the beginning point of the therapeutic journey to be able to even understand what it's going to look like and get clear on the goals together, I think is such a beautiful aspect of it all, too.
Dr. David Langer 32:48
Yeah. Right. And I think sometimes mental health could seem more amorphous, and it sounds like more, what are the symptoms? And what what does what do these different diagnostic labels mean? And in that way, could seem a little bit like a black box, and well, I'm just gonna go to a therapist, and they'll do what they do. But if we think about going to a primary care provider, that for for any kind of issue, say, say a leg injury, and there are different treatment options, maybe one's surgery, one's kind of pain relief, one's physical therapy, one's wait and see, like all these different things. What kind of provider would you want? Are you wanting someone to say like, oh, well, I see what's going on with your knee. So do this, or someone say, Here are the options. And let me tell you a bit about each option. And this one, the recovery may take longer. But you could continue in your lifestyle, what this one like it'd be surgery, and you'd have to miss three weeks of work. And here's the likelihood that the surgery will be successful, but then you'll have full mobility, that you want to that it's good to learn about the information. Because the choice that may be right for one person may not be right for the other. It's all about what's important for someone in their life. And it's the same for therapy, what may be what's important to one family or or any individual youth is not going to necessarily be the same as for another family or youth. And it's not really in the therapists could certainly have the expertise and perspective to provide feedback, but isn't going to be able to make those decisions about what are the priorities for any individual youth or family.
Alexis Reid 34:42
I think that authenticity and the clarity is so important because that's also an initial point of trust and building trust in the relationship that's going to establish or not right or just establish a sense of trust and faith in the process of finding assistance, finding help and hopefully You're going on a journey of healing in that way.
Dr. David Langer 35:02
Right? Yes. And I think it is that that process itself is, I think therapeutic. Like you were saying as well that one modeling that humility, and coming into it with I'm not saying I have all the answers, and it's okay not to have all the answers, or not to have any answers yet, that this is going to be a process that we're going through together and working on together. And I certainly have things I could do to help. And I'm confident and hopeful that I will be able to help and that together will be able to make things better. But that this is a team effort. And that that is also empowering, that it's it's not I'm going to do something to fix what's going on, but that we're going to work together and you're going to bring your experiences and your strengths. And I'm going to bring my experiences and my strengths. So that together, we could find a better way forward.
Gerald Reid 36:04
Yeah, yeah. The term my belief in the literature was collaborative empiricism, right? Where it's, we're gonna go on this journey together to find what works and what doesn't. And that is kind of like an experiment. And so it doesn't mean you're just throwing spaghetti at the wall to see what sticks. That's not absolutely not what it is. It's a it's a very detailed, comprehensive treatment plan that I know, you really emphasize, there should be a clarity around how you're conceptualizing what the problems are, and the issues and the symptoms. What's the conceptualization, there should be a very clear conceptualization, I pride myself on having a very clear conceptualization, that doesn't mean it doesn't evolve over time, or the treatment plan doesn't evolve in subtle ways or different ways. But to be able to have the humility to say, hey, we're gonna work on this, and we may tweak it along the way but this is what we're working on in the here's the reason for it. Here's the conceptualization, let me explain that. And for me, when I'm, you know, supervising students, I always tell them conceptualization is so key. And for people listening conceptualization essentially says, here's the presenting problem or symptoms in here is all here are the factors and how they interact with each other, to you know, to manifest these the symptoms, problems, emotions, and the more you can understand knowledge is power, the more you can understand and work together. And as you said, that is therapeutic in of itself. Because you become the patient, you become self aware, you reflect on yourselves, you're gonna have to do that for your whole life. You know, we know that we're older now. And you got to reflect on yourself. And that in of itself is therapeutic to be reflecting on yourself, hey, I tried this way of communicating with my parents that didn't work. So well, let me try something different. Or, you know, when I feel sad or depressed, this is what I've tried to do to work through it. But maybe that didn't work. So well, let me try something different. That is a collaborative process. But it is also in of itself therapeutic for the person self awareness, self reflection is is therapeutic in nature.
Dr. David Langer 37:56
It is. And you know, what you were, as you were talking about, that it really made me think even more so in that collaborative empiricism, about the importance of therapists humility, of recognizing we don't have the answers. And I think that is especially important when working with youth. Because youth are often facing a bunch of adults, in their caregivers, and their teachers, coaches, all in all these different areas of life, who can often come at it with, oh, well, I've lived through this, I know the way things are. And there are advantages to having that lived experience. But often, the way that we get through the world as we develop is by kind of falling into the patterns that work for us, and ways of understanding the world that hopefully work for us. But those may not be the same ways that work for any individual youth. And at the same time that coming from an adult perspective, we may have that lived experience and have thought about some of these questions and challenges and life choices and have made those decisions for ourselves. That youth I think, come with something that is all also unique and equally valuable, have an openness to different ways of looking at things have an awareness of things that we may have lost through our time of pruning and saying like I can't manage all of this, so I have to focus on this area, or this way of approaching problems and that I find it to be most genuine and fruitful. That to not that it's not like a fake Oh, I'm gonna pretend to be collaborative, but really just try to get them to do this. But to like really say like, this is so wonderful to get an opportunity to be here. unwelcomed and privileged, as a therapist, so wonderful to get an opportunity to like to be welcomed and privilege into someone's life, and to have someone share parts of themselves or thoughts or emotions or experiencing that they may not readily share or share it all with others, and to hear and learn about their way of seeing the world, and in their way of coping with the world, that I think that is just as much growth, when therapy is going well, it is just as much growth from the therapist for the therapist as it is for for the youth. And, and that's kind of in its ideal way. Because youth, you know, have experiences and thoughts and perspectives that are unique to them unique to them. And just as important, if not more kind of aware and mind blowing, then then kind of our experiences as adults, which could sometimes be a little bit more narrow and rigid. And we need to keep challenging ourselves to have that sense of awe and wonder and curiosity that we might have lost somewhere along the way.
Alexis Reid 41:16
I agree in the Child Development course that I teach, I go all the way back to the historical perspectives of psychology and remind them that, you know, children aren't just little adults, they have a unique scent that a unique set of characteristics and qualities and new experiences that they've never had before. And we need to honor that and allow for that to unfold in stride. Instead of trying to manipulate or change based on what we expect, or what we want, we really have to allow for them to have that point of development, because it helps them to develop themselves and understand themselves and understand the world, and often help us like you said, understand the world through their eyes. And it's such a beautiful thing. I say this to educators all the time, oftentimes, young learners, especially they will come up with the most creative and beautiful ideas that we could have never anticipated or imagined. If we give them the space to do that. And in collaborative work that you're describing here through mental health, I think it's so important to give them that space that often they feel so secluded and isolated in their own worlds, because they don't have that forethought, all the time of thinking about the future. Thinking about different options. Yeah. Because they often just don't know what's out there. What's possible.
Dr. David Langer 42:28
Yeah, it's a, it's maybe a slightly nerdy tangent, but not completely attention because it is related. When thinking about why, why are little kids so funny, sometimes it's because I think a lot of it is the surprise of this unique way of seeing the world is unique connections of Oh, does this word mean this missplay switching up words. And it's that novelty, that and when I'm talking like toddler age now and four and five, but I don't think that's necessarily lost, even though the the cuteness of it may change as caregivers, and adolescents are kind of navigating the growth and increasing autonomy, there's still that new way of looking at things. And some of the ways may not fit with our current systems the way the world works. But that doesn't mean they're necessarily not accurate. And here's here's that nerdy you're part of that, just in case you thought that was the nerdy part, it wasn't, this is the nerdy part, in the way children understand numbers, you know, there is the arithmetic way, which is like the counting 1234. And seeing the distance between three between one and four, and four and seven being equal, it's three, you know, difference difference between one and four, and four and seven, and very young children may see it more in a geometric way. So as a factor, so they would see the distance between one and three as the same between three and nine. So it's tripled. And that we train that out of children over those first few years of development and say no, the way our world works, the way we think about numbers is zero and three is the same as same distance as three and six. And it's not that one's right or wrong. And in some fields of mathematics and some applications, that way of thinking about it as factors in the geometric way is what they use. But we're it's not that one's better or worse. It's just that we're kind of training our growing generation to think about it in the way that we've always thought about it. So there's the nerdy tangent, and I love that number theory of sorts.
Alexis Reid 44:47
And I'll bring it back to an educational caution because I often work with learners who have this abstract, unique way of thinking about learning. That isn't the way they're told to learn. And that actually causes is a lot of anxiety in them that they're doing something wrong, which can spiral into their executive functions not coming online. And in a lot of things kind of going awry, where they're like, How can I be so intelligent and struggle so much, just because not because they're necessarily struggling, but they're not necessarily thinking in the same way as they're being taught. And that causes this conflict within themselves. That brings it back to this idea of, okay, let's figure out what actually is happening here. And let's figure out actually what's getting in the way, which I think you both do so beautifully in the work that you do. From a clinical perspective.
Dr. David Langer 45:33
Yeah, you know, this is now just on a nerdy tangent, and we'll need to fact check this because I'm pretty sure this is accurate. The root of the word education is Drew car a are is to draw out, yes. So it's not so much about imposing and saying, like, oh, you need to take all this on. It's about drawing out what the understand understandings the ability to take in information, make use of it. And and I think sometimes that that's been
Dr. David Langer 46:06
not as it's been lost, it's been, it hasn't been as commonly understood that
Alexis Reid 46:11
way. It often gets lost in checkpoints and deadlines and expectations that are outside of ourselves as educators and as learners. And it's unfortunate that the system is turning out that way. But you know, in an earlier episode, I talked about Leonardo da Vinci talking about how he would create these beautiful sculptures, that it wasn't that he was the one creating anything from these blocks of marble, that he was helping to reveal what was already there. And I think about education in a very similar way that we're just in these children's lives to help them reveal the best versions of themselves, and guide them and inspire them to understand themselves a little bit better as they navigate through this very complicated, always changing world.
Dr. David Langer 46:59
Yeah, exactly.
Gerald Reid 47:01
When that's therapy to right, that education, the root of education being the draw out, a lot of times that's therapy, you know, what are you feeling, let's try to understand what you're feeling. Let's let that come out. I think songwriting is actually like that I'll give, I'm gonna go on a tangent here real quick about like to how those two things combined, I once had a session where someone had to really just get in touch with really sad feelings that hadn't been acknowledged or understood. And all really came out in tears. But you know, tears are not that, as you pointed out, sadness is not a bad thing. You understand your sadness, and it tells you something important. It's very important for her to be able to experience that and not you know, think a lot of times in the CBT world, you know, come around to seeing, like, if you push away emotions, or you just try to avoid them all the time, it could be counterproductive, sometimes. And so it came out and I thought it actually mentioned this term, like, I think there's gonna be a song that comes from this. And like, I came home, and I wrote this song called teardrops I just recorded in this like a novice songwriter, but I think this is pretty good one that
Dr. David Langer 48:03
link will be included in the
Alexis Reid 48:07
saga, we'll have to say that's also your therapy is to be able to write songs, and process information in your world.
Gerald Reid 48:12
200% Yeah, and I don't know where it comes from, it just comes out pours out of me. And the song is, where do teardrops come from? Maybe they're like prisoners waiting for their chance to run. Maybe there's a reservoir that overflows when life gets hard. Where do two jobs come from? Maybe they're like, a special key that helps me unlock everything. So, you know, you know, why do we wipe our way or teardrops when they heal us? So, you know, there's there there's their words, but you know, and some therapies actually implement some artistic or creative ways of tapping into emotion that, you know, sometimes can be overlooked as a tool or important part, journaling, even one of them, you know, you had we talked about journaling earlier before the show. So, you know, there's a lot of ways to access things or therapeutic in your life.
Dr. David Langer 49:00
So, so many different approaches to helping oneself and I think that is part of the question is finding therapy, and also finding things that are therapeutic, right. And, and that often, you know, when I think of therapy more, in a more classical or like, standard way, often I'm thinking about talk therapy, or psychosocial therapy, where two people are working on skills or using a different theoretical framework to work on relationships, family structures, things like that. But there are many, many things that could be therapeutic, that if they wouldn't necessarily fall into a therapy framework and not be something that psychologist or social worker or someone trained in therapy would do. That could certainly be really, really helpful and important for people's mental health. And that sometimes are termed therapy. But that's kind of broadening it what therapy could be, that's a great way to put a great way to put it right. And I think that's part of what, what caregivers and youth themselves could be thinking about, of what would be most helpful. Sometimes, it might be most helpful to be meeting with someone who has expertise and specialized training in mental health, and in anxiety and depression and attention difficulties and behavioral disorders and to benefit from their expertise and working together on skills. Sometimes, working with some sometimes what may be going on may not need or may not be. We may not need at that point, working with someone with that particular expertise, but may need an opportunity to develop skills and feel a part of something. Yeah. And that like, maybe a theater group, for example, like just and like, well, we're going to join this theater group and like and build some friendships and have something to build some mastery and skills in or working with, with animals, doing music, skills, sports, things like that there, there are lots of different things that could be therapeutic, using that term more broadly.
Gerald Reid 51:37
Yeah, I'll tie this in. So you know, we did a lot of exposure therapy with patients at a time I card. And for those who are not familiar exposure therapy, in so many words, is helping people to confront the things that they're afraid of knowing that by doing so you can learn something and you can learn number one is the thing that you were afraid of really accurate or completely accurate in the way that you imagine it that leading you to avoid the situation. So you might learn that it's not necessarily as bad as you had thought. Classic example is, you know, going up to approach someone have a conversation, you're terrified of what might happen, and you learn that it's not that bad. But number two, and David always told me, you know, just two things. The other part of it is, even if it is kind of bad, that you can you can live through it with your support system, if you access your support system, because we don't want to have a false reality that everything is going to be peaches and cream through life, that not everything is going to be you know, perfect through life. Sometimes there will be challenges and it's good to become resilient. So, you know, sometimes to your point, we may need different things at different times, sometimes exposure therapy may not be so helpful, right? Maybe there's things to process, let's say within the family that are really conflictual as you said, maybe there's problems going on or divorce or something that you need time to process and maybe making you anxious in different situations, but you know, probably be more helpful in some ways for certain people to learn how to process the emotions and the conflicts in your mind. And, and the ways of thinking that is leading you to become anxious and all these situations met that might be more appropriate, you'd have to figure that out with the person. But sometimes exposure therapy can really be empowering, we really experienced this with a lot of our patients that, you know, you help people to be courageous and to get over those humps that are can are holding them back from expanding their life doing things that they never thought they can do, experiencing things that will have a positive upward spiral where they're starting to have positive experiences from that, getting over the hump. And I'll share a quick funny story to bring some levity here. So one example would be someone I worked with who is afraid of upsetting people. So terrified, guilt, shame. Never want to upset people, you know. And so I try to think creatively, how can we actually help you experience upsetting someone? She's like, What do you want me to upset someone kind of therapy. And obviously, I, as you say, I help her to understand the conceptualization about why this is therapeutic. This is not to force you to do something you don't want to do. You shouldn't feel forced to do things you don't want to do in therapy. This is a collaboration. Let me explain it to you and your parents so that there's a full rationale around why. And she understood it and she was motivated, right? We want to make sure that the person is motivated to confront their fears. We don't want to instill our own motivations on the patient. So she's motivated and so Okay, let's let's take step by step, little gradual steps and one of the steps was going to Starbucks, Starbucks, you're gonna go to Starbucks, and here's the idea. You're gonna go in line, and you're gonna order something, say it's a croissant ordered croissant. Got the croissant. And when you're about to pay, and when the cashier says, Okay, that'll be 250 you're gonna look into your pocket and you're gonna go, oh, shoot, I don't have my wallet. I can't pay you for this. And there's gonna be people behind you and they're going to be maybe a little upset because you're holding them up. Maybe they gotta be somewhere they gotta get their coffee get to work. So we're kind of playing out Fear of what that might look like. And she's like, Oh my God, they're gonna call the cops on me. That was a real fear, right? Because people have a big imagination and it could really terrify people. And it could be crushing, right to think anxiety really could be crushing. It could feel like your whole world is ending and you lose perspective. And so it's okay, let's play this out. It's an experiment, let's see what happens. And you know, take your time, if you feel like you gotta leave, you can leave, it's okay. But we're gonna, if you feel like you're gonna be courageous, you can do it, I believe in you. So she did it. So she comes out of the store, because I stayed outside to give her her privacy to do it. And she goes, Okay, did I did it, except they gave it to me for free. Like, she's like, oh, like, I think we just stole from Starbucks. Let's go back, and I'll pay them for it.
Dr. David Langer 55:49
Starbucks is financially secure. And, you know, when you said that, I remember that story. That's wonderful, you know, kindness of people, all right, and each other out. And, and it's, it's a great example of, of practicing using skills facing challenges, trying new ways of approaching things. And, and exposure therapy is one of the most, if not the most, actually, it is the most commonly researched and effective approaches towards dealing with anxiety, because what is anxiety really, except the body's alarm system, anxiety, fear is our body's way of saying, Ah, there could be danger here. And it's really, really important to have an alarm system, we should all have smoke detectors in our home. And we should all have alarm systems in our body. But just like smoke detectors sometimes go off, when there's not actually fire, our body's alarm system of anxiety could go off when there's not actually fun when there's not actually danger. And when a smoke detector goes off a whole bunch when there's not fire, and for some reason, in my house, it always seems to happen at night, never never zero false alarm during the day. But then we think like, how can we recalibrate this, like maybe that's vacuuming it out, maybe it needs a new battery, like thinking about ways of teaching it. And our smoke detectors are not that intelligent. So we can't really teach it, what the level is what's really dangerous and not. But fortunately, our bodies are much more intelligent and responsive than our smoke detectors at home. And by going out and practicing things that our bodies are saying this is dangerous, and the anxiety alarms going off. And then getting the experience of oh, it actually wasn't as dangerous as our body's alarm system was saying it was going to be that trains our body's alarm system, and it helps our body's alarm system say, maybe this isn't going to be as bad. And it starts to not be as loud of an alarm over time.
Gerald Reid 57:48
Definitely. Yeah. And helps you to differentiate what really is a true threat and what's not. And that takes life experience, like we've been saying takes life experience, and to bring it back to engaging families and therapy caregivers, parents, and even teachers and coaches, right. It's hard to work with a child who's anxious because it can make you anxious, you know, I actually saw this Nick Mian, who was training at CARD, too, he's one of my supervisors at the time, andn I found this study where they found this study where they had anxious kids in a playground. And they actually found that the adults around them they didn't, they kind of monitored how the adults interact with the inner child. And the adults actually were more likely to sort of cuddle the anxious children, just by nature of wanting to know help, because they want to help the child to feel better. And so I think it's hard to again, we've talked about the conflictual feelings you can have as a parent, like how do I encourage and push towards a goal versus also be empathetic and try to understand their emotions and work with them. And, you know, you know, a lot of the work in child CBT is actually helping families and parents and caregivers to even teachers and coaches to learn how to, to navigate that and to, to become the kind of emotional coaches in some ways to validate, but also to find the right level of challenge. I think sometimes parents don't know what the right level of challenge is. Maybe they push too much, maybe they push too little. And that just takes time to figure out. And in my work in therapy, you probably see this too is like you don't want the trial and error to become a disaster where people are like, Oh, I give up on this. Or like, we push too hard. We put too little or we did this we did that and everything falls apart. It's like no, this is part of a process to figure it out through navigating it and to learn from the experience. Okay, I think I gotta approach these situations like this, those situations like that. And then it's the holistic version of therapy to bring other people involved to help everybody play a role in their own way. Yeah,
Dr. David Langer 59:54
you know, oftentimes we're faced with making decisions that will benefit us in short term or long term. And sometimes there are just decisions that things that feel good in the short term and feel good. In the long term, I've become obsessed with oatmeal lately, it's healthy in the short term, I tasty in the short term, it's healthy in the long term. So it's like a win win on both. But a lot of things in life kind of are, don't fall into both categories. And, you know, kind of experiencing fear and anxiety challenging ourselves to do something that is difficult, may be harder in the short term, even if it is going to be helpful for us in the long term. And I think caregivers are naturally wanting to protect their children. And that is a good instinct and a good value. And sometimes it's hard to think like, Ah, well, this is going to be harder for my children child in the short term, but I need to let them do this. So that we they could learn and, and grow that confidence for the long term. And, and oftentimes in therapy, it is working all together to figure out where that balance is, and what people are capable and ready to practice and at any particular point. So that way, on the whole, the practices end up being more successful.
Gerald Reid 1:01:24
Definitely yeah, and it empowers the person, I think the more empowered a person feels to do stuff like that, the less they fall into sort of rumination or hyper focus on the past, or things that have gone wrong in the past. I think when people feel trapped, like, oh, I can't, I can't speak up, I can't open up to this person. And I've seen this, I'm like, wow, like, you know, you really opened up to so and so. And it really helped you to feel more connected and help all these positive things happen and you're less focused on the past, you're less focused on hating yourself or feeling badly about yourself, because you feel more empowered about what's happening now. And in the future, you feel like you, you feel empowered, I think that these other symptoms naturally, sometimes kind of subside because of that, you know, sometimes you do have to focus on the past and the difficulties that you've gone through in the process and emotionally for sure. But I think as we're saying, like, both things could be important that that, you know, it's not an either or sometimes.
Dr. David Langer 1:02:18
Now. Yeah, I think there is, so many choices and balances to make in the process. And and it could certainly. And I think that's where it could be so helpful to be able to work with someone and talk about that and figure out especially when people are getting stuck in terms of how to what to emphasize what to try different points.
Alexis Reid 1:02:45
I think, especially from a child perspective, to remember that, you know, learning these skills will take time, from a neuro developmental perspective, their brains are still coming online. So sometimes, even if it sticks or works once doesn't mean it's going to work continually. There needs to be a support system to help to nurture and practice these skills, that sometimes in our busy lives, we forget that we need to be patient with that process to from an executive function perspective, this is such an important point that I try to drill home with, with caregivers and families and educators that just because something a behavior that you're expecting presents itself once doesn't mean it's going to continue without the proper supports and scaffold sometimes until you know, neuro biologically, you know that prefrontal cortex is still developing, oftentimes until you're in your 20s or 30s. So we want to make sure that we're supporting the children to realize that it's not always going to work out exactly the way we have practiced or planned or prepared for every single time. And then it's a process I often will teach about, you know, the mama bear that comes in, swoops in and saves the cub from danger every single time. And it's great instinct, and oftentimes, well meaning adults in children's lives will do a lot of that. But sometimes, like you're saying that balance of being able to allow for them to explore and have agency and feel empowered, even when it doesn't work out is so important
Gerald Reid 1:04:13
in the literature has consistently showed authoritative, non authoritarian meaning like you know, might make sure I'm going to tell you what to do child you have to do what I say that's authoritarian, not that. And also not permissive, where you just let the child just kind of go out on their own and they sink or swim. Those two extremes has consistently in the research not shown to be great for children. It's really that in between of you're going to be firm, but you're going to be warm and empathetic at the same time. You're going to be understanding but you're also going to be firm because kids do need boundaries and a lot of ways to write like if you're living in a world where there's absolutely no boundaries. That's like it's so expensive, like you can't, you don't feel contained. If it's scary. It's overwhelming to not feel like there's sometimes the irony like kids say they want no boundaries. They don't want rules, but like sometimes People need that to feel contained in like, okay, I get how this works. Now I don't have to, like make up my own rules. It's like the dog. Right? If you look at how dogs develop and I learned about this with your dog Rafa is that if they don't see an alpha in the house, and obviously again, it's not like you have to be authoritarian, aggressive, like leader where you like Do what I say it's not, it's not like aggressive it's it's assertive and calm and kind and collected, that if dogs don't see an alpha in that type of way, they try to become the Alpha themselves. I think kids do this to, you know, the more aggressive kids, if they don't feel like there's trust, they don't feel like there's boundaries that are reasonable that they believe in, and they respect the adults that they can try to become the Alpha within the structure around them. And that could be you know, in that type of situation, like the dog, the dog started, you know, the dog can start biting us. He's not doing that, because he hates us. He's just like, I need boundaries, I need someone communicate. He's like, Yeah, I need someone to take the lead, because there's a pack, and the pack needs a leader. And he's like, I'll become the leader, especially
Alexis Reid 1:06:05
when developing new skills from a learning perspective, right? When things are new, that structure is so important. Maria Montessori spoke about this so beautifully, that there needs to be flexibility within structure. So that we can help to nurture and create and establish these experiences and opportunities to learn and grow.
Gerald Reid 1:06:21
And sometimes, you know, kids can see their parents struggling. And it's unfortunate because parents are human, still, we have to remember that parents have their own difficulties. And sometimes kids can feel like they have to take care of their parents in some ways as young kids, it's to become a leader or to you know, have, you know, different different environments where they feel like they have to step up and lead that can be overwhelming for the child, you know, it just it is what it is. Because they're just a kid, they don't have the capacity to fully do something like that
Alexis Reid 1:06:47
yet, but I also want, I'm realizing that our time is coming to a close. And we could talk about this forever. I think this conversation can continue on for many days, if not many hours. But I want to put a question back to both of you, especially for our listeners who might be thinking about how therapy might play a role in their life, their children's lives or in their family's lives. And I want to ask you both what isn't therapy? Right? You talked a lot about what it is, what the process is, what the different versions of therapy might look like, what might be therapeutic for different individuals at different times. But going into this process? What are some of those things that maybe therapy won't be able to provide for somebody who's looking for support or potentially answers?
Dr. David Langer 1:07:44
That's it's a good question. And I'm trying to get my head around it in. Are you meaning in terms of what what to expect? And what might be unrealistic expectations?
Alexis Reid 1:07:56
That's a good way of thinking about it. Yeah.
Dr. David Langer 1:07:59
So I hesitate to say, oh, therapy will never be able to do this, because therapy could depending on the approach, and what, what a person does with their therapist, that it could also be a staging ground, a chance to talk about and reflect on and work on skills to help that person do all different types of things. And where the lion is like, Oh, well, that's not because of therapy. That's because the person was doing this in their life. You know, could therapy support them in doing that? I think yes. In most times, yes. So. So I'm hesitant to draw a line of saying, oh, therapy would never do that. But I do think you have a really good point about going in with realistic expectations. And some of those expectations, or some of the things to think about is if you're meeting with someone for, say, 50 minutes a week, that that type of change, or any type of change will take time. Right? And especially for issues and relationships or emotional challenges that have been very long standing, that that's not something that is going to be most likely a quick fix, or, oh, we'll meet a time or two. And it'll be and we'll just see, like, Oh, it'll be all shifted, or oh, well, we've already discussed this one. So therefore, if it's not all better, it means this isn't working. I think you want to talk with a therapist about what the timeline expectations are, how will you know if it's working, so you could see if you're on track, which also shouldn't be, oh, well, let's just do this indefinitely. Because you'll never know when it'll work, but kind of really quick miracle fixes or miracle cures, especially for things that are are long standing, or are less likely. That said there are a lot of research about ones Session treatments are different ways of thinking about the world different framings feeling about or thinking about problems as being changeable instead of static, that that could help like problem solving, like problem solving, and kind of a different approach a more flexible mind approach to problems and seeing them not as things oh, this is just the way I am. But everything is being dynamic and changeable. So I want to give credit to the approaches, there are some types of problems. And sometimes where a couple sessions are just talking about something can be helpful. But in terms of realistic expectations, oftentimes, most of the time for things that have been long standing problems, it's going to take more. So that would be one of the things they'd say.
Gerald Reid 1:10:52
And there could be reasons for that people need to be ready to change to motivation is a huge part of treatment outcomes, to be ready to do something to be motivated to find a reason to want to make changes and thinking behavior or feelings, and so forth. So that could that could take time for sure. And different goals could be worked out at different times of therapy, that could be also important to to think about.
Alexis Reid 1:11:16
Yeah, I'm thinking a lot about, you know, my work in particular, it's a little different than clinical therapy. But from an executive function perspective, sometimes people aren't ready to take on the process of change, because it is such an emotional experience, whether you realize it or not. And sometimes, you know, there's different points in our lives where we have more resources or capacity to be able to focus in. And I just want to kind of bring up that, that that's nothing to be embarrassed by and that sometimes our lives unfold in a way that we might not even expect. And sometimes the timing really needs to be right, the Fit needs to be right, the context needs to be right. But also that, and I know from hearing a lot about Jerry's work, especially in yours to David, that, you know, it really is about this collaboration, it's not that you go to see a professional seeking assistance, and they're the ones that are going to make the change, I think it really is about that process of working together. And being able to be available to that because, again, at different points in our life, we may or may not be.
Dr. David Langer 1:12:21
there's there's a fair amount of research on stages of change and readiness for change. And that is a really important part. And sometimes in therapy, that's part of what could be worked on, is thinking about one's openness to change and readiness to do any kind of therapy, therapeutic work. So I would, if I would encourage people who were thinking it might be helpful to explore, I wouldn't want to discourage people thinking like, Oh, I just don't think I'm ready to talk about this, I'm not going to because it may be that getting to know people getting to know a therapist may open up possibilities that you weren't, that someone might not have been aware of already. But there are, there are times when it may be you know what, maybe this isn't the fit for right now, with this person or this particular work. And maybe at another point in life, it might be a better fit
Gerald Reid 1:13:20
and to consider to giving it time, right, like you said, I have patients sometimes they really got to do hard work and therapy, they got to be really honest with themselves, they got to really face harsh realities. And sometimes they'll say to me, like, Oh, I was really like, not wanting to be here today. But after this session, I feel so much better. And that always happens.
Alexis Reid 1:13:42
Sometimes it's just the support knowing you have a supportive person in your world that you can feel comfortable sharing and being vulnerable. I think that's a societal issue that sometimes it feels uncomfortable being vulnerable around people. So I think
Dr. David Langer 1:13:57
that support and I think some often the validation and the normalization of that, you know, with back to social media that and that kind of drive for perfectionism, and seeing, Oh, well, this is what others are doing. And this is what life should be even though it's a very often non complete picture of life that we could see online. That if coming in with expectations of Well, I never want to feel anxiety, or I never want to be scared of anything or I never want to feel down or feel badly about anything, then that's those are expectations beyond what beyond what it is to be human. Yeah, I think then that would be disappointment, lead to disappointment. But coming in sometimes a lot of the work is recognizing that humans do feel sad sometimes. And that's okay. And that doesn't mean anything's wrong in itself, and taking the judgment away from the few feelings because sometimes there's a feeling of sadness, a feeling of anxiety, and then there's the judgment of I shouldn't be feeling sad, I shouldn't be feeling anxious, this means something's wrong with me, this means I'm not going to be able to achieve these things I want to achieve. And some of that work, some of the work is finding that balance of working to grow and change, and also working to accepting care for oneself for who one is,
Gerald Reid 1:15:25
yeah, you can learn so much about yourself through the hard feelings, as you're saying, they won't call them negative feelings. But the hard feelings sometimes that are uncomfortable, you can learn so much about yourself, and to have someone help you to contain them and to have the space to, to confront them and to feel them to understand them is, is one of the most important things we can do in life. And I'm just going to give a quick, a quick example about how in light of this conversation, so I once had a patient say, you know, I learned a lot of skills previously in therapy. And I actually use those skills to get people to like me. And I'm thinking to myself, like this is a good example, like those skills could have really helped that person to regulate to do different things. But her process of therapy could have evolved into actually feeling good about herself. And to your point, David, like, you know, what you're getting out of therapy should be collaborative, in terms of where they are, at that point, people could need different things at different points in stages of their life. And that is, it's important to be aware of what that might be, like, you know, skills can be very, very useful. And but if they're used, maybe not in a way that's going to help them to grow in different ways, then it's good to be aware of that and to say, Wait, you know, I think beyond just using the skills to just get through a moment, or just to survive a moment, and to feel a little bit more regulated. Let's also to help you to like you're saying, develop relationships, feel more secure within yourself, to feel more strong and capable of handling situations in life, be more able to solve problems, and so forth. And, like, that's a lifelong process, you know, therapy is great to kind of get that jump started. And to give you some ideas and concepts through our fields to facilitate that. But, you know, in some ways, the patient that's, that's their journey to, and we have to remind them, this is your journey, and you will continue this process your whole life. And you will utilize this, you know, in therapy is not forever, but you're going to learn a lot. And that's the hope and you're going to utilize it and the more you integrate into your life, we hope that you know, different aspects of your life will get better. So with all that said, we are so happy to have you today, David, join us this conversation, in many ways was not scripted at all. We really just let this evolve, which really speaks to the cohesion that we have my sister and I knew coming together and I'm just so happy that I get to have you join in on this because with Alexis has been such a great experience for me. We know each other really well. We collaborate really well we we can have these types of conversations that are free flowing. And back in the day, I was probably way more shy than I am now. I would never imagine myself doing this. So I have to give credit for Alexis to helping me with exposure therapy. To push myself
Alexis Reid 1:18:05
it was a process to get you here. But we're thrilled
Gerald Reid 1:18:08
for sure. And David, thank you so much for being here. You provided such great insight. From your perspective and insight. Thank you so much.
Dr. David Langer 1:18:16
It's been my pleasure. Thank you so much for having me. And it's it's great to be in a room with you again and to be chatting about these things. Totally.
Alexis Reid 1:18:23
Thanks, David.
Gerald Reid
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 needed 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 the opinions of those we work with or who we are affiliated with. The reconnected podcast is hosted by siblings Alexis Reid and Dr. Gerald Reid. Original music is written and recorded by Gerald Reid (www.Jerapy.com) recording was done by Cyber Sound Studios. If you want to follow along on this journey with us the Reid Connect-ED podcast. we'll be releasing new episodes every two weeks each season so please subscribe for updates and notifications. Feel free to also follow us on Instagram @ReidConnectEdPodcast that's @ReidconnectEdPodcast and Twitter @ReidconnectEd. We are grateful for you joining us and we look forward to future episodes. In the meanwhile be curious, be open, and be well.
How do we get started with finding the most effective and helpful mental health treatment for our children? In this episode, Gerald and Alexis are joined by Dr. David Langer from Suffolk University to discuss a more collaborative approach to understand and begin a wellness journey through therapy.
Dr. Langer, Clinical Psychologist, specializes in child and adolescent psychology; treatment efficacy and effectiveness; psychosocial treatment process; child and adolescent psychopathology; personalizing treatment planning; and shared decision-making.
He explores questions of how do we help children and families when a child is anxious or depressed? More specifically, how do we identify which treatments are the most likely to be effective for anxiety, depression, or any other mental health issue (treatment effectiveness); figure out how those treatments work (treatment process); and adapt treatments to fit the needs, preferences, and values of individual families (treatment personalization)?
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.
