What to Do When Your Child Refuses Therapy

You’ve noticed a change in your kid. She’s irritable all the time, she spends most of the day in her room, and you’re worried something deeper is going on. Maybe you have a good guess about what’s to blame, like a friendship with someone who isn’t a great influence or a particularly stressful school year. Or, maybe this seems to have come out of the blue, which can feel even scarier. Either way, no matter how delicately ask whether your child wants to talk to someone, you get the same answer.

”I’m fine!”

What do you do? I know so many parents who are trying to get their kids the help they wish they’d received when they were young. When a child refuses therapy, it can be confusing or even frustrating. Let’s talk about a few ways parents can start a genuine conversation with kids who say they don’t want help.

Clear Up Any Misconceptions About Therapy

I cannot tell you how many times I’ve had a kid sit on my couch for a first session and tell me that they have no idea what’s going on. They don’t know what to expect from therapy, and they may not even know why they’re in my office in the first place!

Young children may have heard the word “therapist” or “counselor” before, but may not know what it really means. They may imagine that a therapist is someone who administers tests, prescribes medications, or even gives out shots. I’ve had a few little kids arrive at therapy in tears because they remembered a recent vaccination appointment and worried they were in for more of the same.

Older kids and teens usually have a general idea of what to expect, but their vision of therapy may be vague or stereotypical based on what they’ve seen in the media. Because older kids have the maturity to think about cause and effect, teens often worry about confidentiality in therapy. What will happen if they share what’s really going on with a therapist? Will the therapist just turn around and tell everything to their parents? Could what they say in counseling get them or someone else into trouble?

For a younger child, explain what a counselor can do (play, talk about feelings) and cannot do (give shots or medicine). It might be helpful to explain what happens in a therapy room, including that therapists keep some things private. Older kids may benefit from learning the ins and outs of confidentiality: they need to feel confident that they’ll have some privacy if they’re going to consider counseling at all. You can also share any information you have about your prospective therapist’s personality or way of working with kids.

If you’re getting ready to explain therapy to your child, I’ve gone into what to say in more depth in an earlier blog post on having the “counseling talk”.

Don’t Make Therapy Sound Like a Punishment for Bad Behavior

If your child bristles whenever you bring up the word “therapy”, be mindful about when you’re mentioning it. Are you only talking about going to counseling on the heels of a big fight, or after a bad report from school? It’s understandable that bad stuff happening would remind you of the need for therapy, but if you’re bringing up the idea in the heat of the moment it might come off as sounding like a punishment.

When an adult goes to therapy, it’s usually a decision they’ve made for themselves. It may feel scary or vulnerable to get started, but it’s also empowering and a form of self-care. On the flip side, it isn’t always a child’s idea to seek out a counselor. Kids sometimes tell me they feel they were sent to therapy for being “bad” and that the goal of therapy is to make them “good.” Instead of feeling empowered, they feel ashamed and a bit like they’ve just been sent to the principal’s office. No wonder they don’t want to come.

An honest conversation held during a calm time can go a long way toward changing a child’s opinion about therapy. It can be really helpful for your child to hear that you are struggling, too. Shifting the focus away from the child and toward a “family problem” lets your child know that you are all in this together, rather than singling out your child as the sole person in the family in need of help.

Even if you’re 99% sure of the cause of your child’s distress (a mean friend, a recent breakup, upcoming state tests) it is sometimes helpful to stick to talking about what you can see. For some kids, having an adult speculate about the cause of their troubles feels like someone is putting words into their mouth. By sticking to the facts, you may help your child feel a little less defensive. For example, saying “I notice you’ve been spending a lot more time in your room” is likely to go over better than “Ever since you made that online friend, we never see you anymore.”

Consider Alternatives to In-Person Talk Therapy

Introverted kids in particular may not be thrilled about the idea of sitting in a room with a strange adult and pouring out their deepest, darkest emotions. Even though sitting on a couch and talking face-to-face is what we consider “traditional” talk therapy, it may not feel all that traditional to a child to be alone with an adult who isn’t a relative or a teacher.

If you suspect that solo, face-to-face therapy is intimidating to your child, consider other less “traditional” alternatives. Group therapy might help some kids feel a little less on the spot, and there’s good research to show that it is just as effective as individual therapy for many problems. For others, seeing a therapist online may feel safer and more comfortable than sitting six feet away in an office.

In my own practice, I’ve noticed that tweens and teens are sometimes able to open up about difficult subjects more easily online. Maybe it’s because communicating through tech feels more natural to them, or maybe the computer screen helps them feel a bit more anonymous. Either way, it’s an option to consider if your child is refusing therapy.

Depending on your child’s interest, you might even be able to find a hyper-specific group that plays to their passions and strengths. For example, my online D&D groups for middle and high schoolers can be a helpful first step into meeting peers, exploring emotions, and practicing social skills.

My Child Still Refuses to Go…Is It Ever Okay to Force a Child to Attend Therapy?

It’s possible that you’ll say and do everything you can to cast therapy in a positive, non-judgmental light, and it still won’t change your child’s mind. Some kids fell so sure that therapy won’t help—or so uneasy about going—that they’ll put their foot down, no matter what.

It’s really hard to “therapize” a person who doesn’t want to be in therapy. In an ideal world, a therapist and client are equal partners in the therapy room, with both people bringing in ideas and nobody acting like the boss of anyone else. If a child is forced to attend, it immediately puts them in a low-status position and makes the therapist the boss. That makes it hard to grow.

I will sometimes ask kids and teens who are unsure about therapy if they’d be willing to give it a try for a set number of sessions, like 3 or 4. If your child is on the fence, you may want to give this approach a try—you might be pleasantly surprised! However, if after those sessions your child wants to end therapy, hold up your end of the bargain.

If a child is forced to attend therapy long-term against their will, it may give them a negative perception of therapy and keep them from seeking help in the future. I’d rather give kids a sense of agency, and let them return to therapy on their own terms when they feel ready to do the work.

There’s one big exception to this rule: if a child is self-harming or feeling suicidal, they need to be in therapy no matter what. However, these kids may need more support or a more specialized approach than once-a-week therapy can provide. If you think your child is at risk of serious harm, speak to a guidance counselor or pediatrician or, in an emergency, dial 911.

How Do You Help a Child or Teen Who Doesn’t Want Help?

So, you’ve determined your child is not going to therapy. Maybe you tried a few sessions and it didn’t work out, or the therapist you found didn’t seem to be the right fit. Now what? How do you help a child who refuses help?

If a child is absolutely dead-set on going to therapy, and there are no safety worries like self harm or suicidal thoughts, forcing a child to go to therapy can do more harm than good. It reinforces the idea that therapy isn’t really for helping, it’s a punishment for bad behavior. It will make it even harder for your child to feel safe enough to give therapy a try in the future.

On the other hand, kids are growing and changing all the time. Many Gen Z and younger kids view therapy in a positive way, so it’s likely your child will learn more positive things about mental healthcare from peers as she grows. By respecting your child’s decision and continuing to check in about therapy as an option, it’s possible she’ll come around to the idea on her own.

In the meantime, your best option is to get yourself into therapy. I know it’s a suggestion that gets recommended a lot and it may not feel great to hear. However, therapy with a counselor who specializes in working with parents can equip you with the tools you need to help your child—whether they attend with you or not. Parents have so much influence over the lives of their children and the culture they choose to create in a home. When you take the time to care for yourself, it almost can’t help but rub off on your children, too.

In-Person and Online Therapy for Kids in Charlotte, NC

I love working with tweens and teens struggling with anxiety, and have some therapy options that go beyond the usual sit-on-the-couch-and-talk to meet kids where they feel most comfortable. Even super reluctant young children are often excited to attend play therapy, which uses kids’ natural creative instincts to work through feelings using actions instead of words. Older kids and teens may prefer online therapy, which feels a little less intrusive than being face-to-face.

If your child has a passion for games or geek culture, you may also want to consider my Dungeons and Dragons-based groups for tweens and teens. They’re an introvert-friendly space to meet new people and practice social skills in an online setting that still feels meaningful.

Interested in getting started? You’re always welcome to contact me here.

Would Your Child Be a Good Fit for Dungeons & Dragons Group Therapy?

Have you ever wondered what help is available for kids outside of individual talk therapy? Social distancing has made many of us acutely aware of how important it is for kids to be around other kids. If you’re trying to find ways for your child to stay connected to peers during another few months (or more!) of online school, I want to introduce you to a quirky new kind of therapy you may not have heard of before. In this post, I’ll be sharing a little about how Dungeons & Dragons can be used in therapy groups, and how to tell if this approach could be a good fit for your child.

What Happens in a Dungeons & Dragons Therapy Group?

Dungeons and Dragons is a little bit like a choose your own adventure book come to life. Each player in D&D creates a character with their own unique strengths, weaknesses, and magical powers. These characters work together to navigate a fantasy world, solve problems, and generally get up to mischief and adventure.

Rather than following a pre-set story or rules, D&D players are making up their own story as they go. They’re helped in this by a “Dungeon Master”, who acts like a referee and emcee in the game. The dungeon master sets the scene for the players, gives them problems to solve, and helps them to build a magical world. A roll of the dice determines how successful the player is at whatever they’re trying to do, which adds an element of surprise to the game.

Dungeons and Dragons is collaborative, not competitive, and it requires tons of creative problem solving. This makes it a great fit for therapy groups, and therapists around the country have started incorporating D&D into group therapy sessions with kids and adults. Dungeons and Dragons is a great way to meet new people, practice communication and teamwork, and experience the satisfaction that comes from learning a new skill.

Is Dungeons & Dragons OK for Kids?

The name “Dungeons and Dragons” sounds a little…sinister. It conjures up images of a game that is heavy on gore and may not be suitable for children. If this is the reaction you had when you first heard about D&D, you aren’t alone! Just like rap music and video games, there was some controversy in the 80s about whether D&D was too violent for kids.

Name aside, there is nothing inherently age-inappropriate about D&D for kids. The game is all about imaginative play, and it doesn’t even have to include dungeons or dragons: stories have been set in all sorts of cool, child-friendly fantasy worlds, from outer space to fairy forests to fantasy worlds inspired by Studio Ghibli movies. Because the game is fully customizable, it’s up to every group to decide what content is okay and what is not, and how to handle violence.

Today, we know that there are many ways in which role-playing games like D&D support child development. Game play requires both math and reading skills, encourages teamwork and turn-taking, and gets kids see the world through someone perspective, which helps to develop empathy. Dungeons and Dragons promotes all sorts of positive social skills that kids can apply not just to the game, but to their day-to-day lives.

Who Is a Good Fit for Dungeons and Dragons Groups?

So, what kind of kid might enjoy playing D&D? Is it only for children who already really into nerd culture? Is it better for extroverts or introverts? What about kids who have never played the game before—could they figure it out in a group setting?

Personally, when I started playing D&D, I was not very familiar with anime, video games, or any other aspect of “nerd culture.” I had also never played the game before, and the rules seemed a little intimidating at first. Now that I’ve played the game for a while, I think the only skills you really need to be a great D&D player are imagination, creativity, and a willingness to play.

Here are a few signs or traits that your child might be an excellent fit for a Dungeons & Dragons therapy group:

• Your child loves getting lost in fantasy worlds like Harry Potter, Lord of the Rings, or Star Wars

• Your child is a “theater kid” who enjoys acting or performing

• …or, on the flip side, your child is shy and would love to make new friends, but isn’t sure how to reach out to new people

• Your child is imaginative and was always great at pretend play

• Your child would like an opportunity to practice teamwork, verbal communication, and taking turns

• You think your child could use the self-esteem boost that comes from mastering and succeeding at a new activity

Both extroverts and introverts can excel at Dungeons & Dragons, as long as they are willing to step a bit outside of their comfort zone to play around with new friends.

How Old Do Kids Need to Be to Play Dungeons and Dragons?

I usually see 12 being recommended as the ideal age to start playing D&D. The rules can be a little complicated, and kids need to be able to think abstractly in order to enjoy playing the game. In my own D&D group, I work with middle school aged kids from ages 11-14.

The right age to start playing depends a lot on your individual child. If your elementary school-aged kid has been playing other tabletop games for years and is a fantasy story fan, she may be ready to dive into D&D. It’s also possible to simplify the rules of D&D to accommodate younger players, which can be a fun option for families with mixed-age kids who would like to play the game together.

More Information on Dungeons & Dragons Therapy Groups for Children

If you want to experience some of the therapeutic benefits of D&D for yourself, check out Young Dragonslayers. This program started as part of my therapy practice, and has grown to offer online D&D to kids across the country with the goal of practicing social-emotional skills in a friendly, inclusive environment.

For further reading, check out my earlier blog post on the mental health benefits of D&D as well as Geek & Sundry’s helpful article about D&D therapy, which focuses on how the game can be useful for kids with social anxiety.

If you have any questions or you’d like to learn more about counseling, you are always welcome to contact me.

Understanding Accommodation in Child Anxiety: A Guide for Parents

Is all the comforting you’re doing backfiring? Learn about the role accommodation plays in a child’s anxiety.

As a parent, you’d probably do anything to help your child when they’re in distress. It’s kind of our main job as parents: we’re here to provide comfort, offer reassurance, and keep our kids safe. One of the trickiest things about child anxiety is that well-intentioned actions aimed at providing comfort and reassurance often backfire, making anxiety worse in the long run.

If your child has anxiety, you may have already sensed this: the more reassurance you give your child, the more reassurance they seem to need. The more you avoid feared situations, the more their anxiety seems to grow. You’ve unintentionally become the narrator of If You Give a Mouse a Cookie and your child’s anxiety is the insatiably hungry creature who somehow always craves more.

Anxiety therapists have a term for this phenomenon: accommodation. In this guide, we'll explore what accommodation entails, why it's important to address in therapy, and practical strategies for navigating accommodation as parents.

What is Accommodation in Anxiety?

In anxiety therapy, an accommodation refers to any way that you or your family alters your behavior in order to avoid triggering anxiety in your child. This might mean offering extra reassurance, changing your routines, or accompanying your child to activities they used to do alone.

If you’re like me, you are probably used to hearing the word “accomodation” used in a more positive way. Academic accommodations can be a huge help to kids in schools: a child with dyslexia might benefit from getting extra time to complete tests, for example. ADA accommodations make sure that people with disabilities are given equal opportunities in the workplace. These types of accommodations are objectively great!

In the therapy world, unfortunately, accommodation is not so great. While it might provide temporary relief for your child, it tends to make anxiety worse over time. Kids don’t get a chance to learn how to cope with their anxiety, which reinforces their belief that it’s something they can’t manage or control.

Basically, when we accommodate a child’s anxiety, we’re really just enabling the anxiety.

If you’re reading this and kicking yourself for being an anxiety enabler, please don’t. It’s human nature to want to keep someone else from feeling bad. The truth is, we all accommodate our kids sometimes. It’s usually harmless, but for kids with anxiety disorders, it can lead to larger issues.

What are the Risks of Accommodating a Child’s Anxiety?

Accommodation risks making anxiety worse over time, leading to more stress for the whole family.

When you accommodate a child’s anxiety, you risk entering a vicious cycle. By giving in to anxiety’s demands, your child misses out on a chance to test whether or not their worries are accurate. Instead, they avoid the situation entirely, which sends the message that maybe this scary thing really is worth staying away from.

This means your child is likely to be even more anxious the next time this scary situation comes up. They’ll need even more accommodation in order to cope. Before you know it, you’re bending over backwards to try to avoid anxious feelings.

An occasional accommodation here and there is a part of life. But repeated accommodation can come with the following risks for anxious kids:

• Worsening anxiety

• Lack of effective coping skills

• Increased reliance on parents to manage anxiety

• Disruption to daily routines due to avoidance of triggers

• Poor sense of self-efficacy (ability to solve problems independently)

• Increased family stress

These risks are much greater if your child suffers from an anxiety disorder, like social anxiety, generalized anxiety, or OCD. These kids’ super-sensitive brains are always looking out for danger, and they’re much more likely to fall into the trap of avoiding scary things.

Examples of Parental Accommodation

Excessive texting is a common and subtle example of accommodation.

So we know accommodation is not great. How can we tell if we’re doing it? While some accommodations are obvious, others are sneaky and subtle. It can be easy to fall into the routine of accommodating anxiety in small ways without even noticing you’re doing it.

Here are some common examples of anxiety accommodation, based on my experience as a children’s therapist:

• Allowing a child to skip activities that could trigger separation anxiety, such as field trips.

• Driving a child to school to avoid having to ride on the bus or carpool with a friend.

• Responding to text messages from the child all day (or all night!) to offer reassurance.

• Making sure to always tell you’re child where you are going or what you are doing.

• Repeatedly answering anxiety-driven questions, such as “Do you think I’m going to get sick?”

• Accompanying a child to activities that peers would attend alone.

• Helping a child stay away from triggers, such as crossing the street to avoid a barking dog.

• Participating in overly long or rigid bedtime routines.

• Changing family routines to help a child remain calm.

• Sleeping in a child’s room to avoid bedtime fears.

• Keeping special items on hand, such as Purell for a child afraid of germs or a barf bag for a child afraid of vomiting.

If any of these examples of accommodation seem familiar to you, don’t panic! As bothersome as accommodation can be, it’s also incredibly common.

Pretty much every family with an anxious child has some amount of accommodation going on. Therapy can help you scale it back, and empower your child to tackle their fears more directly.

Strategies to Reduce Anxiety Accommodation

Like gradually stepping in to a pool, reducing accommodation is a slow and steady process.

Even if the accommodating is making everyone fairly miserable, you don’t want to needlessly torture your kid. Like it or not, they’re relying on these defense mechanisms to cope. Removing them all at once would be hard on you and even harder on them. Instead, we can gradually reduce our accommodation, which gives kids a chance to adjust, face their fears, and develop healthier coping skills to manage anxiety.

If you want to start gradually reducing anxiety accommodation at home, you can try:

• Setting a limit on how many times you’ll reassure your child each day.

• Answering anxiety-driven questions only once.

• Limiting texting and communication during school hours or after bedtime.

• Encouraging your child to try new and challenging things rather than offering a way out.

• Making a plan with your child to go to scary places or try scary activities on purpose.

We want anxious kids to learn that they can do things even when they feel scared. Anxiety isn’t something to be avoided: it’s a part of life! Most of the time, their anxiety is just a false alarm, and not an indicator that a situation is really dangerous.

When kids develop this mindset, they can start facing their fears head-on, anxious or not. And, weirdly, the more this happens, the less anxious kids tend to feel. They’ve broken the anxiety-avoidance cycle and taught their brains there’s nothing to be afraid of.

Exposure Therapy for Anxious Kids and Families

Seems simple enough, right? Just…slowly stop doing the stuff you’re doing. But if you’re already way far down the accommodation rabbithole, this is easier said than done. It can feel nearly impossible to course correct if you’ve been answering a million texts a day or sleeping on the floor of your child’s bedroom for six months.

If you find you’re doing tons of accommodating, or your child’s anxiety symptoms are severe, therapy can help. A therapist can help you find creative ways to support your child in gradually facing their fears—without you doing the work for them. If things don’t go as planned, your therapist will help you problem-solve and keep you on track. Their job is to keep everyone feeling challenged, but not burned out.

This kind of therapy is called exposure therapy. In OCD treatment, you’ll also hear it called Exposure and Response Prevention. The goal is to help your child take back the parts of her life that anxiety has held hostage, whether that’s sleepovers or field trips or staying home alone. Facing your fears is hard, but a whole childhood without these kinds of activities is even harder.

Therapy for Anxiety Accommodation in North Carolina

Therapy can help anxious kids and teens learn to face their fears and live more confident, independent lives. Photo by Kindel Media via Pexels.

Wondering what could have possibly compelled me to write over 1300 fully original, non-AI-generated words about anxiety accommodation? I’m a children’s therapist specializing in anxiety and OCD. I am lucky enough to help families through exposure therapy on a regular basis, and honestly, I could talk about its benefits all day.

Exposure isn’t right for every family. But if you think it could be the answer to ending accommodation for you and your child, I would love to help! My office is in Davidson, North Carolina (North of Charlotte) but I can practice online therapy throughout the state, and in New York and Florida, as well.

If you don’t live in one of these states, you can search therapist databases for local therapists who practice CBT, exposure therapy, or ERP. These folks will be specifically trained in helping families reduce their accommodation to overcome anxiety.

To summarize, reducing anxiety acommodations helps kids build the skills they need to overcome fears, build resilience, and generally lead more confident lives. If you’re interested in taking the next step, you can contact me here.

Fear of Throwing Up: A Parent’s Guide to Emetophobia in Children

Fear of throwing up, also called emetophobia, is a common and challenging problem for kids and teens.

Nobody likes throwing up. It’s only natural to want to avoid being sick. But what do you do if you’re the parent of a child who really, really, really does not want to throw up: not now, not ever? Unlike many other common childhood fears (ghosts, clowns, monsters under the bed), anxiety about vomiting can seem pretty logical—at least on the surface. But for some kids, anxiety about throwing up grows past what’s typical and starts to get in the way of daily life.

This extreme fear of vomiting is called emetophobia, and it’s one of the most common phobias experienced by young children. Frustratingly for parents, it can also be one of the trickiest to diagnose and treat!

If it feels like your life is being consumed by your child’s increasing worries about getting sick, there is good news. There are therapy techniques that are proven to help kids with emetophobia get back to living happier, less anxious lives. In this guide, we’ll cover the signs and symptoms of emetophobia that set it apart from a passing childhood phase. We’ll also discuss how it develops, what you can do to support your child, and how therapy can help.

How Do I Know if My Child Has Emetophobia?

Children with emetophobia have a fear of vomiting that goes above and beyond the discomfort a person would typically feel about throwing up. It’s common to be nervous about throwing up during an illness, but kids with emetophobia are preoccupied by their worries all the time, even when they’re healthy.

If your child has emetophobia, you may notice them going to great lengths to avoid places, activities, or things that they associate with throwing up. You might also observe your child repeatedly saying or doing things that they think will make it less likely that they’ll get sick.

Most people with emetophobia start developing their fear in early childhood: the average age of diagnosis is around 9 years old. While kids of any gender can have emetophobia, it’s more commonly diagnosed in girls than in boys.

All kids go through phases, and if a child’s worries are just a passing phase they will likely resolve on their own after a few days or weeks. Emetophobia is different. It grows and worsens over time. You may notice that your child’s list of avoidances gets longer and more generalized. For example, rather than staying off one specific rollercoaster where she once threw up, now she avoids all rollercoasters, as well as any vehicle she worries will be too bumpy.

Signs and Symptoms of Emetophobia in Children

Excessively avoiding people, places or activities that could cause illness is a common symptom of emetophobia in children.

Kids with emetophobia experience anxiety symptoms when they start thinking about the possibility of throwing up. To cope with their fear, they may avoid things that they believe could put them at risk of throwing up—even if it doesn’t logically make sense to do this. They might also repeatedly ask for reassurance or repeat behaviors that reduce their anxiety and make them feel more safe from the risk of throwing up. Here are some examples of anxiety, avoidance, and repeated behaviors to look out for:

Anxiety Symptoms:

• Overwhelming worries that are hard to control

• Panic symptoms, like sweaty palms, racing heartbeat, or shaking

• Dread before entering a situation that your child associates with throwing up

• Feeling sick to your stomach (anxiety can cause nausea, which sets off a vicious cycle!)

Avoidance Symptoms:

• Refusing to eat certain foods, either because your child once threw up after eating them or because your child fears they could cause nausea (too rich, too close to expiration date, etc.)

• Staying away from places where your child has previously thrown up or seen someone else throw up

• Avoiding activities that could cause nausea, like rollercoasters

• Keeping away from sick people, doctor’s offices, or hospitals due to a fear of catching germs

• Refusing to take medications that list stomach upset as a possible side effect

• Difficulty saying words like “vomit” or “threw up”

Repeated behaviors:

• Repeatedly asking for reassurance that they will not throw up

• Excessively washing hands

• Compulsively checking expiration dates on food or medications

• Repeatedly checking for bodily sensations like a gag reflex or stomach pain

• Staying close to a trash can or barf bag

• Eating slowly, cutting food into small pieces, or otherwise changing eating habits to avoid nausea

If you’re noticing several of these signs or symptoms of emetophobia in your child, check in with your pediatrician or a children’s therapist.

What Triggers Emetophobia?

Like most anxiety disorders, emetophobia is probably triggered by a combination of genetics and stress. There’s no one singular thing that causes emetophobia to occur, and it’s nobody’s fault: there’s nothing you could’ve done as a parent to prevent it.

Anxiety has a strong genetic component and tends to run in families. If your child has biological relatives who struggle with anxiety, there’s an increased chance your child will naturally have a heightened anxiety response, too. Even if nobody else in the family has emetophobia, simply having other anxiety disorders in the family tree can put a child at increased risk.

Even with a genetic predisposition for anxiety, there’s usually some kind of trigger or event that sets a child’s emetophobia into motion. Many children start showing symptoms after getting sick and throwing up. However, it’s also possible for emetophobia to be triggered by seeing someone else throw up, or even just having the sensation of choking or gagging.

These kinds of stressful events could have any child feeling worried or stressed for a little while. But kids who are already anxiety-prone may have a harder time brushing the event off and moving on. Instead, their experience with vomiting sticks with them and triggers recurring worries and attempts to avoid throwing up again.

While unlikely to cause emetophobia, parents may also notice that their child’s symptoms get worse after any stressful life change, like a move, the birth of a new sibling, or starting at a new school.

Do Children Grow Out of Emetophobia?

Symptoms can get much better with treatment, but it’s unlikely that a child will outgrow their emetophobia without help from an adult.

If you’re in the thick of it with emetophobia, you may be wondering if your child—and you—will have to cope with this debilitating fear of vomiting for life. The thought of a lifelong diagnosis can be a scary prospect: how can you enjoy a happy childhood when you’re struggling this much?

Generally speaking, kids won’t grow out of emetophobia on their own. One a child’s anxiety symptoms are this severe, they need help from parents and professionals to get back on track. In fact, research suggests that kids with emetophobia who don’t receive treatment tend to struggle with emetophobia into adulthood.

There also isn’t great data available (at least that I’ve found) about how many kids with emetophobia are 100% cured of their worries. This is probably because kids with a fear of vomiting often have other forms of anxiety they deal with, as well, like generalized anxiety or OCD.

I realize this all sounds a little hopeless. It isn’t! There’s good news: while emetophobia can be tricky to treat, especially without help, it can get better. Therapy can help kids and their parents gradually face the situations that trigger fears of vomiting, without needing reasssurance or special treatment.

Kids can become more confident in their ability to handle their anxiety on their own. When this happens, worries may not disappear entirely, but they become a passing annoyance instead of a debilitating fear.

How Can I Help My Child With Fear of Vomiting?

Kids with a fear of vomiting absolutely benefit from therapy with a professional. However, if you’re just starting out on this path and still searching for a therapist, there’s a lot you can do on your own to help your child. Parents play a huge role in their child’s recovery from emetophobia. Changing how you respond to anxiety can help your child cope better with their worries and prevent symptoms from snowballing.

The most important thing you can do to help your child with their fear of vomiting is to be mindful of how you are changing or adapting the way you do things to keep your child from experiencing fear. Nobody wants to see their child suffering, and it’s only natural to want to reassure a worried kid or take them away from an anxiety-provoking situation. However, when a child has an anxiety disorder like emetophobia, preventing a child from facing their fear head-on makes symptoms worse over time.

In therapy, we call this accommodation: families learn to change their ways over time to accommodate and “make room” for a child’s anxiety. While this might appear to help in the short term, over time you’ll find the anxiety takes up more and more space. Its list of demands grows: instead of one reassurance, your child may need many. Throwing out expired crackers once may lead to repeated requests to check expiration dates on everything in the fridge.

You may realize that you’re already doing a good deal to accommodate anxiety, and that’s okay. You don’t need to suddenly remove all the supports you’re offering your child. A therapist can help you gradually pull back on accommodation so your child feels empowered to face their fears, rather than overwhelmed by them.

Here’s some other quick tips to support your emetophobic child at home:

• Educate your child about their diagnosis: knowing that there’s a word to describe this problem and that many others have experienced it can help a child feel less alone.

• Practice daily relaxation skills with your child during calm moments. This can help them better manage overall stress, and will better equip them to use skills the next time they’re anxious.

• Listen to and validate your child’s fears, rather than rushing to reassure them that nothing’s wrong. Phrases like “I’d really scared, too, if I thought I was going to throw up in front of all my friends” can go a long way in helping your child feel heard.

• Once you’ve validated the feeling, ask your child questions to help them think logically about their fear. For example, how many times have they thrown up at school? Have they felt this anxiety before, and has it correctly predicted that they would throw up? Even if they did vomit, would it really be the end of the world?

• Keep an eye on how you’re accommodating anxiety, and be careful not to give in to any more of the anxiety’s demands. You can even try to gradually reduce your accommodating over time by setting gentle limits on how much support you provide your child: for example, offering only 3 reassurances per day.

Is Fear of Vomiting Related to OCD?

Excessive cleaning due to a fear of germs can be a symptom of both OCD and emetophobia in kids and teens.

There’s a lot of overlap between emetophobia (fear of vomiting) and OCD. For some kids, fear of vomiting may be a standalone phobia. For others, however, it can be part of a bigger picture that includes other symptoms of obsessive-compulsive disorder.

Children who have emetophobia without OCD may have a more straightforward fear of vomiting. While they’re likely to avoid situations that could prompt them to throw up, they’re less prone to associating things with throwing up in a superstitious or illogical way. As an example, a child without OCD might avoid hanging upside down or riding a tilt-a-whirl, but they probably wouldn’t think twice about wearing the same outfit they wore the last time they got sick.

On the other hand, kids who fear throwing up due to OCD are more likely to make these kinds of mental connections, and avoid anything that feels somehow linked to a time that they or someone else threw up. You may also notice more compulsive behavior from your child, such as repeatedly checking labels, frequent handwashing, or needing to keep a trash can or bucket nearby.

If you look at your child’s overall history, you may notice that their fear of vomiting is part of a larger trend: maybe they’ve had other intense, recurrent fears in the past that have also resulted in needing to repeatedly say or do things in a certain way. This is also a good sign that OCD could be a better, more helpful diagnosis for a child’s struggles.

Either way, OCD and emetophobia have a lot in common: they both involve recurring, uncontrollable worries as well as repeated behaviors to manage the anxiety. Because of this, the same therapy techniques that work well for OCD can help kids with emetophobia feel better, too.

How Do You Treat Emetophobia in Children?

Some common child therapy approaches, like play therapy and traditional talk therapy, may not work particularly well to help kids with emetophobia—at least not on their own. Kids with emetophobia need more than just a listening ear to help them express their feelings. They also need someone who can help them gradually face their fears, so that they can prove to themselves (and their anxiously wired brains) that things are rarely as bad as they seem.

Exposure and Response Prevention, also called ERP, is a special form of therapy that was designed to help kids with obsessive compulsive disorder tame their recurrent worries and break the cycle of compulsive behaviors that go with them. It’s a version of cognitive behavioral therapy (CBT), which teaches anxious people to use specific coping skills in the present, rather than spending a lot of time understanding the past.

In ERP therapy, you and your family might learn the following skills:

• An understanding of how anxiety works in the brain

• Relaxation techniques to physically calm down your body

• How to notice and “talk back” to anxiety when it gives you exaggerated or illogical worries

• How to support your anxious child without giving into their anxiety’s demands

• Strategies to gradually face fears, starting small and working your way up, without avoiding or trying to “fix” the anxiety

• How to prevent anxiety from spiraling out of control in the future

While treatment won’t solve your child’s emetophobia problems overnight, it can absolutely help in the short-to-medium term. Families who attend therapy regularly and follow up with at-home practice often notice significant improvement in a matter of weeks or months. Importantly, therapy also helps kids to maintain their progress over the long-term, making it less likely they’ll need to return to counseling in the future.

Therapy in Charlotte, NC for Kids with a Fear of Throwing Up

Treatment with ERP therapy can help Charlotte-area kids recover from emetophobia and live life without fear of vomiting. Photo courtesy of Skylar Ewing via Pexels.

If you’re in the Charlotte, North Carolina area and looking for therapy for emetophobia, I may be able to help. I’m a children’s therapist who specializes in helping tweens and teens navigate life with anxiety. As you’ve probably guessed by the length of this blog post, I spend a lot of time thinking about anxious kids and what we can do to make their lives easier.

I got trained in ERP and CBT therapy for anxiety and obsessive-compulsive disorder due in part to my own experiences with childhood OCD. These are the therapy approaches I wish I’d had access to growing up, and I hope they can help kids like yours feel better faster.

My child therapy office is located in Davidson, convenient to families in the Lake Norman area or North Charlotte. If you can’t manage the commute, I also see children for online therapy and find this format works really well for many middle and high schoolers. If you’re even further afield, I can work with families throughout the states of North Carolina, New York, and Florida. I also have an online coping skills course available for download wherever you live.

Ready to get started? Contact me here.

The Most Common Types of Childhood Anxiety: Forms, Prevalence, and Symptoms

Childhood anxiety is increasingly common, but often overlooked. Learn the 5 most prevalent types of anxiety in this post.

Anxiety isn’t exclusive to adults: children can experience it, too. Childhood anxiety, while often underestimated, is a very real and prevalent concern. Research suggests that 1 in 8 American kids suffers from some form of anxiety, and that 25% of kids will have symptoms at some point during their teen years. We also know that childhood anxiety is on the rise: some studies show that anxiety rates have doubled over the last few years, possibly due to a combination of pandemic stress, social media exposure, and world events.

As a therapist, what concerns me most is that many of these children—40%—are not getting treatment for their anxiety. And as a parent, I imagine you want to make sure you’re not missing any symptoms! It’s perfectly normal for kids to experience stress and worries in the course of day to day life, and it’s not always easy to tell when those more typical worries are evolving into something more.

In this guide, I’ll cover the 5 most common anxiety disorders experienced by children. You’ll learn the basics of each anxiety type, including its prevalence, common symptoms, and examples of how these symptoms might look in kids. We’ll wrap up by talking about how you can make sure your child gets effective help if they’re struggling with anxiety.

1. Specific Phobia: Most Common Overall (and Rarely Discussed)

How Common Is It? Hands down, this is the most common anxiety disorder that affects children and teens—and yet I rarely see content about it online! Around 7-9% of children have a diagnosable phobia, and the National Institute of Mental Health says that 19.1% of teens will have a phobia at some point in their lives!

What Are the Symptoms? Children with this disorder have an overwhelming fear of a particular thing or situation—hence the “specific” part of the name. Their fear is out of proportion to the trigger: often, the thing or scenario they’re afraid of is not actually dangerous at all. Children with phobias will go out of their way to avoid being around or even thinking about the thing that scares them.

Examples of Phobias in Kids: Animals, blood, needles, clowns, and bugs are all very common phobias in kids and teens. However, any object, animal, or situation can become the source of a phobia. Here are a few examples:

• Sofia and her mother are in a standoff about scheduling her annual physical. Sofia is terrified of needles and doesn’t want to get vaccines or a blood draw during her doctor visit. Last year she was only able to cope by holding her mother’s hand, but since then she’s avoided even talking about getting a shot.

• Even though he’s never been bitten by one, Jackson is terrified of dogs. He won’t visit the houses of friends who have dogs unless they are kept outside while he’s there. If he encounters a dog while walking in the neighborhood, he makes the family turn around and take a different route.

• Cecilia has asked to stay home from an upcoming family vacation because she dreads flying on airplanes. She often has panic attacks while on the plane, and needs a lot of support from both her parents in order to get through. The trip is still weeks away, but Cecilia is already getting anxious about the flight.

Good to Know: It’s common for kids to experience temporary fears after watching a scary movie, having a negative or traumatic experience, or even after participating in Halloween events. These fears tend to resolve on their own in days or weeks, whereas phobias stick around and may even worsen over time.

2. Generalized Anxiety Disorder (GAD): Prevalent in Tweens and Teens

A child or teenager who is overwhelmed by frequent and excessive worries may be suffering from Generalized Anxiety Disorder, which is prevalent in older kids. Photo by Leah Kelley via Pexels.

How Common Is It? Generalized Anxiety Disorder (also called GAD) is one of the most common forms of childhood anxiety, especially for older kids. Estimates vary, but approximately 2.9-4.6 percent of American kids would qualify for this diagnosis.

What Are the Symptoms? Kids with GAD experience overwhelming, frequent worries about a variety of subjects, like school, health, safety, and family. The worrying occurs most days and gets in the way of a child’s life, potentially making it harder to focus at school or go to bed at night. Kids with GAD often complain of bodily symptoms like muscle tension, headaches, and stomach aches, and may feel irritable, as well.

Examples of GAD in Kids: If your child or teen is dealing with Generalized Anxiety, these examples may feel familiar to you:

• Julian has a hard time unwinding at night because he can’t seem to turn off his worried mind: each night, he vents about a variety of subjects to his mom including school shootings, homework stress, and letting down his team in basketball. He knows he worries a lot, but he’s still not sleeping well.

• Maya often stops by the school nurse’s office complaining of headaches or tummy aches, but doctors haven’t found anything wrong. At home she often seems tense—physically and emotionally—and often snaps at her mom. Things are calm in Maya’s life, but she often asks “what if” questions about worst-case scenarios.

• Lulu has always been a worrier: the topics change, but the habit of worrying remains the same. Recently, though, things have taken a turn: Lulu is worrying so much that her attention drifts from her work at school. She’s having a hard time focusing, and her grades have dropped a bit.

Good to Know: Kids with GAD often have other mental health diagnoses, too. GAD is common in children with ADHD, depression, and other types of anxiety like Separation Anxiety.

3. Separation Anxiety Disorder: Common in Young Children

How Common Is It? Separation anxiety is the most common form of anxiety in young children. About 2-5% of kids under the age of 12 experience it. Older kids can have separation anxiety, too, but it’s not quite as common.

What Are the Symptoms? Kids with separation anxiety are fearful of being away from their parent or primary caregiver. They often worry that something bad will happen to themselves or their loved one while they are apart. It’s common for kids to miss their parents, but for children with this disorder, the fear is so intense that it can cause physical symptoms or prevent them from participating in age-appropriate activities.

Examples of Separation Anxiety Disorder in Kids: The main symptom of separation anxiety is pretty clear—kids are nervous to be away from Mom or Dad! Even so, this disorder can look quite different from kid to kid. Here are a few examples:

• 12-year-old Bella is the only one of her friends who has never been on a sleepover. She hates feeling left out, but the idea of being away from her mom overnight is just too frightening. Every time she considers going, she imagines having an emergency while she’s gone, without her mom there to help.

• Oliver started preschool this year but hasn’t attended very many times. He often tells his mom he has a stomach ache in the morning, and asks to stay home. His mom has noticed these tummy aches only appear on school mornings, and never on the weekend. Oliver has a harder time at drop off than most of his friends, and takes longer to recover from his upset.

• Jaci’s mom has worked from home for years, and just started going back to the office a few days a week. Jaci has an epic tantrum every time her mom has to leave the house. When asked, Jaci said she worries her mom will get into a car accident on the way to work and won’t come back.

Good to Know: Some separation anxiety is a normal —and even healthy—part of child development. To qualify for a diagnosis of Separation Anxiety Disorder, a child’s symptoms need to be long-lasting (more than a month) and be more intense than what is expected given a child’s age.

4. Social Anxiety Disorder: Not Just Shyness

Public speaking is a comon trigger for Social Anxiety Disorder, one of the most common forms of anxiety affecting children and teens. Photo by Rica Naypa via Pexels.

How Common Is It? Most estimates agree that between 3 and 6% of kids have Social Anxiety Disorder, making it one of the most common forms of childhood anxiety. It tends to affect teens more than younger children, and may be more common in girls than in boys.

What Are the Symptoms? Children with Social Anxiety Disorder aren’t really afraid of socializing: they have an intense fear of being embarrassed, humiliated, or judged by others. They may avoid activities where they could be observed or judged, refuse to participate in class, or worry excessively about offending other people. Physical symptoms include blushing, trembling, and an increased heart rate.

Examples of Social Anxiety in Kids: A kid can be friendly and outgoing and still experience severe social anxiety in certain situations. Here are some examples of social anxiety signs to look out for:

• Jeremiah arrives home from school starving every day because he refuses to eat in the cafeteria with his peers. The idea of people watching him eat makes him anxious. Although he enjoys sports, he’s started to hang back in gym class due to concerns that his classmates will be watching him there, too.

• Natalia’s biggest worry in life is that other people are judging her or talking about her behind her back. She describes feeling like she’s being watched when she’s riding the bus or walking in the halls at school. Her worries have gotten so bad that she dreads the ride to school in the morning and class changes during the day.

• Although he’s an excellent student, Hugo asks to stay home whenever he’s due to present a project in class. As soon as he gets to the front of the room his hands become sweaty, his body shakes, and he feels so lightheaded he worries he could faint.

Good to Know: A history of being bullied, trouble with social skills, and general shyness can all contribute to developing social anxiety. However, plenty of kids with Social Anxiety Disorder don’t have any of these risk factors.

5. Obsessive-Compulsive Disorder: Frequently Overlooked

How Common Is It? Less common than others on this list, OCD is estimated to affect around 1-3 percent of children. Technically, it’s also not quite an anxiety disorder: it gets its very own category in the DSM-5, the manual therapists use to diagnose mental health conditions. Due to its sneaky symptoms, however, OCD is commonly overlooked or mistaken for other forms of anxiety.

What Are the Symptoms? OCD involves the presence of unwanted and upsetting thoughts, called obsessions, as well as repetitive behaviors, called compulsions. Kids with OCD get stuck in a vicious cycle of obsessive thoughts or worries, which they try to manage through their compulsive behavior. Common obsessions include fears of contamination, harm, or moral wrongdoing, while compulsions may manifest as repetitive hand washing, checking, or counting.

Examples of OCD in Children: OCD in real life doesn’t always look the way it does in the media. Kids and teens with OCD are no more likely to be clean or organized than anybody else! To add to the confusion, some compulsive behaviors are invisible: mental rituals like counting, checking, and praying aren’t always noticeable to others. A child with OCD may experience difficulties like these examples:

• Nina is very concerned about locking the front door whenever her family leaves the house, for fear that a robber could break in while they are away. Nina meticulously locks the door and checks it several times before heading out. Within a few minutes, though, she doubts whether she really locked the door, and often returns home to double check.

• Sasha learned about germs and handwashing during Covid, and got very worried about possibly having germs on his hands during that time. Since then, his handwashing habits have gotten more frequent and more extreme. Sasha often leaves class to wash his hands, and his skin is chapped and dry from frequent washing.

• Gracie has repeated worries that she might have said or done something during the day to offend or upset her friends. In order to help herself feel better, she confesses anything she fears might have gone wrong to her mom. Gracie’s mom wants to be supportive, but the confessing is happening more and more often, even though Gracie knows she didn’t really do anything wrong.

Good to Know: Kids with OCD are often aware that the thoughts they’re having are “weird” or unusual. This causes a lot of distress, and sometimes prompts children to avoid sharing worries or try to disguise their compulsions.

Treatment for Children and Teens with Anxiety Disorders

Treatment is readily avialable for all of the most common forms of childhood anxiety—and it can really help kids get back to enjoying their lives without worry. Photo by Jonas Mohamadi via Pexels.

The statistics around childhood anxiety are intimidating: so many kids are suffering, and relatively few are getting help! Knowledge is power, however, and being able to identify when a child’s symptoms go above and beyond “normal” worries is a great first step toward supporting an anxious child. There are many treatment options available to help kids manage anxiety and get back to living a healthier, happier life.

Cognitive Behavioral Therapy is often considered the “gold standard” for childhood anxiety treatment because it has loads of research to back up its effectiveness. CBT therapy tends to be skills focused, with an emphasis on solving problems as they exist now rather than delving into the past to figure out their origins. Kids in CBT therapy can expect to learn coping skills to relax their bodies, deal with unhelpful worries, and face the fears they may be avoiding in day-to-day life.

Play therapy is another popular treatment option, especially for younger kids who may not feel comfortable sitting still and talking to a strange adult about their problems. Young children naturally use play to work through their feelings and understand the world around them. Play therapy allows children to tap into this innate ability, rather than putting all the emphasis on verbalizing thoughts and feelings. In play therapy, you can expect your child to use make-believe, art, and imaginative play to express themeslves and work through their feelings over time, with support from a counselor who knows how to interpret their activities from a psychological perspective.

I offer both play and CBT therapy in my Davidson, NC office, and also meet virtually with clients throughout North Carolina, Florida, and New York. If you’re looking to get your child started in anxiety therapy, you can reach out to me here.

Navigating Transitions: How to Move from Elementary to Middle School (Without Losing Your Mind)

Need to help your child through the dreaded middle school transition? You’ve come to the right place.

Shifting from the safety of elementary school into the uncharted territory of middle school can be a bumpy ride for kids and parents alike. If you’re about to make this leap with your child and find yourself feeling anxious, you are not alone! So many kid clients in my practice start therapy around this transitional time, and even more opt to hold off on ending therapy until they feel settled into sixth grade. Even for kids without significant anxiety, beginning middle school can be a source of stress.

You don’t even have to take my word for it: we have reserarch to back up the idea that the middle school tranistion is hard on kids. A study from my home state of North Carolina found that sixth graders who move to a middle school building are more likely to be disciplined for behavior problems than their peers who remain in their elementary school for sixth grade. Other studies have found that students’ academic achievement drops between fifth and sixth grade, possibly due to the stress of tranisitioning to middle school. In both of these cases, the negative effects can be seen for years, even as the students enter 8th and 9th grade.

That data is a bummer, but the silver lining to all of this is that it’s not just you: the struggle for kids entering middle school is very real. In this guide, we'll explore why this transition is so nerve-wracking and share practical strategies to make the journey a little smoother.

What Makes the Shift to Middle School So Hard?

We know that the tranistion is hard, but why? For American kids, middle school is a nearly universal experience. If you’re a child of the 90s like me, you may have less-than-fond memories of your own junior high years, but ultimately, we all survived. Here are a few dynamics that make moving from elementary to middle school particularly challenging:

Small Fish in a Big Pond:

As a fifth grader, your child ruled the school. It was their home base for years—maybe as far back as Kindergarten—and they might not even remember life without it. By fifth grade, you know every nook and cranny of that school building, and it’s filled with familiar faces. Plus, your child enjoyed high status at the top of the social food chain. Fifth graders are the biggest, smartest, strongest, fastest kids in school. A Kindergartener practically looks like an infant in comparison! E ven if your child is not the competitive type, wielding this kind of power over your surroundings brings a sense of security.

Then you get to sixth grade and the whole ecosystem changes. You’re the youngest kid in the building, surrounded by teenagers who are way more physically and mentally developed than you. You’re no longer the big fish in a small pond: you’re a little fish, and the pond just got a whole lot bigger.

Unfamiliar Territory:

I’ve spoken to roughly a bajillion middle schoolers about their anxiety. Of all the fears I’ve heard about junior high, one reigns supreme: all kids worry about getting lost in their new building. In public school systems, multiple elementary schools typically feed into one middle school, so students tend to be dealing with a bigger school building.

What’s more, students face the new challenge of traveling from class to class between periods. Gone are the days of spending 7 hours in one cozy classroom: it’s not your job to get yourself to your teacher’s room on time. In most schools, you’ve got about 5 minutes between class periods, which goes by pretty quickly if you need to stop by your locker or the restroom. If I was racing against a timer 6-8 times a day, I’d be stressed out, too.

Students often worry that they’ll show up late for class and embarrass themselves in front of their new teacher and classmates. They imagine having to slink into class and sit down in their seat, humiliated, while everyone’s eyes are on them. And, honestly? Lots of kids will get turned around and end up late to a class, especially during the first week of school. It’s common, not a big deal, and definitely won’t ruin anyone’s social life. Whcih brings us to our next issue…

Fear of the Unknown

The process of starting middle school is shrouded in mystery. Most kids have not spent any meaningful time in the building. Their understanding of what middle school will be like is based on rumors passed down from older kids, as well as representations of middle school in the media. And let’s be honest, the media representations of middle school are not awesome.

With so little information to go on, kids are more likely to imagine worst case scenarios or cling to rumors that may not be rooted in fact. A child who hasn’t received their schedule yet may worry about being placed in classes without their friends or getting saddled with the teacher nobody likes. A student who hasn’t toured the building may worry about getting a locker in a bad location, or struggling to manage their combination lock. And virtually every student feels at least a little worried about the increased homework and friend drama they’ve heard comes along with life as a middle schooler.

In Middle School, School and Social Life Become More Complex

From more homework to cliques to passive aggressive bullying, there’s a lot for preteens to navigate starting aroudn sixth grade.

Middle school students are expected to do almost as much schoolwork as high schoolers, but with few of the perks. Most can expect nightly homework, more advanced subject matter, and more pressure in general to do well on tests and earn good grades.

Although they’re expected to behave like “big kids” academically, in most other respects they’re still receiving “little kid” treatment: no lunches away from campus, limited control over their class schedule, and micromanaged behavior. If I was given a heavy workload and then told by my boss that I was expected to sign out in order to use the bathroom, I’d quit immediately. Sadly, middle schoolers don’t have that option!

Things get trickier on the social front, too: friends become a primary source of support over these years. In middle school and beyond, friends are way more than just a companion on a play date: they’re confidantes, amateur therapists, and your family away from home. The older a tween or teen gets, the more central these friendships become in life.

As important as they are, we all know that navigating middle school friendships can also be fraught with drama. Everyone is figuring out their identity, and the influx of new classmates means that friend groups are frequently shaken up. Kids are dealing with issues like jealousy, gossiping, and cliques for the first time. It’s not surprising that so many kids make less-than-ideal social decisions that result in bullying or hanging out with the wrong crowd.

Create a Supportive Environment for Your Middle Schooler

Ideally, home and family life is a safe haven from the stresses we experience all day at work and school. But we don’t live in an ideal world! It’s easy for work and school stress to “bleed” into home life, or for resentment to build between parents and kids—especially during this increasingly hormonal and volatile age. Doing your best to create a supportive, consistent home environment is one of the best ways to help your middle schooler deal with the chaos of school.

Here are a few ways to emotionally support your middle schooler at home:

Take their perspective: Fumbling with a combination lock or arriving 2 minutes late to class may feel trivial to us as adults. But put yourself in your child’s shoes for a minute: in the microcosm of their middle school world, these are make-or-break issues. Keeping this in mind makes it easier to empathize with their worries, rather than brushing them off as insignificant.

Avoid toxic positivity: When a child comes to you with a worry, it’s so tempting to say something like “You’re going to have an awesome day!”, “Try to think positive,” or “You’re the best kid ever—who wouldn’t like you?!” While some kids appreciate this kind of pep talk, others find it makes them feel even more anxious, because it’s not acknowledging their concerns. Instead, try validating their fears while also focusing on their ability to overcome obstacles: “I can totally see why that would be embarrassing. I would be nervous too! But I’ve seen you handle so many awkward situations well, and I know you’d figure out this one, too.”

Normalize the struggle: Your middle schooler may feel as though they’re the only one who is having a hard time with this transition. As a parent, you can remind them that this is not the case! Let your child know that their worries are totally common and normal, and that they’re not alone.

Practice open-mindedness: If they haven’t started yet, the difficult parent-child conversations are just around the corner. You can set the stage for future conversations about hard subjects like drugs and dating by being mindful of your reactions now. Middle schoolers are highly aware of cause and effect, and if they see you’re flying off the handle about minor misbehaviors, they’ll be much less likely to approach you with the big stuff.

Avoid overscheduling: If your child is currently enrolled in 3 travel sports teams, now may be the time to consider cutting back. I’ve personally seen several anxious middle schoolers whose symptoms improved once they streamlined their after school activities. Prioritizing unstructured downtime can help ease the adjustment to the higher workload and demands of middle school.

Strategies for Middle School Anxiety Management

Anxiety about starting middle school is totally normal. There’s a lot you can do to help your kid cope.

In addition to creating a supportive home environment, there’s a lot you can do to proactively help your child navigate their middle school transition. Many of the same coping skills we use for other forms of anxiety work great for back to school anxiety, too—with a few tweaks.

Here’s how you can help your child manage their stress as they adjust to junior high life:

Be prepared: We talked earlier about how fear of the unknown can fuel worries about the middle school transition. Visiting the school, meeting teachers, exploring the school website, and speaking to rising seventh and eighth graders are all ways you can help your child prepare for their first day. This prep serves two purposes for your child: you’re helping make a strange environment feel more familiar, while also helping your child face their fears one little step at a time.

Question unhelpful assumptions: If you notice your child starting to get worked up over worst case scenarios, don’t let it slide—you can gently call out these thoughts and help your child adjust their thinking. We call this kind of worrying “catastrophizing”, and kids can expend a lot of time and energy thinking about horrible situations that are very unlikely to ever happen in real life (“I’ll arrive to class late, everyone will laugh, and the teacher will think I’m an idiot!”) You can ask your child questions like these to nudge them towards a more realistic perspective:

• Do you have any evidence this is going to happen?

• How likely do you think this is to happen?

• Can you think of some other ways that situation could go?

• Is this worry predicting something in the future that hasn’t happened yet?

• If your friend was worried about this, what would you tell them?

• Have you handled anything like this before in your life? If this happened, could you cope?

Support study skills: Executive functioning skills allow us to prioritize tasks, set and reach goals, folllow multi-step directions, and generally manage our impulses in order to get work done. It takes time to build these abilities, and a middle school workload asks a lot of kids from an executive functioning standpoint. If you suspect your child is struggling in this area, step in to support. Ask your school what they offer for kids needing study skills help, and check out the many resources available for parents of ADHDers on YouTube. Even if your child doesn’t have this diagnosis, you’ll find many helpful tips for strengthening executive functioning at home.

Don’t avoid: If your child is dreading getting to school every day, it can be tempting to let them stay home for a mental health day…and then another…and another. While everyone deserves the occasional day off, avoiding your anxiety trigger is an easy way to make anxiety grow. The more we avoid something that scares us, the bigger our fear will be when we try to return. In extreme cases, kids who frequently avoid school may become so anxious they’re unable to enter the building at all. I don’t want that for you or your kid!

It’s Not All Bad News: Make the Most of School Resources

Admittedly, this blog post has painted a pretty grim picture of middle school life so far. But it’s not all doom and gloom! I mentioned earlier that many of my preteen clients begin or continue therapy due to their nerves about starting middle school. However, once middle school actually starts, many of them return to tell me that it isn’t so bad after all.

As challenging as middle school can be, it has its upsides. Middle schoolers are some of the funniest people I know. Their imagination knows no bounds, and they’re independent enough to try out ideas on their own. This generation is so aware of social issues that, despite the usual peer drama, I find they tend to have a strong sense of morality. In short, they’re awesome.

Middle school kicks off a new developmental stage for kids. They’ve spent much of elementary school seeking praise from grownups in order to feel capable and confident. In the tween and teen years, kids are less reliant on that feedback from adults and more able to trust their own gut. Issues of identity come to the forefront: kids are figuring out who they are and what they stand for. They’re beginning to figure out what kind of adult they might like to be someday.

You can tap into this positive side of the middle school experience by making the most of what your school has to offer. Here are a few common resources that can support kids emotionally as they develop their sense of self:

• Extracurriculars: Many kids find their identity—and a group of kindred spirits—in after school clubs. Moving to middle school typically means gaining access to a much wider range of extracurriculars. Every kid needs a chance to shine and feel appreciated, and if their academics or social life are struggling, these groups can be a real safe haven.

• School counselors: These people know your particular school better than anyone! They’ve seen it all, heard it all, and probably tried it all. If you’re having a specific school-related issue, like anxiety at drop-off or loneliness at lunch time, they can likely offer strategies that have worked for others in the past. While most school counselors aren’t able to provide ongoing weekly therapy, they’re your best bet if an emergency comes up in the middle of a school day. Think of your counselor as a sort of Urgent Care for your mental health.

• Lunch Bunches and Social Skills Groups: Increasing numbers of schools offer extra support for kids looking to make friends. Lunch Bunches pull a small group of like-minded kids together during their break to get to know each other better in a structured environment, with support from a teacher. Your school’s guidance office may also run social skills groups for kids looking for more specific help. These services aren’t always widely advertised, so it doesn’t hurt to ask about them.

• Psychological and Learning Assessments: If your child is truly struggling emotionally or academically, you can request an evaluation from your school district at any time to see if they may qualify for a 504 or IEP plan. These two plans help kids with learning differences or disabilities get the support they need at school, either through changes to the learning environment or through special education. Your school district may not agree with your request, but if they do, your child can be screened for vision and hearing difficulties, autism and ADHD, learning and emotional difficulties, and sensory processing differences. These kinds of evaluations are pricy and hard to get from private psychologists, but are provided at no cost in schools.

When to Seek Extra Help

If you’ve tried to help your child through the middle school transition on your own, consider adding some extra help in the form of a counselor.

By fostering open communication, offering support, and being proactive in addressing anxiety, you can help your child navigate the transition to middle school without (we hope) losing your mind. Know that you’re not alone, and that the challenges of middle school can yield a lot of growth and personal development despite all the angst.

If you find that the stressors of middle school are becoming overwhelming for your child, or if you simply want extra guidance on supporting their emotional well-being during this time, consider reaching out to a professional therapist like me. My counseling practice specializes in helping tween clients learn effective coping skills to deal with anxiety and OCD.

For those who prefer to take a self-guided approach, I also offer an online coping skills course designed to equip middle schoolers with the tools they need to manage stress, anxiety, and the challenges of growing up.

Good luck out there, parents—I salute you.

Should Your Child's Therapist Be a Parent, Too?

Do you need to have kids of your own to be an expert on child psychology?

“Do you have kids?”

Back in the day, I kind of dreaded this question when it came up in therapy sessions. I’ve been a mom since 2021 and a counselor since 2016, which means I spent the first 5 years of my career as children’s therapist with no children of my own.

I always answered honestly, but I wondered about how my childlessness might change a client’s perspective of me. Did they think I lacked experience? Did they worry I wouldn’t be able to understand their struggles? Would they feel unfairly judged if I offered feedback on parenting strategies to try, given that I wasn’t a parent myself? Usually, families who asked this question opted to continue therapy even after hearing the answer. Sometimes it even led to fruitful discussions about subjects like infertility, the way parenthood changes you, and the high standards parents get held to by society at large.

So, do therapists need to be parents in order to provide effective therapy to kids and families? This question has been on my mind for ages, but I waited to respond until I was fully in the trenches of parenting so that I didn’t have too much bias one way or the other. We’ll take a look at factors to consider when choosing a children’s therapist, and why it may (or may not) be helpful to see someone who has kids of their own.

The Case for Therapists Who Are Parents

It can definitely be helpful to meet with a therapist who shares your lived experience. It’s common for clients to seek out therapists who share their racial or ethnic backgrounds, and queer clients may feel more comfortable meeting with queer-identified therapists. And for good reason! A therapist who shares your identity will better understand your values, your community, and the specific challenges you face.

Being a parent is a huge part of my identity, and I can see why it would be valuable to speak to a therapist who has also been through this crazy, intense life experience. It’s easy to imagine that a fellow parent will really and truly get what you are going through, and have valuable insights to share. At the very least, you know they aren’t going to judge you for feeding your child a partially defrosted Uncrustable and goldfish crackers for breakfast.

Shared experience is especially valuable when you’re looking for help with a unique parenting situation, like adoption, disability, blended families, or raising a child who is from a different race or culture than your own. Just being in a room with someone who’s in the same boat as you can be a comfort.

While I don’t think becoming a parent magically transformed me into a better therapist, it definitely given me a new level of empathy for just how hard it is to keep a kid alive on a day-to-day basis. I always intellectually understood that sleep deprivation was hard, but man, these days I feel it in my bones. If you’re the parent of a young child trying to stay awake today, I salute you.

So, yes, there’s a case to be made for seeking out a therapist who is also a parent. If finding someone with shared life experience is important to you, that’s totally valid! But there are also some potential benefits to meeting with a childfree therapist that you may not have considered.

The Case for Therapists Who Are Not Parents

A well trained therapist should be able to empathize with you and your family, whether or not they have their own children.

While researching this topic, I came across a blog post from Dr. Amy Marschall, a children’s therapist who doesn’t have kids. Like me, she says she frequently gets asked about whether or not she’s a parent. Unlike me, non-parenthood seems to be her long-term plan. Here’s what she has to say about the issue:

I don’t have kids, but at one time I was a kid who dealt with some of the same issues my clients and their families bring to me. My lived experience isn’t identical to that of my clients, but that’s true for everyone. Even if I had my client’s exact diagnosis, my experience of that diagnosis would be different. Every single person is an individual, so you will never find a therapist who completely and fully understands your experience.

Dr. Marschall makes two great points here. The first is that while not everyone has been a parent, we were all children once. Every one of us, parent or not, remembers what it feels like to be on the child side of a parent-child or caregiver-child relationship. In fact, non-parent therapists may feel a little closer to that childhood experience than the rest of us: they can still remember clearly what it was like to be a kid. They don’t have the newer memories of being a parent clouding that vision.

It’s also true that no two people are alike, so even if your therapist shares a lot of your life experiences, they still won’t have fully walked in your shoes. Think about the fellow parents in your social circle: do you agree on every issue? How much do you have in common outside of parenting? Are your values identical? Probably not. Research has shown that there’s more diversity within groups than there is between groups, meaning that two moms (or two Christians, or two Latinas, etc.) aren’t going to have identical experiences and worldviews.

All therapists, regardless of their parental status, are trained to be empathetic listeners who are curious about other people’s lives. We’re taught to view differences with respect, to not pass judgment, and to do our best not to impose our own beliefs or values on someone else’s life. Even if your therapist isn’t a parent, they should be able to understand and empathize with your feelings about parenthood. In fact, they might be able to look at your problems from a fresh perspective, since they’re not stuck in the same parenting rut every day themselves.

Parenting and Therapy Are Very Different Skillsets

Children’s therapists have a broad base of knowledge: we learn about child development, different mental health conditions, and the symptoms that commonly show up in kids and teens. Most of our training is based on research: we’re trained to look at big trends to figure out what strategies or coping skills are most likely to be effective for a given kid. Once we’re in the real world and practicing therapy, we have the privilege of meeting tons of families from all walks of life. Getting to know so many kids and parents helps you notice common struggles and see firsthand what does and doesn’t seem to be useful for the majority of families.

On the other hand, parents have a depth of knowledge: they’re the experts on their individual kid. They know the subtle signs that their child is overtired or overstimulated. They remember exactly when and how a child developed their fear of ghosts. They know what is and isn’t typical for their child, and they know how their child tends to behave in different settings. Spending 24 hours a day with a person for years, watching them grow and change, creates a kind of understanding and connection you’ll never see in therapy.

When I’m deep in the weeds with my toddler trying to figure out an issue, it is hard to take a step back and look at the bigger picture, like I can when I’m counseling. You can’t be in “parent mode” and “therapist mode” at the same time. And if you could, it probably wouldn’t be healthy! That’s part of why seeing a therapist can be so helpful. Because they don’t have the same super-close bond with your child, they can look at things with fresh eyes, and offer possible solutions that have worked for other families.

Becoming a Parent Didn’t Make Me a Parenting Expert

Does being a parent automatically make you a better therapist? It didn’t work that way for me!

I’m just being honest here. I wish I could say that the moment I became a mother, the wisdom of the ages was bestowed upon me and I knew how to respond in a perfect, emotionally attuned way to every parenting situation. But it didn’t happen! Instead I was handed a squealing newborn and told I had to keep him alive while running on 3 hours of sleep.

Before I had my son, friends would tell what a great parent I’d be someday because of my therapy background. How flattering! Now that I have a toddler, though, I know the truth. Being a therapist did not make me an expert parent. Sure, the knowledge is helpful, but I’m up at night looking for answers on Google and worrying I’ve messed up my kid just like everybody else.

Simply having a kid, in my humble opinion, does not an expert on parenting make. Maybe someday when I’ve successfully raised a child to adulthood, I’ll feel more confident claiming expertise on this topic. But even then, I’d really only be an expert on my kid, not yours.

Think about the parents in your social circle. Do they have it all figured out? Heck no. Would all of their approaches work for your kid or your family? Probably not. Are there a couple that you would never take advice from in a million years? I bet.

If your child’s therapist is a fellow parent, they may approach your situation with the kind of empathy that only comes from first hand experience. But that’s not a guarantee that they’ll know how to help. Therapy is based on more than just personal experiences, and what worked for their family might not be a great fit for yours.

In Conclusion: Finding a Therapist Who’s Right for You

Research has shown that your connection to your therapist is the single most important factor in predicting whether or not therapy will work. No matter what style of therapy you’re getting, if you trust your therapist’s ability to help you, you’re much more likely to make good progress. So if you’re searching for a children’s therapist and wondering how important it is that they’re a parent, keep that in mind.

You may decide that having that shared life experience really is crucial for you in order to feel fully comfortable. This may be particularly true if you’re trying to get help with a specific parenting issue, or if you have a unique family composition. In these cases, it might be really valuable to have guidance from someone who’s been in similar shoes.

On the other hand, you may find that parenting experience isn’t so important after all. We’ve all had the experience of being a kid, and most children’s therapists have vivid memories of their own childhoods that help them connect to their young clients. No two parents’ experiences are exactly alike, anyway, and a well trained therapist should be able to empathize with your family’s situation even if it’s not identical to their own.

For more help with getting started in therapy, check out the following blog posts:

• What Questions Should I Ask My Child’s Therapist?

• Should My Child See a Therapist, Psychologist, or Psychiatrist?

• How Often Should a Child See a Therapist?

Child Anxiety Counseling in Charlotte, North Carolina

Finding the right therapist can be tough, but CBT and play therapy can make big differences in the lives of anxious kids.

I hope you found this post helpful, and that it’s encouraged you to consider the many incredible children’s therapists we have in our midst, whether they’re parents or not. If you and your child are hoping to start anxiety therapy and live in North Carolina, New York, or Florida, maybe I’m a good fit for you!

My child therapy office is based in Davidson, North Carolina, just North of Charlotte. If you’re nearby, we can practice CBT and play therapy in person to combat anxiety and OCD symptoms. Since I’m licensed in multiple states, I’m also available for virtual appointments throughout North Carolina, New York, and Florida. About half my practice is online, and I love being able to help kids who I’d never get the chance to see in person.

Ready to get started? Check out my FAQ to learn more about my fees and services, or send me a message.

What’s the Difference between an Intrusive Thought and a Normal One?

Many kids and teens wonder if they’re experiencing intrusive thoughts. Keep reading to learn more about them, and how they differ from more “normal” thoughts and ideas. Image by Liza Summer via Pexels.

As an elder milennial therapist, I’ve decided I don’t need TikTok in my life. I have plenty of apps and screens stealing my attention as it is! Instead, I behave like a responsible adult: I wait for all that TikTok content to make its way over to Instagram, where I consume it a few weeks (or months) late. This is how I discovered that, apparently, intrusive thoughts became kind of A Thing on TikTok for a while this summer.

Suddenly, my feed was awash with memes about “letting intrusive thoughts win.” Who would have guessed that this humble psychological symptom would ever enjoy such fame? Although the memes have slowed down, mentions of intrusive thoughts in my therapy office have not. So, I figured it was time to talk about intrusive thoughts: what they are, why they happen, and what makes them different from other, more “normal” thoughts.

Can You Really “Let the Intrusive Thoughts Win?”

Before we dig into intrusive thoughts, let’s talk about the meme. Maybe you’re an elder milennial, like me, who doesn’t have TikTok and somehow missed this entire phenomenon. Or, maybe you’ve found this article many years from now, when the intrusive thought’s 15 minutes of fame is nothing but a distant memory. Let’s take a journey back in time to this strange cultural moment in the summer of 2023…

According to the website Know Your Meme, catchphrases like “He/she let the intrusive thoughts win” and “Intrusive thoughts won” are “used to caption memes in which people, usually celebrities, exhibit behavior that breaks social norms. In memes, intrusive thoughts are typically confused with impulsive behavior.” Basically, these memes usually feature video of someone doing something kind of random or weird, usually to comedic effect. Said something awkward on live TV? You let the intrusive thought win. Hit a pane of glass with a hammer to see what would happen next? Intrusive thought won.

As an OCD therapist (and a person with OCD), am I offended by these memes? No. I am also a human being with a sense of humor. But they’re not a very accurate portrayal of intrusive thoughts. As Know Your Meme wisely points out, many of these memes show examples of impulsive behavior, as opposed to an intrusive thought.

It’s really common for a person to act on an impulse. It’s much less common for someone to act on an intrusive thought. In fact, that’s kind of an intrusive thought’s whole deal: people really, really don’t want to do what the thought is telling them to. And in almost every case, the person wins over their thought.

Intrusive vs. Impulsive: What’s the Difference?

An impulsive thought happens when we get the urge to do something without reflecting on cause and effect. We’ve all had these moments where we react in a knee-jerk way, without considering whether or not it’s actually a good idea. Most of us are more likely to act impulsively when we’re overwhelmed by emotion: think about the last time you blurted something unfortunate when you were angry.

Generally speaking, impulses are urges that, on some level, we want to act on, even if we know it might not be a great idea. Someone swipes a cookie off the plate because it’s too tempting to resist. A toddler runs off into traffic because they don’t have the self-control to hold themselves back. Curiosity gets the best of that Instagram guy, and he hits the car window with the hammer. Intrusive thoughts can be good, bad, or neutral, but usually they are fleeting. If you ignore them, they go away and never return.

Intrusive thoughts, on the other hand, are almost always negative. In fact, they’re often beyond negative: they’re dark, frightening, or embarrassing. They aren’t always realistic, either: they can be pretty illogical and bizare. Unlike an impulsive thought, intrusive thoughts sometimes repeat themselves. Even if you succeed in ignoring it or pushing it away once, it may pop up again when you least expect it.

Most importantly, intrusive thoughts are usually the total opposite of what a person wants to do in real life. A peaceful person may find themselves having violent thoughts, or a caring person may experience cruel thoughts about a loved one. People who suffer from intrusive thoughts are usually horrified by them. They may worry that they’ll somehow lose control and act on their unwanted thought, even though it’s the last thing they’d ever want to do.

Okay, So What Is an Intrusive Thought?

Intrusive thoughts are sudden, unwanted thoughts that are upsetting to experience, because they go against a person’s actual wants and desires. Photo by Andrew Neel via Pexels.

An intrusive thought is an unexpected, unwanted thought, image, or idea that makes the thinker feel uncomfortable. These thoughts pop into the brain on their own, and they’re not something a person is trying to think about. Because they’re outside of our conscious control, people often feel like these thoughts are “weird” in some way, almost like they have a mind of their own.

Intrusive thoughts often feel out of character, and may go against the thinker’s morals and values. They can sometimes be illogical or bizarre, leaving a person wondering why on earth they’d ever think such a thing. These thoughts are usually negative and cause upset for the person having them, although this can range from mild discomfort to extreme distress, disgust, or fear.

Intrusive thoughts often fall into one of the following “taboo” categories. These tend to be subjects we don’t feel comfortable thinking about, which makes the thoughts extra disturbing when they show up:

• Violence, aggression, and hurting others

• Sex, puberty, and sexuality

• Germs and illness

• Bad things happening to yourself or others

• Doubt about whether something was done correctly

• Doing something “wrong” or immoral

• Doing something that goes against your religion or angers God

Some intrusive thoughts are a one-time occurrence. Other thoughts repeat in the thinker’s mind, showing up over and over again. As you can probably imagine, this can cause a lot of stress.

Examples of Intrusive and “Normal” Thoughts

I’ll share some examples here of how an intrusive thought might look when compared to a similar, more typical thought. Please keep in mind that these are just examples and that intrusive thoughts come in many shapes and sizes! The quality of the thought—the fact that it pops up when you don’t want it to—is a big part of what makes it intrusive.

“Normal” thought: I should wash my hands before dinner.
Possible intrusive thought: Maybe touching that expired yogurt container got food poisoning germs on my hands, and now I’ll throw up.

“Normal” thought: What if I get a bad grade on tomorrow’s test?
Possible intrusive thought: What if I scream out a swear word in the middle of the test tomorrow?

“Normal” thought: I’m mad at my sister.
Possible intrusive thought: Having an image come to mind of pushing your sister down the stairs, for no reason, when you’re not angry.

“Normal” thought: Now that I’ve said my prayers, I can go to bed.
Possible intrusive thought: What I did something bad today that I don’t remember, and now God is mad at me?

“Normal” thought: My mom is picking me up from soccer practice tonight.
Possible intrusive thought: Unexpectedly picturing your parent’s car crashing.

Sometimes it can help to see an example in writing, especially if you think you may be suffering from intrusive thoughts yourself. If one or more of these thoughts felt familiar to you, you’re definitely not alone. Many people have intrusive thoughts—probably way more than you’d guess.

Does Having Intrusive Thoughts Mean You’re Crazy?

Intrusive thoughts can make you feel out of control, but they don’t mean you’re going crazy. They’re a really common experience! Photo by Liza Summer via Pexels.

You may have noticed in my example section above that I put the word “normal” in quotes. That’s because even though intrusive thoughts feel extremely abnormal, they’re actually incredbly common. A 1995 study found that 90% of people report having intrusive thoughts, which means it’s actually crazier not to have them. As uncomfortable as they are, intrusive thoughts are just part of the human experience.

I explain intrusive thoughts to kids in my therapy office like this: imagine your teacher is making you write 100 essays a day. From the time you wake up to the time you go to bed, you’re just writing essay after essay. With all that practice, you’d probably come up with a few pretty good ones. But a lot of them would be mediocre at best. And some of them would be absolute garbage. How could they not be? You’re writing 100 a day!

We have way more than100 thoughts a day. The average person has around 60,000 thoughts. With a number that high, some of them are bound to be less than awesome. Intrusive thoughts are the brain’s equivalent of a burp or a fart. They’re just a little poof of randomness that our brain hands to us asking “I dunno, is this anything?”

So if 90% of the population is having these thoughts, why isn’t everyone panicking? Why aren’t the intrusive thoughts winning? Here’s the deal: most people barely notice their intrusive thoughts. The thought pops up, the person thinks “Huh, weird.”, brushes it off, and moves on with their day. They know it’s not something they really want to do, so they don’t take it seriously. It’s only when people have trouble setting their intrusive thoughts aside that they start to cause problems.

Does Having Intrusive Thoughts Mean You Have OCD?

Having the occasional, fleeting intrusive thought doesn’t mean you have a mental health problem. Like I mentioned above, it’s just part of being human. However, intrusive thoughts can be part of several different conditions. In these cases, the intrusive thoughts tend to be frequent and overwhelming to the point that they start to interfere with a person’s daily life.

Intrusive thoughts are best known as a symptom of Obsessive Compulsive Disorder, or OCD. People with OCD have a much harder time disregarding their intrusive thoughts. They may start to question whether the thought could be true, or if having the thought in the first place means they’re a bad person.

The intrusive thoughts show up over and over, and they cause so much anxiety that the OCD sufferer is willing to do just about anything to make them go away. This can lead to a vicious cycle of repeated thoughts or worries—called obsesions—and repeated behaviors or rituals—called compulsions. Unfortunately, the more a person gives in to their compulsive behavior, the worse the obsessive worries tend to get.

Intrusive thoughts can show up as a part of other conditions, too, such as:

• PTSD

• Anxiety Disorders

• Depression

• Eating Disorders

If your child’s intrusive thoughts are happening often and causing a lot of distress, it’s worth speaking to a therapist to see if an underlying condition could be causing the problem.

Therapy Can Help Kids and Teens with Intrusive Thoughts

Therapists can help kids with intrusive thoughts learn to take them less seriously, so the thoughts don’t feel so overwhelming. Photo by Julia M Cameron via Pexels.

Intrusive thoughts are freaky. They are weird, they’re unpredictable, and they can be difficult to ignore. But they don’t have to take over your life! If you’ve taken anything away from this post, I hope it’s this: intrusive thoughts are all bark but no bite. They’re not as powerful as they feel, and they can’t compel you to do something you don’t want to do.

We have great therapy options to help kids with intrusive thoughts and OCD. Exposure and Response Prevention was designed specifically to help people cope with their OCD symptoms. It’s a specialized version of CBT, a popular, skills-based therapy approach that has helped people of all ages manage many forms of anxiety.

If you need help for a child or teenager with intrusive thoughts, take a look at the International OCD Foundation’s searchable database to find a therapist near you who has completed ERP training. You can even look for therapists who’ve gotten specialized education in how to practice ERP therapy with kids. You may want to consider broadening your search to include therapists throughout your state, if online therapy is an option for you.

If you live in North Carolina, New York, or Florida, I may be able to help. I’m a children’s therapist trained in pediatric ERP therapy—and I was also diagnosed with OCD as a kid. I’ve been on both sides of the OCD therapy equation, so I know exactly how hard it is for my kid clients to face their fears. I meet with kids in-person in my office in Davidson, North Carolina, and online with families throughout these three states where I’m licensed.

Looking to get started in therapy? Reach out to me here, or check out my About and FAQ pages to learn more about me and my work.

Signs of Panic Disorder in Children (And How You Can Help)

Learn how to help your child cope with Panic Disorder in this handy guide for parents and caregivers. Photo by Ron Lach via Pexels.

“The only thing we have to fear is fear itself.” We’ve all heard this famous quote from Franklin Roosevelt before. And it’s a great message, right? Often, our fear holds us back from doing things that really wouldn’t be so scary, if only we faced our anxiety head on. But when a child is dealing with Panic Disorder, the “fear itself” is pretty terrifying! Sweaty palms, a racing heartbeat, rapid breathing, and lightheadedness can make kids feel like the world is about to end.

Fear not! This post will take a deep dive into panic disorder, so you can feel confident navigating your child through their next wave of panic. We’ll talk about how panic disorder works, review common signs and symptoms, and discuss what parents (and professionals) can do to help.

What is Panic Disorder?

Panic Disorder is a type of anxiety disorder that can affect both kids and adults. It’s much more common in teens than in younger kids, but can strike at any age. People who have panic disorder have experienced panic attacks (also called anxiety attacks), and struggle with the fear of having another one.

Panic attacks come on suddenly, and may or may not have a clear trigger. A child may have a panic attack because they’re extremely anxious about boarding an airplane: in this case, the trigger is clear! But a child could also have a panic attack come on seemingly out of the blue, while relaxing at home or hanging out with friends. Sometimes, panic attacks can even wake a child up in the night!

Panic attacks are frightening, and it’s common for kids (and even adults) to worry they mean something’s seriously wrong. The physical symptoms can feel like you’re losing control of your body and mind. Children may worry they’re having a problem with their heart or lungs, or might even fear that they’re dying or going crazy.

Understandably, kids who’ve had a few panic attacks can get really worried about having another one. Sometimes this leads to desperate attempts to avoid things they think might trigger a panic attack, or to stay away from places where they think nobody will be able to help them. When this starts getting in the way of life, we call it Panic Disorder.

How is Panic Disorder Different Than a Regular Panic Attack?

Many people have panic attacks: up to 35% of people will have one at some point in life. They can happen as a part of other anxiety disorders, like social anxiety, generalized anxiety, phobias, or even OCD. They can also happen by themselves, without any other mental health problems.

Panic disorder, on the other hand, is much less common. It affects about 4.7% of U.S. adults and about 1-3% of kids and teens. For kids with Panic Disorder, the panic attacks are the source of anxiety. Kids are worried about having more attacks, of something bad happening during an attack, or of having a panic attack in a place where they’re not able to get help.

If a child is worried about something else—dogs, germs, other kids judging them—and they’re having panic attacks as a result, that’s not Panic Disorder. If a child is worried about the panic attacks themselves, and is trying to avoid them in unhelpful ways, that’s Panic Disorder.

What Are the Symptoms of Panic Disorder?

The symptoms of Panic Disorder include multiple bouts of extreme anxiety, as well as worries about having more attacks in the future. Photo by Shvets via Pexels.

To get a diagnosis of panic disorder, kids need to have had more than one panic attack. A panic attack is a sudden, unexpected burst of extreme anxiety or fear that only lasts a short time, usually 10-30 minutes.

They don’t always have a clear cause and may seem totally out of the blue. During a panic attack, a child may notice 4 or more of the following symptoms:

• Sweating

• Shaking

• Rapid or pounding heartbeat, or feeling like the heart is skipping a beat

• Chest pain or pressure

• Upset stomach

• Feeling short of breath or like you can’t breathe

• Strange sensations, like heat, tingling, or numbness

• Feeling dizzy or lightheaded

• Feeling detached from reality

• Feeling as though something really bad is about to happen (impending doom)

Essentially, a panic attack sends your body into full on fight-or-flight mode with no warning, which causes these intense physical symptoms. Kids with panic disorder become so afraid of these attacks that they go to great lengths to try to prevent them from happening. This means you’ll also see the following:

• Worries about having another attack

• Concern about the meaning of the panic attacks or negative consequences they could cause

• Trying to avoid or prevent attacks in ways that lead to significant behavior changes

Once these symptoms have happened for at least a month, a child can be diagnosed with Panic Disorder.

Signs of Panic Disorder in Kids

Panic attacks might be easier to spot than some other forms of anxiety, but Panic Disorder can still look different for each individual kid. If you’re beginning to suspect panic may be to blame for your child’s difficulties, here are three examples to consider.

1. Maya has had a handful of panic attacks over the past few months: her hands start to sweat, then she starts hyperventilating and crying. She was sitting in Biology class one day when she noticed her palms getting sweaty, and asked her teacher if she could leave class. Her teacher asked her to wait for another student to return from the bathroom, and Maya had a panic attack. Maya’s teacher has apologized and reassured her that this won’t happen again. However, Maya doesn’t want to go back to class for fear that she’ll have another attack.

2. Mateo has heart palpitations with his panic attacks, and gets a terrible feeling like something bad is going to happen. He’s gone to the doctor for a checkup and has a clean bill of health, but he can’t shake the feeling that his panic attack could turn into a heart attack. He worries about this possibility all the time, and asks his mom for reassurance that there’s nothing wrong with his heart. Every time he feels the slightest twinge in his body, he worries it means another panic attack is coming.

3. Ash has only had a couple panic attacks, but they really left an impression on her. Each one felt like an emergency, and luckily her mom was close by to help. Even though she hasn’t had one in a little while, Ash is really nervous about going to summer camp or sleepovers with her friends, because she’s anxious about having a panic attack away from home. She worries what her friends would think, and who would help her to calm down. Ash friends have noticed she’s turning down their invitations, but Ash is too embarrassed to tell them why.

Even though their symptoms are different, all these kids are struggling with repeated, unexpected panic attacks. As if that wasn’t enough, their anxiety about the attacks is so big that it’s getting in the way of important parts of life.

What Do I Do If I Think My Child Has Panic Disorder?

It’s important to rule out any medical problems or lifestyle issues before settling on a diagnosis of Panic Disorder for a child or teen. Photo by Liza Summer via Pexels.

If you’re concerned your child is having repeated panic attacks, it’s a good idea to check in with their pediatrician first to make sure what you’re dealing with is really anxiety-related. There are some medical conditions that can mimic panic attacks, and you’d hate to brush something off as “just anxiety” that could be made better with medical care.

Conditions like tachycardia and POTS can affect your heart rate and blood pressure, causing palpitations and dizziness. A child complaining of shortness of breath should be checked out for asthma, just in case. The cause could even be as simple as having too much caffeine: it’s hiding in all kinds of sports drinks and energy bars these days, and it’s so effective at triggering panic attacks that scientists use it when they want to research panic.

Once you’ve ruled out any underlying medical stuff, you can rest assured that as scary as your child’s panic attacks may be, they’re totally safe. Many children worry that panic attacks will cause serious harm or lasting damage. Knowing this isn’t the case can be a relief.

Next, take a look at some of the strategies below to help your child cope with panic and get back to enjoying life.

Helping a Child with Panic Disorder

You've learned the symptoms, you’ve ruled out any medical causes…now that you’re sure this is Panic Disorder, how can you help your child cope? It’s painful to watch your child go through debilitating anxiety, and emotionally exhausting for everyone involved.

Fortunately, Panic Disorder is very treatable! We have ways to help kids and teens who are dealing with panic, and we know they work. Here’s how a parent or caregiver can help a child through panic:

1. Educate Your Child About Panic Attacks

   Part of what makes panic attacks so scary is how mysterious they are. They seem to come out of nowhere, with little to no warning. Even if they aren’t dangerous, they feel like they are. It’s important for kids to know that panic attacks are not dangerous, and that they’re the result of their body doing the right thing at the wrong time. The symptoms kids feel during a panic attack are the result of their fight-or-flight response kicking in, which exists to help us escape life-threatening situations. We want to be able to feel that adrenaline rush when we really need it—just not on the school bus.

2. Practice Regular Relaxation

   It never hurts to learn new ways to calm down your body and mind, especially when you’re dealing with any form of anxiety disorder. Coping skills like deep breathing, muscle relaxation, and guided visualization really can help a lot of kids—but they work better when you practice them regularly, instead of trying them only when you’re panicked. Just like with any exercise, regular practice helps your child’s nervous system get better at coming out of fight-or-flight mode and returning to calm. Download my free guide for more ideas!

3. Use Grounding Skills When Panic Strikes

   Many kids find that typical relaxation skills don’t work super well in the midst of a panic attack: it’s hard to get all noodly when there’s adrenaline coursing through your body. Your child may find they have better luck with grounding skills. These skills give your child something to focus on outside of themselves, so they’re not just fixating on their body sensations and anxiety. Any kind of strong sensory input, like holding an ice cube, tasting a sour candy, or splashing your face with cold water can be helpful for grounding.

4. Accept That Panic Happens

   You may be surprised to learn that our goal when treating Panic Disorder is not to eliminate panic attacks from a child’s life. That’s like trying to keep yourself from ever sneezing again: it’s a bodily function that’s mostly outside of your control. The more time we spend stressing about panic attacks, the more anxious we become. Interestingly, the more kids accept that panic sometimes happens, the fewer attacks they tend to have. You can remind your child that although panic attacks stink, they’re manageable, they’re not dangerous, and they always end.

5. Approach, Don’t Avoid

   Kids with Panic Disorder are so fearful of having another attack that they change their behavior and routines to try to protect themselves. This can look like avoiding places where they’ve previously had an attack, repeatedly checking in with parents about their worries, monitoring their body for signs of panic, or saying no to activities that feel too risky. The more kids avoid these places and activities, the worse their anxiety is likely to become. Over time, the list of “dangerous” places can get longer. We can help kids overcome their anxiety by gently helping them return to these off limits places, so they can prove to themselves that they’re not so dangerous after all.

Panic Disorder Therapy for Kids

Cognitive Behavioral Therapy gives kids and parents the tools they need to deal with panic when it strikes. Photo by Any Lane via Pexels.

You don’t have to keep living in fear of your child’s next panic attack. In addition to the tips above, meeting with an anxiety therapist can help your child recover from Panic Disorder and learn skills they can use to manage anxiety as they grow. Cognitive Behavioral Therapy is often called the “gold standard” for anxious kids because we have lots of research to show how effective it is. It’s my first recommendation for families looking for help with panic.

Many “find a therapist” directories allow you to search for therapists who use specific forms of therapy, so you can specifically seek out counselors who practice CBT. This kind of therapy is very focused on education and skills. You can expect to get “homework” to practice with your child between sessions, and to be involved in your child’s therapy process. Happily, kids who learn CBT skills often move through therapy a little more quickly than kids who do not.

I love using CBT to help kids with anxiety, both in my therapy office and online. This kind of skills based counseling works great over telehealth, especially with kids ages 8 and up. If you’re located in the Charlotte area, I’d be happy to meet at my Davidson office. If you’re somewhere else in North Carolina, New York, or Florida, I offer virtual sessions using a secure platform that works just like Zoom.

Ready to get started? Send me a message. You can also download my free anxiety guide to learn more coping skills you can start using right away.

What to Do if Your Child's Therapy Isn't Working

If you’re worried your child’s therapy isn’t working, don’t despair! There’s a lot you can do to get things back on track. Photo by SHVETS via Pexels.

Therapy can be a transformative experience for kids, helping them overcome challenges, devleop essential skills, and thrive in their daily lives. If you’ve reached this page, you’re probably a believer in the many benefits therapy can provide for children. So what do you do when…it just doesn’t seem to be working?

We all know that growth isn’t linear, change takes time, and all that good stuff. But it’s still disheartening when, after all hard work finding a therapist and attending sessions, things don’t appear to be improving for you and your child. Sometimes, despite everybody’s best efforts, progress in therapy can seem slow or nonexistent. The good news is there’s a lot you can do to get things back on track.

What Should You Realistically Expect From Therapy?

No matter what kind of therapy you choose for your child, you should expect that it will likely take some time before you see major results. In my counseling practice, the average length of a child’s therapy is about six months. Of course, some kids need a lot less time, and some need a lot more.

This lines up with what the big therapy organizations say about how long therapy takes. The Association for Play Therapy estimates that kids will need an average of 20 sessions to resolve the problems that brought them to therapy. According to the American Psychological Assocation, 50% of people in therapy will be ready to go after 15 to 20 sessions, and the rest will need more time. Even “short term” forms of therapy may take longer than you might expect: TF-CBT, a short-term trauma therapy, usually requires 18 to 24 sessions.

If you’re meeting once a week, that means you’re looking at 5 months or more of therapy before your child will be fully ready to move on. Given that estimate, I think it’s safe to start questioning whether a therapy approach is effective around the two month mark.

Here are some other points to keep in mind as you evaluate whether therapy is working out:

• Early therapy sessions focus on relationship building: your child might learn about their diagnosis and feel a lot more hopeful about therapy, but you probably won’t notice huge changes during the first few weeks.

• It’s not typical to notice big, positive changes after every session. Over time, though, you should see gradual improvement.

• Sometimes, symptoms may get worse before they get better, especially if your child is in anxiety or trauma therapy that involves exposure (facing feared situations).

• Pretty much every kind of child therapy requires some level of parent involvement. Even though kids need their privacy, you should expect to be kept in the loop by their therapist about their progress and how you can help.

If your child is new to therapy, it’s possible that you’re just too early in the process to see changes. On the other hand, if you’ve been in the therapy game for a while and progress has slowed or stopped, keep reading to learn what might be getting in the way.

What Are the Signs That Your Child’s Therapy Might Not be Working?

Stalled progress, difficulty using skills in real life, feeling uncomfortable in sessions, communication struggles, and worsening sypmtoms can all be signs of problems in therapy. Photo by Monstera via Pexels.

So, let’s say you have realistic expectations for therapy: you’ve been at it for 8 sessions or so, and you know change isn’t going to happen overnight. You’re still not seeing the differences you’d hoped for. How can you tell if you’re on the right track? Here are some indicators that something about your current therapy approach isn’t working for your child:

Lack of improvement over the long term

In therapy, progress tends to happen in fits and starts. You might have a big breakthrough one session, followed by a week or two that are relatively quiet. It’s even possible that symptoms will become more intense for a little bit, if your child is confronting tough stuff in therapy that they have avoided until now. If you zoom out and look at the big picture, though, you should notice an upward trend over time.

Skills aren’t translating into real life

Many forms of child therapy, like CBT, put an emphaisis on learning coping skills and other practical strategies a child can use to manage their feelings and handle tough situations. There’s a big difference, though, between learning these skills and putting them into action. If your child is consistently unable to use what they’re learning outside of therapy, it means something is getting in the way.

Your child feels uncomfortable in therapy

It’s pretty normal for kids to be reluctant to go to therapy some of the time. This is especially true if therapy is getting into difficult subjects, like facing anxiety fears or talking about trauma experiences. This can usually be figured out with your therapist. On the other hand, if a child consistently dreads therapy and really doesn’t want attend, this might indicate a bad fit or lack of trust in the relationship.

Communication isn’t clear

Does it feel like stuff is always getting lost in translation with your child’s therapist? Maybe it feels like your child is avoiding the big issues in sessions, and you never get a chance to meet with the counselor to bring up concerns. Or, maybe you’re not sure what’s being worked on and how you can help at home. Kids need some privacy in order to make therapy work, but as a parent you should always know what the current therapy goals are, and have a way to check in with the therapist.

Things are getting worse

Okay, this one may seem a little obvious, but it’s true! If you haven’t been warned that your child’s symptoms might flare as a part of the therapy process, and things are getting worse at home, its’s time for a talk with your child’s counselor. This is especially true if you’re noticing worsening depression, thoughts of self harm, or aggressive and destructive behavior.

It’s important to note that seeing one or more of these signs doesn’t necessarily mean you have a bad therapist or that you have completely wasted your time and money. It’s absolutely a sign, though, that you need to have a conversation with your child’s therapist and figure out how to make things better, so you don’t spend additional weeks or even months doing something that’s not working.

Please, Talk to Your Child’s Therapist!

If you are feeling frustrated and don’t think your child’s therapy is working, please don’t keep this to yourself! As awkward as it might feel, telling your therapist you are concerned is a really important part of turning things around. You aren’t going to hurt your therapist’s feelings if you tell them you’re not loving how things are going!

Speaking from experience, I always want to know when something I’m trying is not landing with a client. It’s a huge bummer to hear that something wasn’t working long after the fact. We could have changed approaches so much sooner if I’d known, and saved that kid a lot of unnecessary suffering!

Pretty much every therapist out there cares more about kids getting better than they do about their own ego. Your therapist wants to hear from you. In fact, hearing feedback from parents—the good, the bad, and the ugly—makes it much easier for us to do our jobs.

When you talk to your child’s therapist, try to be as specific as you can about what you’re seeing at home and what doesn’t seem to be improving. You can mention things like:

• How often your child is struggling, and how severe or long-lasting these episodes seem to be. For example, is your child having anxiety about school 4 out of 5 nights a week? Are tantrums lasting 30 minutes or more?

• What you’ve been trying in order to help your child at home: what strategies are you using? How are you implementing them? What doesn’t seem to work out when you do?

• Any concerns you feel haven’t been addressed yet in the therapy process

• Anything you’re confused about, like how a specific strategy works or what the current therapy goals are

One final note about having this talk with your child’s therapist: please set up a time to meet with the counselor when your child isn’t present. You want to be able to speak openly about behaviors you’re seeing at home or family dynamics that might be getting in the way of completing therapy goals at home. Kids tend to personalize these conversations and may believe that it’s their fault if therapy isn’t going well.

Common Therapy Problems, and How to Handle Them

Often, an honest conversation with your child’s therapist is enough to clear up issues that are keeping you from progressing. You may need to clarify treatment goals, rethink your child’s diagnosis, figure out what’s getting in the way of using skills at home, or consider switching approaches or therapists in order to get things working again. Photo by Cottonbro via Pexels.

Hopefully, you are able to bring these concerns to your child’s therapist, along with some specifics about what doesn’t seem to be going well. Together, you can figure out what the roadblock might be that’s preventing therapy from being effective. There are all kinds of reasons therapy might not work, but here are a few common ones to consider, along with ways you can help things improve:

Unclear Treatment Plan

I often hear from parents that they’re not sure what’s going on in their child’s therapy aside from “just playing.” This should never be the case! Start off your troubleshooting process by making sure you and your therapist are on the same page regarding your child’s therapy goals.

Every therapist is required to create and maintain a document called a treatment plan. This outlines what problems brought a child to therapy in the first place, and what goals have been set in order to make those problems better. If you’ve been in therapy a while, this document has likely been updated to show how much progress your child has made toward these goals.

If you aren’t clear on your child’s treatment plan, you can:

• Ask to meet with your child’s therapist to review the treatment plan together

• Let the therapist know that you’d like to get clear on what the current goals are, and be more direct in working toward them

• Get feedback from your therapist on what they’ve observed in sessions and how they feel your child is progressing

• Ask how you can support your child in achieving treatment plan goals at home

If your child’s therapist doesn’t have a treatment plan, can’t give clear answers about goals, or isn’t able to provide specific responses to your questions, you may not be a good fit for each other.

Treating the Wrong Problem

It’s also possible that your therapist has a clear, detailed treatment plan…and you’ve been focusing on the wrong problem. Sometimes, one mental health problem masquerades as another. Girls with autism, for example, have a harder time getting diagnosed and their symptoms might be mistaken for anxiety or another disorder at first. Trauma symptoms can look an awful lot like ADHD. Children who have OCD might take a while to get the right diagnosis, as well, because the behaviors can be hidden or hard to spot.

If you’ve been diligently working on your treatment plan, trying to follow through with things at home, and nothing seems to be moving the needle, it’s worth questioning if something else might be going on.

If you’re wondering if there’s another diagnosis at play, you can:

• Ask your child’s therapist if there are any other diagnoses (sometimes called “differential diagnoses”) they have considered for your child.

• Give a thorough review of any possible symptoms, behaviors, or difficulties you’re seeing at home,

• Reflect on your child’s history: have they lived through anything that might be considered a traumatic or highly stressful event? These are good for your therapist to know about, even if they seem unrelated to the problem at hand.

• Consider getting an evaluation from a psychologist to screen for ADHD, autism, or other developmental or learning conditions

Depending on what you learn, you may find that your goals in the therapy process need to change—or you may discover that your child is a better fit for another kind of therapy altogether.

Trouble Following Through

What happens outside the therapy room matters just as much as what goes on inside of it. This is especially true if you’re in a skills-based form of therapy, like CBT, or treating a problem like anxiety or behavior difficulties where a lot of the struggles occur at home.

Kids are still in the process of learning to regulate their emotions, and need an adult’s help to do this. Even if they’re learning skills perfectly in session, they won’t be much use if there isn’t a parent or caregiver helping with follow-through in real-world situations.

Of course, this is way easier said than done. Working on therapy skills can be time-consuming and emotionally draining. It can be really hard to find the time and emotional reserves to work on therapy when you’re managing a busy and stressful life. It’s also possible that a plan that sounded really good in the office falls apart when you get home: either your child is reluctant to do it, or you encounter some kind of issue that you can’t figure out how to navigate.

If you’re having a hard time following through on therapy goals at home, try the following:

• Be honest with your therapist about what’s going on. You aren’t getting graded, so there’s no need to lie about not doing your homework!

• Make sure you feel clear and confident about what your assignment is: you should know exaclty what you’re doing, and what to say when

• Sometimes, a plan sounds okay in the office but feels difficult, uncomfortable, or scary to a child when it’s time to follow through at home. If this is the case, you may need to adjust the goal or come up with a plan to support your child through it.

• Let your therapist know about any sticking points that you’re tripping up on when you try to practice at home

If you’re in the middle of a major life transition, experiencing trauma or loss, or feeling totally overextended by work and family obligations, you may just not have the reserves to fully participate in therapy right now. It may make more sense to focus on those life stressors first, and return to therapy once things have settled down a bit.

Child Needs Higher Level of SuPport

If you aren’t seeing improvement, and especially if things are getting worse, you may simply not be getting enough help. Some issues need more attention and support to resolve than a 50-minute sit down with a therapist once a week can provide. This is kind of the “bare minimum” of therapeutic support, and there are a lot of other options to consider when it isn’t enough.

Somtimes, families opt to try therapy on an every other week or even monthly basis. This may be due to financial concerns, time constraints, or limited availability from your therapist. While this can be a good option for kids with mild symptoms, kids who are really in the thick of it will have a hard time keeping momentum up if they’re only coming every other week.

If you feel like things are steadily worsening, and particularly if your child is struggling with suicidal thougths or self-harm, it’s worth talking to your therapist about ways to increase support. Here are some possibilities to consider:

• You child may need more frequent sessions: weekly if they’re coming every other week, or twice a week if they’ve attended weekly.

• Adding group therapy, like a DBT skills group, can add another layer of support for kids struggling with suicidal thoughts or self-harm.

• Consider meeting with a psychiatrist to see if medication could help your child make more progress in therapy: you can talk this over with your therapist and pediatrician.

• If finances make it hard to attend therapy more often, ask about a sliding scale or consider making a transition to a therapist who takes your insurance or can offer a lower rate.

• If your child is not safe at home, intensive outpatient therapy (meeting daily for part of the day) or an inpatient stay might be needed before your child is ready to “step down” to weekly therapy sessions.

It might be hard to think about adding more therapy when things are already not working: it means more time, more money, and more effort. While a higher level of care isn’t the right answer for every child, it can make a world of difference for kids who really need it.

Therapist is Not the Right Fit

Sometimes, it’s just not a good match. Maybe the style of therapy your counselor offers doesn’t work for your kid: a child who’s reluctant to attend therapy might not do well in an approach that requires a lot of self-motivation, for example. Or, maybe you’re feeling a lack of clarity about what the treatment plan is, and you can’t seem to get on the same page. If your child’s diagnosis or needs have changed over time, they may need a form of help your therapist no longer specializes in.

It’s also possible that your personalities just don’t mesh well: just like you’re not going to be friends with every person you meet, you’re not going to hit it off with every therapist you meet, either. Simply not feeling comfortable with your therapist—even if they’re a nice person—can be reason enough to make a change.

If you’re just not vibing with your child’s therapist, there are a few things you can do:

• As awkward as it may seem, you can still bring this up to your therapist, as long as you don’t have any big ethical concerns about their behavior. They may sense that it’s a poor fit, too!

• Try to get specific about what you need out of therapy that you’re not getting now. Would your child respond better to a therapist who is more animated and engaging? Do you need someone who specializes in a specific diagnosis, or does more parenting work?

• Ask yourself whether a difference in culture or background might be part of the problem. It may or may not be, but sometimes finding a therapist who shares your racial or cultural heritage can help.

• Search for therapists who meet your new criteria. You can even ask your current therapist for referrals, if you’d like!

Just like doctors have no problem with patients seeking a second opinion, most therapists genuinely just want our clients to feel better, whether that happens with us or someone else. I’m always happy when a family is able to find someone who is exactly the right fit for their situation.

Should You Switch to Another Therapist?

It’s always within your rights to switch to a new therapist, and sometimes that’s exactly what you’ll need to do if your current therapy plan isn’t working. If you’ve tried talking with your therapist and things still aren’t working out, it’s perfectly okay to transition your child to a new counselor. There are so many different styles of therapy out there that you might not find the right match on your very first try.

Just like you wouldn’t fire an employee over a minor offense, I don’t recommend leaving therapy the first time something goes wrong. In fact, you should expect that things will go wrong sometimes! Your therapist won’t always get it right. They may interpret something in a way that doesn’t sit right with you. Or, they may have a policy you don’t agree with, like charging a cancellation fee.

Minor missteps and frustrations can be worked through, and will often make your relationship with your therapist stronger. If you left therapy every time something like this happened, you’d be repeatedly starting from the begining and it would be hard to make any meaningful progress. On the other hand, unethical behavior—things like making racist or sexist comments, not protecting your private information, or saying something inappropriate in session—should never be tolerated. Get out of the situation immediately if this happens to you, and consider filing a complaint with your therapist’s board.

Most of the time, there won’t be a big, dramatic reason for ending therapy: it’ll just turn out not to be a good fit. In these situations, I strongly recommend being upfront with your therapist about what’s going on. Scheduling a final “goodbye” session for your child gives them a sense of closure before moving on.

Take Care of Yourself As a Parent

Your child’s therapy process isn’t going to look like anyone else’s, so resist the temptation to compare your child or family to others. You can’t help your child through therapy if you’re completely burned out! Photo by Albert Rafael via Pexels.

It’s easy to feel burned out when therapy isn’t working for your kid. Here you are, contributing all this time, money, and emotional energy in the hopes that things will get better…and then they don’t. You might blame yourself, worry that your child’s problem is unfixable, or start to question whether therapy will ever work.

We all know the adage about the oxygen mask in the airplane: there’s no use in bending over backwards to find help for your child if you’re feeling utterly fried by the whole process, and have no time to take care of yourself. Do whatever you need to do to prioritize your own mental health during this stressful time, even if it feels a little selfish.

Your kid’s process is not going to look like any other kid’s process: they’re a unique individual. There’s no reason to beat yourself up if so-and-so’s kid had a miraculous transformation in 3 sessions of therapy and your family is still struggling 6 weeks in. Just like kids hit their developmental milestones at their own pace, you and your child will figure this out on your own timeline, too.

When you’re really feeling stuck, it can be easy to overlook the small, everyday ways that things are getting better. It sometimes helps to refocus on those small victories. Did your child encounter a triggering situation today, but not melt down? Were they able to articulate their feelings to you this week? Have some aspects of your problem gotten better, even if other parts have stayed the same? This is all growth and progress to be celebrated.

Be patient, hang in there, and don’t neglect these little wins while you figure out how to get unstuck.

Begin Child Counseling in Charlotte, NC or Online

Finding a therapist who is the right fit for your child can make therapy more effective. If you’re looking for someone who specializes in tween anxiety and OCD, I’m available to work with children throughout NY, NC, and FL. Photo by Victoria Rain via Pexels.

If you’re still looking for the right fit for therapy for your child, I might be able to help! I can see kids in person at my Davidson, North Carolina office, or online anywhere in North Carolina, Florida, or New York.

I mainly work with tweens (rougly ages 8-13) who are struggling wtih anxiety due to OCD, difficult life circumstances, or just by virtue of having an anxious temperament. We’ll work together using practical, skills-based therapy along with a healthy portion of fun and play to learn new ways to deal with difficulties in life. I’m trained in three research-based forms of therapy: CBT (great for anxiety), TF-CBT (designed for trauma), and ERP (for OCD). I’m also a drama and play therapist, so we won’t just be learning dry skills from a book, but we won’t be playing Uno all day either :-).

If you think your child could benefit from this approach, feel free to reach out! You can also join my mailing list to get my free coping skills guide, as well as monthly information on how to help kids and tweens navigate life with anxiety.

How Can I Help My Minor with OCD?

OCD symptoms often develop for minors during the tween or teen years, and most people are diagnosed before age 25.

If you’re looking for help for your minor child with OCD, you’re not alone. It’s common for OCD symptoms to first show up in childhood: two of the most common times to develop OCD are during the tween years or the late teen years. In general, most people with OCD start noticing symptoms before age 25.

Research suggests boys tend to devleop OCD at an earlier age than girls do. However, every kid is different. For example, I’m a children’s OCD therapist who was also diagnosed with OCD as a child, and my symptoms started at age 7.

Regardless of your child’s age, your support as a parent is really important. Kids—especially young ones—need their parents to be involved in the therapy process, and this is especially true when it comes to OCD therapy. The good news is that your support will have a huge, positive impact on your chid’s recovery from OCD. In this post, you’ll learn 5 simple ways you can help your minor child—and yourself—through OCD

Identifying OCD Symptoms in Minors

It’s not always easy to identify OCD symptoms in children. Kids are often aware that the worries OCD gives them are unusual, and will try to mask their symptoms as a result They may feel embarassed, ashamed, or afraid of the thoughts they’re having. They don’t want other people to know about these weird thoughts, so they cover them up instead.

Also, a child’s OCD symptoms might not fit the mold of what we expect OCD to look like. We might envision a very neat, orderly person who’s focused on avoiding germs or keeping things organized. In reality, OCD can look many different ways, and the signs are often very subtle. It’s entirely possible for a child with OCD to be messy, disorganized, or totally unworried about dirt or germs.

People with OCD have two things in common: obsessive thoughts and compulsive behavior. An obsession is an unwanted thought, worry, or mental image that pops up at unwanted times. It’s hard to get rid of, and causes a lot of anxiety or distress. In order to deal with these obsessions, OCD sufferers feel like they have to do something to alleviate their anxiety. This repeated behavior is called a compulsion.

Common obsessions for kids with OCD include:

• Worries related to getting sick, throwing up, or contracting germs

• Fear about somehow losing control and doing something bad, like hurting themselves or someone else (even though they don’t want to)

• Thoughts that if they don’t do something just right, something terrible could happen

• Worries about bad things happening to loved ones

• Doubts about whether or not they may have misbehaved or done something wrongj

• Worries about sexuality or being gay in children who aren’t otherwise questioning their identity

You may notice compulsive behaviors like these in your minor child with OCD:

• Checking and-rechecking that they’ve done something, like turned off a light switch

• Creating rituals that have to be done exactly the right way, such as a specific process for washing hands or a rigid bedtime routine

• Excessive cleaning, showering, or handwashing

• Repeatedly asking for reassurance about things, even after they’ve been given an answer

• Confessing bad thoughts or possible misbehavior to a parent

• Repeatedly touching or counting objects, or repeating actions to make them symmetrical (like tapping one leg and then the other)

The tricky thing about OCD is that compulsions never permanently get rid of an obsessive worry. This means that people get stuck in a cycle of doing their compulsive behavior over and over in order to feel some sense of relief.

Five Ways to Help Your Minor Child with OCD

As a parent, you can help your child understand their symptoms and work together as a team to combat OCD.

Now that we’ve reviewed the symptoms of OCD, let’s talk about how you can help your child to cope. OCD is a stressful diagnosis not just for the child who is suffering, but their entire family. Keep reading to learn ways to demystify OCD, reduce feelings of shame and loneliness, and start looking at OCD from a different perspective. These 5 steps will help you and your child look at OCD in a new light, so you can start working on healing together.

These techniques aren’t a replacement for therapy (more on that below), but they are tried-and-true approaches that I teach in my child therapy office. They’re also exactly the kinds of things that I think would have helped my family when I was a kid. If you’ve just noticed OCD symptoms in your minor child and you’re not sure what to do, start here.

#1: Help Your Child Understand OCD

I mentioned above that kids with OCD often know that their thoughts are unusual. That’s because OCD is ego dystonic: this means that the thoughts it causes go against a person’s temperament and values. They can feel weird, confusing, or “other,” almost like they’re not coming from you. Often, OCD preys on a child’s worst fears: peaceful kids may experience violent images, responsible children might worry about mistakes, and typically subdued kids can suddenly have thoughts about losing control and doing something inappropriate.

As you can imagine, this is really upsetting. Kids with OCD may worry they’re going crazy or that something is deeply wrong with them. They may also assume they’re the only one having these “weird” thoughts. This is especially true if their obsessions are about something embarrassing, shameful, or taboo.

You can help your child understand OCD so they feel less alone. Learning how OCD works can help kids realize that their symptoms aren’t so unusual after all, and that there is treatment that will help. Start by teaching a few important facts about OCD:

• Nothing a person does causes OCD. It’s mostly genetic, and not anybody’s fault.

• Just because you have a bad thought doesn’t mean you’ll act on it. In fact, people with OCD tend to have obsessive thoughts about things they’d never do in real life.

• OCD isn’t dangerous: it’s just a little glitch or “hiccup” that happens in the brain.

• You can fight back against OCD by not doing what it tells you to do: this is hard, but it teaches your OCD who is boss!

Reading books together is a great way to get these points across. It gives parents language they can use to explain OCD, and seeing that someone has gone through the trouble of writing a book can reassure kids that they really aren’t alone. What to Do When Your Brain Gets Stuck is a classic, and many people enjoy Up and Down the Worry Hill, too.

Your child might also appreciate taking a look at a list of celebrities who have OCD. About 1.2% of people are diagnosed with OCD. This means there are plenty of public figures who have been affected by it, including David Beckham, Daniel Radcliffe, and Camila Cabello.

#2: Be a United Team with Your Child Against OCD

Your child can separate herself from her symptoms by drawing a picture of what she imagines OCD looks like.

Battling OCD is not easy work. You have to do exactly the thing your brain is saying not to do in order to feel better! This can put parents at odds with their kids, because parents are the ones who have to hold bnoundaries and stick with the plan to overcome OCD. It’s important to remind your child (and yourself) that this fight is not you against them: it’s the two of you against OCD.

You can maintain a united front by imagining OCD as a little character or creature that is totally separate from your child. This is called “externalizing:" it’s a tool we use in therapy to help separate a problem from the person suffering from it. Externalizing OCD can help you feel like you’ve got a common enemy. It also reduces some of the shame and frustration kids feel when they experience thoughts and urges beyond their control.

Encourage your child to give their OCD a name: kids often choose something funny and nonthreatening, like “Bob” or “Dr. Annoying.” Your child might also enjoy drawing a picture of what they imagine their OCD would look like. Creating this kind of OCD character is a coping skill I use with almost all kids at the beginning of treatment (you can check out other OCD coping skills here).

Next time you notice your child saying or doing something related to their OCD, don’t blame them—blame Bob.

#3: Don’t Fall Into the Reassurance Trap

It’s only natural to want to comfort your child when they’re worried. As parents, we probably offer reassurance all day without thinking twice. Sometimes, a simple “it’s okay” or “everything will be alright” is all a child needs to hear in order to feel better.

Unfortunately, the usual rules don’t apply to OCD. Reassurance typically does more harm than good: even though it helps kids feel better in the short term, it fuels their anxiety in the long run. Reassurance-seeking is the most common OCD compulsion I see among kids in my therapy practice. Cutting back on reassurances can go a long way toward helping your child.

You might notice your child asking you the same question over and over, even after you’ve already explained that things will be fine. That’s because reassurance only quiets the OCD worries for a little bit. The OCD worries always come back, which means your child has to ask again to get relief. Over time, this pattern actually makes the symptoms worse.

One of the big goals of OCD treatment is to help parents gradually stop enabling their child’s OCD by giving into its demands. This means gradually scaling back on giving reassurance if you’ve been doing it a lot. If your child’s symptosm are mild, you may have good luck doing this on your own at home. If you’ve been stuck in this pattern for a while, a therapist can help you to gently break the cycle.

#4: Research Therapists who Treat Minors with OCD

Databases like the one provided by IOCDF can help you find therapists who specialize in treating OCD in minors.

While some minor children will recover from OCD without therapy, many will need extra help. Research has found that for about 1 in 5 kids, symptoms will resolve on their own, without treatment. For that remaining 4 out of 5, therapy will help kids get back on track and manage their symtpoms.

It might sound daunting at first to hear that most kids with OCD require therapy to recover. However, there are a couple of big silver linings here. The first bit of good news is that we have a form of therapy called ERP that’s been designed specifically for treating OCD, and it is highly effective. We also know that entering therapy early in life helps people with childhood-onset OCD make a much fuller recovery. That’s good news for your child!

Working with OCD is a specialty: not all therapists have extensive training in this area. The same is true for working with children. Finding a therapist who specializes in both OCD and working with minors might require a little extra legwork. The International OCD Foundation (IOCDF) has a searchable list of therapists who are trained in ERP, the “gold standard” treatment for OCD, including therapists who have been specifically trained to treat children. You can also run a search on Psychology Today to look for therapists in your area who offer ERP and see kids or teens.

Not all therapy therapy training programs don’t cover OCD or child therapy in tons of detail, so it can help to ask prospective therapists what their training and experience is with these two groups. Registered Play Therapists often have lots of training working with kids. ERP is the most common, best-researched therapy for OCD treatment. You can also ask more general questions, like the ones in this post, to get a sense for whether a therapist seems like the right fit for your family.

#5: Practice Self-Care So You Can Support Your Child

OCD is tough for kids, but it’s incredibly draining for their families, too. The bigger OCD symptoms grow, the more time and energy it takes to keep up with all the compulsive behaviors and rituals. Families—and parents especially—may feel like they’re bending over backwards or walking on eggshells to avoid triggering their child’s OCD. And even with all that effort, new worries pop up, seemingly out of nowhere.

It’s common for parents to feel exhausted, hopeless, or even resentful when they’ve been dealing with a child’s OCD for a long time. Kids often pick up on this tension, which adds extra stress to an already stressful situation. Gradually facing fears through OCD treatment is the most surefire way out of this vicious cycle, but it requires a lot of work, too. You’ll need a lot of patience and compassion to help your child through therapy.

Treating OCD is more of a marathon than a sprint. Resist the temptation to put yourself last on the to do list, and make sure you’re setting aside time to do whatever will help you continue to show up for your child. Date nights, exercise, time away from parenting, or watching something on TV that isn’t Bluey all count. You can also ask to speak to your child’s counselor in private or seek out your own therapist if you need to vent and get your own support.

OCD Therapy for Minors in North Carolina

You can help your child through OCD with the support of a therapist. I provide OCD treatment for kids and their families throughout North Carolina, New York, and Florida.

I hope you’ve found this article helpful, and that it gives you some options to try while you consider looking for a therapist. If you’re looking for OCD counseling for your child, I may be able to help! I’m physically located in Davidson, North Carolina, and can meet with local children in-person or online. I’m also available for virtual sessions with families in Florida and New York. You can learn more about my practice or email me to get started.

Looking for more information on how OCD affects minors? Check out some of my other posts:

Can a Child Have Mild OCD?
What Are the 4 Types of OCD?
How to Help a Child with Intrusive Thoughts
Does Childhood OCD Go Away?

Should Parents Be Involved In Their Child's Therapy?

Since becoming a parent myself, it’s dawned on me what a leap of faith it is to send your child to therapy. Whether you’re meeting in person or online, you’re sending your child into a room with a near-stranger without knowing exactly what’s happening behind that closed door. Does this person have your child’s best interests at heart? Do they know how to help? Are you missing out on important information? Are they just playing Uno in there?

Involving parents in a child’s therapy can be a tricky business. On one hand, kids need enough privacy to trust that they can safely share difficult thoughts and feelings. On the other, it’s fair for parents to want to be kept in the loop…and research shows therapy is more effective when they are.

Being a part of your child’s therapy process benefits everybody: you, your child, and your child’s therapist. But how you get involved will depend on your child’s age, maturity level, and the reason they’re coming to therapy.

You Are the Expert on Your Child’s Life

You know how, in documentaries, there’s always a “talking head” segment where an expert drops a bunch of knowledge and historical information about the subject of the movie? If there was a documentary about your child, you’d be that expert. You have insight about your child that your therapist doesn’t.

Child therapists have broad knowledge: they have data about a large number of kids. They know what anxiety, depression, and other mental health issues tend to look like in kids. They’ve studied child development and probably attended countless lectures and trainings on specific ways to help kids with different conditions. On top of that, they’ve met with hundreds of kids for therapy. Based on what’s helped all these other kids, your therapist can make a strong educated guess about what will be helpful for your child.

Parents have deep knowledge: you know your individual child better than anyone else. You’ve spent years learning to decode your child’s tiny facial expressions or tones of voice. You know their history and you’ve seen them at their most vulnerable. You’ve likely been with your child since the day they were born and seen them grow and change. You’re the family historian, and you can remember details about your child’s life that they cannot.

Your deep knowledge is really useful in therapy. It provides background and context. You can give your therapist feedback to help them tailor their skills to work for your specific child and family. And learning those skills alongside your child will help them to get the most out of therapy.

The Pros and Cons of Parent Involvement in Therapy

Participating in your child’s therapy is a bit of a balancing act. You want to be involved enough that you know what’s going on and how to support your child, but not so involved that your child feels like they don’t have any space to do their own thing.

There are definite benefits to parent involvement, but there are also some potential drawbacks to be aware of. Let’s take a look at both.

The Pros:

• We have a lot of research that shows that being involved in your child’s therapy is linked with better outcomes: kids do better when parents actively participate.

• Participating in therapy sends a message to your child that going to therapy isn’t a punishment for bad behavior: you’re committed to growing and changing, too.

• Coping skills are great, but kids will need help from an adult to put them into practice. You can reinforce what your child is learning at home.

• You can share important information with your child’s therapist about your family history, religion, culture, or anything else that might influence your child’s experiences.

• Children of all ages need help from their parents to handle their feelings. To create lasting change, both kids and their parents need to learn new ways of dealing with anxiety and behavior struggles.

The Cons:

• If everything a child says is immediately relayed back to the parent, it’s a betrayal of trust. Children will quickly figure this out, and stop sharing important information in therapy.

• Sometimes it’s easier for children to bring up difficult, embarassing, or scary subjects for the first time with someone who isn’t a family member: it helps to protect those important relationships. If parents are in the room all of the time, it’s hard to do this.

• Older children are more aware of cause and effect, and may worry about the consequences of sharing things in therapy as a result: if I say this to my therapist, will I get in trouble at home?

• As kids become teenagers, it’s normal and natural for parts of their lives to become more private from their parents. It’s no longer age-appropriate for them to share every detail of their personal lives.

A lot of these risks can be managed by setting clear boundaries in advance: everybody, including your child, should know what gets kept private and what doesn’t. You can talk with your therapist about the best way to participate, based on your child’s age and needs.

How Involved Should I Be in My Child’s Therapy?

There’s no “right” level of involvement in a child’s therapy. Every kid is different! Your child’s age is the biggest factor to consider when trying to figure out how to participate: the younger your child is, the more present you’ll need to be.

Your child’s reason for attending therapy matters, too. Children experiencing anxiety or OCD may need a little more privacy, safe space to begin talking about their fears. A teen having relationship struggles may not want or need to talk about all the details with a parent.

On the other hand, behavior concerns like fighting, tantrums, and not following rules usually need more parent involvement. An argument takes two people, so you really need both people to figure out how to respond differently.

Finally, the severity of your child’s symptoms might also dictate how involved you need to be. A child who is feeling stressed about homework may be able to learn ways to cope with her worries fairly independently. A child who is so anxious about their work that they’ve stopped going to school most days is going to need lots of support and guidance from parents to overcome their fears.

Participating in a Preschool Child’s Therapy

Sometimes people are surprised to hear that therapy options exist for toddlers and preschoolers. They absolutely do! If your very young child is struggling emotionally, you have options. Forms of therapy have been created specifically to help preschoolers cope with trauma, manage difficult behaviors, and explore feelings through play, rather than words. Kids in this age range need a lot of parent support in order to make therapy work.

As a parent, you’re the center of your preschooler’s universe. You’re their first playmate, their protector, and the person who sets the schedule for their day. Little children look to their parents to decide how to respond in stressful situations: they’re always checking what your reaction is. When feelings get too overwhelming, it’s hard for preschoolers to self-soothe: they need your help to do this. Because preschoolers rely on their parents for so much, you can expect to be highly involved in their therapy.

Depending on your child’s needs, parent involvement in a preschooler’s therapy could look like:

• Attending sessions alongside your child, so the therapist can guide you through play-based activities together.

• Getting coaching in real time from a therapist as you interact with your child, so the therapist can “translate” the possible meaning of your child’s behavior or offer suggestions on how you can respond.

• Learning coping skills together in session that you can help your child to practice at home.

• Meeting frequently for parent sessions with your child’s therapist to discuss their progress

• Learning parenting strategies that you can try at home to support your child and the work they’re doing in therapy

To summarize, if you have a child between the ages of 2 and 5, you should expect to be a very active participant in their therapy process. Younger preschoolers will need your support in the room for the entire session: and what you learn will be just as important as what they learn.

Older preschoolers might be able to meet alone for play therapy some of the time, but you’ll still need to be involved and open to trying new things in order for therapy to work well. If your child’s therapist meets with them alone for play therapy, you should expect (and ask!) to be included on a regular basis, either for part of each session or for regularly scheduled parent-only meetings.

Including Parents in Therapy for Elementary-Aged Kids

Elementary-aged kids have mastered the art of pretend play, which makes play therapy a wonderful option for this age group! Between the ages of 5 and 10, children are also working on their ability to verbalize their thoughts and feelings. Starting school opens up a whole new world for kids: there are new important people in their lives like teachers, coaches, and friends.

All these factors mean that unlike younger children, elementary school kids can often benefit from some alone time in the therapy room. Sometimes, practicing being apart from Mom or Dad can even be a helpful goal for kids with separation anxiety!

However, it’s not realistic to expect this age group to put what they’re learning into practice by themselves: they’re going to need help and support from you. You’re still your child’s biggest teacher, and the 50 minutes they spend in therapy once a week will never have as much impact as their time with you.

If you’re participating in your elementary schooler’s therapy, you might be asked to:

• Check in about how things are going at home at the start or end of each week’s session.

• Join your child for the last part of their appointment to learn a coping skill together—or have your child teach the skill to you!

• Help your child practice simple “homework” over the course of the week.

• Meet for parent sessions to discuss your child’s progress and talk about ways you can tweak things at home (like discipline or the way the family responds to anxiety) in order to best support your child.

In general, you can expect that a child between the ages of 5 and 10 will attend therapy sessions by themselves, but that you’ll still be needed as as major source of support. Whether it’s helping your child practice relaxation skills or encouraging them to gradually face their fears, your participation makes a huge difference in the therapy process.

How to Get Involved in Your Tween or Teen’s Therapy

It’s totally normal and age-appropriate for tweens and teens to want some privacy in therapy. They’re at an age where they no longer need to share every thought that passes through their head with their parents. As kids hit adolesence, friends become a huge source of support and a helpful sounding board…but they can also be a major source of drama. It can be a relief to talk to someone like a therapist, who isn’t a close friend or family member and who is removed from a teen’s day-to-day life.

Tweens and teens are also much more capable of considering cause and effect: what will happen to me if I share this information with my therapist? Will my parents find out? Will I get in trouble? Because of this, it’s really important for these older kids to be informed about how confidentiality works in therapy. Safety concerns (like thoughts of suicide) will always be shared with a parent, but issues that aren’t urgent or dangerous (like a fight with a sibling) might not be.

Despite all this added independence, parents still need to be kept in the loop. Teenagers still need guidance from their parents, even if it looks different now than it did when they were little. It can be stressful to raise a teenager, and parents could use some support during this time, too. Participating in your teen’s therapy also sends the message that you don’t simply see them as a “problem child”: you’re willing to put in the work to make things better, too.

Participating in your tween or teenaged child’s therapy could look like:

• Having an initial session with your child’s therapist before they meet to share your perspective and fill them in on your family’s history.

• Having an open conversation in your teen’s first therapy session about how confidentiality works and what will and won’t be shared.

• Meeting periodically with your child’s therapist to discuss the progress they’ve made toward their treatment goals—but not necessarily talking about their specific worries or problems.

• If your child is in a skills-focused form of therapy, like CBT or ERP, collaborating with your child and the therapist to come up with a plan to work on skills at home.

• Getting support for yourself and learning new ways to manage your tween or teen’s strong emotions.

Until your child turns 18, you can expect—and request—to be a part of your teenager’s therapy. Once your child turns 18, however, things change. Once your teen is a legal adult, they’re entitled to total privacy in therapy, even if they’re still living in your home and you’re the one paying for their sessions.

If your child is approaching this age, you should talk with both your teen and their therapist about how to prepare for this transition. Turning 18 doesn’t necessarily mean you can never participate in your child’s thearpy again—you’ll just need their permission to get involved.

What if I Can’t Attend My Child’s Sessions?

There are many reasons why it may not be possible for you to physically attend appointments with your child’s therapist. Maybe your child is in online therapy, and meets with their therapist while you’re still at work. Or, maybe your child’s other parent is typically the one who drives them to their sessions. Divorced parents may not live in the same town or state as their child’s therapist, which can also make it more difficult to stay in touch.

Research on children’s therapy has found there’s a difference between a parent who attends a child’s therapy sessions and a parent who participates actively in the sessions. Being physically present at the appointment is a great start, but it’s not going to be very helpful unless the parent is open to sharing, listening to feedback, and following through at home. Any parent can actively participate in therapy, whether they live 1 mile or 100 miles from the office.

If you want to be involved but you can’t make your child’s regularly scheduled appointment time, you have some options:

• Ask your therapist if it’s possible to schedule a monthly “parent only” appointment at a time that works better for you.

• Online therapy is common now, which is a great option for working or out-of-town parents. See if you can schedule periodic online check-ins to avoid a long commute.

• Many children’s therapists have much more flexibility to meet while children are in school. If you can meet remotely during your lunch break at work, this can be a good option to stay involved.

• Phone calls, emails and texts can be a good way to keep in touch when video calls aren’t possible. Your therapist can keep you updated on treatment plan goals and let you know how you can help reinforce these goals at home.

• If your child is under 18, you have a right to access their medical information. Consider asking for a copy of their treatment plan, if your therapist hasn’t shared it with you.

Regardless of how you keep in contact, your participation will have a positive effect on the therapy process. Being open to change and trying new things along with your child is a huge deal!

Therapy for Kids and Tweens in Davidson, North Carolina

Ready to get started in therapy? I’d love to help you take the next step. My child therapy office is located in Davidson, North Carolina, just north of Charlotte. I also offer online therapy for kids living anywhere in North Carolina, New York, or Florida. You can reach out to me here.

If you’re searching for a local therapist, or unsure if therapy is the right step, check out my anxiety coping skills course for kids and their parents. It can give you practical, actionable skills to try at home in the meantime to deal with overwhelming worries and panic. The course includes sections for both kids and parents, so you can support your child in learning more helpful ways to cope.

If you’re looking for more information on getting started with children’s therapy, check out my other blog posts on the subject:

What Questions Should I Ask My Child’s Therapist?
Should My Child See a Therapist, Psychologist, or Psychiatrist?
What Are the Different Types of Child Therapy?

If you’re ready to get started, email me here to inquire about therapy sessions.

Can a Child Have Mild OCD?

It’s bedtime, and your child’s goodnight routine is a little longer than usual. Over the past few weeks, it seems like things have gotten a little more elaborate, and the steps have to be done just right. Or, maybe you’ve noticed your child repeatdly asking if things are okay—even when they know the answer is yes.

You know kids can have quirky habits sometimes, and your child has always been prone to worrying. Is this just a passing phase, or could your child possibly have mild OCD? Is “mild OCD” even a thing?

When we see OCD portrayed on TV, it’s often easy to spot. Characters with OCD usually have easily noticeable symptoms, and they’re often pretty severe. In real life, OCD is much better at hiding: symptoms can be really subtle. What’s more, kids with OCD sometimes feel they need to hide their compulsive behavior. Children are often aware that not everybody has these “weird” thoughts and urges, and so they try not to advertise what’s going on.

The short answer is: yes, it’s very possible to have mild OCD. For the longer answer, keep reading! We’ll take a look at the different, sneaky ways that OCD can show up for kids.

First, Let’s Clarify What OCD Is

If your child’s problems are mild, it might be harder to distinguish whether or not OCD is really what you’re dealing with. Anxiety and OCD have a lot in common. And some personality traits and quirks can resemble OCD too, like perfectionism, superstitiousness, and orderliness.

People with OCD share 2 big symptoms in common:

• They have recurring unwanted thoughts, urges, or mental images. These are unwanted, tough to control, and cause the person anxiety or distress.

• The person tries to push away or “neutralize” these thoughts, usually with some kind of special thought or action.

That’s where we get the name “Obsessive Compulsive Disorder” from. The unwanted thought that shows up again and again is the obsession. The thing a person feels they have to do in order to make the uncomfortable thought go away is the compulsion. The trick is that, while compulsions make a person feel better in the short term, they actually make the thoughts and anxiety worse over time.

A child who holds herself to a high standard at school, prefers a clean room, or likes to carry a lucky charm on important days is unlikely to have OCD. However, a child whose worries seem to be stuck in a loop, or who repeatedly performs the same action might be showing OCD symptoms.

OCD Has a Range of Severities

Just like most other mental health problems, OCD can be mild, moderate, or severe. Some children might experience OCD as a minor inconvenience, while for others it can be completely debilitating. The media tends to show mental illness in its most severe forms because that’s what’s most dramatic and interesting. However, this isn’t the reality for all kids with OCD.

Many kids are able to fly under the radar for a while, without their symptoms being apparent to others. Even parents may not notice anything unusual, especially at first. By the time a child comes to treatment, they may have had OCD symptoms for quite a while.

Therapists look at a few areas to see if a child’s symptoms are mild, moderate, or severe:

• Frequency: A child whose worry shows up once a day may be on the midler end of the OCD spectrum. A child whose thought pops up many times throughout the day may have more severe OCD.

• Intensity: If a child can sometimes brush off the thought or it causes only mild anxiety, their symptoms are more mild. If a child can’t let go of a thought and it causes extreme stress, that’s severe.

• Duration: Kids with mild OCD symptoms may spend a few minutes a day doing something compulsively. Children struggling with severe OCD may spend hours.

• Functioning: Mild OCD may not really get in the way of things like school, friendships, or other everyday activities. On the other hand, severe OCD can affect relationships and keep kids from doing the things they want or need to do.

If you take your child to a therapist, they can use a special assessment to confirm an OCD diagnosis, and to see if your child’s symptoms fall into the mild, moderate, or severe range. This can be helpful to know because therapy recommendations will be different depending on where your child falls in that range.

You May Have Caught Your Child’s Symptoms Early

If you are noticing mild OCD symptoms in your child, it’s possible you’ve caught your child’s condition pretty early, while it’s still developing. As worrying as it can be to learn that a child is having these kinds of problems, discovering them early is great news.

Even though OCD is common, it can be hard to catch: one study found that it took the average OCD patient over 12 years to get a correct diagnosis! Younger people in the study had an easier time than older people when it came to getting diagnosed, but this is still a pretty long time to wait for the right help.

Research also tell us that kids who participate OCD therapy early often have better results than adults do. OCD symptoms tend to start in childhood or adolescence, so kids who are in therapy generally haven’t lived with their symptoms for as long as adults have. Quick treatment seems to make a difference: on average, they had more improvement in their symptoms than the adults in the study.

One final reason that it’s great to catch OCD symptoms early: mild OCD doesn’t always stay mild. When left untreated, kids may develop more complex and time-consuming rituals, and have more frequent and severe worries. As OCD grows, it can have more and more of an impact on a child’s quality of life. Kids who start therapy when their OCD is still mild can avoid a lot of this difficulty, and get their lives back on track sooner.

Sometimes, OCD Symptoms Are Invisible

There may be more to your child’s OCD than meets the eye. OCD involves obsessinos and compulsions that aren’t always easy to see. When we imagine a child performing OCD rituals, we might think of physical actions like handwashing or flipping light switches repeatedly. However, kids can have mental rituals as well, that don’t involve physically doing anything. Some examples are:

• Thinking a special word or thought in order to “undo” their worry.

• Praying compulsively

• Making mental lists

• Counting in their head

• Reviewing certain events over and over to double check them

Other times, compulsions involve saying something rather than doing something. These can also be a little more difficult to notice, at first. Pay attention for behaviors like:

• Asking for reassurance over and over

• Saying “I love you,” “I’m sorry”, or another phrase excessively

• Repeated confessions about things the child fears they have done wrong, such as having a bad thought, or possibly saying something unkind to someone

When parents begin to take stock of compulsions like these, what initially looked like mild OCD may look more complicated. There can be a lot happening beneath the surface, and these kinds of mental thoughts and rituals can be difficult for kids to talk about, or even put into words.

Do Kids with Mild OCD Still Need Therapy?

Even if your child’s symptoms seem mild, it’s a good idea to consult with a therapist to see if counseling could help. A therapist who specializes in OCD can complete a full assessment to see if any sneaky symptoms are going unnoticed. They can teach you and your child skills to deal with OCD worries without giving in to them all the time. Sometimes, it can be reassuring for a child just to hear from an adult who isn’t their parent that OCD worries are common, harmless, and not a sign of “going crazy.”

Occasionally, OCD symptoms may resolve on their own without therapy. Often, however, therapy is needed in order to overcome them. We know that mild symptoms tend to grow worse over time, and that younger kids do better in OCD therapy than adults. Because of all this, it’s worth talking to a counselor and considering therapy, even if your child’s symptoms aren’t getting in the way of life too much right now.

There are some great self-help resources out there for children with OCD. My favorite book for kids, What to Do When Your Brain Gets Stuck, is a great place to start. Up and Down The Worry Hill is another popular option. These books can give your family some helpful background information on OCD and how it works. You’ll also find tools you can use to take action right away.

How Can I Help My Child With Mild OCD?

There’s a lot you can do as a parent to help your child with OCD. In fact, parents are an important part of OCD therapy. A child’s symptoms tend to affect the whole family. Whether you’re waiting around for a child to complete a ritual or answering a question for the 100th time, parents ofen notice that they are changing the way they do things in order to keep the peace at home.

Unfortunately, OCD is never satisfied with what you give it. The more you give in to OCD, the bigger it grows. That’s why mild OCD often morphs over time into more moderate or severe illness.

OCD therapy helps both kids and parents to break this cycle. Using a form of therapy called Exposure and Response Prevention, a therapist can help your family learn new ways to stand up to OCD without giving in to compulsions and rituals. Kids can learn that they don’t have to listen to the thoughts and worries OCD gives them. Parents can learn how to support children without giving in to OCD’s demands.

If you’re noticing mild symptoms of OCD in your child, you can help right away by letting your child know that OCD thoughts are just random noise. The thoughts don’t mean anything, can’t hurt anyone, and everybody—even non-OCD sufferers—gets weird thoughts sometimes.

If you’re looking for help to deal with thoughts and worries right now, my free coping skills guide might help. You can download 5 Coping Skills for Anxious Tweens (That Aren’t Just Deep Breathing) right now, wherever you are.

If you’re hoping to begin therapy for OCD and you live in the states of North Carolina, New York, or FLorida, I may be able to help! I’m certified in Exposure and Response Prevention, the therapy that’s been proven most effective for OCD. As someone with a childhood OCD diagnosis, I remember how scary and overwhelming these symptoms can be. And I know that ERP therapy can really make a difference in the lives of children, whether their symptoms are mild or not.

You can learn more about ERP here, or contact me to inquire about starting therapy.

How to Find a BIPOC or LGBTQ+ Therapist for Your Child or Family

It can be really challenging to find a therapist of color—and even harder to find one who specializes in working with children. I hear similar struggles from families looking for therapists who are part of the LGBTQ community: it is sometimes difficult to find affirming therapists for kids.

Usually, I write in this blog about issues that I can help kids with in my therapy office, either in-person or online. This post is a little different: I’m not a BIPOC or queer therapist, but if you need one I’d love to help you find one for your child.

Below, you’ll find a list of directories designed to help match you and your child with therapists and other helpers who understand where you’re coming from. Each of these directories has an option to search specifically for children’s therapists, and also to filter the search results for therapists who share a specific identity or background.

The Benefits of a Therapist Who Shares Your Culture

In order for therapy to be effective, your child needs to feel understood. Of course, this doesn’t mean your child has to have every life experience in common with their therapist: sometimes it can be helpful to work with someone of a different gender or background. But research shows that therapy works better when a therapist understands the client’s culture, and can tailor the therapy to line up with their client’s experiences and beliefs.

Some potential benefits of working with a therapist who shares your culture include:

• Spending less time in session having to explain yourself or your experiences

• The ability to have therapy sessions in your native language

• More informed care when dealing with issues related to racism or systemic oppression

• A stronger, more trusting relationship with your therapist

For kids, having a therapist who looks like them can also be a helpful role model or racial mirror, providing another example of a helpful, caring adult in their community who looks like them.

Directories for Finding BIPOC Therapists

The following directories were created to address the challenge of finding therapists of color. While not all directories cater to children, the ones on this list do have options to search specifically for therapists who help kids.

Therapy for Black Girls was founded by a psychologist to help Black women and girls improve their mental health. They have a large database of therapists, and their search function allows you to look for therapists who accept your insurane, as well as therapists who specifically work with children or teens.

Therapy for Black Men, according to their website, was “born from the idea that Black men and boys face unique challenges, and therefore need a dedicated space for seeking and finding mental health support.” You can find Black therapists here who specialize in helping boys, and search specifically for therapists trained to help toddlers and preschoolers, elementary-aged children, tweens, or teens.

Latinx Therapy is a bilingual database that helps people find therapists who understand the Latinx experience in the U.S., as well as Spanish-speaking therapists. Their database allows you to search specifically for help with many different problems that could bring a child or family to therapy, including some specific to the Latinx community. You can also filter your search results for therapists who work with specific ages of children, from toddlers through teens.

Asians for Mental Health is a directory for AAPI therapists. All therapists list their specific ethnic backgrounds in their profiles. You can search for issues specific to the AAPI community, including transracial adoption and immigration, as well as filter the results for therapists who speak a wide range of languages. You can also run an age-specific search to find therapists who work with specific age groups, including young children.

Llapanchik Hampinakuy is a new directory for indigenous and native healers of all kinds. Founded by two Quechua therapists, its name means “we heal each other mutually” in Quechua. Expect to find indigenous and native therapists listed here, as well as other kinds of healers who take more holistic views on health and wellness.

Directories for Queer-Affirming and Culturally Competent Therapists

While the directories above are all devoted to specific racial or ethnic groups, the ones in this section are more broadly committed to inclusivity and cultural awareness. You can find therapists who have deep knowledge of specific cultures, experiences, or religions, as well as therapists who identify as LGBTQ themselves.

Inclusive Therapists is a very large database that, according to their website, “offers a safer, simpler way to find a culturally responsive, LGBTQ+ affirming, social justice-oriented therapist.” You can search for therapists with expertise in a variety of religious beliefs, racial and cultural backgrounds, and social justice issues. You can also search for therapists who self-identify as part of the LGBTQ community or as part of a specific race, culture, or group. “Children and Tweens” and “Adolescents and Tweens” are included as searchable specialties in the database.

The LGBTQ+ Healthcare Directory can help you find therapists, doctors, and other healthcare providers who are LGBTQ-affirming and who specialize in helping members of the queer community. While not specifically focused on mental heatlh, the databse includes a good number of therapists. Therapists can also be filtered based on ethnic background, languages spoken, and whether they specialize in working with youth.

TherapyDen is another large database with an emphasis on inclusivity. It allows you to search for therapists not just by cost or location, but by gender, ethnicity, and many other factors. Their “specialized experience” drop-down menu allows you to select for therapists who have described themsevles as Queer-competent, Trans-competent, Neurodiversity-affirming, and working from a racial justice framework. You can also search fror therapists specializing in child, adolescent, or family therapy.

More Mental Health Help for Kids

If you’re looking for some support while you search for the right therapist, my online coping skills course for tweens is available to download right now. My book, A Parent’s Guide to Managing Childhood Grief, might also be a helpful resource for children and families who are recovering from a loss.

I provide counseling for kids and tweens with anxiety and OCD, both in-person in my Davidson, NC therapy office and online throughout the states of North Carolina, New York, and Florida. Want to learn more about therapy with me? Check out my FAQ or contact me with questions.

5 Common Types of Intrusive Thoughts Your Child Might Have

Intrusive thoughts are freaky. Like an uninvited guest, they pop up and bother us with ideas or images we wouldn’t want to think about on our own. They can be frightening for kids to experience, because it feels like you’re losing control of your own mind. But they’re also unsettling to hear about as a parent, especially if a child’s thoughts are about something taboo, like death or violence.

The truth is, many intrusive thoughts are about taboo subjects. The more upsetting or off-limits something is to think about, the more likely it is to push back into our consciousness as an intrusive thought. It’s sort of an “opposite day” situation, where the things we find the most unpleasant—things we’d never actually want to do—pop up as thoughts or mental pictures.

Just knowing that other people have these types of thoughts can be reassuring, and a first step toward learning to manage them better. So, in this post, we’re going to go over 5 types of intrusive thoughts children commonly experience.

Content Warning: We’ll discuss specific examples of intrusive thougths in this article, which are often about upsetting or shocking subjects.

What Exactly Are Intrusive Thoughts?

An intrusive thought is any kind of idea, urge, image, or impulse that comes to mind when you don’t want it to be there. They can be about anything, but tend to be about subjects that a person finds upsetting, gross, or wrong. They usually happen repeatedly, and they can cause a lot of distress.

Intrusive thoughts are “ego dystonic”, which is a therapy jargon way of saying that they go against a person’s beliefs or don’t sync up with their personality. They can feel foreign or weird. People who have intrusive thoughts are aware that the thoughts are unusual, but can’t stop them from happening.

Intrusive thoughts are a really common symptom of OCD, which often starts in childhood. They can also happen in kids with anxiety or a history of trauma. However, that doesn’t mean every kid who has an intrusive thought has OCD! Pretty much everybody experiences a thought like this at some point. However, less-anxious people are more able to shrug them off as a weird, random event that doesn’t really mean anything. People with anxiety and OCD are more likely to hold on to these thoughts and worry that they mean something is seriously wrong.

What Are Some Characteristics of Intrusive Thoughts?

Intrusive thoughts stand out from the usual noise our brains make all day. If you’re trying to figure out whether your child is dealing with intrusive thoughts, consider the following list. Intrusive thoughts are unique because they tend to be:

• Involuntary: a person doesn’t want to have the intrusive thought, but it happens anyway.

• Repetitive: these thoughts tend to come back again and again.

• Anxiety-triggering: the thoughts can be annoying at best, and scary at worst.

• Out of character: the subject matter is something a person wouldn’t usually think about.

• Inappropriate: often, intrusive thoughts have to do with taboo subjects like sex, death, illness, violence, or bad behavior.

• Unwanted: the person has no desire to act on the thought, which is part of why it’s so upsetting. However, kids with anxiety or OCD may worry that having the thought means that someday they’ll lose control and act on it anyway—that’s not how these thoughts work.

Once you know what to look for, it gets easier to spot intrusive thoughts when they happen.

What Sorts of Intrusive Thoughts Do Kids Have?

Kids tend to have intrusive thoughts about subjects that society thinks are wrong or impolite to talk about—actually, this is true of adults with intrusive thoughts, too! Themes related to religion, sex, death, illness, or immoral behavior are all common when it comes to intrusive thoughts. Children may imagine themselves doing something they don’t really want to do, or see a mental picture of something they don’t like.

Younger children are still in the process of understanding adult concepts like sex, death, and violence, and their intrusive thoughts can reflect this. Even though the subject matter is the same, a child’s intrusive thoughts may not be the same as an adult’s. You might notice that your child’s thoughts are not realistic or logical. This can help set intrusive thougths casued by anxiety or OCD apart from the flashbacks caused by trauma or PTSD.

Next, let’s take a deeper look at 5 of the most common types of intrusive thoughts kids experience.

Type 1: “What If” Thoughts

OCD loves to make people doubt themselves. These “what if” thoughts often happen as a part of OCD, but they’re also one of the more common types of intrusive thoughts in general. A “what if” thought prompts you to question something you thought you knew for certain.

“What if” thoughts can affect people’s perceptions of their relationships, tasks they’ve completed, or even their own identity. Even if you have a clear memory of yourself doing something, the thought injects the possibility that maybe you actually forgot—and something bad might happen as a result.

Some examples of “what if” thoughts children might have include:

• A usually responsible child worrying that they somehow forgot to lock the door, and their dog will run away.

• A teenager who is secure in their sexual identity wondering if they might unknowingly be gay.

• A child who is bothered by thoughts of someone possibly hiding in their bedroom, even after checking under the bed and in the closet.

The hard thing about “what if” thoughts is that reassurance or double-checking only helps for a little while. Eventually, the doubt creeps in again and the cycle starts over.

Type 2: Thoughts About Hurting Self or Others

It can be alarming to hear your child is having repeated thoughts about hurting themselves or somebody else. Just like all other intrusive thoughts, these harm-related thoughts are unwanted and go against the personality of the child. Often, children who have these kinds of intrusive thoughts are described as being particularly kind, empathetic, and gentle.

Of course, any time you hear a child talking about harm, you can’t automatically assume it’s an intrusive thought. You need to rule out other possibilities, like suicidal ideation, which always need to be taken seriously. An intrusive thought—rather than an actual urge—might look something like:

• A child who has images pop into mind of pushing a sibling down the stairs, even though they’d never do something like that in real life.

• A usually kind child has thoughts about stabbing people that are so frightening they avoid being around knives or sharp objects.

• A teenager complains of fleeting thoughts about jumping in front of a train or running into traffic that bother him, because he really doesn’t want to die.

In all these examples, the thoughts are causing a lot of distress. Kids with this kind of intrusive thought don’t want to be thinking about violence, and may take great lengths to avoid being in situations they worry could be unsafe.

Type 3: Thoughts About Doing Something Embarrassing, Unkind or Illegal

Similar to thoughts about harm, this variety of intrusive thought is based on a fear that a child might somehow “lose control” and do something that’s socially unacceptable. Many people experience a stray thought like this, and shrug it off knowing they’d never act on it.

When children have these thoughts, they may not be so easy to shrug off. These taboo behaviors flash into a child’s mind, which makes them worry that some part of them really wants to do that bad thing. They put a lot of meaning into the experience, which leads to more anxiety.

Examples of this type of intrusive thought include:

• A child having thoughts about saying something inappropriate in a public place, like yelling “fire” in a movie theater or “bomb” in an airport.

• A student having bothersome thoughts while at school of saying insulting things to a classmate.

• A child who worries that their thoughts about shoplifting mean that they actually want to steal something.

When a child is truly having an intrusive thought, it’s extremely unlikely that they’ll ever act on it. Thinking and doing are very different things! However, the fear of possibly losing control can be very powerful, and get in the way of a child’s day-to-day life.

Type 4: Sexual Intrusive Thoughts

Even though they are common, this category of intrusive thought can cause a lot of shame and distress for kids. It can be hard enough to talk about the birds and the bees under normal circumstances, and even harder when you’re having your day interrupted by thoughts or images of upsetting sexual situations.

Because they are so taboo, children experiencing these types of thoughts may choose to keep them a secret. Even if children are open about most worries, they may fear that hearing about sexual thoughts will change a parent or therapist’s opinion of them. It can be a relief for children to know they’re not alone with these thoughts and to hear about examples of common intrusive thoughts. Some common worries in this category are:

• Worries about losing control and groping or sexually abusing someone.

• Unwanted thoughts that include family members, animals, or children.

• Fears related to unintentionally getting pregnant or getting someone else pregnant, even when this may not be logical.

There’s nothing pleasurable about these kinds of thoughts. Instead, kids experience feelings of shock, disgust, shame, and fear. Just like kids who have thoughts about harm, children with sexual intrusive thoughts may worry that having the thought means some part of them must want to act on it, and may avoid certain people, places, or activities as a result.

In reality, kids suffering from these types of intrusive thoughts are not violent or bad people: they’re just normal kids experiencing a bothersome mental heath symptom. It isn’t a reflection on their personality or character.

Type 5: Thoughts About Illness, Contamination, or Germs

Most of us have been worried about getting sick at one time or another. Health anxiety is really common, especially in the wake of the recent pandemic. Kids who struggle with intrusive thoughts may worry about sickness, too. They may worry about catching a disease, picking up germs, or spreading illness to other people. But there are some differences between their intrusive thoughts and regular health anxiety.

The thoughts children have about illness, contamination, and germs may be illogical or extreme. They may worry about catching germs from things that aren’t usually considered dirty, or about getting sick with a disease they’re highly unlikely to get. They may also worry about touching, breathing, or eating something that has somehow been contaminated. Some common fears for children with this type of intrusive thought are:

• Repeated fears that their food, drink, or utensils have been poisoned or contaminated by a chemical or cleaning supply.

• Fears that common objects or surfaces may have had germs on them.

• Thoughts about getting sick and dying from a disease such as cancer or AIDS.

• Worries about unintentionally spreading germs or serious disease to loved ones.

Children with these thoughts may avoid touching items with their bare hands, only eat “safe” foods or use “safe” utensils, or repeatedly wash their hands in an effort to avoid transmitting disease. These behaviors go above and beyond the hygiene we’d expect to see in a Covid-conscious kid, and interfere with day-to-day life.

Get Help for Kids with Intrusive Thoughts

As upsetting as they may be, intrusive thoughts are normal and common. Kids dealing with these types of worries are not alone! Sometimes, just knowing this can help soothe children’s anxiety about intrusive thoughts. When children accept these thoughts for what they are—random brain hiccups—it’s easier to just let them pass by without trying to push them down. Over time, this can help the thoughts to happen less and less often.

Other kids will need more support in dealing with their thoughts. This is especially true if the thoughts are accompanied by an urgent need to do something again and again, like washing hands or asking a parent if everything is okay. Kids whose intrusive thoughts begin after a traumatic event should also get support to help them recover.

Exposure and Response Prevention is the most effective tool therapists have to help children with compulsive thoughts and behaviors get their lives back. TF-CBT can help kids and their parents learn skills to cope with trauma symptoms and move forward in life without feeling overwhelmed by flashbacks or memories.

I offer both these therapies in my child counseling practice. I’m based in the Charlotte, NC area, but also work with kids online throughout the states of North Carolina, New York, and Florida. If you’re interested in starting therapy for intrusive thoughts, contact me here.

If you’d like to learn more about intrusive thoughts, check out my other blog posts on the subject:

Intrusive Thoughts in Children, Explained
How to Help a Child with Intrusive Thoughts
Signs of OCD in Children: What Parents Can Look For

What Are the Different Types of Child Therapy?

“Play Therapy” is a catchall term to describe many different types of counseling that help children explore feelings using games, toys, and make-believe.

Considering therapy for your child but not sure where to start? This post is for you. Kids today have more options for therapy than ever before, which is definitely a good thing. However, it can also be an overwhelming thing when you turn to Google looking for a therapist only to discover a sea of jargon and acronyms. With so many types of therapy available, it can be tough to determine what’s right for your kid.

I love that families have so many different styles to choose from. No matter what your child’s concern is, there’s probably a therapy out there that’s been researched and proven to help. You can find therapists who teach practical, concrete coping skills, if that’s your thing. There are also therapists trained in forms of therapy that don’t require much language, for children who feel better expressing themselves in other ways.

There’s no one right way to do therapy, so this won’t be a ranked list. Instead, I’ll be doing a quick breakdown of 5 common types of child therapy you might encounter during your search. Even though there’s no such thing as “best’, hopefully you’ll come away with some ideas about what might be best for your child. All these types of therapy are valid, and they can all help kids and families change their lives.

Play Therapy: Exploring Feelings Without Words

Play therapy builds on a child’s natural tendency to learn about the world through play, so they can work through big feelings and difficult life changes without having to sit and talk for hours on end. Sitting on a couch across the room from a strange adult isn’t always the most natural thing for little kids. Play therapy is a wonderful way for younger children to feel safe and comfortable in the therapy room.

Play therapists like to say that “play is a child’s language, and toys are a child’s words.” With this in mind, you’ll see a wide variety of toys in a play therapists office that aim to give children a broad vocabulary to choose from. Expect to find nurturing toys, like dolls, aggressive toys, like punching bags, and creative toys, like art supplies. What you probably won’t find a lot of is electronic stuff: most play therapy toys are open-ended to encourage kids to play in avariety of ways.

So how is play in a therapy office different than play at home? Play therapists are trained to notice underlying themes that repeat themselves in a child’s play, and may give insight into how they’re thinking and feeling.

Within the umbrella of play therapy, you’ll find a variety of differen approaches. Some play therapists are child-centered, meaining they are trained to follow a child’s lead and let them set the pace for therapy. Others may incorporate education about feelings or coping strategies into play to help children learn new skills.

Cognitive Behavioral Therapy: Tools for the Here and Now

CBT differs from some other forms of therapy because it teaches children tools, like mindfulness, that they can use in the present—and continue to practice in the future.

Cognitive Behavioral Therapy, or CBT, is a form of counseling that focuses on helping people learn how to cope with strong emotions by changing their behavior or becoming more aware of their thinking patterns. It’s less focused on uncovering the past or figuring out why a problem evolved the way it did (although you might do some of this in CBT). Instead, the emphasis is on figuring out how to handle the problem now that it’s here, in the present.

One strength of CBT is that it’s an evidence-based treatment, meaning that there’s a lot of research to back it up and prove that it’s effective. Variations of CBT have been designed for pretty much every mental health concern. Exposure and Response Prevention is a specialized form of CBT for children and adults with obsessive compulsive disorder. TF-CBT, which you’ll read about below, is used for kids and teenagers who’ve survived a trauma. You’ll also see CBT used often with children dealing with anxiety, depression, or angry outbursts.

CBT gives children education to help them better understand their feelings and how they work. This can reduce fear and shame, and empower children to feel more in control of their emotions. They’ll also learn coping skills they can use during difficult moments to deal with their emotions in healthier ways. CBT skills require kids to be able to think abstractly—thinking about your own thinking is a complex skill! For this reason, it’s sometimes a better fit for older children.

TF-CBT and Trauma Therapy: Resilience and Storytelling

Children often need extra, more specialized support in order to recover from the after-effects of trauma. Highly stressful or dangerous experiences like accidents, illnesses, a death in the family, or exposure to abuse or violence can lead to long-lasting symptoms that don’t resolve on their own. You may notice a child having difficulty sleeping, experiencing big emotional outbursts, or regressing: going back to habits from earlier in childhood, such as thumb-sucking or bedwetting.

Children need to be able to share their feelings about what has happened to them in order to heal. However, traumatic memories can be very overwhelming. Trauma therapists understand how to help children gradually work through these memories in a safe way, so they don’t feel as confusing or hard to manage. This can happen through play, art, storytelling, or just by talking to a counselor.

Trauma therapy can also give kids and parents tools to deal with symptoms of PTSD, which can affect the whole family. One common form of trauma therapy for kids is Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT. This is a step-by-step approach that teaches children skills that build on each other, eventually helping a child to feel comfortable sharing their story with a parent or other supportive adult.

Parent-Child Interaction Therapy: Behavior Help for Kids and Parents

This is a special form of therapy designed for toddlers, preschoolers, and young children who are struggling with big behaviors and meltdowns. All little children tantrum, but sometimes these acting-out behaviors get so intense and difficult to manage that it puts a strain on the relationship between parent and child. This creates a vicious cycle of bad behavior, frustration, and disconnection.

Sometimes these behavior struggles are a response to trauma or stress, and other times it may just be due to temperament and sensitivity. Regardless of the reason, therapies like PCIT can help parents and children break the cycle of “bad” behavior, set appropriate limits, and enjoy more time spent together.

You can expect to spend a lot of time in the office with your child if you’re participating in PCIT. You’ll learn skills from your therapist to practice at home, and also get opportunities to use them in real time, with your therapist there to coach you through the process. The first part of PCIT is all about strengthening your relationship with your child through play and positive attention. The second is a set of discipline tools you can use to shape behavior without accidentally fueling the fire.

Expressive Arts Therapies: Use Mind and Body Together

Art materials give children a sensory experience that can help them stay grounded as they explore feelings in counseling.

Many kids (and adults) already know that the arts provide a mood boost. Mediums like dance, visual art, theater, and music can also be integrated into therapy to help children work through feelings and heal from trauma. We call this whole group of methods the expressive arts therapies, since they focus on creative expression.

Like play therapy, using art gives children a way to let out feelings they may not have words for, either because the feeling is too big or because they don’t yet have the vocabulary to do so. Music, dance, art, and drama are multi-sensory experiences, so they help kids engage their bodies and brains at the same time. This can be soothing, help children stay engaged, and even make it easier to process trauma.

Therapists can become specialists in any of the expressive arts, and use them as a way to connect with children in sessions. Your child doesn’t need to have any prior experience in a particular art form in order to do well in expressive arts therapy. All kids are creative thinkers, and therapy is focused on the process of artmaking rather than a finished product.

What’s the Next Step? Choosing the Right Type of Therapy for Your Child

Ultimately, the type of therapy you choose is going to be based on your family’s needs, and your child’s specific situation. As you’re weighing your options, you may want to ask yourself some questions, such as:

• Is my child still very interested in make-believe play?

• Are we the kind of family that does well with structure and direct advice?

• Does my child prefer to learn by doing or by talking?

• How is my child feeling about starting therapy? Are they self-motivated or a little unsure?

• Is there a specific event, like a trauma, that’s bringing us in to therapy?

• Is there a therapy option that’s tailored to my child’s specific concern?

• To what extent should I expect to be involved in this type of therapy, as a parent?

You may also want to check out my blog post on the differences between a therapist, psychologist, and psychiatrist to help you navigate those choices. Once you’ve got a list of potential helpers, this list of questions to ask your child’s therapist can help you interview them to find the right fit.

Options for Child Therapy in Davidson, North Carolina

Kids in North Carolina, New York, and Florida can participate in several forms of therapy in person or online through my Davidson, NC office.

If you’re located in the Lake Norman area of North Carolina, like I am, you may be interested in one of the different types of therapy I offer to kids in our region. At my child therapy office in Davidson, I help anxious kids and tweens through:

• Cognitive Behavioral Therapy for Anxiety

• Play Therapy

• TF-CBT

• …and one special form of expressive arts, Dungeons & Dragons Therapy

I also provide online therapy to children throughout the states of North Carolina, New York, and Florida. And if you’re further afield than that, you can check out my coping skills course, which covers my favorite strategies to help tweens with anxiety. It’s available on demand, wherever you live.

What Triggers Anxiety in a Child?

Sometimes, a child’s anxiety seems to come out of nowhere. One day, everything seems okay, and the next day, boom! You’re begging them to leave the car to go to school. Other kids may have seemed anxiety-prone since toddlerhood: they were just always more sensitive than their peers. You may even have been told that their worries were just a phase. But here you are, years later, still dealing with the same fears.

When you’re trying to tackle anxiety, it can help to know the root cause. Whether you’re dealing with an all-of-a-sudden attack or an always-been-there anxious temperament, knowing what’s triggered your child’s anxiety lets you better help them to manage it.

Genetics + Life Experiences = Your Child’s Anxiety Risk

Stress affects all of us differently. It’s not always clear why one child may struggle with anxiety after a tough experience, when another gets through the same situation seemingly no worse for wear. It’s likely that our genes and life experiences combine to give each of us a unique way of coping with anxiety and stress.

We know that anxiety runs in families. Kids who have relatives with anxiety disorders are more likely to develop one themselves. This is true even if the types of anxiety are different within the family; for example, a chid who has many family members with generalized anxiety may have a slightly higher risk of developing OCD. Depending on the genes your child inherits, they may be more or less anxiety-prone from the start.

Even if your child has inherited some anxious traits, anxiety still needs an outside event to trigger symptoms. Big events, like moves and divorces, can do this. However, more day-to-day stress plays a part, too. In general, a child who has a strong family history won’t need as big of a stress to set off anxiety. On the other hand, a child with very little family history could still become anxious after a big enough trigger.

There are plenty of things parents and families can do to support a kid with anxiety—and sometimes best intentions can accidentally cause anxiety to grow. But there are so many factors that contribute to childhood anxiety that it’s never one person’s fault.

What’s a Trigger, Exactly?

“Trigger” has become a household word…and sometimes a word used to tease people who are deemed overly sensitive. So let’s clarify what exactly we mean when we talk about anxiety triggers.

A trigger is a catchall term for anything that sets off anxiety. Triggers can be physiological, like drinking too much caffeine if you’re sensitive to it. They may be sensory, like the sound of a fire alarm going off if your child has a sensitivity to loud noises. They can also be situational, like taking a test if you struggle with perfectionism. The pandemic has served as an anxiety trigger for many kids in recent years.

Triggers are unique to an individual. What triggers one person might not be an issue for another. Sometimes it can be hard to figure out what exactly is setting off anxiety for a child. It’s helpful to discover your child’s triggers so you can figure out how to prepare for potentially difficult situations in advance. The goal isn’t to avoid triggers forever, but to find ways to gradually learn to deal with them.

Sometimes, people talk about triggers as being the thing that set off a child’s anxiety in the first place. Other times, “trigger” is used to describe the day-to-day events that cause anxiety to flare up again. We’ll talk about both types in this post.

Any Big Life Change Can Trigger Worries

Predictabilty and routine help children feel safe. Knowing what’s about to happen next gives kids a sense of control in a world that often feels big and unpredictable. Anything—good or bad—that upends routines in a major way can lead to increased anxiety for kids.

This is one reason why so many kids are struggling with anxiety after covid, even if their loved ones haven’t been seriously affected. Even without major illness, the stress of household routines collapsing in on themselves during quarantine was a lot to cope with. It’s also why starting at a new school or moving to new town can set of anxiety, even if your child is excited about the change.

Here are some big changes that can set off anxiety for kids:

• Moving to a new place

• Divorce or remarriage of a parent

• The birth of a new baby

• The death or loss of a loved one

On a more day-to-day basis, these changes in routine can cause anxiety to flare up, too:

• Unexpected changes in plans

• Changes in a parent’s work schedule that affect their time spent at home

• Vacations or travel

• New babysitters or caregivers

Family Stress Increases Anxiety Risk

Kids are really good at picking up on family stress. Sometimes, a chlid’s anxiety is almost like a release valve for pressure that’s been building up at home. If a child starts showing new symptoms of anxiety, it’s never a bad idea to do a quick assessment of how you and the rest of the family are doing managing your own stress.

If children sense that things are a little tense at home, they may respond by clinging or getting more anxious when they have to be away from a parent. Kids instinctively want to be close to a parent during uncertain times, to make sure they stay safe.

Any major stress in a family will affect children too, such as:

• Intense, frequent fights between parents

• A family member’s chronic or serious illness

• Job loss or trouble with finances

• A parent or caregiver’s own mental health struggles

• Struggles with racism or other systemic oppression

If your child is sensitive to family stress, you may notice that their anxiety gets set off by everyday scenarios such as:

• Changes in family routines or plans

• Parents leaving the house for work or date nights

• Having to separate from the family, such as for school or a sleepover

• Seemingly minor arguments, disagreements, or discipline

Friend and School Drama Are Often Triggers

The older kids get, the more important friendships become in their lives. And these friendships can be pretty turbulent! On one hand, most kids are desperate to be accepted as part of a group. On the other, they’re still figuring out the social skills they need to manage conflict without escalating disagreements into full-on drama.

Kids have to juggle all this social stuff while also dealing with academic pressure that can feel overwhelming. Homework, college admissions, and even just getting to class on time can be stressors for kids.

School and peer issues like these can contribute to the development of anxiety troubles:

• Returning to in-person school after being online during Covid

• Bullying or social isolation

• Transitioning fo a new school building, such as the move from elementary to middle shcool

• Learning difficulties, low grades, or other academic problems

Kids may notice that smaller triggers like these set off everyday anxiety at school:

• Projects that require public speaking

• Testing, especially standardized testing

• Feeling judged for their appearance, clothes, or interests

• Having to navigate a large or complicated school building

• Not sharing many classes with familiar friends

Grief: A Surprisingly Common Source of Anxiety

Grief is often associated with sadness, anger, denial, and a whole host of other feelings. But when we think of grieving children, anxiety might not be top of mind. Losing a loved one often means a loss of stability for kids. Their routines are upended, a safe person is gone, and suddenly, they’re aware of the many unexpected dangers that can happen in life.

It’s normal for grieving children to experience separation anxiety while grieving, because keeping loved ones in sight feels more safe. Health anxiety is also common, since children may worry about whether or not they or a loved one could get sick or die, too. The stress of grief can also lead to more generalized worries, trouble sleeping, and body aches and pains due to anxiety, too.

Some types of grief that can trigger anxiety include:

• The death of a family member or close friend

• Losing a loved one due to estrangement, a move, or imprisonment

• The death of a pet

• The loss of a pregnancy in the family

Triggers related to grief, death, and loss can trigger kids on a more day-to-day basis, too. Grieving kids may notice their anxiety heighten when faced with situations such as:

• Scenes of violence, illness, or death on TV or in movies

• Mentions of suicide in health class

• Assigned school readings with themes of grief and loss

• Anniversaries and holidays that remind a child of their loved one

• Being away from caregivers

Illness, Accidents, and Trauma Can Lead to Anxiety

Highly stressful and traumatic events can also shake up a child’s sense of safety. Even if nobody gets seriously hurt, the experience of an accident or a dangerous situation can leave a child with lasting worries.

At the beginning, you may notice your child is only anxious in situations that are closely linked to their stressful event. Over time, however, that anxiety can generalize. This means the anxiety pops up more often in situations that are only loosely connected to the original event. As time passes it can be harder to connect anxiety symptoms to the underlying trauma or stress that triggered them in the first place.

Traumatic or stressful events that can lead to anxiety include:

• Car accidents

• Attacks or bites from dogs or other pets

• A loved one experiencing a major illness

• Natural disasters such as fires, floods, and tornadoes

• Repeatedly hearing about crime, disasters, or other emergencies affecting people on the news

Children dealing with trauma may notice they feel nervous or overly aware of their surroundings even when there isn’t a clear trigger. They might also notice anxiety caused by:

• Sudden noises

• Sensory experiences (like sounds and smells) that remind them of their trauma

• People, places or things that are associated with the stressful event

Help Your Child Learn and Cope With Their Anxiety Triggers

Learning what triggers anxiety is the first step toward helping your child cope with worries in a healthier way. Once children know what sets their anxiety off, they can learn strategies to help them in difficult situations. They can even practice noticing their thoughts, and questioning whether the worries that bother them so much are even accurate.

These skills may seem small, but over time they add up. Coping skills can change a child’s perspective on anxiety and other big feelings. They can empower children by giving them some control when things feel totally out of hand. We can’t always change a stressful situation, but giving kids coping skills can help them deal with hard moments, both now and as they grow up.

I teach coping skills so much in my therapy practice that I’ve created an entire coping skills course for tweens on the subject. Kids ages 8-13 can learn anxiety management tools they can use right away. There’s content for parents, too, so you can learn why the skills work and how to support your child in practicing them. You’ll also learn what isn’t as helpful for anxiety, so you don’t unintentionally make worries worse.

You can learn more about the course, preview the lessons, and enroll your child here.

Do Coping Skills Work, or Are They Just a Band-Aid?

At first glance, you wouldn’t think coping skills were a controversial subject. What’s not to like about deep belly breathing or guided relaxation? We’ve all been talking about these kinds of skills for ages. Maybe that’s why we’re seeing a bit of a coping skills backlash these days. Coping skills have become such a popular concept that it’s tempting to think they’re the answer to every mental health problem.

It’s true. When they’re used incorrectly, coping skills can be a little like putting a band-aid on a major wound. But most of us still use band-aids, right? They give us quick help and make our lives more comfortable. We’re not going to outlaw band-aids just because they’re not the right choice in every situation.

The truth is, many parents and kid clients come into my therapy office asking for coping skills to deal with anxiety, stress, and even trauma. I think they’re right to ask! Coping skills may not be The Answer to Everything, but they do work. Let’s talk about what makes coping skills effective for kids.

No, Deep Breathing Isn’t Going to Magically Solve All Your Problems.

If a child is dealing with anxiety so severe that they have stopped attending school, they’re going to need more than coping skills to get back to living their normal life. Similarly, a child can learn all the coping skills on earth and it won’t be sufficient if parents are constantly fighting at home. Big, long-term, or complicated problems need more than just a few coping skills to resolve. They need to be looked at holistically.

Sometimes we put a little too much responsibility on kids to solve issues that are much bigger than themselves. For kids dealing with mild anxiety or a sensitive, deeply feeling temperament, coping skills may be all they need to course correct. For bigger issues, coping skills may just be the first step in a longer therapy process that involves parents or caregivers, too.

But When Coping Skills Work, They Can Change a Child’s Life.

Yeah, this is kind of a big statement, but I stand by it! I believe coping skills can change a child’s life. I wish I’d had access to more coping skills back when I was an anxious kid.

When we give children coping skills, we give them a sense of control over their own lives. We provide the emotional first aid they need to get through the day, which buys us some time to address the root cause of theri anxiety. And often, coping skills open the door to deeper learning. By changing their behavior, children make new discoveries about their feelings and relationships.

Anxious Kids Need Help Right Away

Imagine you’re a kid who has been dealing with debilitating anxiety for a long time. You can’t sleep at night, and you spend the whole bus ride to school feeling sick to your stomach. You haven’t gone on a sleepover in ages because it’s too scary to be away from home, and you’re pretty sure you won’t be going on any of the big field trips coming up, either.

Your parents have been begging you to try therapy, and you finally work up the courage to give it a try. You sit in a strange lady’s office, who tells you that she can absolutely help you with your anxiety…in 3 to 6 months.

How would that feel? 3 to 6 months is eternity for a kid. But that’s often how long it takes for a child to complete therapy, and during that time they’ll probably need to put in some hard work and try some things that scare them.

Coping skills give kids some “quick wins” that help them feel better right away. It may not cure their anxiety, but it can make it a whole lot easier to tolerate. Experiencing this fast relief—and discovering the control they have over their emotional responses—can help motivate children to go the distance in therapy.

Coping Skills Help Kids Stabilize, So They Can Do the Deep Work

Not only do coping skills motivate kids to go deeper in therapy, they’re often a necessary first step. Kids dealing with severe anxiety or trauma spend a lot of their time in fight-or-flight mode. When you’ve got all that adrenaline coursing through your body, you’re focused on survival, not learning.

It’s really hard to effect big, lasting change when a child is too worked up to learn. Effective coping skills soothe the nervous system, so kids can calm themselves more easily and spend less time in fight-or-flight.

If your child is participating in trauma therapy, learning to self-soothe is critical. As children tell deeper and more difficult parts of their story, they may find their symptoms get worse before they get better. Revisiting their coping skills helps kids care for themselves and prevent overwhelm.

Effective Coping Skills Help Kids Discover Their Own Power

Many kids (and adults) enter therapy feeling powerless in the face of their anxiety. It’s bigger than them, it’s frightening, and it’s seemingly impossible to control. Anxiety feels like something that happens to them, and since they’re powerless to change it, they might as well just give in to its demands.

Coping skills show children that they have agency when it comes to their feelings. Sure, painful emotions are going to happen sometimes, that’s just life. But we get to decide how to respond to anxious thoughts, and there are ways to calm anxiety so it doesn’t take over your whole day. Returning that sense of control to children can change their whole outlook on how they handle anxiety and challenging situations in life.

Coping Skills Work by Healing From the Outside In

Before I went to therapy school, I went to theater school. I took a bunch of acting classes. There are two big schools of thought in acting: “inside out” and “outside in.”

If you imagine a stereotypical, old school actor asking “what’s my motivation?” you’ve got a basic sense of what inside out acting is all about. In this approach, actors create an inner emotional life for their character that helps them decide what to do onstage: how to talk, how to move, how to behave.

Outside in actors do things in reverse order. They might figure out their character’s walk, first. Maybe they figure out an interesting voice to use. Going through the physical motions helps them understand how the character might be feeling, and why.

Neither approach is wrong! Both actors are going to get to the same place in the end.

I promise there’s a reason I’ve devoted several paragraphs to this. Therapy is the same way. Coping skills may seem shallow at first, compared to “deep” work like understanding the origins of anxiety or changing family dynamics. But they work from the outside in. They help kids get to that deep work.

I’ve had many a kid client figure out solid coping skills and return to therapy in a couple weeks with important new insights about their lives. They come into session and make a connection between their worries and a specific family situation, or share something they’d like to change about how they relate to their friends. Changing your behavior disrupts old patterns and gives you space to discover something new.

When Are Coping Skills a Bad Idea?

Before you think I’m some shill who has been paid off by Big Coping Skills or whatever, let’s talk about some of the drawbacks. There’s no one size fits all in therapy. Coping skills aren’t going to work for everyone or serve kids well in every situation. Here are some examples of times that coping skills will not be effective:

• When coping skills are used to avoid anxious situations forever, rather than gradually facing your fear

• When a child uses coping skills to push down or deny “bad” feelings in an attempt to “stay positive”

• When coping skills are used as a substitute for support from parents, caregivers, or other adults

• When a child doesn’t see anyone else modeling how to cope with feelings effectively

Coping skills aren’t a substitute for feeling your feelings. They don’t work very well in isolation, either: kids still need support from the adults in their lives to overcome worries and change family patterns that might accidentally contribute to anxiety. If they’re not used thoughtfully, coping skills can easily morph into an unhelpful form of toxic positivity.

Effective Coping Skills for Tweens

Coping skills work for kids of all ages. However, in my therapy practice I mostly work with tween-aged kids, roughly ages 8-13. Since these are the kids I see day in and day out, they’re the ones I feel most equipped to help when it comes to coping skills.

You couldn’t pay me enough to go back to middle school. The tween years can be really rough. Studies show that when kids tranistion to 6th grade, their grades dip and don’t fully rebound until they begin high school. Friend drama, relationship woes, academic pressure, and puberty all start during middle school, but most of the privileges and freedoms that come with growing up don’t arrive until later. Tweens get all of the angst, and not much of the fun.

The good news is tweens are at the perfect age for coping skills. Cognitively, they’re leaps and bounds ahead of where they were in elementary school. They’re ready for challenging stuff. But socially, they’re right at the beginning of the “big kid” years. There’s still so much in front of them. Learning coping skills in middle school sets kids up for success as they manage stress and drama in the years to come.

If you have a tween who would like to learn coping skills, you’ve come to the right place! My course, Worry-Free Tweens, was created just for them. It’s available online and on demand, so your child can complete the lessons at their own pace. Since we know coping skills work best when parents are involved, you’ll find plenty of information for yourself, too.

You can check out the course here.

Do Kids Grieve Differently Than Adults?

Children’s grief doesn’t always look the way we expect it to. With kids, sometimes still waters run deep. If your child has just experienced a loss and they aren’t talking about it, are they still feeling it? Should you bring it up to them, or wait until they come to you with questions? How can you tell if your child is processing their grief in the way they need to in order to move forward and heal?

All children are capable of grief: they just show their feelings differently than adults do. In this post, we’ll take a look at the key differences between child and adult grief. We’ll also go over how children of different age groups tend to grieve, so you can keep an eye out for common signs of grief in your own child.

Children’s Grief Can Be Hard to Recognize

Back in the days of Freud, experts believed young children weren’t capable of feeling grief, because they couldn’t fully understand what death meant. Today, we know that isn’t true at all: even little babies can sense when a caregiver has left. Children don’t need a complete understanding of death to mourn the loss of a loved one.

When most of us think of grief, we imagine lots of crying, maybe even depression. We might imagine grieving people talking a lot about how much they love and miss the person who died. We might assume it will be a long time before the griever starts to feel or act like themselves again.

Kids’ grief doesn’t always fit this traditional mold. While many children will cry or feel sad after a loved one dies, others may not. Their feelings and reactions to grief might change rapidly or seem short-lived. Because their grief looks so different, it’s easy to miss. Parents may notice behavior changes or physical symptoms in their children, but not recognize them as being related to grief.

Difference 1: Delayed Reactions

When a loved one dies, children have to deal with a huge shock that they don’t fully understand. In addition to dealing with the loss, kids often have to figure out what exactly death is, and what it means for them. Most children also don’t have a lot of prior experience with grief, so they may not know how they are “supposed” to react when faced with such horrible news.

Kids can grieve even if they aren’t old enough to fully conceptualize death. However, it might take them longer to process what has happened and begin showing their feelings about it. Grievers of all ages experience shock and denial after death. For children, this might include wondering if a loved one might still be alive, or wishing they could come back to visit. Little children may ask repeated questions about the death in an attempt to understand it better.

Once time has passed and children have developed an age-appropriate understanding of death, you may notice more recognizable grief symptoms begin to show up. But if a child doesn’t appear sad right away, it doesn’t mean they aren’t grieving.

Difference 2: Grieving in Bits and Pieces

Children process their feelings differently than adults do when it comes to grief. A bereaved adult is likely to feel their grief intensely for weeks, months, or even years after a loss. They may have to work hard to give themselves breaks from grieving, so it doesn’t overwhelm them. Adult grief is ever-present, and the feelings tend to exist even when the griever is focusing on other tasks.

This isn’t how grief works for most children. Kids are much more able to jump in and out of grief. It’s normal for a child to cry and have intense feelings for a short period of time, before seemingly moving on to another activity, like playing with friends or watching a show.

This kind of back-and-forth would seem weird if an adult did it, but it’s perfectly normal for kids. Adults have a much bigger emotional capacity than kids do: they can tolerate a lot more before getting overwhelmed. If you imagine that an adult’s capacity for grief is like a big empty cup, a child’s might only be a tiny thimble. Once a child’s thimble is full, they need to step away from their grief process for a while, and return when they’re ready to handle some more.

Difference 3: Kids Feel Grief in Their Bodies

Studies have shown that kids are much more likely than adults to have physical pain and other body-based symptoms as part of their grief. This may be, in part, because it’s harder for kids to put their feelings into words. Instead, they hold on to all those feelings inside, and they show up in other ways.

It’s common for kids to complain of headaches and stomach aches as a result of the stress. They may also feel fatigued, dizzy, or have trouble focusing on things. Sleep and eating habits can change, too: bereaved children may have poor appetites or trouble falling asleep at night.

It’s always a good idea to talk to a doctor if your child isn’t feeling well. However, if your child’s symptoms don’t have a clear cause, they might be an outward sign of your child’s grief.

Different Signs of Grief in Preschoolers (3-5 Years)

Little children are in the earliest stage of understanding death. They’ve probably seen movies or cartoons in which characters die, and this might be their only basis for comparison. Children may assume death means that a person has gone away, fallen asleep, or otherwise left them in a way that is not permanent. They may also worry about whether or not their loved one is afraid or feeling pain.

Any stressful event can cause regressions for preschool-aged kids, and death is no different. You may notice your 3, 4, or 5-year old returning to earlier habits, like thumb-sucking or bedwetting. Your child may be extra clingy for a while, or have trouble sleeping alone when they were once independent.

You might also notice that themes or details from your loved one’s death show up in your child’s play. While it might be a surprise to see your child having a funeral for a Barbie doll, or re-enacting an accident with toy cars, this is usually a healthy sign. Children process feelings through play, so these types of activities help kids make sense of what has just happened in their world. If the play is prolonged, rigidly repetitive, or seems to make your child upset instead of relieved, it might be worth speaking to your child’s doctor or a children’s grief counselor.

What Grief Can Look Like for Big Kids (6-10 Years)

6, 7, 8, 9, and 10-year-olds have their own unique experiences during the grieving process, including magical thinking.

Older children have a more solid understanding of death, which is both good and bad news. On one hand, it’s easier to help kids in this age range understand what’s going on when a loved one dies. On the other, kids tend to develop their intellectual ability to understand death before they build the emotional skills they need handle the strong feelings of grief. As a result, elementary-aged kids may have the hardest time coping with loss.

Big kids may be wondering why their loved one died, and searching for explanations that make sense to them. Kids in the younger end of this age range often believe that their thoughts and feelings have a direct influence on the outside world. This can lead to children worry that something they said, did, or thought might have caused their loved one’s death. It’s important for children to have a clear explanation for their loved one’s cause of death that removes any possible blame for what happened.

Children may ask repeated “why” questions at this age. It’s likely, though, that your grade schooler will show you their feelings more than they tell them. Physical complaints are common among this age group, and so are problems with sleeping and difficulty concentrating at school. Keep an eye on how your big kid handles school and friends in general: some children may throw themselves into too many activities in an attempt to cope, while others may withdraw from friends and hobbies they once enjoyed.

How Do Tweens and Teens Grieve Differently?

Tweens and teens are able to think more abstractly, which means they’re able to grasp the concept of death in ways that younger kids can’t. They understand that death is permanent, and they may wonder about their own mortality or the afterlife when a loved one dies. Even though tweens and teens think about death in similar ways to adults, they still face their own unique emotional challenges.

As kids near the teen years, their friend group becomes increasingly central to their lives. This means tweens and teens may be more likely to turn to their friends for comfort when a loved one dies. If your child is part of a healthy, mature friend group, this can be a great source of support. However, it can be hard for peers who haven’t experienced their own loss to empathize in the way that grieving teens need.

Depending on your relationship with your tween or teen, you may notice that relying more on friends for support means you hear less about your child’s grief. Changes in grades, dropping out of school activities, and self-isolating can all be ways that older kids show they’re struggling with grief. It’s also common for kids in this age range to compare their situation to non-bereaved friends, so keep an eye out for unusual arguing or difficulties with peers. Death is unfair, and it’s easy to feel jealous or angry at a friend who complains about their family when you’ve just suffered a loss in yours.

Finally, tweens and teens are more likely than younger kids to find unhealthy or harmful ways to cope with grief. They may have access to drugs or alcohol, or may use self-harm as a way to deal with strong feelings. Any signs that a child may be considering self-harm or suicide should be taken very seriously, especially when a child is grieving.

Grief Timelines Look Different for Kids, Too

Grief can be a lifelong process, and this is especially true for children. Many kids start working through their grief before they fully understand the concept of death. This doesn’t make their grief any less valid or painful, but it does mean they’re likely to revisit their grief as they age. As children mature, they may understand their loss in new ways, and more fully grasp everything they will miss out on in the future with their loved one.

Milestones like special birthdays, graduations, and other coming of age traditions can rekindle grieving feelings for kids. These events, while happy, are also a reminder that someone is missing from the family. This is especially true for children who have lost a parent or caregiver. As kids become young adults, they may be increasingly aware of how their early loss will affect their weddings, the birth of their children, and other life milestones.

If you notice your child has a hard time around the holidays, or enters a period of intense grief when a milestone occurs, it’s okay. It doesn’t mean your child’s grief is getting worse or moving backwards. They’re just looking at their grief with a new perspective and working through it in a deeper way.

Grief Help Made Especially for Kids

I hope you reached this page either out of curiosity, or to prepare for the future, just in case. If that’s not true, and you’re here because your child is grieving, I have a resource to share with you.

I wrote an activity book, A Parent’s Guide to Managing Childhood Grief, that was created to help parents understand and support the unique ways that children grieve. The book contains 100 playful and creative activities for kids ages 5-11, divided into categories to address some of the most common needs children and families face when a loved one dies.

If you’re wondering how to help your child understand what death means, or explain difficult details about a loved one’s passing, you’ll find scripts inside to help. There are also chapters devoted to safely expressing feelings like guilt, anger, fear, and sadness that tend to show up during a child’s grieving process. Finally, you’ll find activities you and your child can complete together to encourage a sense of safety, meaning, and hope after grief.

A Parent’s Guide to Managing Childhood Grief is available at all major bookstores, including Amazon, Barnes and Noble, and independent bookstores.

Do Children Go Through the 5 Stages of Grief?

It’s hard to take something as huge and overwhelming as grief and divide it up into neat stages. The truth is, grief is a lifelong process. It never truly ends, and it’s impossible to wrap it up into a neat package with clearly defined steps. This is especially true for grieving children, who may need to revisit their feelings again as they grow older and understand their loss in a deeper, more permanent way.

Children may grieve differently than adults do, but that doesn’t mean they don’t grieve at all. Even preschool-aged children can have very deep, complicated feelings about death. Although they may not follow a tidy, 5-step process, kids may experience some or all of the grief stages as they process their loss.

Even though “real life” grief is more complicated than any model, it can still help to be familiar with these stages. If you’re a parent or caregiver, knowing about common grief reactions in advance can help you be better prepared to support your child. This post will outline the 5 stages of grief, as well as how children commonly express them, so you can better recognize the signs in your own child.

How Did We Come Up With the 5 Stages of Grief?

Grief has existed in every culture on earth, but we haven’t always thought about it as being divided into stages. In the United States, we sometimes have difficulty thinking and talking about death at all. The 5 stages were created by Dr. Elisabeth Kübler-Ross, a psychiatrist, to help doctors, dying people, and their loved ones think and talk about this difficult subject.

Dr. Kübler-Ross spent her career studying death and dying, and developed the 5 stages after working with terminally ill patients. The stages—denial, anger, bargaining, depression, and acceptance—are based on the emotions she observed these patients working through as they faced their own illness and death. She hoped that learning about these feelings would lead to more compassion and better care for people dealing with terminal illness.

So, these stages were not originally meant to be for grievers. They were also not meant to be for children. And yet, so many people found the stages helpful, that the idea has spread and been applied to many different situations. You’ve likely heard people talk about the “stages of grief” in casual conversation, and they’ve even been mentioned on TV shows like Gray’s Anatomy.

Do Children Have to Go Through the 5 Stages in Order?

As the stages of grief became more popular, people began to make assumptions about them. Many people mistakenly believe that a person has to go through the 5 stages in order, starting with denial and finishing with acceptance. The way the stages are organized can also make grief seem like a linear process, with a clear beginning and an end.

This isn’t a very helpful or accurate way to look at grief. It can make it seem as though there’s a “right” or “wrong” way to grieve. People who are mourning a loss may worry that they aren’t handling their feelings the right way if they don’t exactly match up with the model, or if they grieve for a long time.

Children do not have to go through the stages in order, and they most likely won’t. It is possible for a child to experience multiple stages at once, to seemingly skip a stage entirely, or to feel as though they’re in one stage on one day and a different one the next. Kids might spend a long time in one stage and eventually move through it, only to revisit it again at a later time. Finally, just because a child has accepted their loss, it doesn’t mean they won’t experience anger, sadness, or other painful feelings again as they grow up.

Children Express Grief Stages Differently Than Adults

Children’s grief may be as deep as an adult’s, but they may express their feelings in different ways. Their capacity to deal with big feelings tends to be smaller, so children may not sit in their grief for long periods of time like an adult does. Instead, it’s common to see kids moving in and out of their grief, and balancing moments of deep emotion with periods where they seemingly get back to “normal” life.

For example, a grieving adult may feel intense sadness for weeks, but a grieving child might cry intensely for an hour and then ask to go outside to play. This doesn’t mean the child has stopped grieving, it just means they’ve reached their capacity for now. They’ll come back to their grief again when they feel ready.

Death is a hard concept for young children to understand, and this can influence how they grieve, too. As children grow up, they’re better able to think about abstract ideas like the afterlife, and understand that death is truly permanent. New milestones and life stages will also heighten a child’s awareness of everything they are missing out on with their loved one. This may prompt children to re-grieve their loss as they grow up and understand things on a deeper level.

Finally, kids show their big emotions in different ways that may be hard for adults to recognize as expressions of grief. Separation anxiety, clinging, nightmares, acting babyish, tantrums, and problems paying attention at school can all be symptoms of childhood grief. Let’s take a look at each of the 5 stages and the unique ways that children work through them.

Stage 1: Denial in Children

All feelings exist for a reason: even painful and “negative” emotions serve a useful purpose. Denial protects children from getting completely overwhelmed by grief. At times when taking in the full reality of what happened is too much to bear, denial and shock can help cushion the blow.

Denial doesn’t necessarily mean that a child completely ignores the fact their loved one has died. It just means that at any given moment, they might not be fully absorbing the loss. While it’s common for children to experience this type of shock right after learning about a death, it can happen at any time.

In children, denial can look like:

• Appearing to have little or no response to the news that a loved one has died

• Asking when their loved one is coming back home

• Thinking they have spotted their loved one in a crowd

• Taking breaks from grief to play, socialize, or return to “normal life”

• Avoiding telling friends or teachers about the death

For young kids, denial is complicated by the fact that they have a limited understanding of death. Little children may ask about a loved one returning home even after they’ve moved through this stage, because they don’t yet understand that death is final. No matter your child’s age, denial is a normal and healthy response. Most children will move past this stage on their own when they are ready to address deeper, more painful feelings.

Stage 2: Anger in Children

Even in the best of times, anger can be a difficult emotion for parents to deal with. It’s easy to comfort a crying child, but harder to figure out what to do when your griever seems to be pushing you away. But grieving children have a lot to be angry about.

Death is often a traumatic event for children, sending the brain into fight or flight mode in an attempt to keep the child safe. Kids who tip over into the “fight” side of fight or flight may find themselves filled with energy that comes out as anger.

Anger is also a way that children can take feelings of helplessness or fear and turn them into something more active. Death is terrible and unfair, and we’re powerless to stop it. Expressing anger gives children an opportunity to speak their mind, try to find answers, and take charge at a time when they may feel very out of control.

In children, anger can look like:

• Irritability, tantrums, and defiance at home or at school

• Getting into fights with siblings or peers

• Feeling mad at God for taking a loved one away

• Expressing anger toward the deceased for abandoning them

• Blaming doctors or other caregivers for not doing more to help

• Feeling jealous of other kids whose loved ones are still alive

• Turning the anger inward by feeling guilty or ashamed

Parents should know that children often worry that they have done something to cause their loved one’s death. It’s common for young children to believe that mean or angry thoughts or words can cause bad things to happen. You can help your child understand that nothing they said, did, or thought had anything to do with their loved one’s death.

Stage 3: Bargaining in Children

Bargaining is a little bit like denial, and a little bit like guilt. Kids in the bargaining stage of grief are trying to make sense of reality while still holding on to the idea that somehow, things could be different. They may wish that their loved one had never died or could be brought back to life. Or, they may simply wish they could stop feeling so much pain and be a normal kid with a normal family again.

This stage involves trying to change yourself, change the past, or make a deal with God to make things better. Kids in this stage may go over what happened in the day or weeks leading up to their loved one’s death, trying to figure what could have been done differently. You can expect lots of “woulda, coulda, shoulda” statements, especially from older kids, during this stage.

In children, bargaining can look like:

• Trying hard to be a perfect child (so that maybe their pain will go away)

• Avoiding showing negative feelings

• Regretting things they failed to do or say when their loved one was alive

• Repeatedly searching for ways their loved one could have lived if things had been different

• Asking God to bring their loved one back

Bargaining may be harder to spot in children than some other stages of grief, because children may not always share these thoughts out loud. You can help your child by reminding them that these kinds of thoughts are normal after someone dies, and not a sign that we did anything wrong.

Stage 4: Depression in Children

Even though grief can contain many emotions, when most of us think of grieving we imagine a deep sadness. Depression is the most common emotion that grievers experience, whether they are kids or adults. Crying, low mood, hopelessness, and feeling empty or numb are all ways that this stage can manifest.

However, going through depression during grief doesn’t mean a person has a mental health condition like Major Depressive Disorder. The sadness that comes with grief is a natural part of the healing process, and most children will be able to work through it on their own in time.

In children, depression can look like:

• Not wanting to do things they used to find fun, like sports or after school clubs

• Changes in sleeping and eating habits

• Spending more time in their room, instead of hanging out with friends or family

• Body symptoms, like headaches and stomach aches

• Frequent crying

Some depression symptoms can be a sign of more serious problems that need the attention of a therapist or doctor. If your child copes with their depression by cutting, shares that they’ve been thinking of suicide, or tells you repeatedly that they wish they could join their dead loved one, seek help. You can search online for local children’s therapists, or speak to your child’s pediatrician to figure out next steps.

Stage 5: Acceptance in Children

Reaching the acceptance phase of grief doesn’t mean a child is okay with what has happened. A child can be aware of how sad and unfair their loss is and still be in this stage. Instead, acceptance is about finding ways to keep moving forward in life while continuing to grieve. Children who are in this stage are able to acknowledge their loved one’s death really happened, and that their loved one isn’t coming back. They are adjusting to their new life, and discovering moments of joy and normalcy mixed in with the sadness and loss.

This stage is last on the list because grievers often need to work through many of their harder feelings in order to reach a place of acceptance. However, that doesn’t mean acceptance is the end of grief. It’s possible to cycle in and out of acceptance, or for grief reminders to trigger new feelings of sadness and loss.

In children, acceptance might look like:

• Showing interest in seeing friends again

• Beginning to talk about the future in hopeful ways

• Speaking openly about memories of their loved one

• Creating rituals or other ways to remember and mourn

• Reduced anxiety, tearfulness, or anger

• Growing, changing, and developing new interests

Children who have reached this stage may understand their loss in new ways. For some grievers, part of acceptance is finding meaning in their loss. This doesn’t mean justifying why a loved one died. It’s more about figuring out who you are and what you care about in light of your loved one’s life and death.

For some children, finding ways to give back to the community or other grieving children can be a source of comfort and meaning. Others may find meaning in thinking about the ways they’ve grown and changed as a person now that they’ve survived something very difficult and painful. While we often dwell on the negative symptoms of grief, many people also find they become more empathetic or discover strength within themselves after a loss. Therapists refer to these positive changes as post-traumatic growth.

Help Your Child Move Through the Stages of Grief

The stages of grief don’t move in a straight line: children will travel between anger, sadness, bargaining, denial, and acceptance many times as they process their loss. Your child’s grief may change over time, but it never really goes away. It’s normal for children to grieve intensely again when they’re reminded of their loved one, or when they reach an important life milestone.

As children grow into young adults, they’ll be able to work through their feelings on a deeper level than they could when they were young. You may find your child revisiting any or all of these 5 stages again over time. This doesn’t mean your child’s grief is getting worse: they’re just experiencing their grief in a new way.

Children need to feel safe sharing whatever feelings are on their mind about their loss, whether they’re happy or sad, angry or afraid. It can be hard for kids to voice these feelings, especially if they know you are grieving, too. You can support your child as they move through the stages of grief by creating an environment where all these tough feelings are welcome.

Don’t wait for your child to bring up your loved one or their grief. You can set an example for your child by sharing your own positive and negative feelings. This can feel uncomfortable at first, especially since most of us don’t get a lot of experience talking about death. If you need help finding ways to open up these conversations, you can check out A Parent’s Guide to Managing Childhood Grief.

The book is organized by grief stages, with suggestions inside for over 100 activities you can use to help your child explore each one, as well as other common emotions such as anxiety and guilt. You’ll also find ideas for encouraging your child to rebuild their life and find meaning after loss. It’s available now on Amazon, at Barnes & Noble, and at local bookstores near you.