Jeremy Weisz 14:42
Well, what about these self? Yeah, these thoughts inside that are holding them down, essentially.
Dr. Eli Lebowitz 14:50
Yes, yes, exactly. There’s that constant voice, right. That’s telling you you’re messing up. You’re saying the wrong thing. You’re not funny. You look like a fool, you’re gonna make a mistake, like that voice is just chronically going and it makes you avoid it. 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 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 play dates, for example, in their house, and the parent would explain to them, like, it makes your sibling right and makes the other it makes them so uncomfortable if somebody comes to the house, so maybe you go to the your friend’s house. Now, if you have kids, like you might have experienced this, 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 have actually lost friends. Because that friend was like, you know what, I don’t think like you really liked 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 lot of social anxiety, but you start to wonder about it.
Dr. Leigh Weisz 16:37
But that accommodation has now trickled down and affected the healthy, quote-unquote, “healthy siblings” too.
Dr. Eli Lebowitz 16:44
Exactly. And if there was an event, you know, maybe there’s a concert or a play or a movie, even, 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 but okay, like, we understand because the kid has anxiety. And so, 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. It starts out so well-intentioned, did so well intention, 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, they’re even more anxious, maybe I should do, yeah, just 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 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, when 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.
Jeremy Weisz 18:57
I’d love to hear an example in that case, what the 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 your muscle aches, 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 19:24
Yeah, that’s right. That’s a good example — that’s good analogy, like the muscles. If your child does have weak muscles, like no doctor is gonna say, okay, always can’t read 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, I don’t know, a form of paralysis. Then you do carry them around, or use some kind of 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 be 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. 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 ready to buy, but 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 to 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 the first session, I’ll say to them, here’s a commitment. At no point in this treatment will I asked you to make your kid do anything at all. And they’re surprised, because they kind of assume 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, 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 let your child know about that change and not going to surprise them, you’re not going to get mad at them if they don’t speak. But you’re going to 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, things like that. So you have to kind of, 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 that the anxious child might have, maybe they’ll get upset or angry.
Dr. Leigh Weisz 23:50
It’s not always smooth sailing right off the bat.
Dr. Eli Lebowitz 23:53
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, 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 still rose today, even though you didn’t accommodate me yesterday, right? Like I’m still here.
Dr. Leigh Weisz 24:26
They can handle it. 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 want me to snuggle with them until they fall asleep. Can you take us through the kind of typical bedtime struggle that parents and children with anxiety have and kind of how you coach the parents.
Dr. Eli Lebowitz 24:54
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 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 a child. So maybe you’re not worried about separation, maybe you’re worried about the test in school tomorrow. So you have, like a generalized anxiety symptom. But guess what, being with your parent 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 think we have to, 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 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 that child that they’re able to cope with some of this on their own, or 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, theater, we’re going to put on a show. And there’s an imaginary audience. And we’re going to fool this imaginary audience into thinking that you’re the child, that you’re gonna go to sleep alone by yourself in your bed, but you’re not. You’re not. 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, like, maybe we need to clear off all the things because you’ve been sleeping in mom’s bed for months, or let’s make it might put some fresh linen, maybe buy a new set, 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 gonna 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 kids are very often willing to go along with this, because you’re not asking much.
Dr. Leigh Weisz 24:55
You are asking two minutes for them to go along.
Dr. Eli Lebowitz 27:05
Two minutes, 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 10, 15 minutes, guess what happens? Kid 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 are 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, calling and thinking churning away in their mind. They’d be on for hours. But they know they don’t 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, you’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 every night. Maybe 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 if you’re listening and you’re a parent of a kid is like you’re wishing, why will they sleep in their own bed? Give it a try.
Jeremy Weisz 29:38
Dr. Eli, there was another example you’ve talked about 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 29:52
Absolutely. This is a really good example of how much an accommodation can really take over life because it sounds really small, like what kid doesn’t want their parent to say I love you. But this was an eight-year-old boy. And he was really scared of spiders. Particularly, he was really scared of the black widow spider, he thought it would come into his bed.
Jeremy Weisz 30:14
Me too. I totally relate to that.
Dr. Eli Lebowitz 30:19
Yeah, I mean, who doesn’t want a black widow spider at night, right? Like, 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 search 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, Jeremy, 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, good night, 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, are 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 goodnight, 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 to fall asleep? Soon another thought crawls into the kid’s mind. Now it’s ruined because that back into the room? He says, can you say it again? Okay, say it again. walks out, calls him back, says 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, and 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 nonstop. 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.
Dr. Leigh Weisz 32:49
No one’s sleeping in the household.
Dr. Eli Lebowitz 32:51
No one’s sleeping. No one. You know, then again, you have siblings? What if that’s 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’s on and I love you very much. And 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 four hours.
Dr. Leigh Weisz 33:21
Preparing sweetness and saying “I love you, good night” changes very rapidly.
Dr. Eli Lebowitz 33:28
Really, when you’re at 120 times, I guarantee it does not sound like “good night son, I love very much.” We’ve all been there. Really. I mean, it’s like, you wish you had a spider to throw in this kid’s face. Of course, and like I say jokingly but actually these intense levels 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. 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. 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 lose some of the pleasure that comes from like the fun of actually giving. And by the way, happens for the child to win 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 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.
Dr. Leigh Weisz 35:11
Right? It’s like it gets worse before it gets better. You got to be prepared for that, for that journey.
Dr. Eli Lebowitz 35:16
Exactly.
Jeremy Weisz 35:17
So what did that parents end up doing? How did they get — pare it down from 120? And four hours a night?
Dr. Eli Lebowitz 35:23
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 gonna go from 120 to 110. Because, like, I think that’s going to, like, 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 good 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 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 35:24
You’re worried if the other kids in the family don’t get sleep? And I’m like, well, yeah, that’s part of it. You just Yeah.
Dr. Eli Lebowitz 36:08
Exactly. Exactly. Maybe, 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.
Jeremy Weisz 37:07
Oh, see, OCD is a common problem that you see. Especially with the SPACE Treatment. There was a case, an example with OCD that involved a sister. Talk about that.
Dr. Eli Lebowitz 37:22
Yeah, I mean, OCD is, is it’s actually interesting. OCD is the first disorder in which family accommodation was ever identified and studied. And when I was doing a postdoc at the Child Study Center at Yale, where I 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 a review of like, what is the literature? What does the research say on accommodation in other anxiety problems? It ended up being a very short literature review, because there 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 really so prevalent in all the anxiety and definitely in OCD as well, in the case that you mentioned, it’s such an interesting story, because actually kind of again, involves both parents and siblings. So we had a child who 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 coco 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 a sports game because he thought he would become a fan of the wrong team just by coming into contact with the enemy. But this kid 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 Barbie unlike too girly in perhaps dated terms, but you know, too girly in her mind. And so she avoided anything like that. Now 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 pearls. 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 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 really did do that. And they would not go in the car together at the same time. And so parents, 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 two, 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-old came up with a new rule. And the rule was 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 37:24
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 team. And it only becomes obvious when it’s so far.
Dr. Eli Lebowitz 42:44
Yes, I think that’s exactly why and I go back to something that you said before Lee 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. If you are a truly committed, motivated person, you can do a lot of damage, 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. 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 gonna 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 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. Don’t give one more. All So 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 mom 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 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? 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, everybody’s talking about 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 46:35
Exactly, exactly. Dr. Eli. I’m just gonna ask one more question…
Jeremy Weisz 46:38
Really quickly, 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 46:53
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 have confidence, the idea that I do get that it’s hard, and also, I believe you can handle it, and 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 they’ll often be a lot, and then we’ll pick one thing, maybe it’s the driving on the other street or like, any one 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 kind of 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 plan for that child with the wheelchair and the car. The first step that the parent actually took, was not censoring, which she would do very carefully the materials that were in the house like newspaper books, television, she would pre-scan and like censor to make sure that there wouldn’t be something that the child saw that would trigger the OCD. And that was like, one first step for them to take. And 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 not..
Dr. Leigh Weisz 48:59
Any practice at all. Exactly. Being uncomfortable feeling this way.
Dr. Eli Lebowitz 49:05
Exactly. So that was her first step. Now again, it’s very different from saying you need to, 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, the photos and updates because she could not 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 49:50
It’s so nice 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. This could be a divorce situation, or it could just be a married couple where one is ready to make changes, and one is not.
Dr. Eli Lebowitz 50:13
Sure. Yeah. And of course that does happen whether right, like you said, whether married or divorced, there are divorced, there are divorced parents that really work amazingly well together. And of course, there were married parents that are not working amazingly well together. Put it that way. The first thing that I will typically do is, is tried 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, that 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 it’s 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 difference. The other thing that I’ll do is I will keep open communication to 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 sometimes that is what the parent or comms 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 52:35
Especially if they see some improvement.
Dr. Eli Lebowitz 52:38
Exactly there’s a case of a kid with social anxiety who showed up, 13 years old, this dad, it didn’t make sense to him, the whole flow 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, so you know, I’m gonna be giving 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 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.
Dr. Leigh Weisz 53:29
That’s empowering and encouraging. Yeah.
Jeremy Weisz 53:31
First of all, Dr. Eli, I want to be the first one to thank you, thanks for sharing your knowledge. And 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 and 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 and other parents aren’t on board? Well, it goes back to we can only control ourselves and help through ourselves. And I just want to thank you, I’m just 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, I know Leigh and I have watched a lot of these and read a lot of these and there’s even research articles, which 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 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’s training for therapists here as well. So I just encourage everyone to check out spacetreatment.net and all the resources there. Dr. Eli, just thank you so much.
Dr. Leigh Weisz 54:12
Thank you so much for your time.
Dr. Eli Lebowitz 55:17
Thank you very, very much it’s really been a pleasure and an honor you really put your finger, you hit the nail on the head with the you can only control yourself that is the underlying I think principle that guides so much of the, like the way this treatment works, so thank you really very much for the opportunity to be on. Really appreciate it.
Jeremy Weisz 55:36
Thanks, everyone.
Dr. Leigh Weisz 55:37
Thank you.
