Dr. Jeremy Weisz 11:18
I’d love to talk, actually about a couple examples. You mentioned anxiety and social anxiety, I was actually talking to a friend at a gathering couple weeks ago. And he just said, it’s really tough for me to be here, because I have social anxiety. And he’s had it since he was a kid. And I’m glad he felt comfortable sharing that with me, and that he got out of the comfort zone. But I’d love to hear some examples from you. And you have one or how it affected siblings. Yeah, you could talk about that.
Dr. Eli Lebowitz 11:45
Yeah, and by the way, you know, the example of your of your friend, it’s such a, it’s such a classic example. Because these problems, anxiety problems, they do start in childhood, right? Like that is so typical, you could meet somebody, maybe they’re first diagnosed with anxiety, they might be 55 years old, they might be 65 years old, 45 years old. But you ask them, when did this problem start? Nine times out of 10 they’re gonna say it’s been my whole life. Right? Maybe I didn’t get help. I never got treatment. Nobody knew about it. But when did it start? It started when I was a child, because, like these problems start when you’re when you’re really small. So in that sense, it’s really typical. And yeah, you know, the, the, the social anxiety will often like all the anxiety problems will affect the parents and the family because of their tendency to look to parents. And because of parents natural tendency to accommodate those anxiety problems, meaning to just change what they are doing, because of what their, you know, anxious child is experiencing, because they don’t want them to be anxious. And in social anxiety, a lot of times we’ll see a really big impact on siblings as well. For example, I worked with a family where there was one child who had pretty severe social anxiety. So felt really overwhelmed in social situations. Now, I’m not just talking about the kid who doesn’t want to get up in front of everybody and start belting out songs out loud, right, like that’s, you know, that’s what we call normal, but in and don’t bear a child who, you know, just like walking, walking down a hall is flooded with thoughts about what’s that person thinking about me? Am I walking funny? Am I Am I do they think I’m stupid killed. We won’t go to any event. Now. Where do the siblings come in?
Dr. Jeremy Weisz 13:41
What all these self? Yeah, these thoughts inside that? are holding them down? Essentially?
Dr. Eli Lebowitz 13:49
Yes. Yes, exactly. There’s the constant voice, right? That’s telling you you’re messing up. You’re saying the wrong thing. You’re not funny. You’re You look like a fool. You’re gonna make a mistake. Like that voice is just chronically going and it makes you avoid, you might be really lonely. You might wish oh my gosh, I wish I had some friends that I could just like, hang out with and have fun. But you’ll also avoid any situation that might lead to making those friends because Oh, no, it’s gonna go so badly. Where did the siblings come in? This kid had two siblings one older, one younger, right? The child that was the patient was 11 years old. Had an older sibling was a teenager and a younger sibling. Those children were growing up as though they had social anxiety. They were not allowed to have any playdates for example, in their house and the parent would explain to them like you know it makes your sibling right it makes the the other day it makes them so uncomfortable. If somebody comes to the house, so maybe you go to the your friend’s house. Now, you know if you have kids, like you’ve made of experiences if one kid always wants to be the guest. And never the host. At some point, they start to get some pushback on that. Because the friends don’t get it right, like, what’s your problem? Why don’t you want us to come to your house, sometimes that creates some friction, they had actually lost friends. Because that friend was like, You know what I don’t think like you really like me, or you’re taking advantage of me or something’s wrong, the parents start to wonder what is going on in that household that they never want our child to see. Right now, like nothing’s going on. Except there’s a kid with a lot of social anxiety, but you start to wonder about it.
Dr. Leigh Weisz 14:12
But that accommodation has now trickled down and affected the healthy, quote unquote, healthy siblings, too.
Dr. Eli Lebowitz 15:43
Yeah, exactly. And if they if there was an event, you know, maybe there’s a concert or a play or a movie, even if, if the sibling with the, you know, if the child with anxiety wasn’t comfortable going? Well, a lot of times the siblings would have to miss it too. Right. And so you know, but okay, like, we understand because the kid has anxiety. And so, you know, we’re trying to do our best I am. And this is like, a really important thing about accommodation. Accommodation is a not a crime.
Dr. Leigh Weisz 16:16
It starts out so well intentioned.
Dr. Eli Lebowitz 16:18
So well intentioned. It’s a parent, bending over backwards, doing everything they can pouring time, energy, sometimes money into trying to help their anxious child not feel anxious. But I think one really important thing for parents to know is that there’s a lot of research on this. And all of it literally, without exception shows the same direction, which is that as accommodation gets more and more, children’s anxiety gets worse rather than better. This is a really important thing to know, because it’s so bewildering, like you feel like, well, maybe I have to accommodate even more, maybe, oranges, maybe, yeah, I should even more accommodation. And so you get trapped into this cycle, one of the things that we try to do in space, right in the treatment that we do with parents, is to actually give them tools to start dialing back back in the other direction, in a gradual way, not all at once, not overnight. But gradually, you start to make a change. So that you can be reducing, rather than increasing that accommodation. And it’s so important, because when you do that, what you’re also doing is communicating to your child, the anxious child, you’re communicating the message, actually, I think you’ve me, okay. I think you’re not so sick, so helpless, so vulnerable, that I need to arrange the whole world, just around your anxiety, actually, I think you will be okay. Even if you get anxious, which is a really important message for an anxious child to hear.
Dr. Jeremy Weisz 17:55
I’d love to hear an example in that case, what the parent parent could do in that situation, because I know I’ve heard you talk about how analogy is if your child has muscle weakness, right, and you want him to go to PT, you don’t say, oh, you know what, you have muscle weakness, I’m gonna just carry you around the rest of your life, you send them to PT, and they have to strengthen those muscles. Right? So what should the parents do? Or could they do in this situation?
Dr. Eli Lebowitz 18:22
Yeah, that’s right. That’s a good example of the it’s good analogy, like the muscles, if your child does have weak muscle, like no doctor is gonna say, okay, always carried that, right. Like, that’s, that’s never going to be the recommendation, it’s always about strengthening that muscle. Why? Because you know, they can, right? Like, that’s the critical thing. If your child has, you know, I don’t know, a form of paralysis, then you do carry them around, or, you know, use some kind of like aid in order to help them get around. Because it’s just cruel to expect them to do something they can’t do. Right. It’s like, the difference between teaching your child to ride a bike when they’re five. And when they’re five months. If you are teaching your child to ride a bike, and they’re five months old, you’re just a jerk. You know, they’re gonna fall and there’s no value to it, because they can’t really learn that. And I’m sure somewhere there’s a YouTuber out there have like a five month old riding a bike, but someone’s gonna, someone’s gonna send him the YouTube. But, you know, at five months, they also might feel sorry, five years, they also might fall. But there’s value to it, because you know, they can achieve it. Now, going back to the accommodation, or the anxiety, what does that look like? Now, a really important thing to know, is that in space, we’re not saying you have to make your child strengthen their muscles. It sounds like that’s what I’m about to say. But actually it isn’t. We’re not saying go home and tell your child they have to do this thing that they’re scared off, or they have to stop doing this. Other thing, giving that kind of advice to parents go home and tell your child to do X or not to do Y is actually a recipe for disaster. Because what we really know is that, although that might sound really good, in theory, what every parent actually knows is that getting your kids to do things they don’t want to do is really hard. And when you as a therapist, if you say to the parent, go home and make your kid do something, you may be setting them up for a lot of conflict. For fighting for resistance, you may make things worse, rather than better. So what do we do in space, we just focus on changing what the parent themselves are doing, what the parent is doing. We never say make your child do anything, I literally make it as a promise to kit to parents, like first session, I’ll say to them, here’s a commitment. At no point in this treatment. Well, I asked you to make your kid do anything at all. And they’re surprised, because they kind of assumed that’s what it’s going to be about. But it isn’t, it’s about what you are going to do. So what might that look like? You have that kid with social anxiety? Maybe you start thinking about all the ways you have been accommodating, like the fact that every time someone speaks to them, it’s always you answering. Because your kid has social anxiety, they’re not going to answer. So you jump in, because it’s awkward. And when the waiter walks over and asks, what do they want to have you answer when they want to get the book from the librarian, you speak for them, when the you know, like all of those situations. Maybe you decide, okay, I won’t be doing one may start with one of those things, I won’t be doing that one thing anymore. And you’re gonna let your child know about that change. And I’m going to surprise them, you’re not going to get mad at them if they don’t speak. But you’re gonna make that change on yourself. Maybe you say, I am going to let my other child have a playdate in the house, I’m going to have a conversation and say, You know what, yeah, we get it, it’s true, it will be hard for everybody, because it will cause anxiety. But we don’t think we’re helping. By arranging life like this, we don’t actually think that’s the best thing for anybody in the family. And so, from now on, yeah, actually, you’re gonna be able to have a playdate in our house. And we will be there to ensure that it is not turned into a nightmare by your anxious kid who’s going to be so upset and so worried or scared or whatever, you know, things like that. So you have to kind of, you know, stand by it, you have to have a really good plan. When we tell parents to start reducing accommodations, we always think really carefully about how they’re going to cope with all the different responses to that, you know, that the anxious child might have, maybe they’ll get upset or angry.
Dr. Leigh Weisz 22:49
It’s not always smooth sailing right off the bat.
Dr. Eli Lebowitz 22:51
Yeah, it’s not always smooth sailing right away. But when you stick to it, when you’re when you’re thoughtful about your plan in advance, and you stick to it in a calm, loving, supportive way. You get past those, you know, very quickly, it changes from anger, to relief, because I’m seeing to hope, because I’m seeing I actually can cope with this. Maybe I didn’t want to see that. Maybe I didn’t believe it. But you know what, the sun’s still rose today, even though you didn’t accommodate me yesterday, right?
Dr. Leigh Weisz 23:25
They can handle it’s uncomfortable, I always say but not dangerous. Exactly. Dr. Eli, let me ask you a question. In our practice, we see a lot of younger kids. And so separation anxiety at bedtime, in particular is a common presenting problem where parents, they you know, they want me to snuggle with them until they fall asleep. Can you take us through kind of typical bedtime struggle that parents and children with anxiety have and kind of how you coach the parents?
Dr. Eli Lebowitz 23:53
Who are of course, this is like such a common difficulty, such a common challenge, right? Like, I mean, nighttime is when our fears come up. It’s the longest separation that we have. It’s kind of a scary time. A lot of fears will come up in that moment. And you know, the tricky thing about separation anxiety is that any anxiety can be separation anxiety. Why? Because whatever it is that you’re scared or worried about, being with your parents might make you feel better when you’re when you’re a child. So maybe you’re not worried about separation. Maybe you’re worried about the test in school tomorrow. So you have like, you know, like a generalized anxiety symptom. But guess what, being with your parents might help you to feel better. So it turns into a separation anxiety symptom just again, because of how we are built as the species that we are. Now, I do want to say it is important to distinguish between a child who actually has like a problem and a child who occasionally feels anxious and wants to snuggle with a parent. I don’t I don’t think we have to You know, the first time your kid comes into the room and says there’s a monster under my bed, you don’t have to give them Prozac and, you know, send them to the clinic in the hospital, like those are normal things, we expect kids to be worried sometimes. But when it is more of an ongoing challenge, then just like with the other accommodations, it’s worth it to be able to show the child that they’re able to cope with some of this on their own, there’s a lot of different ways to try to make a change there, I will tell you my favorite way to try to make a change around bedtime. And I love this because you can do it as a game, you can do it in a playful way, rather than in a more kind of like, Oh, I’m laying down the law kind of way. And so what I’ll often do is say, let’s play a game. And the game is we’re going to put on a show, right? Like, like, like theater, we’re gonna put on a show. And there’s an imaginary audience. And let’s get we’re gonna fool this imaginary audience into thinking that you the child, that you’re gonna go to sleep alone by yourself in your bed, but you’re not, you know, and in fact, they’re not right, and we’re not lying to them. It’s all true, don’t worry, it’s just the show. So how would we do that? Well, we’ll make sure you’re actually have a bed, you know, like, maybe we need to clear off all things because you’ve been sleeping in mom’s bed for months, or, you know, like, let’s make it may put some fresh linen and maybe buy a new set, you know, like, let’s make it nice and fun. And you’re gonna get ready for bed, brush your teeth, put on your pajamas, you’re gonna get into your bed, mom, or dad, they’re gonna come in, they’re gonna kiss you, goodnight, they’re gonna leave. So the audience watching thinks, here’s a kid going to sleep by themselves, except you won’t. Because two minutes later, mom or dad, they’re gonna come back into the room, they’re going to say game over, and they’re gonna lie down next to you just like they do every other night. Or you’re gonna go to their bed just like you do every other night. And you’re gonna go to sleep. And because you present it like that kids are very often willing to go along with this, because you’re not asking much, right?
Dr. Leigh Weisz 27:04
You’re asking two minutes for them to go along with it.
Dr. Eli Lebowitz 27:06
And then they get to be successful. And they get to be with the parent after success rather than after failure, right? It’s like, this is great. And then you do that for a few nights. And the only thing that happens is we will inch up on the amount of time that the parent leaves. So we’ll do a few nights at two minutes, and then five minutes, and then seven minutes, 10 minutes. But here’s the thing, when you get up to about 1015 minutes, guess what happens? It falls asleep during that time, because they’re tired, it’s nighttime. And critically, they’re not anxious. Why are they not anxious, because they know the parents coming back. And so they’re not sitting there worried if you said, you have to go to sleep by yourself. They would be up for hours, yelling, crying call and thinking turning away in their mind. They’d be up for hours. But they know they don’t they know the parents coming right back. And so they’re calm. Well, you know, you take a calm, tired kid, put them in a comfortable bed, they’re gonna fall asleep, and then you just let them sleep. And you keep going with that the next day, you say, Hey, that was really cool that you slept in your bed. But you don’t say from now on? You’re gonna do it by yourself at that. Yeah, exactly. And you just keep going like that. We have had so much success with getting kids to sleep in their own bed using this approach that I really, you know, if you’re listening and you’re a parent of a kid, it’s like you’re wishing, why will they sleep in their own bed? Give it a try.
Dr. Jeremy Weisz 28:36
It’s actually there was another example you’ve talked about with in this regard. An extreme example, where the child just wanted someone to say I love you. You talk about that for a minute. And how that manifested?
Dr. Eli Lebowitz 28:51
Absolutely. This is a really good example of how, how much an accommodation can can really take over life. Because, you know, it sounds really small, like what kid doesn’t want their parents to say I love you. But this was an eight year old boy and he was he was really scared of spiders. Particularly He was really scared of the black widow spider, he thought it would come in to his bed. And me too, by the way.
Dr. Jeremy Weisz 29:16
I totally relate too.
Dr. Eli Lebowitz 29:18
Yeah, I mean, who doesn’t want a black widow spider at night? Right? Like not? Not many of us do. But here’s the thing. I mean, he would do a lot of things to try to prevent you know, he would like close the windows keep a light on searched the room for spiders, which if you really do have the same level of fear as he did, you might find yourself doing as well. Derby but he was eight years old. And so he also had another thought. And this was the idea that for him to be safe. The very last thing that had to go through his mind before he fell asleep. Had to be his father saying to him, Goodnight, son and I love you very much. If that was the last thing he would be safe, which rationally, doesn’t actually make a lot of sense. No, all of our research indicates spiders do not care. If your father loves you very much or not spiders, by the way, not really known for their paternal caregiving behavior of all the species in the world, but it does make sense emotionally. Because when you’re a child, and your father says, I love you, that is that attachment system that is an attachment signal, and it makes you feel safer. And so when he was going to sleep, he called his dad into the room and he said, Dad, can you say good night, son, I love you very much. And his dad felt pretty good at first. And he said, of course, good night, son, I love you very much. And he walked out of the room. But guess what it takes time to fall asleep? Soon another thought crawls into the kid’s mind. Now it’s ruined because they’re back into the room. He says, Can you say it again? Okay, says it again. walks out, calls him back. That’s it again, walks out. When I met this family. I asked this man, the father of this eight year old boy, how many times are you actually saying good night, son, I love you very much before your kid is finally asleep. And he counted for seven nights until our next appointment, he counted every night. And he was averaging about 120 times every single night. That is, like three hours. Easily. And that’s if you do it non stop. It’s three hours. If you take a break. It’s more than that. And it really shows you how much this can take over because everybody is affected by that. Everyone. Right? No one sleeping in the household? No one sleeping? No one. You know, the the again, you have siblings? What if that? What if that? What if that kid has a sister who needs help with her homework? Well, Dad can’t do that. Because he’s running in and out of his kid’s room to say good night, son. I love you very much. And, you know, mom and dad can’t be spending some time together maintaining their relationship. Dad can’t be doing I don’t know, like catching up on work. And the kid that himself he’s up until the middle of the night, right? Like he’s not getting those are for our
Dr. Leigh Weisz 32:20
Parents’ sweetness and saying I love you Good night changes very rapidly.
Dr. Eli Lebowitz 32:27
We’re at 120 times I guarantee it does not sound like good night’s on I know very much. And we’ve all been there. Really. I mean, it’s like, you know, you wish you had a spider to throw in this kid’s face. Of course, you know, and like I say, jokingly, but actually these this intense level of accommodation, it really does build up some resentment, like you do it, because you feel like you have to do it. But it can build up some resentment because this is impacting your life on a really deep level, you are so frustrated by it. And it places real strain on the parent child relationship. You know, when you feel like your kid is constantly taking from you, it’s hard to have the pleasure of giving. Right? It’s hard to have, it’s you know that that’s that’s a principle that holds true even with other things, right? Like, you know, you have a kid, they always want you to buy something, right. And it’s like, you’re always like, you feel like they’re always like taking from you, you lose some of the pleasure that comes from like the fun of actually giving. And by the way happens for the child too, when you are always in the position of demanding, you also miss out on the pleasure of receiving, because it doesn’t feel like receiving it feels like taking from someone. And the accommodation can work in the same way and place a real strain on that parent child relationship. We looked at parent child relationship before and after space treatment, and found really significant improvements in the quality of the relationship between the parent and the child. And that’s even though the parent is doing things along the way that the child like might not like. But actually you get to the end of treatment, and they have a better stronger and warmer relationship than at the beginning. Right?
Dr. Leigh Weisz 34:09
It’s like the gets worse before it gets better. You got to be prepared for that for that journey.
Dr. Eli Lebowitz 34:14
Exactly.
Dr. Jeremy Weisz 34:15
What did that parent end up doing? How did they get pare it down from 120 and four hours?
Dr. Eli Lebowitz 34:22
Yeah, I mean, sometimes you want to break things off a little bit at a time. So maybe you say like, Okay, I will say good night, but I will say at X number of times, like I’m not I’m not gonna go from 120 to 110. Because, like, I think that’s going to like, you know, not be noticeable enough. But you know, a parent like that might say and and very genuinely like they’ll say to the child like I know how scared you are. Right? We’re not dismissing that. We’re really validating it. It really is very scary for you. Also, I know you can handle being scared sometimes. And I don’t think I’m helping by doing this. And so starting tonight, I will say go Night, two times. And then I won’t. Now you go into that you have to put on your Flak Jacket a little bit, right like your, your helmet your hind, you have to be ready for maybe a really long night, right like that first night that you do that. Maybe your child will not sit up and say, Thank you so much for understanding how to treat child anxiety in this method, right? Like, they may be really, really upset, they may not get much sleep maybe started on a weekend, when if they don’t get much sleep, it’s not the end of the world. But a few nights later.
Dr. Leigh Weisz 35:34
I’ll be worried if the other kids in the family don’t get sleep. And I’m like, Well, yeah, that’s part that’s part of it, you just have to be prepared.
Dr. Eli Lebowitz 35:40
Exactly, exactly. Maybe have like, you know, have your have your sister come over and help with like the other kids, because you’re gonna be dealing with this for a night or two, right? Like, get some help in doing it. But a few nights later, when your kid is actually falling asleep in half an hour instead of three hours and you’ve had that time. You’re gonna feel really different.
Dr. Jeremy Weisz 36:05
OCD is a common problem that you see, especially, you know, with the SPACE treatment. There was a case in example, with OCD that involved a sister.
Dr. Eli Lebowitz 36:21
Yeah, we talked about that. Yeah, I mean, OCD is, is it’s actually interesting. OCD is the first disorder in which family accommodation was ever identified and, and studied. And when I when I was doing a postdoc at the Child Study Center at Yale, where I’m still work today. I was learning about this, like research on OCD and family accommodation, and I was seeing all these accommodations in other anxiety problems. And so I went to do like a review of like, what does the literature what does the research say on accommodation in other anxiety problems? It ended up being a very short literature review, because they were exactly zero studies of accommodation, outside of OCD. So we did that study, and many more since then. And now we know a lot about it. But accommodation is is really so prevalent in all the anxiety and definitely in OCD as well. In the case that you mentioned, you know, it’s such an interesting story, because actually kind of again, involves, involves both parents and siblings. So we had a we had a child who was she was, she was 13. And she had a form of OCD, that’s gonna sound a little weird to people who are not so well versed in OCD, but actually is not so rare. Because maybe you’ve heard about contamination, fears in OCD, and you think about germs, bacteria, things like that. But another kind of contamination is contamination from human beings of the essence of the person, as though you can become more like that person through contact with them, which sounds a little cuckoo when you first hear it, but actually is not so rare, and is not psychotic. It’s just an OCD thought. So for example, you might, you know, think, Oh, if I see someone who is bad, I will become bad, right? Like, I’ll see a picture of a criminal and I will become a criminal or things like that. I had a kid who was afraid to go to sports game because he thought he would become a fan of the wrong of the wrong team just by like coming into contact with the with the enemy. But this kid was she was 13 years old. And she was what back in the day, they used to call a tomboy, meaning she was not stereotypically feminine. And she actually had a great aversion for anything that was to pink and Barbie and like to girly in in, you know, perhaps dated terms, but you know, too girly in her mind. And so she avoided anything like that. Now, this she had a younger sister. And her younger sister, who was only six years old, was of course the opposite. And was the most girly girl that you could imagine. Everything was pink, and everything was rails. And her older sister was just terrified of this. Now, what did this lead to? She did everything she could to avoid any kind of contact when the mother did laundry. She not only would not wash their clothes together, but would actually run an empty load of the dishwasher of the washing machine, just empty with no clothes between. Oh my goodness, putting the siblings clothes in the wash and putting hers or at the very least, she promised that she did do that. I think she mostly did some misses. But she moved, she really did do that. And they would not go in the car together at the same time. And yeah, they would like carpool. But like, it’s the opposite of carpool, right? It’s like whatever the opposite of carpool is, that’s what they did like separate vehicles to drive the to even if they’re going to literally the same place, and so many other forms. Now, actually, all of that was not enough to bring them into treatment. What actually brought them into treatment was when this 13 year olds came up with a new rule. And the rule was that went that the younger sister, who, by the way, wanted nothing more than for her older sister, to smile at her. Like with her, she looked up to her she adored her. But the 13 year olds came up with this rule that said that the younger sister is not allowed to cross her field of vision. Now, what does that mean? That means that if this six year old wants to get a cup of milk, she needs to chart a course through the house that will guarantee that her older sister will not see her which, frankly, starts becoming abusive toward a six year old child who is not just allowed to freely move around in the household. And at that point, the parents said, we think we need some help.
Dr. Leigh Weisz 41:27
Yeah, yeah. It’s amazing how it gets to that point, right before parents are aware because again, most parents, you know, well intentioned parents just will do anything to avoid these outbursts, the tantrum the teen, and it only it only becomes obvious when it’s so far.
Dr. Eli Lebowitz 41:43
Yes, I think that’s exactly why and I go back to something that you said before Leigh about, we’re not blaming the parents for these problems, you know, we, I say we I mean mental health like writ large, right, like we represent a field that has done a lot of damage over many years. By espousing theories that blame parents for child psychopathology. Parents have been blamed, repeatedly blamed for schizophrenia. It’s not true there is not a schizophrenic, genic mother that causes schizophrenia in her children. This was an influential theory, parents were blamed for autism eating disorders, like everything and time and again, empirical evidence fails to support those hypotheses. I don’t believe that parents cause anxiety disorders in their children in the vast majority of cases, you know, if you are a truly committed, motivated person, you can do a lot of damage with things like maltreatment, abuse and neglect. But that is not at all the story for the huge majority of kids with anxiety. And so parents are trying their best. And there are so many other contexts in which accommodation is the right answer. You know, if your child has food allergies, you should accommodate that. Right? Like, what should you do? Should you say, well, we don’t believe in accommodation. And so you’re going to prepare foods as though you don’t have food allergies, and then what you’re gonna die like, That is awful advice, right? If you have diabetes, if you have asthma, if you have like a lot of conditions, accommodation is necessary. In anxiety, it’s natural for parents to apply a similar model, right? Like this makes you anxious, why would I not avoid it? That makes sense. And by the way, it’s also a message. Unfortunately, that is all that is also delivered by poorly informed mental health providers. You know, I spoke to, we’ve been giving a lot of examples. I’m gonna give one more. Also in an OCD example, but this was actually I kind of touched on something really related a moment ago, because this was a kid who was really terrified of seeing or coming into contact with people with a physical disability. For example, when mum would drive him somewhere, she would not drive on the road where the YMCA was because he knew that there were people with disabilities who went to work out there. And this bothered him that one day his his grandma took him to the mall, and she didn’t know all the rules and she parked the car in the parking spot next to the spot for a person with a wheelchair. Now, there wasn’t even a person with a wheelchair. There wasn’t even a car there. But the wheelchair is painted on the ground, right in the parking spot. That was enough. He would not get in the car anymore. They bought a different car. Literally, they bought a different car. Now granted, this was a family that could afford to do that. But they did and when I asked this parent. Seriously, right? Like, wow, why? They? She said to me, because the psychiatrist told me don’t trigger him. Which sounds like good advice, right? Like, why would you trigger like, nobody wants to be triggered? Like our whole, you know, everybody’s talking about like not triggering people. Why would you want to trigger and it sounds like good advice. And yet it actually is very poor advice because what it translates into for a parent is always accommodate.
Dr. Leigh Weisz 45:33
Exactly, exactly. Dr. Eli. I’m just gonna ask one more question.
Dr. Jeremy Weisz 45:39
Dr. Leigh, before you ask it, what sort of the parents do it seems like it’s so far gone that they’re buying a new car? How do you back away from that? Right? What did they actually do?
Dr. Eli Lebowitz 45:51
Yeah, well, they took one step at a time, which is what we generally do, the way we’ll work through this treatment is the first thing that we’re going to do, even before we start making these behavioral changes, we work on what we call being supportive, starting to communicate to a child those messages of acceptance, but also of confidence, the idea that I do get that it’s hard, and also, I believe you can handle it, when we start trickling those messages into the discourse into how I’m responding. We do that for a couple of weeks. Now. The next step that we’ll do is to map out what are all the different ways that we’re accommodating. And, you know, they’ll often be a lot, and then we’ll pick one thing, maybe it’s the driving on the other street or, you know, like, any one of of the things that are happening, I like to choose something that is happening pretty frequently. So that we have a lot of opportunity to practice. And we will let the child know, this is our plan, we’ll write a letter, actually what we’ll do with parents gonna write a letter to the child where we’ll just lay out, here’s what we’re doing, and here’s why we are doing it. And then we’ll follow through on that. We’ll follow through on that plan for for that child with the with the wheelchair and the and the car, the first step that the parent actually took, was not censoring, which something she would do very carefully the materials that were in the house, like newspaper books, television, she would pre scan and like sensor to make sure that there wouldn’t be something that the child saw that would trigger the, you know, the OC D. And that was like, one first step for them to take it again, it goes back to the message that I was saying before, when you’re doing that censoring, like you think okay, I’m being helpful. But it’s so clearly sending a message to the child that says, I know you can’t cope with this, by any practice at all.
Dr. Leigh Weisz 48:00
Exactly. In with uncomfortable feeling this way, walking on eggshells.
Dr. Eli Lebowitz 48:04
Exactly. So that was her first step. Now, again, it’s very different from saying you need to read like she never said, she never said to the child, you need to back up and stop avoiding or go shake hands with the person on the wheelchair. Like she never said anything like that. She just said, this is what I’m doing. Because this is what I believe. And that kid got so much better actually, she was years in touch with me and would send me like, you know, the photos and updates because she cannot believe that her child was living a life that was not as limited and impaired in the way that it was prior to her treatment.
Dr. Leigh Weisz 48:49
It’s so neat to hear these to hear these anecdotes. I’m just going to ask one final question Dr. Eli, how do you handle it when one parent is not entirely on board with this plan of reducing the accommodations? And the other parent is really motivated. And this could be you know, a divorce situation or it could just be a married couple where one is ready to make changes and one is not sure.
Dr. Eli Lebowitz 49:13
Yeah. And of course that does. You know that does happen whether right like you said whether married or divorced, there are divorced, divorced parents that really work amazingly well together. And of course, I also married parents that are not working amazingly well together. I put it you know, that way. You know, the first thing that I will typically do is is try to understand what the objection of the other parent is like, are they willing to have maybe just one conversation with me with no strings attached? I just want to understand, maybe like, they don’t is it that they don’t like me is that they don’t like this treatment. They don’t think there’s a problem. They don’t believe in therapy like what are the issues and try to understand it but bottom line, if they are really not willing to participate, I will work with that other parent and I will And then one that does want to work with me. And I will encourage them to also just focus on themselves not to go home and say to that other parent, you should also do this, because they’ve told you they’re not motivated, that is just going to antagonize them. But treatment can still be effective, even when one parent is doing it. And even if the other parent continues to, like, very explicitly not follow the plan, they continue to accommodate, there’s still tremendous value in having even one of your parents showing you that they believe you can handle your anxiety, that makes a huge, huge difference. Difference. The other thing that I’ll do is I will keep open communication to that other parents, I’ll usually send them a brief email at the end of every session and just say, hey, here’s what we talked about. I’m not saying I want you to do it, too. I’m just saying, Here’s what we talked about. Because I want to be respectful. I want to show them that I’m not mad that there’s an open door for them to come back. And I also want them not to be speculating on what is happening in those sessions. For example, maybe they’ll sit there thinking, Oh, they’re just talking about me the whole time. And why I’m a lousy husband, partner X. And you know, sometimes that is what the parent comes wants to do. It’s not unheard of, but that’s not what we do. And I want them to know that. And so I’ll send that like, here’s a little summary, we’ve had a lot of parents who change their mind.
Dr. Leigh Weisz 51:33
Especially if they see some improvement in the child.
Dr. Eli Lebowitz 51:36
Exactly. There’s a case of a kid with with social anxiety showed up with 13 years old, this dad, it didn’t make sense to him, the half of ideas didn’t make sense to him, you know, like, didn’t add up, like, why are you? Why do you want to work with parents and like the whole therapy thing. And so he was like, You know what, I don’t really think so. But a few weeks later, you know, I’m gonna give this a try, he ended up being the rock star of that whole treatment, he carried the treatment, like such an, like, really amazing dad, who found like his words to communicate to his child the messages that we’re trying to communicate. And so you know, the door is open, sometimes, like, they’ll change their mind. But even if they don’t, you can still make a meaningful and impactful change. And you don’t have to fight with your partner or ex about it. That’s, that’s empowering and encouraging.
Dr. Jeremy Weisz 52:29
Yeah. First of all, Dr. Eli, I want to be the first one to thank you, thanks for sharing your knowledge. And, you know, this is really, for me to take out of it. It’s just a life lesson. In general, we can only control ourselves in this equation, regardless of anything that’s going on. And so that, to me, is really a resounding message of what you talk about in breaking free of charge, anxiety, OCD, and just the space treatment, which is we can control ourselves. And like you said, even when you give the same answer, it’s like, hey, what if a parent, another parent is not on board? Well, goes back to we can only control ourselves and help through ourselves. And I just want to thank you, I’m going to I’m going to share if anyone wants to learn more, which they should, their spacetreatment.net, you can see if you’re listening, the audio, there’s a video piece, and we’re looking at the website, there’s lots of resources here, we’re looking at the book breaking free of child anxiety and OCD. There’s another one for parents and clinicians. There’s one for clinicians, there’s videos, you know, I know Lee and I have watched a lot of these and read a lot of these. And there’s even research articles, which, you know, we didn’t have a chance to talk about all these things. But I was fascinated by you know, there’s a pilot trial space in autism. And there’s so many, so much other research that you’re doing here, so you can actually poke around on the website, and check these out. And in addition, there is training for therapists here as well. So, just I encourage everyone check out spacetreatment.net And all the resources there. Dr. Eli, just thank you so much.
Dr. Leigh Weisz 54:14
Thank you so much for your time.
Dr. Eli Lebowitz 54:16
Thank you very very much. It’s really been a pleasure and an honor you really put your finger you know you hit the nail on the head with the you can only control your yourself that is the underlying I think principle that guides so much of the of the like the way this treatment works. So thank you really very much for the opportunity to be on. Really appreciate it.
Dr. Jeremy Weisz 54:35
Thanks, everyone.
Dr. Leigh Weisz 54:36
Thank you.
Outro 54:38
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