Question: Since about the age of six, my daughter (who is now eight) has become a bit of a worrier. She can be fearful about lots of different things such as going out to a party (eg that none of her friends will be there) or when there is bad news on the telly. When the news covered fires in Portugal recently, she became really worried that these could start here in Ireland. Recently, she is now worried about me or my wife going out in the evening incase something "bad" happens to us. My wife and I try of course try to reassure her each time she is fearful and sometimes we can get through to her, but then in a couple of days she has a new fear. We want to get to the bottom of what is causing her to be worried like this. We want to get to the root cause of the problem, rather than just treat the symptoms. We have asked her what has made her worry like this all the time and she says she does not know. We were wondering about taking our daughter to get professional therapy. Who would you recommend? Lots of the websites recommend CBT for dealing with anxiety. One of our friends took their son to to a play therapist and this seemed to help. We were wondering about taking our daughter to the same person. Do you think play therapy will help her or should we go somewhere else?
Answer
Anxiety and worry are very common childhood problems. Indeed, there are many children like your daughter who have a tendency to worry about everything. Just as as you think you have reassured them about one worry, then another worry can appear and you have to start again. Anxious children do require a lot of reassurance and patience from their parents. Over time the goal is to teach them skills of self-managing their anxiety and worry
While there might be triggers for certain worries, such as the fires in Portugal or bad news on the TV in your daughter’s situation, frequently there is no one “root cause” for their anxiety that can be clearly identified. While some children have a sensitive personality that makes them more likely to be anxious, their pattern of worry and anxiety can be best thought of as habitual ways of thinking that develop over time. Like all habits there is a lot you can do to break this pattern of worrying and to develop more constructive ways of thinking though it does take time and patience.
Helping your daughter
In helping your daughter, continue to be reassuring and patient. Listen to each of her worries and acknowledge her feelings – feeling understood will relieve a lot her distress and help her cope. It is also important, not to just see her tendency to worry as a problem, but rather to take time to appreciate and channel the positive strengths behind it. For example, you might say to your daughter – “you have such a great imagination, the problem is that you just imagine everything that can go wrong. I wonder what it would be like if you were to imagine things going well instead?’
Over time it is important to teach your daughter strategies on how to mange her worry and anxiety such as learning to distract herself when she starts to worry or challenging the thinking that underpins her worries or learning to problem solve when she has a specific worry. For example, if she is worried about going out to a party, you can talk through how she might manage this situation step by step. You can encourage her to express her fears about something that might happen (eg that no one will talk to her) and then explore solutions to each of these problems (eg identifying someone she knows who she can approach and/or rehearsing what she might say, etc). In addition, helping your daughter learn relaxation strategies ( such as counting breaths or visualisation or mindfulness) will be beneficial and give her strategies that she can use when worries take over. Last year in The Irish Times I wrote a six-part series on all the different strategies parents can use to help anxious children; for more detailed information, please access these online at irishtimes.com
Picking the right therapy for your daughter
Professional therapy can be of benefit in helping children overcome anxiety. Play therapy can be particularly helpful in building a child’s confidence and helping them understand and express their feelings. With respect to anxiety, there is more evidence for skills-focused models such as cognitive behavioural therapy (CBT) that concentrate on helping children develop new thinking and behaviours in response to their anxiety.
However, the most crucial factor in successful therapy is picking the right therapist and in particular one who is child-centred and who knows how to communicate with children. More important than choosing the “right” model is choosing a therapist who your daughter is comfortable with and who is able to engage and motivate her. In addition, most child therapists are eclectic in how they approach their work, drawing from a range of models as they try to help individual children. For example, a skilled play therapist could also use many CBT ideas in their approach as they support a child in managing anxiety. Finally, in picking the right therapist for your daughter, pick a person who you can work with as well. The best child therapists also know how to support parents and to assist them in dealing with the situation at home. To maximise progress, the ideas practiced in the therapy should also be ones you can apply at home with your daughter. Before taking your daughter to a therapist, I would recommend meeting them yourself first and taking time to judge whether they could be helpful to both of you.
Dr John Sharry is a social worker and psychotherapist and co-developer of the Parents Plus programmes. His new book, Bringing up Happy Confident Children, is now available. See www.solutiontalk.ie