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Separation Anxiety in Children and Adolescents: An Individualized Approach to Assessment and Treatment
This unique book presents a research-based approach to understanding the challenges of separation anxiety and helping children, adolescents, and their parents build the skills they need to overcome it. The authors provide step-by-step guidelines for implementing the entire process of therapy--from intake and assessment through coping skills training, cognitive-behavioral interventions, and relapse prevention. Featuring in-depth case examples, the book is written for maximum accessibility for all clinicians, including those with limited cognitive-behavioral therapy experience, who treat separation anxiety and other childhood anxiety disorders. Useful reproducibles include the Separation Anxiety Assessment Scales, which facilitate individualized case formulation and treatment planning.
298 pages, Paperback
First published February 25, 2005
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January 22, 2014
This book offers a highly structured (some might say "cookbook-like") approach to treating separation anxiety in children and adolescents.
The book begins by describing the nature of separation anxiety, which is characterized by unrealistic and excessive anxiety when separating (or anticipating separation) from attachment figures, usually parents. Separation anxiety can make it difficult for a child to go to school, be alone, sleep alone, go on a playdate, go to parties, or participate in other activities that involve separation. Children may resist these activities by throwing overpowering tantrums, causing parents to give in and allow them to continue avoiding these activities. This perpetuates an unfortunate vicious cycle.
Some of these children's fears are mainly about being alone in particular areas of the house (e.g., the basement). These children may be afraid to sleep alone in their rooms at night, which is a common reason that their parents seek therapy for them. When this is the case, these children's fears may be limited to specific situations mostly or only at home. They may function well in other spheres such as school and social life. For other children, separation fears are about abandonment. They may be afraid that something will happen to their parent if they are not with them and may resist being left with a babysitter or dropped off at an activity. This is a more pervasive and limiting situation. Children with strong separation fears may experience physical symptoms (e.g., headaches, stomachaches) in response to separation situations and can develop additional fears about these symptoms as well, causing them to further avoid anxiety-provoking situations.
Some children with separation anxiety cope through the use of safety signals like a security blanket. While this can be useful and appropriate at earlier stages of development, it can become a problem if it prevents the child from learning to deal with anxiety in a more mature and healthier way. The use of safety signals will not always be possible for the child, and expanding the child's repertoire of coping skills is important.
The book goes on to talk about how separation anxiety develops and how to assess it in initial meetings with parents and children. The book encourages the use of several different rating scales, which may not always be practical in some clinical settings. In any case, my feeling is that these rating scales will at best supplement a good clinical interview.
The book's next two chapters describe child coping skills in detail, focusing on relaxation exercises (progressive muscle relaxation, deep breathing, visualization) and cognitive tools. The presentation and teaching of these exercises needs to be varied of course according to the child's developmental level, temperamental intensity, and motivation.
This section is followed by two chapters on parent coping skills. Therapists are encouraged to begin by validating parental anxieties and addressing common tendencies to blame themselves or the other parent. The next goal is to educate the parents about separation anxiety, address any misconceptions they might have about their child and the situation, and set the stage for positive treatment outcomes. The book prepares therapists for a variety of parent reactions -- lack of insight into their own behavior and its role in reinforcing the problem, wanting to know (or thinking they know) the underlying cause when in fact there is rarely if ever a single cause, labeling their child as manipulative or oppositional, the likelihood that the parent is also anxious and the role that plays, etc.
According to the book, anxious children often have well-intentioned but overprotective parents. Some overprotective parents are indulgent, wanting to accommodate the child and enabling them to avoid anxiety-provoking situations. Other overprotective parents are controlling and intrusive, resulting in passive or overt resistance from the child. Many parents make the well-meaning mistake of accommodating their anxious child's wish for excessive reassurance, which is unfortunately counterproductive if the goal is to teach the child how to manage their anxiety independently.
In this book separation anxiety is treated through a combination of exposure therapy and learned coping skills. The child will need to get through a range of separation situations, starting with easier ones and working their way up to harder ones. Rewards may be used to increase motivation. Parents are taught to respond to the child's resistance in ways that support the child while at the same time encouraging them to continue the exposure rather than ending it prematurely or avoiding it altogether. The child is initially permitted to rely on safety signals during the exposure, as this allows the child to feel a sense of control and enhances their willingness to cooperate with the exposure. Once the child can tolerate the exposures, rewards and safety signals are gradually phased out.
The book offers the therapist a structure for planning both parent and child sessions and goes through a number of case examples, including therapy dialogue. It ends with a chapter on managing pitfalls (e.g., other disorders that co-exist with separation anxiety; overcoming child and parent resistance), exploring the possibility of medication, and dealing with termination and relapse prevention.
This is certainly a useful and highly informative book. I could see therapists responding with mixed feelings about the structured and "cookbook-y" nature of the approach. For anxious clients (and their possibly anxious therapists), it may be helpful to have a very clear road map of how to proceed with treatment and what to expect. Research is frequently cited in support of the authors' recommendations, which is also comforting.
On the other hand, real life seldom mirrors a cookbook. When clients come into my office with a separation anxious child, I acknowledge the cognitive-behavioral piece and its value but I usually see so many more things I want to address. While this book acknowledges family dynamics, it seems to downplay them somewhat and view them as little obstacles to be overcome in the process of carrying out the exposures. This may be a function of my background in family systems (I know that to the man with a hammer, everything looks like a nail), but I tend to find the family piece in separation anxiety highly salient and in need of attention. Addressing both parts of the puzzle is not impossible, but it does preclude carrying this approach out in a step-by-step cookbook fashion. I see this approach rather as something to be integrated within a larger picture, and the precise way to do that will differ for different children and families.
The book begins by describing the nature of separation anxiety, which is characterized by unrealistic and excessive anxiety when separating (or anticipating separation) from attachment figures, usually parents. Separation anxiety can make it difficult for a child to go to school, be alone, sleep alone, go on a playdate, go to parties, or participate in other activities that involve separation. Children may resist these activities by throwing overpowering tantrums, causing parents to give in and allow them to continue avoiding these activities. This perpetuates an unfortunate vicious cycle.
Some of these children's fears are mainly about being alone in particular areas of the house (e.g., the basement). These children may be afraid to sleep alone in their rooms at night, which is a common reason that their parents seek therapy for them. When this is the case, these children's fears may be limited to specific situations mostly or only at home. They may function well in other spheres such as school and social life. For other children, separation fears are about abandonment. They may be afraid that something will happen to their parent if they are not with them and may resist being left with a babysitter or dropped off at an activity. This is a more pervasive and limiting situation. Children with strong separation fears may experience physical symptoms (e.g., headaches, stomachaches) in response to separation situations and can develop additional fears about these symptoms as well, causing them to further avoid anxiety-provoking situations.
Some children with separation anxiety cope through the use of safety signals like a security blanket. While this can be useful and appropriate at earlier stages of development, it can become a problem if it prevents the child from learning to deal with anxiety in a more mature and healthier way. The use of safety signals will not always be possible for the child, and expanding the child's repertoire of coping skills is important.
The book goes on to talk about how separation anxiety develops and how to assess it in initial meetings with parents and children. The book encourages the use of several different rating scales, which may not always be practical in some clinical settings. In any case, my feeling is that these rating scales will at best supplement a good clinical interview.
The book's next two chapters describe child coping skills in detail, focusing on relaxation exercises (progressive muscle relaxation, deep breathing, visualization) and cognitive tools. The presentation and teaching of these exercises needs to be varied of course according to the child's developmental level, temperamental intensity, and motivation.
This section is followed by two chapters on parent coping skills. Therapists are encouraged to begin by validating parental anxieties and addressing common tendencies to blame themselves or the other parent. The next goal is to educate the parents about separation anxiety, address any misconceptions they might have about their child and the situation, and set the stage for positive treatment outcomes. The book prepares therapists for a variety of parent reactions -- lack of insight into their own behavior and its role in reinforcing the problem, wanting to know (or thinking they know) the underlying cause when in fact there is rarely if ever a single cause, labeling their child as manipulative or oppositional, the likelihood that the parent is also anxious and the role that plays, etc.
According to the book, anxious children often have well-intentioned but overprotective parents. Some overprotective parents are indulgent, wanting to accommodate the child and enabling them to avoid anxiety-provoking situations. Other overprotective parents are controlling and intrusive, resulting in passive or overt resistance from the child. Many parents make the well-meaning mistake of accommodating their anxious child's wish for excessive reassurance, which is unfortunately counterproductive if the goal is to teach the child how to manage their anxiety independently.
In this book separation anxiety is treated through a combination of exposure therapy and learned coping skills. The child will need to get through a range of separation situations, starting with easier ones and working their way up to harder ones. Rewards may be used to increase motivation. Parents are taught to respond to the child's resistance in ways that support the child while at the same time encouraging them to continue the exposure rather than ending it prematurely or avoiding it altogether. The child is initially permitted to rely on safety signals during the exposure, as this allows the child to feel a sense of control and enhances their willingness to cooperate with the exposure. Once the child can tolerate the exposures, rewards and safety signals are gradually phased out.
The book offers the therapist a structure for planning both parent and child sessions and goes through a number of case examples, including therapy dialogue. It ends with a chapter on managing pitfalls (e.g., other disorders that co-exist with separation anxiety; overcoming child and parent resistance), exploring the possibility of medication, and dealing with termination and relapse prevention.
This is certainly a useful and highly informative book. I could see therapists responding with mixed feelings about the structured and "cookbook-y" nature of the approach. For anxious clients (and their possibly anxious therapists), it may be helpful to have a very clear road map of how to proceed with treatment and what to expect. Research is frequently cited in support of the authors' recommendations, which is also comforting.
On the other hand, real life seldom mirrors a cookbook. When clients come into my office with a separation anxious child, I acknowledge the cognitive-behavioral piece and its value but I usually see so many more things I want to address. While this book acknowledges family dynamics, it seems to downplay them somewhat and view them as little obstacles to be overcome in the process of carrying out the exposures. This may be a function of my background in family systems (I know that to the man with a hammer, everything looks like a nail), but I tend to find the family piece in separation anxiety highly salient and in need of attention. Addressing both parts of the puzzle is not impossible, but it does preclude carrying this approach out in a step-by-step cookbook fashion. I see this approach rather as something to be integrated within a larger picture, and the precise way to do that will differ for different children and families.
October 6, 2024
كتاب منهجي تعليمي وتفصيلي عن قلق الانفصال، مع سرد لحالات مفصلة وتقديم خطط علاجية بحسب العلاج المعرفي السلوكي.
الكتاب مفيد جدا للعاملين في المجال النفسي أو حتى في مجال الطفولة المبكرة بشكل عام.
أيضا ذكر في الكتاب تفصيل مهمة عن القلق وشرح مفصل لبعض الفنيات المستخدمة مع الأطفال بحسب أعمارهم.
أنا عجبني شرحه عن القلق والتعرض والمشكلات اللي ممكن تواجهها كمختص في التعامل مع الاطفال لما تطبق فنية التعرض مثلا.
حبيت الكتاب وأنصح فيه.
الكتاب مفيد جدا للعاملين في المجال النفسي أو حتى في مجال الطفولة المبكرة بشكل عام.
أيضا ذكر في الكتاب تفصيل مهمة عن القلق وشرح مفصل لبعض الفنيات المستخدمة مع الأطفال بحسب أعمارهم.
أنا عجبني شرحه عن القلق والتعرض والمشكلات اللي ممكن تواجهها كمختص في التعامل مع الاطفال لما تطبق فنية التعرض مثلا.
حبيت الكتاب وأنصح فيه.
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