The most powerful tool you have as a professional working with anxious children is yourself. Being able to connect and bond helps children feel safe. Neuroscience confirms this. 

This doesn’t always come easily; we have to work to build rapport. 

The Neuroscience Behind Connection

If you need more than your own experiences to realize the importance of being around people then look at the science. Humans are wired for connection and safe connections can ease anxiety. Even children with social anxiety crave connection. 

Polyvagal Theory

The polyvagal theory describes 3 possible states, simplified here for brevity.

A child needs to be in the social engagement state to be able to learn self-regulation strategies and to build rapport. 

Coregulation

A young child doesn’t have the ability to self-regulate, so adults provide this for them. This is called coregulation. 

Coregulation is when an adult uses their ability to self-regulate to help a child get to a calm state. A dysregulated adult cannot help a dysregulated child. When adults can stay calm and in control this helps a child to feel safe and become regulated.  

Mirror Neurons

Mirror neurons cause us to imitate what we see others do. Have you ever noticed that when you are with a friend at a restaurant that you often take a drink when they do (and vice versa)? This isn’t typically done with conscious thought, but signals signs of connection and safety. The discovery of mirror neurons is still relatively new and more research is needed to fully understand their impact. However, this is likely a reason why coregulation works. You can take advantage of this understanding by taking a deep breath when with a dysregulated child. You will find that it may work better than telling a child to take a deep breath! 

Connecting Beyond The First Few Visits 

Time and consistency with safe experiences will build a connection. Often therapists are quick to want to jump into targeting therapeutic goals before rapport is well established. We often feel pressure to do as much as we can right away because of the demands of insurance. We also have a desire to provide solutions to parents as soon as possible to ease their stress. However, some children won’t be ready to learn the strategies you want to teach if you rush the process of building rapport. 

Rushing the connection process can be especially challenging with some anxious children who may perceive any external request or demand as a threat. Children with social anxiety may also need more time to feel safe. It can be difficult to find the balance between allowing the time for a strong connection and targeting goals directly. 

What if You Have Rapport, but Progress is Limited?

This can especially be a challenge in outpatient settings. Due to insurance denials or a waitlist it may not make sense to continue to see an anxious child who just needs to have practice at home to carryover their strategies. However, there are times that I believe just knowing there’s someone who cares for you can be powerful in and of itself.

A personal example

During the pandemic, I experienced a significant amount of stress. Not only was my business suffering, my marriage was ending, and I was trying to handle unexpected back pain. I went to numerous physical therapists, doctors, and other medical professionals, most of whom gave me what felt like textbook exercises that weren’t individualized to my needs. My 10th physical therapist, however, was different. When we first met I acknowledged that I had come to terms with the fact I would not be able to return to my favorite kind of exercise, and she said, “I don’t know why you couldn’t do that again.” After seeing so many professionals with so little progress I thought I was being realistic by accepting I’d never do it again. 

She made a powerful connection with me by acknowledging my goals, meeting me where I was at, and moving at the pace that fit my mental bandwidth. 

I was highly motivated to do my exercises and improve my function. Despite this, there were days I just needed the connection with someone who cared. I happily paid her cash rate, even after I was able to return to my favorite workout. I continued to see her much longer than I needed to for my physical needs. 

I had a former client in a similar situation. The child came to me for years and even after it seemed like he was doing well, the parent wanted to continue. We did, and I felt justified in accepting her fee long after an insurance company would have been. It was helpful to maintain our therapeutic relationship so that we could deal with things when they came up even if we weren’t needing major interventions or breakthroughs each session. Our frequency was reduced, and I ultimately had to convince her that I was struggling to come up with anything for us to do and that she was an amazing mom who knew how to handle challenges from her child. 

Being open and honest with yourself and your client is what makes this kind of situation okay. Had this parent been bringing their child each week while I did nothing more than what a babysitter may do would change this dynamic. I had to be creative and communicate outside of sessions to learn what struggles they may be having to prepare for our sessions (the struggles just gradually became closer to what a typically-developing child would experience). I still provided therapeutic interventions, as did my physical therapist, they just weren’t as necessary for our function as they had been originally. 

Connection is not separate from therapy. It is part of the therapy.

Children are more likely to feel safe, try difficult things, and learn new strategies when they trust the person working with them. Sometimes progress comes from the strategy we teach, but sometimes it comes from simply having a consistent adult who listens, understands, and cares.