A Work of Heart
Child and Family Center
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Q: How do I know whether my child or I need treatment for anxiety?
A: It is important to remember that anxiety is a normal feeling that people experience from time to time. Anxiety treatments focus on managing anxiety so that a person can successfully cope when faced with anxiety-provoking situations rather than rid a person of the anxiety completely. An anxiety disorder is diagnosed when a person experiences an excess of anxiety, usually more than is generally experienced by others in the same situation. In addition, the person likely experiences impairment in their daily functioning (for example, being unable to get a job or complete an oral assignment due to social phobia). Only you can be the judge of the severity of your anxiety, or that of your child, and decide whether it is interfering with your/your child's life more than you would like it to. Even a true anxiety disorder is not present, shy or stressed individuals may decide to enter treatment or participate in personal coaching sessions. Examples of anxiety-provoking situations helped by coaching are achieving better grades on tests, enhancing sport or hobby performance, and preparing for and delivering a speech. For more information on anxiety disorders, please visit the Anxiety Disorders Association of America website. You may also consider speaking with a therapist who specializes in anxiety conditions to help you decide whether or not you or your child may benefit from treatment.



Q: What if I also feel depressed, not just anxious?
A: It is not uncommon for people with excessive anxiety to also experience other problems, such as depression. Usually, treatment of anxiety also helps to alleviate the depression because as a person learns to cope with anxiety, they feel better about themselves and have a better outlook on their situation. Anxiety disorders often co-occur with other psychiatric conditions or problems as well. These problems can also be addressed in your treatment.



Q: What is the difference between shyness and social phobia?
A: Shyness is a normal personality trait that does not necessarily warrant treatment. Social phobia, on the other hand, is a psychiatric disorder characterized by anxiety in one or more social or performance situations. Previously termed 'social anxiety disorder,'the characteristics of social phobia include "a marked and persistent fear in one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarassing (APA, 2000)." Unlike people who are shy, the person with social phobia likely experiences significant impairment in their daily functioning at work, school, or with friends and family. Associated symptoms may include situationally bound panic attacks in adults or, in children, crying, tantrums, freezing, or shrinking from social situations. Adults recognize that their fear is excessive while children and adolescents may not. In children, they must be able to engage in age-appropriate social relationships with familiar people and the anxiety must occur in peer settings and not just with adults.



Q: What is selective mutism?
A: Selective mutism is best understood as an anxiety disorder, most commonly diagnosed in children and adolescents. Selective mutism (SM) is characterized by an inability to speak in one or more social situations despite an ability to speak in other situations. A common example is a child who, due to anxiety, is unable to speak with teachers and peers at school but is able to speak freely, when comfortable, with parents and siblings at home. Several other disorders must be ruled out before a diagnosis of SM can be made, as mute behavior can be explained by other factors than anxiety. Most people diagnosed with SM also demonstrate symptoms of another anxiety disorder, most commonly, social phobia. For more information on SM, please visit the Selective Mutism Group website.



Q: How many appointments are needed to feel better and how often should I/my child be seen by a mental health professional?
A: The answer to this question varies depending on many factors including the severity of the presenting symptoms and how much work is done both in and outside of therapy to address the patient's treatment goals. AWOH views treatment as a collaborative effort between the treating professional, the patient, and his or her family. Often the patient's school and other community agencies may be involved as well. Thus, most AWOH sessions occur every other week to allow the patient time to practice newly acquired skills and develop independence in managing symptoms and decision-making, in accordance with their individualized treatment plan. Some patients prefer to meet more or less often and their treatment schedule is adjusted as appropriate for them to benefit the most from treatment.



Q: What is the difference between your "psychotherapy" and "personal coaching" services?
A: AWOH offers several modalities of services, these just being two of them. Your treating professional can help you to determine which type of service best fits your needs. In brief:
Psychotherapy is a process of problem-solving for those in emotional distress. Most of the time, the patient's presenting concerns are elevated to a level that qualifies as a mental health condition or disorder, and thus, they need more frequent, specialized treatment in order to overcome or manage it.
Coaching is a method of helping people achieve a specific goal rather than overcome or manage a presenting problem. It is used to enhance motivation or performance in a specific skill or task. Coaching clients are not in psychological distress, and thus, do not require the level or frequency of interventions that psychotherapy provides. Coaching is not therapy, thus, the individuals involved are called 'clients' rather than 'patients.'



Q: I have looked everywhere for a provider close to my home who treats selective mutism but have found no one. Can you help me if I live far away from your clinic?
A: Upon request, Dr. Boggs is available to travel or provide phone consultation. She can assist by conducting an initial assessment, developing a treatment plan and/or providing training and consultation to professionals.



Q: What if I'm too anxious to call or visit you?
A: It is difficult to take that first step toward managing one's anxiety. As a provider who specializes in anxiety treatment, Dr. Boggs understands that speaking on the phone or attending a visit will likely cause increased anxiety. Dr. Boggs is available by phone or email for an initial consultation. She can assist patients and/or parents of patients to facilitate attending an initial meeting. In addition, Dr. Boggs often provides treatment outside of the office to help patients feel more comfortable in various settings.




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