Monday 22 January 2018

Dear David: 'My daughter has a dog phobia and counselling hasn't helped'


Dog phobia: illustration by Moona AlQahtani
Dog phobia: illustration by Moona AlQahtani
David Coleman

David Coleman

For the last few years my 11-year-old daughter has had a severe phobia of dogs. We don't recall any incidents with dogs that may have triggered it.

She gets very anxious whenever she sees a dog in public. She grabs my hand immediately and starts panicking. Her worst fear is when she sees a dog off a lead; she finds this absolutely terrifying.

She once hid on her own for over 20 minutes when she saw a dog while she was out playing with her friends. We have tried counselling and CBT but all without success.

DAVID: It must be very disheartening to have tried therapy or counselling and to still feel like your daughter's phobia is as strong as ever.

CBT, or cognitive behaviour therapy, is a form of intervention that looks at the links between the thoughts we have, our behaviour and, typically, the interaction of these with our moods or feelings.

CBT is often very effective in dealing with anxiety. Since a phobia is an extreme anxiety or fear, it is usually amenable to CBT approaches. Using CBT with young children can be difficult though.

Depending on your daughter's age at the time of previous counselling, the therapist needed to be quite skilled to adapt the CBT model of therapy so that it made sense to your daughter, and such that it could be effective.

For example, children aged from seven to 10 are usually very concrete in their thinking. This means that they struggle to think abstractly and may have difficulty with meta-cognition, which is our ability to be aware of and understand our thought processes.

For example, with a younger child, I might need to find a specific example of negative thinking and demonstrate how that led to a bad outcome, tying it in to situations and experiences the child has already had.

Or, they may also need more graphic representations of the intensity or experience of feelings such as fear or anxiety. So, I might have to draw a "worry thermometer" and get them to colour in how scary a situation was with increasing amounts of the coloured-in "mercury", representing increasing amount of fear.

So perhaps your daughter was too young at the time to benefit from the style of the therapist, or perhaps there wasn't enough practical support for you and her during the therapy. Sometimes, with young children, parents need to be taught the skills so that they can coach and support their child at home.

Your daughter needs to know that she can regulate her rising anxiety when there are dogs around. It is interesting, for example, that you notice she panics more when a dog is off its lead.

It is as if, at that moment, she feels out of control herself (like the dog is out of control) and that there is nothing she can do to help herself and so her own anxiety spirals upwards.

Learning an effective relaxation technique, like abdominal breathing, will give her greater confidence that she can regulate the physical symptoms of her anxiety. It will allow her to feel more in control of herself.

In addition to that ability to self-regulate her feelings, she needs to be able to remind herself of the times when she has successfully been around dogs, or times when she has been near dogs and has not panicked, nor been hurt by the dog.

Once she has mastered the ability to reduce her anxiety with something like a breathing technique, and is able to build her own sense of capability with some positive self-talk, she can begin graded exposure to dogs.

At each stage of the graded exposure, she needs achieve a reduction in her anxiety to manageable levels before she moves to the next level up of proximity to and/or contact with a dog.

Having a well-trained dog, like a friend or neighbour's guide dog for the blind, who can be present in a non-threatening way for your daughter would also ease this process.

Whatever the origin of her phobia, further CBT gives her the best chance of overcoming her fears, notwithstanding your, and her, previous attempts at counselling.

My 13-year-old daughter is crying every day going to school. Should we just let her change?

We are very worried about our 13-year-old daughter. She began secondary school last autumn full of excitement and after a really happy summer. However, after the first week she has cried every day. She says she doesn't know why she feels so sad. She tells us nobody has done anything to her and everyone is nice but she seems to have no real friend. Her old primary school friends went to a different school in the town. She chose an all-girl school. Is she just missing her old school and friends? Should we change school?

DAVID: It certainly sounds like it is worth considering a change in school. However, before you make such a decision, you need to go through all the pluses and minuses and then see where this kind of rational consideration of the issues might fit with your gut feeling about the situation.

"Gut feelings" are like the emotional heart, or the emotional drivers of our decisions. They are an important part of the information we need to make decisions, but they aren't the only relevant part. I don't believe in just relying on my "gut", without also engaging in a thorough decision-making process.

So, make sure you have gathered all the information you need by talking with both schools. Talk with one to ensure you understand fully her distress and the other to ensure it is a good enough alternative. Involve your daughter, centrally, in all the discussions.

Be clear about the decision you need to take. Rather than, as a family, asking yourselves "should my daughter move school?", you may be better phrasing it as "what school will my daughter be happiest in?".

Thinking about the issue in this way allows for you (with your daughter) to equally consider what is good about both schools. It allows you to predict what kind of factors will make it easier and/or harder to be in either school.

For example, as far as you are aware, one of the key issues is the social dynamic in her current school. Even though the other girls are nice, even though nobody is bullying her, your daughter feels like she is a bit on the outside.

Like it or not, this social aspect of school is as important as any other factor in how children perceive their satisfaction with school.

Research also informs us that the link between satisfaction with schooling and overall life satisfaction is so strong, in fact, that satisfaction with schooling has come to be widely accepted as one of the five critical components in children's overall life satisfaction.

I can only assume that the academic thrust of the two schools is equivalent enough, and that there will be an equivalent mix of teachers of varying skill and ability in each school. Other considerations like location, gender-mix or not and facilities are also important to include in the mix.

However, even incorporating all of those things, the issue of your daughter's social isolation, to whatever degree she experiences it, seems like it is the one that is guiding her, and your "gut" in the decision-making.

In my opinion, that is not a bad thing, as long as you know that the emotional power of this experience, for her, is a driving factor. It doesn't lessen its relevance. By considering the other factors involved, you protect her from making a decision that is based on this element of her experience alone.

Ultimately, her original choice of school may simply have been a bad one for her. She may have misjudged how important it would be for her to have close friends to hand. She may have underestimated how hard it can be, at times, to make and deepen new friendships.

Changing school is a risk, but it may be one worth taking if it addresses the heart, or the "gut", of your daughter's happiness in school. After five months, she is consistently unhappy in her current school.

Having the lifeline of another school, with a potentially supportive group of friends already in situ, seems like a opportunity worth pursuing.

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