Robin B. Zeiger, Ph.D.

In my practice s a clinical psychologist, fears often enter my office. It may be the child who is convinced something is under the bed; it may be the teen who is anxious about taking a test, or it may the father who worries whether his ADHD son will succeed in life.

To adults, fears often appear unfounded and frustrating. For example, we may become frustrated trying to convince our children there are no monsters under the bed or in the closet. Sometimes fears make a whole lot of sense. The child become anxious about a stomachache after a loved one suffers from cancer. And there are times when the stated fear is just the tip of the iceberg and it takes sleuthing to unearth the real cause. Case in point: A child is extremely anxious about riding the city bus. The parents, who do not own a car, alternate between being perplexed and annoyed. The child reveals to the therapist that one of his classmates lost a mother to a terrorist attack that involved a bus bombing. Suddenly, the symptom makes a lot of sense.

So What to Do?

Accept that some fear is good. It is protective.

The world can be a dangerous place. Parents breathe a sigh of relief when children finally understand not to run into traffic. We appreciate a healthy respect for safety when hiking close to cliffs, diving into the ocean, or encountering dangerous animals. That being said, it is best to try to protect children from being inundated by too much danger and fear. Rather, it is best to help them learn about fear and safety little by little. A young child reaches for the medicine bottle. It is our job to make sure the bottle is childproof. It is our job to watch the bottle. But it is also our job to begin to say, "You need to ask adults for medicine. It can make you very sick if you take too much medicine." We learn about how to handle and master the world, step by small step.

Mastery helps.

Control and coping skills often provide the key to unlock the door. We all remember the fire drills we endured in school. Having safety tools in our pocket makes us calmer because anxiety and fear are fueled by the belief that there is nothing we can do. Most of the time, it is possible to exert some control. For example, a child may exhibit anxiety about smoke and fire after witnessing a blaze. Sometimes, providing the child with lessons in fire safety is enough to diminish that anxiety. Likewise, if a child is frightened of snakes, we can teach him or her how to recognize dangerous snakes and what to do if there is a snake in the path.

Faith helps.

Research shows how much having a faith system helps. We can teach even young children to reach out to Hashem and develop a personal relationship. Giving tzedekah, praying, and saying Tehillim are a few examples of tools we can use to face problems and big fears.

Art, play, and other creative endeavors help.

It may be particularly hard for children to put their fears into words. Sometimes we are teaching our children the language of feelings. At other times, we are presenting children with a safe and acceptable medium for expressing feelings. We encourage the use of language rather than acting out. Children are often great at using art or play to communicate. For example, we can encourage a child to draw a scary dream. Children who have experienced a traumatic event and/or who are anticipating a difficult situation often use play to work through their feelings and fears.

Stories are a window into a child's world.

There are some wonderful children's stories. Parents are encouraged to find just the right story to address their child's situation. Reading stories aloud, even to older children, is a great way to discuss a problem. When children are touched by a story on a deep level, they often ask us to read them the book over and over again. This is a way of learning and working through an issue. It is also an invitation for dialogue with our children.

Relaxation training is good even at a young age.

Life is often intense, hurried and stressed. Even little children are swept along in the intensity of adults' lives. Children, too, can benefit from learning how to slow down and relax. It is important to teach them to recognize and begin to manage their own internal responses to stress. For some children, it may be a warm bath. For some it may be retreating to their room to draw. For others it may be listening to soft music. Sometimes children need their own small, quiet place. It may even be a corner of their room or a small play house made out of a cardboard box.

Hugging and holding helps.

As parents, we often work hard to take away pain and make things better. We rush to kiss the scraped knee. But we can't always fix problems. Nor should we always try. I am reminded of a deep and painful encounter with my eldest daughter, now 20. When she was a young child, we made an emergency trip to Israel to visit my deathly ill father-in-law. My daughter prayed for her grandpa to get better and, miraculously, he got a bit better, but he soon relapsed and died. One fateful day, my daughter sat with me on the couch and tried to understand death. She wanted me to promise her everything would always be okay. And of course I couldn't. I could only hold her; together we shared the pain. Sometimes that is all we can do, to be there for each other.

The Role of Psychodynamic Therapy.

There are times when we cannot conquer or manage fears on our own. Then the choice is made to consult a psychotherapist. There are many types of therapy, with many various approaches.

I am a big believer in the power of the past and the power of the unconscious. Often enough, if we attempt to rid ourselves of one problem, another comes in its stead. One anxiety is replaced by another. This is because we have not fully understood the root cause of the problem. If someone is fearful of the dark because they were sexually abused, it does no good to just attack the fear of the dark. We also need to uncover and work through the trauma.

Genetics vs. Environment

Modern psychology and psychiatry often discuss the genetic components of a disorder. Some people seem predisposed from an early age to anxiety. The modern response is sometimes to jump immediately to medication to make it all better. Sometimes medication is in fact called for, and we are fortunate that some good medications are available. But the magic pill is not the final answer. Research often finds that psychotherapy is more effective than medication. (See the APA reference below.) In addition, for those individuals that require medication, the marriage of medicine and therapy is often the most effective response. The medication helps to calm the individual enough to make good use of therapy and learn tools for the future.

Therapy for Children with Anxiety, Are We Just Playing?

Children often do not come into the therapist's office, sit down, and begin to outline their fears. They may be unaware of their fears. They may be too young to engage in or benefit from just talking. Play therapy, sand-tray therapy, and art therapy are some of the tools of choice for children.

Parents may come into a child therapist's office and wonder if this is just an expensive excuse for play. Yet, play and creation is the work of children. This is the way children communicate, express themselves and work through trauma. The therapist, as an unbiased observer, can allow the child to work through all types of issues. In addition, her or his experience with developmental issues and a wide variety of psychological problems allows for a much deeper understanding of the play. The therapist serves as witness and facilitator. In addition, he uses this understanding to consult with parents and sometimes with teachers about the child

Parents Who Worry Too Much

One of the necessary jobs of parents is to worry about their children. Like a mother hen, we work to keep our children safe and we teach them how to cope in the world. Hopefully, as parents, we keep many of our worries to ourselves. Or we share them with our spouse or friends. But sometimes we are overwhelmed with worry. Maybe our own parents worried too much. Or maybe we suffered trauma in our own life. Or maybe there are some a reason to be very concerned -- for example, about a child who has serious special needs or is sickly. Sometimes it is hard to contain our anxiety, and we may fear burdening our children with our own neurotic behavior. This is the time to seek out personal assistance in therapy.

The author can be reached at [email protected] or in Israel at 052-420-3535.