Supportive Parenting for Anxious Childhood Emotions (SPACE) for Parents of Youth with Anxiety Disorders, OCD, and ARFID

Supportive Parenting of Anxious Childhood Emotions (SPACE) is therapy for parents and caregivers of youth with anxiety disorders, Obsessive-Compulsive Disorder (OCD), or Avoidant/Restrictive Food Intake Disorder (ARFID). The unique thing about SPACE is that the child does not attend the sessions at all, yet it serves as an actual treatment for their disorder, not merely an information session for parents. Parents learn to recognize their own behaviors, called accommodations, that keep kids stuck in a cycle of anxiety. For example, a parent who rushes over and hugs and kisses their child after every bump and scrape on the playground may reinforce a fear of falling or taking risks. Caregivers learn in therapy to change their own behavior, not their child’s, in order to make system-level changes that teach the child that they can handle anxiety-provoking situations.

When children are in a dangerous situation, they look to their parent for cues. If their parent says, "Oh, it's just a cutesy wutesey tiger!" and smiles and pats the tiger's head, the child assumes there is no danger. If the parent's eyes go big and they say, "Run!," the child knows there is a problem.

Often, parents are signaling danger with their actions and body language, even if they are saying things are safe with their words. For example, if a parent says "Spinach is no big deal - just eat it" but then takes it away and never serves it again, just how safe could spinach be? Mom or dad clearly had to save their child from spinach.

SPACE teaches parents to identify their accommodating behaviors, which tend to fall into three categories. Here are some examples:

1) Avoidance

• No longer inviting people over, for a child who is afraid of speaking or interacting with unfamiliar people

• Not going on outings, for a child who is afraid of their parent being away from them

• Not talking about relatives who are ill or in the hospital, for a child who is afraid of illness or germs

2) Participation

• Cutting up all meat into tiny pieces, for a child who is afraid of choking

• Repeating statements, for a child who worries they did not hear things correctly

• Emailing their teacher about grades, for a child who is afraid to confront adults

3) Modification

• Driving a different route home, for a child who thinks some routes are "unlucky"

• Doing a prolonged nighttime routine, for a child who is afraid of the dark

• Washing their hands in front of the child, for a child who is afraid of germs

Accommodations usually come from love and wanting the child not to suffer (or tantrum!). Unfortunately, they can balloon into a family system designed to keep the child stuck in their anxiety disorder. Because the parent "has to" do certain actions, the child never learns they would survive, be completely safe, and even thrive if the parent did not accommodate.

SPACE is a great treatment in itself, and also ideal for the following situations:

1) A child who is young and does not yet need to be involved in the therapy process. Parents can learn skills that will benefit them throughout their parenting.

2) A child who is resistant to therapy. Maybe they even enjoy attending the session but they are not willing to do the actual work of exposure therapy. Parents can take on the hard work for them, while the child still reaps the benefits.

SPACE can also be used as a treatment when the "child" is a young adult who is still living at home.