ST. LOUIS – In the 1946 movie “It's a Wonderful Life,” a highly stressed George Bailey berates his sick daughter's teacher for sending the tyke home without her overcoat on when, in fact, the teacher was blameless.
Bailey's erroneous assumption serves as an object lesson for therapists dealing with children who have obsessive-compulsive disorder and separation anxiety disorder, clinical psychologist Anna K. Boller, Psy.D., said at the annual conference of the Anxiety Disorders Association of America.
“Therapists too often get sucked into the blame game between parents and teachers because they don't take the time to get both sides of the story,” she said.
“It's one thing to be the child's advocate, and it's quite another to think that you know the whole world view based on what an 8-year-old is telling his parents. So talking to the teacher is critical,” said Dr. Boller, a school counselor at the Waterford School in Sandy, Utah.
Such communication forms the foundation of a collaborative relationship with key adults–including the teacher and parents–in the anxious child's life, said Dr. Boller, who has taught communication courses at the University of Michigan, Ann Arbor, and the University of Illinois at Chicago.
Obsessive-compulsive disorder and separation anxiety disorder are painful for children, and both research-based therapy and a bit of imaginative thinking must be brought to bear, she said.
“Children with anxiety disorders have functional impairment at both home and school, which is a two-edged sword. The good news is, slight changes in the child's environment, such as seating location and placement in line or timing of daily events, can make a tremendous difference,” Dr. Boller said, adding that nothing can be accomplished without forming a collaborative relationship.
“The information you get from talking to the teacher just one time at the beginning of treatment will tell you something you didn't know that's going to be salient to therapy,” she said.
Dr. Boller borrows liberally from two books she urges every therapist to own: “Anxiety Disorders in Children and Adolescents, Second Edition,” edited by Tracy L. Morris and John S. March (New York: Guilford Press, 2004), and “Talking Back to OCD” by John S. March (New York: Guilford Press, 2006).
Dr. Boller conceded that making contact with angry parents who blame the teacher for their child's problems at school can be intimidating. Once all parties have become involved, it is important to avoid the blame game by maintaining focus on observable behaviors without using or trying to interpret value-laden statements, she said.
“The parent may say, 'Joey goes to the restroom frequently to wash his hands because the classroom is such a mess, and everybody's sick because the school makes no effort to maintain hygiene!' Assumptions and blame destroy efforts to help the anxious child,” Dr. Boller said.
In addition, the therapist should seek information before giving information. “Don't call the school and say, 'You have a student in your classroom named Mark who has obsessive-compulsive disorder.' Ask questions first and make it clear to the parents that it's important that you be given clearance to talk to the teacher,” she explained.
After the initial discussion, the therapist and teacher can track the child's progress by exchanging e-mails. The teacher's role in noticing the child's anxiety triggers cannot be underestimated, she said.
“That initial phone call to the teacher and those follow-up e-mails are going to make all the difference for treatment. It's going to lead to relief of suffering at a more effective rate and empower an increasingly self-confident child,” Dr. Boller said.
'Talking to the teacher just one time at the beginning of treatment will tell you something you didn't know.' DR. BOLLER