Attunement, Following the Child, and Backing Up
With older children and adults, it is possible to ask about fear and anxiety ratings directly, but this is much more challenging with younger children. Therapists need to remain attuned to the behaviors that reflect anxiety levels in younger children so they can effectively calibrate the intensity of the exposure and take a gradual approach. It is important that the child not become overly dysregulated as this will interfere with continued engagement with the anxiety-provoking context. Additionally, one theme of this approach is that it is best to set the stage to entice the child to engage, rather than making commands to request compliance.
- Follow the child’s lead with regard to the child’s participation in the playful scene, but encourage a more and more active role from the child – e.g., for a child with a fear of toilets, move from verbalizing the doll’s reaction, to holding the doll as it sits on the potty, to sitting on the potty briefly, to perhaps flushing the toilet and performing the “silly” or “playful” reaction” and relief. Hand the child various key objects to hold when you are giving (short) demonstrations.
- If you are getting a positive response from the child try repeating the same scenario several times getting the child increasingly involved (e.g. holding more objects; doing the actions; making the sounds/words) each time.
- Take it SLOW. There will be a temptation to try to push forward when you see positive response; keep meeting the child where they are at.