In a recent blog post, I mentioned that anxiety is currently over-catastrophized and over-diagnosed.  I went on to explain that in years past, a child who feared giving an oral presentation would basically be told to “suck it up and deal,” whereas now that same child would be diagnosed with anxiety and allowed to give a written report instead.

What I wanted to clarify in this post is that I am no more a fan of the unhelpful “suck it up and deal” strategy as I am of the ridiculous “poor baby, you don’t have to do anything that frightens you” strategy.  Instead, I advocate for offering both support and accountability.

“Support” comes in the form of offering validation, empathy, and teaching.  You may say, “Billy, that is completely understandable that you would feel nervous (validation); I really feel for you, and wish I had a magic wand to make this completely comfortable for you (empathy); Want to practice your speech in front of me and try some deep breathing and muscle tension exercises to make it a little easier for you? (teaching)”

“Accountability” is when you expect follow-through.  I had a young adult in therapy who was performing poorly at her job and in college.  It eventually became clear to me that the very ideas of doing homework even though you have a stomach ache or biting your tongue with a boss even though you know you’re right or feeling uncomfortable having a conversation but doing it anyway were completely foreign to her.  She was in need of some accountability.

However, accountability could only be heard in the context of a whole lot of support. Only after very healthy doses of “support,” (I KNOW how hard it is, and how miserable it is to work against a deadline when you are not feeling well; While doing a progressive relaxation may reduce your stomach tension, I know it won’t make you completely comfortable, and that just. really. sucks.) could I broach the idea of “accountability” (You might want to consider pushing forward with some of your assignment, even though it pains you to do so, just for the sake of passing the class).

The most important part of issuing “accountability” is making sure the expected task is realistic.  Sometimes something called an “accommodation,” or a slight alteration of the feared activity, has to be implemented in the case of clinical anxiety.  Maybe it wasn’t realistic for my patient to have an assertive conversation with her boss without initiating a panic attack, BUT with the support of repetitive role-plays and some self-soothing strategies, she could certainly repeat a canned sentence to her boss. The goal is for the person to move forward (while gaining resilience and confidence), not remain stagnant and sheltered from life’s discomforts.

For a closer look at my favorite form of “accommodated accountability” or “gradual exposure therapy,” read this.

I hope this helps clarify how to handle an important aspect of parenting kids with anxiety: Supporting them while still allowing them to grow.

As always, if you have any questions about kids, relationships, or psychology, write in!  I’m also looking for guess post submissions on any subject related to relationships, family dynamics, or mental health.  Tell your story!