by Renee Mill, Clinical Psychologist
Originally published in Sydney's Child, Melbourne's Child, Adelaide's Child,
Brisbane's Child, Canberra's Child and Perth's Child, February 2009
Listening to a message left by Reeva Simons* on my voice mail, I noted some anxiety in her voice. I called back immediately and set up an appointment for the next day. Noticing the date was the 14th of January, I decided to consult my notes. Yes, my gut feeling was correct. I had seen Reeva twice before. The first time was January 24, 2006 and the second time was January 26, 2007. A coincidence? I think not.
Both appointments fell in the first week of the first term of school because that is when her son Ryan presents with symptoms. He becomes anxious and finds it difficult to fall asleep. He feels sick a lot of the time and complains of a sore tummy. He picks at his food and cries easily. He does not like to be alone and sticks close by a trusted adult. My simple “diagnosis” is that Ryan does not tolerate change very well and when something new arises, like starting a new year at school; he finds it a major challenge. Ryan does not suffer from classic, pervasive anxiety but anxiety which is triggered by fear of the unknown. Truth be told, this “condition” is very common both in children and adults. It is why many adults stay in difficult and bad situations; they cannot face making changes to their life.
When Reeva sat down in my office, I allowed her all the time she required to state how worried she felt. My knowing what the problem was would not help her until she felt validated and heard. I listened while she described what she had gone through at the beginning of last school year. Ryan became very clingy when she tried to drop him off at school which amazed her because she had assumed that by year 2 he should be independent enough to find his own way to his new classroom. Copying the other parents, she walked with him to the hall, said good bye, and walked off. Ryan began to cry, ran after her and literally held onto her skirt. The more she pushed him away, or shouted at him, the more he clung. In the end, she stayed with him until the teacher took his hand and walked the crying boy to the classroom.
Reeva remembered feeling awful. To this day, she regrets shouting at him but she did not know what else to do. She had felt humiliated that her son was such a baby and that other boys seemed so much better adjusted. Most importantly, she had felt helpless and, after 3 days of Ryan’s clinging, she was at her wits end. That was why she consulted me then, and with my support, she had helped him make the transition to autonomy. Reeva wanted this year to be different. She wanted to be more helpful and to minimise Ryan’s distress.
Calmly, I let Reeva cry and express all her worries. When she settled down, I asked her if she had felt heard by me, understood and not belittled by her “lack of control”. She replied that she felt much better already just because I did not make her feel like a stupid mum who worries about a silly little problem when other mums have much bigger problems to fret over. Leaning forward, and with gravity, I said that this is what she needs to facilitate in Ryan. No matter how immature she thinks he is, to him his anxieties are real and it is vital that he feels validated.
Reeva liked my ‘in vivo’ demonstration as it gave her something to work with immediately. She understood that she needs to make it safe for Ryan to talk about his fears and that she should not jump in with explanations, reassurances or put downs. In the past she would have tried to persuade him there was nothing to fear but now she committed to just listening.
Once Ryan feels understood, I encouraged Reeva to normalise his fear of change by saying something like “It is very common for people to be afraid of new situations. Many children feel sick at the start of a new year at school because so many things will be different to last year.” While feeling validated and understanding his problem will not alleviate Ryan’s anxiety, it will help him feel more centred and able to expend energy on coping with the problem. It becomes a common, manageable problem with known strategies which can assist him.
Moving forward, I asked Reeva to plot what happened each year, on each day. This was easy. Both times he had felt queasy and unsettled for a week before school started. For the first 3 days of school he was clingy until he felt secure with the teacher. By day 7 he usually had made a new friend and was looking forward to the next day and by day 14 he felt totally comfortable.
Recognising a pattern is a preparatory tool Reeva can utilise. You see, when a problem is given a name associated with a known process, it becomes easier to bear. It is like having a medical diagnosis and being told what symptoms to expect, as opposed to having no clue about what is wrong. I coached Reeva to describe the process to Ryan as she had done for me. Then she might offer some suggestions like: “I noticed last year that when you made a new friend, you enjoyed your day more. So perhaps you could focus on finding a new friend early on” or “Do you remember in year 1, you felt more secure when your teacher put you in the front row? Would you like me to ask your new teacher to do the same initially?”
Building self efficacy goes a long way to gradually decreasing fear in the long term (see Sydney’s Child vol X). I explained to Reeva that it is imperative she points out to Ryan what strengths he showed the previous years as this will give him courage to forge ahead now. Comments like: “Do you remember how in year 1 you introduced yourself to a stranger? That showed courage.” Or “In second year I noticed that you walked with your teacher even though you did not really want to. That shows determination.” After making a few comments like that in the week leading up to school, Reeva could look Ryan in the eye and say:” Ryan, you are a person who has shown courage and determination in the past and I know that those qualities will stand you in good stead this year too.”
Another tool I taught Reeva is what I call the “the fire drill method”. It is very effective and is a lot of fun. How it works is that before a new situation a parent can go through what to expect before it happens. That way it is not unexpected and some exigency plans can be made. For example: Reeva and Ryan can role play walking into the large school hall and work out the best place to stand and wait for instructions. They can make a plan B that if Ryan does not make a friend on the first day, he can go to the library at recess. Similarly, plan C can be if Ryan does not like the new teacher straight away, he can jot down notes about it so he can discuss it with Reeva afterwards.
Breathing and relaxation are standard techniques that one uses for anxiety. Reeva should teach Ryan to recognise when his breathing speeds up or his heart starts to race. Once he is self aware, he can be taught to breathe deliberately and slowly which will calm him. A simple relaxation method is all that is required. I like the method where one inhales slowly and as one exhales, one verbalises the word ‘relax’. Doing this 5 times at bed time and on waking is a great way to train oneself to relax. However, one can do this as many times a day as one needs and it is easy to do it sitting at a desk or in an assembly standing up. The key to success in this, I stressed to Reeva, is practice and repetition for many years to come.
Some children are more anxious than others. The problem with anxiety is that it becomes a habit physiologically. In other words, if Ryan gets used to responding to new situations with a fight or flight response, it becomes habitual. Conversely, if he trains his body to be calm in most situations, that becomes the habit. That is why repetition is essential and needs to be carried out long term. Another problem with anxiety is that sufferers develop secondary fears. Simply put, Ryan could become afraid of his symptoms and that causes the symptoms. That is why it is vital that he realises that he can be bigger than his symptoms and that he has the power to override them.
Towards the end of the session, I focused on Reeva herself. I asked how she was feeling. She told me that she felt more normal as she realised that what she goes through with Ryan every year is common and she is not a failure as a mum. She also felt empowered to cope with the problem because I had given her so many simple strategies. Reinforcing her good feelings, I stressed that she would be role modelling an attitude that Ryan could emulate. As his mother and primary caregiver, her coping style and attitude to the problem would go a long way to helping Ryan. Reeva understood what I meant, she said, having experienced it in the session and realising that so much of parenting is about attitude and modelling.
As she left, I asked Reeva what her plan B was. She chuckled, finding the question unexpected. After a moment’s reflection she said “I will take notes of Ryan’s progress and if I feel the need I will call you again. Every night I will debrief with my husband and if necessary, I will summon up the courage to request that the school have an orientation week next year.” Great answer Reeva; and if we meet again next year, we know it will be for just one session as that is our pattern. And that is entirely manageable!
* Not her real name