The Only Certainty Is Uncertainty
Perry’s progress continues. He’s eating more in general, gaining weight, going to restaurants, and sitting at the dinner table without leaving. There are a few “close calls,” but Perry has embraced this new stance and uses his techniques to handle each situation. Sure he might see gross food, and he might throw up, but the more he practices, the less it happens. The less it happens, the more powerful he feels. The momentum continues to shift.
I’m seeing him about once a month now. The final piece for Perry involves moving consistently into uncertainty, without needing to know all the details of what’s to come. I keep reminding both Perry and Beth of anxiety’s dogged agenda: it wants certainty and comfort. It has to know exactly how things are going to go. It hates surprises and doesn’t know how to solve problems or handle uncomfortable moments. When I met Perry, his anxiety required him to check the school lunch menu weeks in advance, so that it knew when to keep him out of the cafeteria. Though the vomiting has almost disappeared, he still often asks his mom when the next assembly at school will happen, and needs lots of reassurance and details about holidays and family gatherings that combine food, noise, people, and potential surprises. When going to someone else’s house, Perry can’t control the menu, the guest list, or the behavior of others.
Anxiety hates this, and begins a pestering quest to get as many details firmed up as possible. Anxiety wants to know—has to know—so it can then decide whether or not Perry will attend or figure out what he must avoid if he’s forced to go. Parents are often peppered with never-ending questions about an upcoming event, because their child is looking for reassurance and certainty. Before parents understand the dynamics of anxiety, they attempt to answer all these questions thinking this is the solution. They don’t know what else to do! The goal is to get families used to the idea that none of us will ever know exactly what’s going to happen next. The future, even five minutes from now, is nothing but uncertain, so I often give homework assignments that help them play with and get used to this reality.
I give Perry one of my favorites. I take a piece of paper and draw a vertical line down the center. The heading atop one side says “What I Know,” and the other, “What I Don’t Know.” There’s an upcoming family event, so for this particular occasion, I want Perry to list what he knows about the party on one side and what he doesn’t know on the other side. For example, he knows the party starts at 6 o’clock on Saturday evening, he knows it’s at Aunt Liza’s house, he knows he’ll wear clothes to the party (I encourage them to throw in some funny ones), and he knows there’ll be food there. He doesn’t know exactly what he’ll eat, how many people will be there, whether or not Aunt Liza’s dog will poop on the carpet, or exactly what he’ll do with his cousins. We identify a few of these unknowns together to get the hang of it, and he’s to take the paper home and add to it. Then, he’s to bring the paper (secretly) with him to the party. Every time he answers one of his many “What I Don’t Know” questions, every time something uncertain becomes certain, he draws an arrow showing that it’s moved from one column to the other, unknown to known. The exercise visually demonstrates a powerful lesson: we don’t know everything, but experience allows us to learn a lot of things we didn’t know before.
Exercises like this help kids better understand anxiety’s trap: the demand to know everything. “How can I know everything?” they ask. “I’m just a kid!” Again, making with the dramatics, I throw up my hands and wail, “I know! Anxiety doesn’t like surprises and has convinced you not to like them either. It’s been telling you over and over that you need to know everything in advance and that you can’t handle things if you don’t. But that’s impossible, isn’t it? It’s about time we show anxiety that you’ll be okay, even if you don’t know exactly what’s going to happen next.”
Beth calls me a few days after the party. Perry brought his paper and had fun drawing his arrows. The “What I Don’t Know” column was highlighted with irreverent boy poop talk, she says, so he laughed as he made his arrows. Aunt Liza’s dog, he wants me to know, didn’t poop on the carpet. More importantly, he had vomit-free fun.
I’ve been meeting with Perry for about nine months, and Beth wonders if we can see how they do on their own for awhile using the tools and settling into their new groove. We decide to meet again in a few months after Perry’s tenth birthday: that’ll be our last session if all continues to go well.
When Perry bounces happily into my office a few months later, I pretend not to recognize him, now that’s he’s 10. The truth is he really does look different from the boy I met a year ago. He’s gained weight and grown a bit. He’s no longer on any GI medication, and his cheeks are ruddy and full. He immediately begins to tell me about his birthday presents, his cake, and the piñata filled with candy. “I’m curious about your worry,” I finally ask him. “Anything new?”
He shakes his head slowly at me, like a disappointed parent. “New? Anxiety? Miss Lynn, I’m surprised at you. You know that anxiety always says the same old things.”
As a society, we’re obsessed with security, safety, and predictability. As good parents, we tend to think that we should keep our children from ever feeling afraid, upset, or vulnerable. After all, we have technology for keeping in constant touch with our kids, reassuring them and ourselves that we always have their backs. It makes us and them feel better, too, so why not use it?
Here’s why not: kids need to be problem solvers. They need to learn how to improvise when things go awry, to take the next step when plans fall apart, in order to grow up. Anxiety will come. So will disappointments, grief, and, occasionally, even disaster. Sometimes our imaginations will be enough to make us panic, but sometimes our imaginations are just practice for the real thing. Children need to learn how to function with anxiety in the passenger seat. When we overprotect them, we deprive them of the practice needed to manage in the world.
As counterintuitive as it sounds at the start of therapy, parents ultimately learn that allowing their children to be uncomfortable—and move forward anyway—is the way out of anxiety’s maze. They understand that a “cure” doesn’t mean the end of anxiety: it means a willingness to try new things, take some risks, and accept anxiety as an inherent part of growing and living. They allow themselves to be uncomfortable, too, but keep their own worries in check so their children can thrive, experiment, and sometimes fail. As I end my treatment with families, parents often tell me that they can look at events in their family life in a wholly different way. What was once a potential crisis to be avoided at all costs is now seen as a golden opportunity to learn.
Lynn Lyons, L.I.C.S.W., is a licensed clinical social worker and psychotherapist who specializes in treating anxiety disorders and disordered eating. She’s created several programs and workshops dealing with the treatment of anxiety, including, “Worried about Your Worrier: Creating Calmer Kids in a Stress-Filled World.” Contact: email@example.com; website: lynnlyonsnh.com.
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