“Accidental” Psychotherapy (Pedcast)

Today, I am going to tell you about an amazing experience I had last week. A longtime patient of mine, a 12 year old boy who I have known for a decade, came in for his checkup. I had reviewed his chart before walking in the room, an noticed that the last time I had seen him, he came in with classic anxiety symptoms of difficulty sleeping and concentrating, feeling anxious, and having headaches, and stomachaches. When I asked him why he felt so anxious, he said that the social aspects of middle school were overwhelming for him. The academics were easy but the fitting in with his peers…that was a whole nother matter as they say down in the South. After we talked all this over,  it was so clear to me and his Mom that he was exhibiting the somatic symptoms of anxiety. I suggested that they go and try a therapy called “Cognitive Behavioral Therapy” or CBT as it is known in the business. Yes there are medicines for this but CBT is at least as effective.


Fast forward about four months.  Here he and his mother are, in for his checkup. I enquired if he had ever gone and spoken to a counselor and tried CBT and his mother chimed in and said “No”.  “We didn’t need to!”  Then she turned to her son and said, “Tell Dr. Smolen what happened”. The child then proceeded to tell me that on his previous visit we talked, I had described what CBT is and how we all walk around with assumptions about daily life that are just wrong and that these incorrect assumptions can create either sadness, or worry, or fear, or even anger. He said that I made the comment that a lot of his friends at school are probably feeling as anxious and unsure of themselves as he was and that many of them have similar physical problems to go along with these feelings.  Their insecurity led them to exhibit behavior that often made my patient feel anxious, threatened, small and worthless when he was around them.


Well apparently, I had done a pretty good job of practicing CBT without even knowing how it is done. Remember, I am a pediatrician, not a psychologist. My comments however, did strike a chord with him and with that simple reassurance, I had apparently changed some of his basic assumptions about his life that were causing him difficulty:

First wrong assumption-He was the only kid in his school that felt unsure of themselves.

Second wrong assumption- The demeaning behavior of his friends that his friends directed at him was his fault.

Third wrong assumption- Unless my patient’s behavior conformed to some unknown standard set by his friends, he would be unhappy and anxious.  Wrong assumption again. I think my patient was mature enough and smart enough to realize that the best benchmark for his behavior was his own sense of right and wrong. He just let it go. He grew in his confidence and simply moved on…exactly what CBT paradigm shifts lets you do! Get rid of the incorrect assumptions, and the problem solves itself.

During my career, I have seen a big shift away from stigmatizing children with mood problems and actually getting them the help they need. CBT or cognitive behavior therapy, is one of the important tools psychologists have to help a children who suffer from anxiety and depression. don’t be afraid to talk to your child’s pediatrician about getting some mental health services for your child if you think they need it. Your child may be healthier, happier, and more resilient as he or she grows into an adult for the experience.


As always, thanks for joining me today and trusting me to bring you reliable, relevant information about your children; you know, portable practical pediatrics. If you enjoy this blog, take a minute to subscribe at www.docsmo.com or on iTunes and send your thoughts while your at it. This is Dr. Paul Smolen, hoping your little brood, is always in a good mood. Until next time.