MENTAL HEALTH SERIES, PART 3
SOOTHING THE ANXIOUS CHILD
SOOTHING THE ANXIOUS CHILD This is the third blog in the Mental Health Series. These blogs correspond to six foster parent training classes that I am facilitating at San Bernardino Valley College on Tuesday and Friday mornings from 9 a. m. to Noon, starting September 28 and concluding on October 15, 2010. If you live nearby and want to attend the classes, email me.
What Does Mental Health Look Like?
was the topic of the first class.
Responding To Depression In Foster Children
was the topic of the second class
Today we are going to explore ways to SOOTHE the foster child’s anxiety.
Again there are several interesting blogs on how our brain works, and you might want to check them out.
SO WHAT IS ANXIETY?
You have a handout from Wikipedia, not that it is the best source, but they did a good and precise job in giving us an overview of anxiety.
I will summarize some of the article here. So this interesting information is not mine.
As the article points out, anxiety is both a physiological and a psychological event. It involves thinking processes, emotional processes, first person or somatic experiences (in contrast to third person objectified experiences), and behavior.
The experience of anxiety leaves us feeling very uneasy and apprehensive. We are filled with fear and worry. Anxiety could be described as a generalized mood condition that can occur even when there is no recognizable trigger.
Sometimes anxiety is contrasted with fear. We experience fear when we feel threatened by what appears to us to be a real and present threat. Our typical response to fear is to run, avoid, and escape if necessary.
In contrast, anxiety is a response to a threat that seems unavoidable and out of our control. Sometimes, anxiety is considered a "future-oriented" mood state in which we prepare to cope with an upcoming negative event.
Anxiety can also be seen as a natural response to stress. And there is actually a small window where the anxiety can actually increase our intellectual acuity, but it is a very small window. It is difficult to maintain that small window without it mushrooming, becoming excessive, and taking us over the top.
There are a zillion (not really) different diagnoses that have to do with anxiety. I do not think it is necessary to go into them for our purposes, but I will list them.
Panic attack, Agoraphobia, Panic Attack with and without Agoraphobia, Specific Phobia, Social Phobia, Obsessive Compulsive Disorder, Post Traumatic Stress, Acute Stress, Generalized Anxiety Disorder, Anxiety Due to a Gerneral Medicatl Condition, Substance Induced Anxiety, and Anxiety Disorder Not Otherwise Specified.
ANXIETY IN OUR OWN LIFE
Most importantly, is taking a look at our own life. How do we experience anxiety in our lives?
*What stresses you out OTHER than the children you take care of?
*Who are the adults in your life who stress you out?
*When do you feel most anxious?
*Do you get anxious when someone you love does not show up on time?
*Do you get anxious when you have to speak in public?
*Do you get anxious when you go back to school as an adult?
*Do you get anxious when you have to talk to bill collectors?
*Do you get anxious when someone you really care about is sick or dies?
*Do you get anxious when you go to the doctors?
*Do you get anxious worrying about getting caught?
*Do you get anxious when you don’t have enuf time to finish cleaning before company arrives?
*Do you get anxious when you are going to see people you haven’t seen you for a long time, and you have changed, grown older, put on weight, lost hair, turned grey, shrunk, and ......?
*Do you get anxious when someone scolds you, yells at you, blames you justly or unjustly?
*Do you get anxious just getting up in the morning?
*Do you get anxious letting your loved ones know what it is that you need form them?
*Do you get anxious around sexual issues?
*And let’s look at the children you care for? What is it with them that makes you anxious?
NOW, LET’S TAKE A LOOK AT WHAT MADE YOU ANXIOUS AS A KID?
Be aware that there may have been events in your life that you have no conscious memory of, and that created a boat load of anxiety for you. Maybe you were born prematurely. Maybe you were on time, but experienced a difficult birth. Maybe you had lots of medical procedures as a child.
In my case, I had a serious medical condition for the first nine months of my life that went undetected and untreated. It was only when my pediatrician went on vacation, God bless him, that the pediatrician taking his place was able to discover the problem and began treatment. Obviously, I cannot remember any of that, but I know I carry considerable anxiety from those nine months. It is difficult to do much about the anxiety because when the anxiety gets triggered, I have no consciousness that the anxiety is being triggered from such a long time ago. And sometimes I feel very anxious about an event that, in a sense, has little or no anxiety attached to it. But the event looks just enough like the pain from a long time ago, that the anxiety fires off. And sometimes I walk around with a kind of a low grade anxiety in my gut, My brain and my body are anticipating the pain from a long time ago, but there is no pain in the present. You can imagine what even a simple medical procedure does to me.
So it is helpful to find out all that you can about your early years. It may give you a clue to an anxiety that you carry around and could at this time of your life, let go of or even transform.
SO AS A KID
*Were you anxious when significant people came and went in and out of your life?
*We you anxious going to the doctors or the dentist?
*Were you anxious going to preschool and then school?
*We you anxious having to dress out for PE?
*Were you anxious when significant others drank or used?
*Were you anxious when Mom and Dad fought?
*Were you anxious about school performance, report cards, home work, tests?
*Were you anxious about getting sick or when you or someone else in the family was ill?
*Were you anxious at the dinner table?
*Were you anxious when you went to bed at night?
*Were you anxious playing sports, or being involved in other activities?
*Were you anxious going to church and participating in church services?
*Were you ever so anxious you threw up or got sick?
*Did you ever get so anxious that you simply avoided the activity?
*Were you anxious about carrying family secrets?
*Were you anxious about carrying your own secrets?
*Were you ever left or lost?
*Did you ever witness violence?
AND AS AN ADULT NOW
*Any military experience or other high risks occupational experiences?
When we live day after day in high risk situations, military, doctors, paramedics, firemen, policemen, stock broker, salesman, CPS workers, Hospice personnel, foster parents....our brain finds a way to disconnect from our anxiety, but it is there all the same, and we pay a high price for it floating so freely around our bodies but undetected. We actually convince ourselves that we are not anxious.
WHAT DO YOU IMAGINE ARE THE ANXIETY-PROVOKING EXPERIENCES IN THE LIVES OF THE CHILDREN YOU CARE FOR?
*Many of the children in your care have experienced first hand HORRIFIC forms of abuse
*Many of the children in your care have witnessed first hand HORRIFIC violence
*Many of the children in your care have experienced the police coming to their door at all hours of the day and night and in some cases pulling them from their parent’s arms.
*Many of the children in your care, especially children with special medical needs, have had to endure repetitive and very painful medical procedures
*Many of the children in your care have never experienced being accepted unconditionally and loved unconditionally, so they live in constant anxiety of blowing one more placement. Note this fear does not prevent them from acting out. In fact, the anxiety may drive them to act out to get it over with.
A QUICK PEAK AT HOW ANXIETY GETS STUCK IN OUR BODY
Check out the above links about the brain and PTSD for more details. But basically whenever we experience an over-the-top emotional event, there is a likelihood that the experience will not get "processed" in our brain because the chemistry that gets triggered by an over-the-top emotional event sends the brain into survival mode. The normal neurochemical and neuroelectric dialogue between our emotional brain and thinking brain is shut down. Therefore we cannot make sense of an experience or have it processed into our memory. Instead it remains "stored"" in our amygdala. It just sits there waiting for another even remotely similar event to happen, and then those same emotions will fire off again, often with the same intensity which then triggers yet another disconnect.
Whenever we have emotional experiences that do not get woven into our overall life experience, we tend to live a part or perhaps our entire life emotionally disconnected and we have a tendency to overreact to almost everything.
SO STOP MINIMIZING what you have experienced in your life and what they have experienced in their life that is obviously an over-the-top emotional experience. And start talking about your own experience with a safe friend or therapist and begin inviting them to talk about their experiences with you and a therapist who will support you in supporting the child in weaving these awful events into the fabric of their lives.
Let’s begin by thinking about what soothes you? Most of us feel too childish to ask for soothing, so instead we turn to addictive behaviors like eating. Or instead of soothing, we seek at worst, torture or at least criticism and put down.
What soothes me is being touched by the people I love. I love it when someone strokes my face, when someone runs their fingers up and down my vertebrae. I feel very secure when someone holds me when I am anxious, sad, scared, or even sick. I like to hold someone’s hand when I am feeling anxious. I like to lean up against someone when I am anxious. Sitting back to back is also awesome. Of course, there are more intimate forms of soothing and comfort and many times, we don’t take advantage, in the best sense of that word, of being soothed with intimate forms affection and sexual affection.
So we all know what feels good to us when we are uptight. Obviously there are boundaries galore here and all kinds of issues with our foster children and teens when it comes to affection, but there are plenty of ways available to us to soothe. Sometimes, just a kind look and a simple statement, "I know this is a difficult day for you," instead of the drill instructor lecture which they have heard a zillion times. Remember too, age. Infants and toddlers and even preschoolers are pretty easy to give lots of physical hands on soothing. Yes, you do have to take into consideration their history of abuse. I am just saying it is relatively easy to run your fingers up and down a three year old’s vertebrae, something you wouldn’t consider doing to a teenager. But a side by side hug from two adults simultaneously might be very soothing for a teenager in the depth of despair. Safe for everyone.
THE KEY HERE IS OBSERVATION
We keep talking about this. I want you to become experts at reading body language, and, in particular, the body language in the face. You can see anxiety written all over the face and the body of your foster children and teens. How do we miss it? Worse, how do we see defiance, manipulation, dishonesty, sneekiness, trashiness, laziness, disrespect when all it is IS anxiety. How do we miss the fear in the lines of their faces? How do we miss the tears sitting on the edge of their eyelids trying desperately not to spill over? What is our need to miss these important messages and in stead make it about us and whether or not they respect us?
"Hey, little one (soothing voice), I am going to keep you safe. You don’t have to fret anymore. But if you, I get it. Believe me, I get it......Hey, you seem anxious to me. What’s getting triggered for you?"
When you ask this last question, the child or teen may look at you like what the heck are you talking about. And so you tell them.
"Hey, I get it. You’ve been through a lot. So I know you’re going to walk around very anxious until you are absolutely certain that it is absolutely safe for you to relax. Yep, I get it, and it’s really okay, really okay. You take your time. You look around and make sure everything is safe before you relax. You’re not going to offend me."
"You know sometimes, it might be really unbelievable to you that we want you here. And sometimes when we can’t believe that someone wants us, we act crazy to try to get them to throw us out. We’re familiar with that experience and it almost feels good at times. I even do that myself, sometimes with....."
"Hey, I know you just came back from a visit. Let’s sit down and have some ice cream. Maybe it will make the butterflies go away."
Hey, I saw that look on your face when I was scolding you a little while ago. I am so so so sorry. I forget what you’ve been through. And in the future, you can just hold your hand up like a stop sign and that will help me remember."
This is not about giving the child or teen an excuse to be a victim. It is simply us recognizing the wounds so we can ad-dress them and support healing so they won’t have to be a victim.
"It must have been scary for you to be taken out of your house by the police so early in the morning. Do you want me to just sit up with you for awhile? How about something to eat?"
"You know today, I was thinking about what you saw and how awful it was. You know, you may not be ready to talk to me about any of it, but I want you to know I can hear all of it. And sometimes when you scream at me and tell me all those things you tell me, I’m imagining that you’re just testing me out!"
NOW BE SURE YOU CAN HEAR ABOUT IT ALL before you say the above. Some of what they experienced is pretty awful, might even make you throw up.
"I can see you anxious you get about homework....going to school....having to give your book report.....going to the doctor....going to practice.....going for a visit..... Talk to me about it, so I can be on track with you and together we can get through this."
"I can hold your hand while you talk about it. I can tell, this is scary stuff.....You want to sit here on the couch between Mom and I while you tell us what happened? That helps me sometimes when I have to talk about something that makes me anxious...."
"You know sometimes when I get anxious, I pee my pants. That ever happened to you?....when I was growing up, I used to pee the bed, and when I woke up in the morning, I was just terrified......Sometimes when we are so overwhelmed, when we feel so out of control over everything in our life, we poop in our pants. Then we feel really anxious....."
"When I feel anxious, the easiest thing for me to do is lash out at EVERYONE. It seems that when I am most anxious, I hate everyone. I really don’t, but that’‘s how it feels, and I end up hurting a lot of people in the process. I sometimes think that that is what must be going on for you. Talk to me about it."
"Sometimes, your face looks so sad, and it looks like you’re doing everything and anything you can do to keep from crying. When I am trying not to cry, sometimes it helps to get really angry with people. When I was a kid and trying not to cry, I’d hit my brother (sister) (best friend) (neighbor)."
"I remember a kid once told me that he got really anxious when he was about to steal something. That ever happened to you? He finally told me that sometimes he stole to make the anxiety go away. Kind of funny, uh?"
AGAIN, you are not making this statement to excuse behavior, but to let the kid know, that you know and understand what’s going on inside, what might be driving behavior. In the meantime, you always hold the child accountable and responsible by having them return what they stole.
"The first thing I do when I’m anxious about getting caught or nervous about the consequences, is LIE! How about you?"
"I just imagine that you feel really anxious about going back home.....that maybe they are going to make you go back home....that maybe someone is going to come and kill you because of everything you saw....that you know if you go back home, you could get shot by the other gang....I bet sometimes you can’t sleep at night thinking about everything you saw.....maybe feel guilty that you told.....feel guilty you didn’t tell.....feel embarrassed.....feel ashamed......"
WELL, I HOPE YOU SEE THE FLAVOR IN THESE SCRIPTS. MAKE UP YOUR OWN. BUT LEAVE OUT THE PROBLEM SOLVING, THE JUDGMENTS, THE PEP TALK, THE DRILL INSTRUCTOR. Just let them know that you see the anxiety and are open to hearing more about it.
THANKS FOR READING AND COMMENTING AND THANKS FOR ATTENDING TODAY’S CLASS AND PARTICIPATING.