Jaime Monaco, LCPC: 17:27
Yeah. Something that you would taste a lemonhead a Sour Patch kid. Something that my mouth feels. Yeah. A lot of people use warheads.
Dr. Leigh Weisz: 17:34
Really sour. Like a strong sour taste, I love that, yeah. Very cool. Okay. No, this is this is super, super helpful in deep breathing. Did you guys have an example that you wanted to?
Jaime Monaco, LCPC: 17:46
Yeah. So I’ll share that. It’s one of our favorites.
Yeah. One of our favorites. But before I get into that, I will say to the biggest tip I have for for parents is when they’re helping Co-regulate. So we’re going to give an example where we would have to co cope with the kiddo before they can do it independently is not to be, I always say the therapists, that’s my that’s our job. We’re the therapists.
We can therapeutically talk to the kiddo. So when we train the parents on five, four, three, two, one are grounding techniques. We’re teaching them to help them do it. So like, hey, why don’t we look at, you know, five blue things that are around the room instead of the parents being like, hey, use five, four, three, two, one, use grounding. So I think the kids get a little bit irritated with with their parents when they are talking to therapeutically or trying to take on that role in the household, and we don’t want them to feel the pressure to do that.
So when we do coach the parents, it’s coaching them on what this skill is and how to implement it in a comforting, supportive way versus, you know, being worthy, annoying therapist that we are teaching them these skills. We want you to be able to be like, hey, you know what really helps? Like, let’s breathe in. What can we smell right now? Oh, it smells like burning leaves.
It’s fall. You know, something that they can do together so they feel supported and safe in that moment. And like, parents know these skills too.
Dr. Leigh Weisz: 19:06
Absolutely. That’s that’s great advice. Again, parents appreciate all this like, very concrete advice for what to do when they’re really in the trenches. And kids again, when kids are dysregulated, parents tend to feel dysregulated internally. It’s hard not to.
And so like you’re saying, if they have like sort of a a go to, what are they supposed to do that’s helpful too to them.
Jaime Monaco, LCPC: 19:29
And we’ll give them sometimes information like on skills because it is important for them to know it. I feel like the kiddo gets more overwhelmed when you’re like, practice tip or deep breathing, you know, and you can’t do it with them. So we always try to teach them some of the skills that the that the kiddos will identify as skills that help them so they’re able to co-regulate with them without, yeah, seeming to to therapy.
Dr. Leigh Weisz: 19:52
I don’t know, again, maybe Rivka, you can tell us, give us an example of a kiddo who had some of the more externalizing behaviors as the reason that they were in the program in the first place. Like, why? Why were they in the program? Like what? What were they doing in their home environment or school environment that was problematic.
And maybe just again, like some of the how you were able to help them practice in vivo, some by exposure, you know, some of these tools so that they could be successful when they were kind of again discharged and starting back in their home or school environment.
Rivka Benjamin, LCSW: 20:28
Yeah. And it’s this it’s I actually the same thing comes to mind with the kid who would put his head down. So he came. The behaviors at home and in school were very similar, you know, difficulty being told what to do. It’s a big one.
Especially things that were tough. So writing out he was very, very smart. So writing out a full math problem was very difficult for him. He’s like, I don’t need to do that in his head.
Rivka Benjamin, LCSW: 20:48
Right? I can do it in my head. So some of like basic compliance was very tough for him and it turned into aggression at home. A lot of property destruction at school, need for the classroom to evacuate. So something that obviously wasn’t sustainable anymore.
And when he came we obviously did. He did math. He did writing. He did all the things he didn’t want to do. Sometimes it was about simple compliance, like, hey, it’s time to lift your head up.
And that was very frustrating for him as well. So what we taught him the two things that he he renamed PMR progressive muscle relaxation, where you kind of take in your whole body and let go. And then we also introduce deep breathing. Now deep breathing for most kids are very triggering, like, do not tell me to breathe. And most of them are like, my mom’s been telling me this my whole life.
Shut up. Yeah. So we we but we do coach them on, like, you know, you get to choose which one you want, which one feels good in your body, and it was probably a couple of weeks into treatment. His mom showed up. He had to go to an appointment that was very triggering for him.
I don’t remember if it was needles or something, and she told him and he was very frustrated. This was one of his big triggers and we were ready. You know, we were prepared for a behavior to show up. And what did he do?
Jaime Monaco, LCPC: 21:59
So I mean, he went like got very tense. You could tell he was doing the progressive muscle relaxation. Relaxation. And then he would go, but he mom was doing it with him. Like we were saying, we coach the parents.
So I feel like in that moment, like mom started to do it and he like knew to take that cue from her. So then it was I mean, it was so cute. No, literally not. No words tensed up, started to do his deep breathing.
Rivka Benjamin, LCSW: 22:25
And he’s like let’s go.
Jaime Monaco, LCPC: 22:26
And he’s like, okay, let’s go. Yeah, it was it was awesome. But yeah, I think yeah, teaching parents those skills and having them have that cue, like, I got this with you, we can do this together. Was it was powerful. It was awesome.
Dr. Leigh Weisz: 22:39
Is that wonderful? Yeah. And just to go back to this, this kiddo you’re describing. So he was destroying property in the school. Does that mean throwing chairs?
Like, what would that look like?
Rivka Benjamin, LCSW: 22:49
Yeah. So throwing chairs, emptying marker bins.
Jaime Monaco, LCPC: 22:52
Ripping up books.
Rivka Benjamin, LCSW: 22:54
Literally making ensuring that the class could no longer learn. And he did do that here. You know, when we expose them, what happens.
Dr. Leigh Weisz: 23:01
If they do that.
Rivka Benjamin, LCSW: 23:02
So he did do that here. So the way Jaime and I set up the the space is that there aren’t many things on the wall for them to take down and hurt themselves or hurt others. And we don’t look at that as like a bubble approach, but rather an opportunity for them to the behaviors to happen. He did make a mess multiple times. He had thrown chairs.
We had to evacuate the room. However, at the end of the day, he was able to take responsibility, clean up after himself. We hold them to pretty strict, you know, compliance standards here to teach them. You know, this is how we take accountability in school. This is what’s going to happen.
So he did destroy rooms. He was able to put them back together and utilize the skills. So they do go through the process. They don’t come here and sit like angels.
Dr. Leigh Weisz: 23:47
Angels, your. And actually I’ve been to your office, your your setting and it’s so funny because it looks beautiful like again it’s a very calming like colorful happy environment. But you’ve shown me, you know, like there was definitely like you said, there’s nothing glass, there’s nothing that if you shatter it, you know, could be dangerous. So it’s very thoughtful how you’ve designed the space to allow for some of these behaviors to show up because like you said, you want them to show up. Yeah, but it doesn’t feel like when I think in my head about a space where there would be like nothing that could be destroyed, I think of like a, you know, a white hospital room on the walls that feels what’s the word?
Jaime Monaco, LCPC: 24:30
Institutional.
Dr. Leigh Weisz: 24:32
Thank you. Yeah. And it doesn’t feel like that at all. So it’s really neat to hear how you’ve really thought through. Like what would the space need to look like? How would it need to be set up in order for us to be comfortable?
Like you said, it’s not that you want them to throw things, but you do want to see the behavior.
Jaime Monaco, LCPC: 24:47
Of course. And I think the biggest advice to parents about behaviors, and, you know, it’s going to get worse here before it gets better in any treatment. I think in therapy it just always a lot comes out. And so it gets worse before it gets better. But it can be so scary as somebody that’s been doing this for as long as I have been.
And I’m one of you know, I feel like here we’re we’re have very high tolerance for behavior. So and a lot of times it’s still scary. Right. Like, and you feel so bad that they’re trying to communicate these feelings through this, you know, type of communication. And and so you want them you want to coddle them.
You want to give them what they want so they feel better. My biggest advice to parents would be to wait it out. Do not break the expectations when your therapist is telling you specific steps. As hard as it is, wait out the behavior. Let it happen.
Stick to the expectations without over accommodating because it will get better. But the more that you reinforce it just it will stay in that stage of.
Dr. Leigh Weisz: 25:50
So just to make sure again that I’m understanding, you’re saying like the kiddo who hates writing, you know, if he throws a full blown meltdown to like, get out of writing, you know, he can’t imagine sitting down and doing it. You’re saying, obviously, wait it out, let him have the meltdown. You’re not going to stop it in the middle of it. But at the end of the day, make sure that he has to still do the writing. Time wise, how long you wait?
But at some point, so that he knows that didn’t actually earn him like a free pass, right?
Jaime Monaco, LCPC: 26:21
Right. And DBT, they call it shaping. So it’s really just ignoring the negative behaviors in a supportive way. You’re not just going to turn and act like you’re not there for them, right? You’re sitting there while they’re destroying the room.
You’re still setting the expectations, but they still have to do the unpreferred task. They still have to clean it up or you know, they’re not going to get the preferred activity if they don’t do the unpreferred activity. They don’t get their preferred activity. So it’s hard though, you know, when they’re struggling that bad and the behaviors are becoming, you know, increasingly more acute. You want to be like, okay, fine.
You don’t have to do the writing. It’s okay. You know, we understand, but they’re never going to build that tolerance if you don’t, you know, make sure that you’re waiting it out, especially during a time like PHP or when they’re in a higher level of care.
Rivka Benjamin, LCSW: 27:07
And we’re here for the parents, you know, obviously we’re coaching them and we’re like, you gotta just wait it out. But we also are here for them understanding it’s scary. It could be embarrassing. Parents are often apologizing to us and we’re like no big deal people to apologize to you.
So yeah, so we we do a lot of like hand-holding for the parents where this is very painful. This is very scary. And we’re going to be here every step of the way to help you get through it.
Dr. Leigh Weisz: 27:32
Which is beautiful because again, parents, It’s funny, they do the same thing with us and outpatient. They’ll say like, I’m so sorry you saw that side of her today, you know? And I’m like.
Oh, like, it took a while to build rapport to get to this point where we can really see, like the true struggles. That means she’s comfortable. That’s a good thing. And now we can work with it. Whereas otherwise they’re like sitting, you know, oh, everything’s good.
Like you’re not going to do the work.
Dr. Leigh Weisz: 27:57
So exactly. Yeah. And for you guys it’s like intensified version of that I think.
Jaime Monaco, LCPC: 28:02
Right. Yeah.
Dr. Leigh Weisz: 28:04
You talked to our practice and it was again really helpful about, you know, how you teach foundational skills before jumping into the higher level like DBT and CBT, which I’m going to just share for the listeners. CBT is cognitive behavioral therapy. DBT is Dia.
Jaime Monaco, LCPC: 28:23
Practical.
Dr. Leigh Weisz: 28:25
And like I never pronounce it right. Dialectical therapy. Thank you. Tell us a little bit about what does that mean. The foundational skills.
Jaime Monaco, LCPC: 28:33
So there’s a couple of things you want to touch on this or do you want me to go? Okay. So there’s a lot of like, modalities that kind of like spin offs of the, you know, the original ones, which is DVT, you know, CBT, especially in short term care. So there’s r o DVT, you know, there’s exposure CBT. There’s a lot of like different kinds that kind of go off of these two.
And I think in order especially for kids that are coming in first time in treatment, you know sometimes they’re not. But for kiddos that are young or it’s their first time, we want to teach them the basic CBT and DBT skills, even when they’re a little bit younger. You’re not going to teach them a whole acronym in DVT because they’re never going to remember it. So like if you just have to start with one basic skill and make sure that they’re really understanding that, I think that is more effective than jumping and going to this, you know, new age modality that’s a little different than CBT, a little bit more complex. But the kids are like, what?
I don’t even know what the CBT triangle is, right? So I think that’s really important is we we’re not reinventing the wheel. We just want to make sure that they’re getting the most effective scientifically based skills. And that is it always starts with the basics of that. And then we just build off of that.
If they’re coming back for their sixth time in treatment and it’s a little bit more of a complex kid, then we’ll, you know, try, try different modalities. But it’s really important to always start with making sure that they understand what has worked for years, which is the basics of CBT and DVT.
Rivka Benjamin, LCSW: 30:06
And for the younger ones, we often even strip it back further. As simple as how to be a good friend. What do I want in a friend? What does it feel to get super angry? How do I how does my face feel?
So we often strip it back even further before the skills to like have them build some type of awareness of what’s going on around them.
Dr. Leigh Weisz: 30:26
I was just going to say it seems like for the younger ones, just even being able to name, like Jaime, you were saying earlier, what does it feel like in your body when you’re getting anxious or when you’re getting mad? Like they have to be able to to identify that before they’re in a full blown meltdown?
Rivka Benjamin, LCSW: 30:41
Right.
Dr. Leigh Weisz: 30:42
And for little kids, that’s pretty hard.
Rivka Benjamin, LCSW: 30:44
Yeah. Oh it is.
Dr. Leigh Weisz: 30:46
What are their signs? What are their triggers? Like you guys rattle that off like no big deal. I think that’s hard work for these kids.
Jaime Monaco, LCPC: 30:52
Really hard. Especially for an eight year old. Like, sometimes I don’t even know my own warning sign. So it’s like for an eight year old, how are they supposed to be like, oh, my body feels hot when I get mad, you know? Because all they’re focusing on is the negative feeling.
So it’s yeah, it’s really important for them.
Jaime Monaco, LCPC: 31:05
Right.
Dr. Leigh Weisz: 31:05
Absolutely. Tell us a little bit. I know you both again, because I’ve gotten the pleasure of collaborating with you. I know you’re both incredibly collaborative individuals. That’s how you work.
But tell us about how this makes the work you do in the PHP and IOP programs so much more productive. Like, how does it look like when you, you know, collaborate with the child’s school parents? Potentially psychiatrist. Like, how does that help the work?
Rivka Benjamin, LCSW: 31:35
Yeah. So when they first come in, that’s one of the first things we do because this is a short term level of care. And I’ll keep repeating myself. We’re not kicking them out, but we do want them to be able to get back to their daily life. We get when we speak to a school outpatient providers.
The psychiatrist always touches base with the psychiatrist. We and sometimes they’ll even have like a PCP who knows them well or like a neuro someone someone who just did their neuropsych testing. We get to see different perspectives. So like here’s how he acts as someone he knew for a long time. Here’s how he acts for someone he knew, with someone he knew for a short time.
School setting, home setting in the store. So collaborating with everyone, including parents, parents. We go through a very detailed list about what their entire day looks like. So we’re gathering a lot of information so we don’t have to pick up the pieces ourselves, every single piece ourselves. And then we’ll probably see a fourth side to things.
So it really helps us like jumpstart treatment, where we can create a treatment plan that will make sense for them.
Jaime Monaco, LCPC: 32:36
Right? It’s really helpful to I’ve noticed in the transition back to school. So like we gather all of that information in the beginning, we kind of leave it up to the schools and outpatient providers on how often they want to touch base, because we kind of let them, you know, take the lead even when they’re in PHP, because that’s their kiddo. They’ve had that, you know, for years. And we’re just a short term, you know, 6 to 12 week level of care.
Dr. Leigh Weisz: 32:59
So that’s actually interesting because some therapists I’ve spoken to really want to, like, have a touch point more frequently and others are like, I’m.
Jaime Monaco, LCPC: 33:07
Yeah.
Dr. Leigh Weisz: 33:08
Not in a bad way, but like, I’m letting them do their thing, right? And I’m really eager to hear, like, what the discharge recommendations are. So every therapist handles a little differently. But it sounds like you’re flexible individuals and you’re willing to kind of meet the other practitioners where they’re at to 100%.
Jaime Monaco, LCPC: 33:23
And it becomes very helpful because when they’re going back to school or when they’re transitioning out of program, we’ll have a meeting with everybody on the meeting. Call outpatient provider school. You know, psychiatrists can don’t usually but are more than welcome to join. And then Enso and we and the parents and we all get on the same page. This is the plan.
This is what works. This is what doesn’t. They’re free to ask questions. The school then, and the outpatient provider can coordinate for when they’re taking over a little bit. So I just we love to make sure that when they’re transitioning out, there’s nothing left.
Unplanned. Even in school exposure days, it’s like, are they taking meds at Enso or at school during their half day exposure? Are they where are they eating lunch? Like every single thing is planned out because that is just going to help. Things go so much smoother in IOP though.
I just have to mention this. We will taper them off like we will coach parents on like how to take over that planning and how not to over accommodate. But we make sure on our end that treatment is done with everybody to just the little details that sometimes are they’re like, he didn’t eat lunch in either spot. Now he’s, you know, regressing or whatever it may be. We just try to set them up for success as much as possible with everybody involved.
Dr. Leigh Weisz: 34:37
I love that, I love that. Jaime, you used the word accommodate, and I know you’re space trained. So just thinking about, again the parents and and what they can do to help when their kids are really struggling, what they can do and what they shouldn’t do. Can you tell us a little bit about what you mean when you talk about accommodation and what that could look like? Give a couple examples.
Jaime Monaco, LCPC: 34:57
Yeah. So accommodation often is when again, parents are seeing their kids struggling and they want to make them feel better. That’s their, you know, their kid. They’re in crisis. So they will, you know, if the kiddo wants to sleep with parents because they’re scared at night, you know, they they let them sleep in their bed or when they’re having anxiety about going to an after school activity or school. The parents are like, okay, today you don’t have to go.
You know, you can sit home and, you know, take a break today, take a mental health day. They’re over accommodating. They’re they’re making this. They’re making them feel so comfortable with these emotions that, you know, if they if the kiddo knows they have an exit plan, they’re going to use the exit plan as an adult. You know, if I know, I can, like, get out of something a little bit, I will do it right.
We’re all human. So I think my biggest advice to parents is supporting while they’re supporting their kid, making sure that the expectation of what they need to do is being held up and and giving them the independence and the what’s the word I’m looking for courage or confidence?
To to use skills and know that they can do it. The more we take away when a kiddo is feeling big emotions about something, the less tolerance they have in that specific situation. So I always say like, don’t. Maybe if they’re in crisis and we have to stabilize them first, we can, you know, temporarily take something out. But if a kid’s just having anxiety about school, like making sure they’re still being held to the expectation and for a while just being there as a support, having them cope independently, you know, not over accommodating where they’re meeting this kid and making everything so easy because in the real world and as they’re, you know, growing up, it’s it’s not going to be easy for them.
It’s going to be harder eventually. So I think just making sure they’re building that tolerance because it will get easier. They just have to learn the skills. And if you over accommodate for them, they’re going to be stuck in this cycle.
Rivka Benjamin, LCSW: 36:50
And sometimes they come to us. They have already over accommodated you know, we give them like a log, you know, so we do walk them through step by step how to decrease the accommodation while increasing the support. So it’s not like we’re like take it all away, set them up. We’re really doing it step by step. And we also educate the parents on how anxiety works.
So anxiety loves control. It feels really good. And once you’re giving them what they need, they’re going to constantly need more control, which is making their anxiety worse. So we educate them on how it’s actually not helping their anxiety. So we try to give the parents a glimpse into what’s going on in their minds instead of just being like, yo, stop that!
Dr. Leigh Weisz: 37:28
Yeah, no. Psychoeducation some support for the parents too. Because again.
Rivka Benjamin, LCSW: 37:33
Of course.
Dr. Leigh Weisz: 37:33
Anyone who’s parented knows in the heat of the moment, it’s hard to like separate what is happening. You know, the logical parts from the emotional parts. You’re swept into it. And so for you to break it down and like have them chart, where are the biggest meltdowns happening? What are the triggers.
You know, and to really unpack what are you doing. What are you not doing. It sounds like you really are helping them to.
Jaime Monaco, LCPC: 37:56
It’s the biggest part because like the kiddo, that’s their one piece of the puzzle and the supports all have to be on the same page in order for it to work. So that’s why we’re so big on collaborating, it takes a village. They need everybody.
Dr. Leigh Weisz: 38:11
Absolutely. So I’d love if you want either of you to share like maybe 1 or 2 more cases just to kind of share an example of, again, a presenting issue of why a kiddo came into the program, some of the skills and kind of how it worked when they were again discharged. And then we’ll let let you speak about anything else that you want parents to know before we wrap up.
Jaime Monaco, LCPC: 38:35
Yeah. One thing I will say, I’m going to give a case example about, you know, how we’re trying not to provide such a therapeutic environment here. And we’re trying to make it very realistic. So they’re exposed to certain triggers. So a lot of questions that we get asked by parents is do you have different tracks. Do you have, you know, a group for externalizing kids.
You have a group for internalizing kids. And oftentimes we’re met with some concern because we don’t we have them, you know, our groups are 8 to 10.
Dr. Leigh Weisz: 39:04
It’s age based.
Jaime Monaco, LCPC: 39:05
It’s age based. But it’s not behavior based or presenting problem based. So a lot of parents will be like, well, I don’t, you know, I don’t want my you know, she has anxiety. I don’t want her with the kiddo that’s destroying the classroom. Or what if they pick up different symptoms? You know, it’s often a fear which is completely valid.
But what Rivka has said is there are no tracks in life, and so there are going to experience this in classrooms, at work, on teams. And so it’s important for them to be exposed to this and then be able to cope with this example. We had two kiddos. One had severe anxiety, very internalizing. When she would get anxiety, put up her hood, head down, wouldn’t talk.
The other kiddo when he was having anxiety was more externalizing, you know, throwing stuff, name calling to kids. Her biggest fear was being called a crybaby. She gets called a crybaby at school. And so in group.
Rivka Benjamin, LCSW: 40:01
He picked up on it.
Jaime Monaco, LCPC: 40:04
Didn’t know that crybaby was the term that she was fearful of, said crybaby. And me and Rivka weren’t like, yes, it’s happening, but we’re like, okay. Like she was exposed to a real life situation that she’s scared of. She was able to not at first, but eventually get get a set of skills to help use when this, because this kiddo picked up on it right away, like the minute that he said it the first time he knew about her and would say it every time he was having a behavior, right? So.
But she eventually was able to like, have this confidence use opposite action was a big one. When she was feeling like she wanted to cry, she would like, stand really straight, would try to act really confident. So it would kind of push those tears down. Oh, also though, the kiddo then we teach we, you know, had to have a conversation with him and he learned how to apologize. He eventually, like they talked it out and they would help each other in group.
So I think it’s really powerful when there are real life situations that they’re going to face. And they’re not in this therapeutic bubble of, you know, all anxiety kids and all externalizing behavior.
Dr. Leigh Weisz: 41:11
Be polite. To each other and tip toe. Right?
Rivka Benjamin, LCSW: 41:14
Yeah. Oh, they. Could be in Trader Joe’s having a meltdown, and a kid walks by and says, hey, crybaby, you can’t control that.
Jaime Monaco, LCPC: 41:19
You can’t control that. So we kind of t tea? It’s it’s very therapeutic. But we love when those situations happen because it’s like, yes, this is exactly what we want them to be exposed to things here because we want to see how they handle it. And obviously we have conversations with the parents like we can’t just be like, sorry, you know, and we’ll we’ll explain why.
How we manage that therapeutically in group. But that’s just an example of why it was it’s so powerful to have this mix of kids because in in real life, there’s going to be a classroom full of, you know, different kind of personalities and diagnosis. And you can never control what’s going to happen outside of here.
Dr. Leigh Weisz: 41:55
So it’s interesting when we talk about exposure, one of the things that comes up sometimes with some of my clients who are more perfectionistic, you know, like straight a student is they’ll be so worried about what if I don’t get an A, you know, on a test or in a class? And the problem is, most of the kids who have those fears have really never had a B or a B+ even. Right? And so there’s no, like, schema in their mind of well, it happened. It wasn’t my favorite feeling in the world, but basically I handled it and the world went on.
They don’t have that notion because it’s never happened. So they really have these, these fears. Like, if that ever happened, the world would crumble. My life would not go on, you know? So we talk sometimes about imaginal exposures and, and just, you know, I can’t make you get a B, but I want you to at least think about what would it feel like if you, you know, you got your test back.
And in big letters it said B instead of A, you know, what would it feel like in your body? And and it sounds like what you’re saying is, you know, this is even better, right? Not only do we can you imagine that someone’s calling this girl a crybaby right before she goes out back out into the school, but actually happens?
Dr. Leigh Weisz: 43:05
Yeah. So it’s not like you would have ever set that up and told the boy all her crap that we would have some issues with.
Jaime Monaco, LCPC: 43:11
Right.
Dr. Leigh Weisz: 43:12
But I love what you’re saying that, like, because of the mixed nature of this group that organically happened.
Jaime Monaco, LCPC: 43:18
So, And I think. It also goes back to like parents wanting to over accommodate their kids and be like, I only want them with the anxious kiddos. And it’s like, well, it’s actually a good thing if they experience certain situations because they’re then going to be prepared in the future to handle them. So it always goes back to that psychoeducation piece.
Dr. Leigh Weisz: 43:37
Absolutely. Oh, what a great example. Thank you, Jaime for that. Any other examples that you want to share? Again before we kind of wrap up. This is so enlightening.
Rivka Benjamin, LCSW: 43:50
It’s a good question.
Dr. Leigh Weisz: 43:52
Social anxiety I keep thinking about or school refusal like some of the some of the ones that come up a lot in terms of, in my mind, what would cause someone to go to a PHP or an IOP program, right.
Rivka Benjamin, LCSW: 44:03
With social? Social anxiety is such an interesting one. It’s it could be in the range of ages, but what’s interesting about it is something we really try is that all the staff understand everyone’s treatment plans. So if they make a mistake, you know they should be okay in groups and how to handle it. So although we don’t try to plan someone calling someone a crybaby, sometimes we will plan, you know, having the therapist call on a kid who didn’t want to raise their hand and try to have them work through it.
Again, we’re we’re we’re pretty sensitive people, so we’re not throwing it at them. But sometimes it really gives them the confidence and they’re like, wait, that wasn’t that bad. I answered the question and I was okay. So social anxiety is always extremely interesting to me. I always enjoy that.
And then sometimes even the OCD, a lot of times that’s in the older kids. Germ. OCD, I forget what it’s called or germ OCD. So, you know, a kid is it’s wintertime. I mean, now we’re blowing our noses all over the place.
So a child is in the teen group doesn’t want to have a big behavior because it’s embarrassing. This kid is 15, right. And people are continuously blowing their noses. Those are great exposures. Again, you’re in.
Trader Joe’s is my favorite store. So you’re in Trader Joe’s and a person’s blowing their nose. That’s a great exposure to be like, you can’t look at them and be like, you shut up. I don’t want to hear you blow your nose. So those are always fun ways to, like, see how naturally it will happen.
And if you have to plant a little here and there, we will. But we’re not evil for the most.
Dr. Leigh Weisz: 45:35
No, no. I appreciate the setups, which is different than the like. Yeah. You now by calling you a horrible name. Right. That’s a little right. Exactly, exactly.
Rivka Benjamin, LCSW: 45:44
We won’t involve other kids. We won’t have other kids set up the exposure.
Dr. Leigh Weisz: 45:48
I think about law school where they cold call people and like, you have to be able to. It’s not. No one likes the feeling. I mean, I don’t know anyone who says I really want to be called on when I’m prepared and don’t feel like I know the answer. Like, I don’t think anyone would say that.
But there’s a difference between being uncomfortable and being able to handle it and feeling like I can’t even go to the class. Because what if this happens? And what if I’m embarrassed? What if I have the wrong answer that it’s just taking, you know, taking a toll on their functioning, right? Yeah.
Jaime Monaco, LCPC: 46:16
Yeah. We try to eliminate breaks here, like taking breaks. Also, just because I know at school sometimes they get passes if they get anxious. And so we’ll try to have them do in the group room skills that they can use at the table. Because I just feel like breaks are so it causes so much more anxiety because then they’re missing classes and they’re anxious about what they missed.
Rivka Benjamin, LCSW: 46:36
And then people noticing how often they leave. Right.
Jaime Monaco, LCPC: 46:39
Yeah. People noticing. So that’s another thing too with socially anxious kid we try or you know, anybody really. But we try to eliminate some of the breaks, you know, in the beginning we’ll allow it. But then we taper them off because it’s just not beneficial when needed.
I’m not this is not like an emergency.
Dr. Leigh Weisz: 46:55
And they’re, you know, about to oh I get it. It’s a last resort.
Rivka Benjamin, LCSW: 46:59
It sounds like. And if it’s, let’s say a child who comes in with an elopement issue, who walks out of the room, we encourage breaks, but we encourage them to ask first. And once they got it down pat, how to ask before they leave. Then we say, hey, maybe we’ll delay the breaks or maybe.
Rivka Benjamin, LCSW: 47:12
We’ll take it. Down. So it’s really case by case, child by child.
Dr. Leigh Weisz: 47:17
So individualized you can tell that like, you are really passionate about this work and it is not a cookie cutter, one size fits all. I’m we’re very glad that you’re in our community. Very lucky. So as we kind of end the podcast, what do you think parents would like in terms of resources? If they’re interested in learning more about, again, their role, how they can help their kids when they’re really struggling to this degree, any it could be a podcast, a book, a website, any resources you recommend.
Jaime Monaco, LCPC: 47:51
I love breaking free of Child Anxiety and OCD by Eli Lebowitz. It really shows you know, space and how not to accommodate and how to organize, how to start with certain accommodations. That’s a big one. There’s a lot of good children’s books, actually. Gabby, one of our therapists, does book reviews on our Instagram and our LinkedIn.
And so We constantly have different books that are helpful for kids, parents, teachers. So yeah, she posts that. So that’s really awesome.
Dr. Leigh Weisz: 48:22
Amazing. Okay, so Instagram do we just look up and so wellness centers.
Jaime Monaco, LCPC: 48:26
Enso Wellness Centers and then.
Rivka Benjamin, LCSW: 48:29
Yep same with LinkedIn.
Jaime Monaco, LCPC: 48:30
Same with LinkedIn.
Dr. Leigh Weisz: 48:31
Okay. Amazing amazing. Well thank you both so much for sharing your time and expertise with us. It’s been such a pleasure to learn from you.
Jaime Monaco, LCPC: 48:41
Thank you. It was such a pleasure. Yeah, we were excited.
Dr. Leigh Weisz: 48:43
Oh, and thank you and everyone, please check out more episodes of our podcast. Please go to CopingPartners.com and click on Podcast & Articles. And thank you as always for tuning in.
Outro: 48:55
Thank you for listening to The Coping Podcast. We’ll see you again next time. And be sure to click subscribe to get future episodes and check out our podcast page at copingpartners.com.