TEAM-CBT with children and
teens,
featuring Jeffrey Lazarus, MD
Tics, Irritable Bowel
Syndrome, Chronic Pain,
Bedwetting, Fears, Phobias, Performance Anxiety, and
more
In TEAM, we usually conceptualize four categories of problems:
depression, anxiety disorders, relationship problems, and habits
and addictions. Although there are similarities in the treatment of
each of these targets, there are also important differences.
Today’s guest, Jeffrey Lazarus, MD, is a pediatrician who
specializes in a fifth category, somatic complaints, which can
include physical symptoms like chronic pain, dizziness and fatigue
without any known medical cause. This category also includes as
irritable bowel syndrome, headaches, tics with and without Tourette
syndrome, bed wetting, and a wide range of other problems which are
common in kids and sometimes in adults as well. Dr. Lazarus also
works with anxiety disorders, such as test anxiety, sports
performance anxiety, public speaking anxiety, school phobia and
more.
Although Dr. Lazarus worked as a general pediatrician for the
first 27 years of his career, he switched to hypnotherapy when the
painful plantar warts on his feet were unexpectedly cured following
a single hypnotherapy session from a colleague. Dr. Lazarus was so
impressed that he began studying hypnosis and incorporating it into
his work with children, teens, and adults. He now works from a TEAM
perspective, incorporating Testing, Empathy, Paradoxical Agenda
Setting (also called Assessment of Resistance), and a variety of
cognitive methods, along with hypnosis.
He began today’s podcast with a case of a young man he was
treating for persistent bed wetting, and was surprised when his
patient slammed him in the written feedback on the Evaluation of
Therapy Session form following the session, labeling Dr. Lazarus as
a bit “narcissistic.” At the start of the next session, Dr. Lazarus
responded non-defensively with the Five Secrets of Effective
Communication. This won the boy over, leading to a successful
outcome. Jeff said that the Evaluation of Therapy Session form and
the Five Secrets have “saved him” on several occasions with
disgruntled patients.
Jeff then presented several fascinating cases where
motivational factors and resistance played a major role in the
treatment, and emphasized that treatment failure would probably
have been inevitable if these factors had not been brought to
conscious awareness. For example, a teenager who frequently had to
go home from school because of somatic symptoms listed, at Dr.
Lazarus’ suggested, the many advantages of his symptoms, such as “I
don’t have to go to school,” “I get extra attention this way,” and
more.
After this intervention, the boy decided that it just wasn’t
worth it, because there were lots of fun things he was missing out
on at school, and his symptoms rapidly subsided.
In another case of bed-wetting, Jeff discovered that a 10-year
old knew that he wouldn’t be permitted to go on sleep overs at his
cousin’s house until he outgrew his bed-wetting problem. But when
he “listened” and encouraged the boy to talk about his distress,
the boy explained that his cousin had a “creepy dog” that
frightened him, so he actually didn’t want to go on
sleepovers.
Jeff encouraged the boy to tell his parents what was really
going on, and when his mother said he wouldn’t have to go on any
sleepovers unless he wanted to, his bed-wetting suddenly
disappeared.
He described many additional cases where motivational factors
dominated his patient’s problems, including a promising teenage
tennis star who suddenly developed a fear of flying which made it
impossible to go with her parents to important weekend tournaments.
But with Dr. Lazarus’ support, she confessed that her life was
dominated by school, study, and going to tennis tournaments, with
no free time to be a “normal teenager.” She finally confided that
she was just “tennissed out” and wanted to have more fun in life,
to have dates, and so forth.
By subconsciously developed a flying phobia, she was subtly
going on strike, and saying “I don’t want to do this anymore.” But
by developing a symptom, she could continue to be nice and say “I
can’t do this,” rather than saying “I don’t want to do this
anymore.”
These subconscious maneuvers are not manipulative, but
automatic. When brought to conscious awareness, the patient finds
himself or herself in control, and can decide to go in a different
direction.
This patient mustered up the courage to tell her parents and
her coach, who were understanding, and her fear of flying suddenly
disappeared as mysteriously as it had first appeared.
Dr. Lazarus emphasized that the child’s complaints are
real—they’re not making up the symptoms, and they need empathy and
support, and the chance to tell their story. Parents are nearly
always focused on “pushing” and “helping,” efforts that just make
the problem worse because the child pushes back.
Although parents do this out of love, their misguided efforts
to “help” can actually be a barrier to successful treatment. Jeff
said he often does what he respectfully and affectionately calls a
“parentectomy,” which means encouraging the parents to stay out of
the picture regarding the individual patient problem and homework
he assigns.
I have called this tendency of symptoms to be hiding the
patient’s actual motives the “Hidden Emotion Phenomenon,” and it’s
equally common and powerful with adults with anxiety disorders as
well. Essentially, anxiety prone individuals, including children,
teens and adults, tend to be exceptionally “nice,” and are often
people pleasers. So, they may not always listen to their feelings,
which then turn out indirectly, as this or that type of anxiety or
somatic complaint.
Essentially, the symptoms are saying what the patient’s mouth
cannot say!
Instead of trying to solve the problem, you can view the
symptoms as a subconscious solution to a problem that’s being
suppressed and not verbalized. Bringing the problem to conscious
awareness can make it possible for adult and young patients to
express their needs and feelings directly, which typically leads to
a rapid disappearance of the initial complaint.
If you’d like to learn more about Jeff’s fascinating clinical
work, and perhaps learn more about this ‘Hidden Emotion”
phenomenon, and how he integrates hypnosis with TEAM-CBT, you can
view a number of resources, including video clips from actual
therapy sessions, at his
website, JeffLazarausMD.com
And, if you’d like, you can contact him directly at
JeffLazarusMD@gmail.com.
Thanks for listening today!
Rhonda, Jeff, and David
About the Podcast
This podcast features David D. Burns MD, author of "Feeling Good, The New Mood Therapy," describing powerful new techniques to overcome depression and anxiety and develop greater joy and self-esteem. For therapists and the general public alike!