Treating young children with anxiety can be challenging, especially when the age of onset is in the pre-school years, which is when parent counselling often forms the majority of treatment.

How common is childhood anxiety?

Childhood mental health conditions are surprisingly common with Youth Beyond Blue reporting that one in seven children between the ages of 4 and 17 experienced a mental health condition (approximately 560,000 young people in a year) and one in fourteen experienced an anxiety disorder (about 278,000 young people in a year).

What is parent counselling?

Parenting is challenging at the best of times, but when a mental health condition is present, most parents benefit from parent counselling and education to support their child.

Parent counselling and psychoeducation are evidence-based approaches that help parents to cope with a range of difficulties that affect their child.

This type of counselling can occur with one or both parents or caregivers and focuses on helping parents learn new ways to support their child by encouraging positive behaviours and thought patterns.

Treatment through parent counselling

Paediatric Psychologist Amanda Abel, a Circle of Security Parenting Educator, said focusing on the relationship between child and caregiver is a critical factor in anxiety management in young children.

“We often work with parents in this context, because they spend a lot more time with their child than we do, so they are in a great position to generalise the skills taught in counselling sessions.

“In cases where the child doesn’t attend sessions, the parent can apply skills they've learned themselves in counselling sessions. 

“These skills might include modelling appropriate stress management strategies and other cognitive behaviour therapy or acceptance and commitment therapy skills,” said Ms Able.

Psychoeducation, which involves teaching parents about their child’s anxiety, also forms a large part of treatment for childhood anxiety.

“We often use these strategies to help parents understand their responses to their child's feelings and how this can sometimes be unhelpful.

“As a parent myself, and in the ten years I’ve worked as a psychologist, I’ve learned that the impact parents can have on the mental health of their child is profound.

“By learning to minimise negative thinking, showing our children that we can respond appropriately to anxiety triggers, and above all else, being accepting of all of our child's big feelings, we teach them that any feelings are fine.

“Having parents attend counselling sessions to address their child's anxiety also helps not to pathologise a child, making them feel as though something may be 'wrong' with them,” said Ms Able.

Ms Able said parents act as mirrors and can help anxious children learn in the moment.

“The way we manage our emotions as adults is often mirrored by our children and thus has a huge impact on their emotional regulation.

“So, parents need to ensure they are not modelling inappropriate behaviours in terms of their emotional regulation.

“By equipping parents with tools to help their child’s anxiety in daily life, such as accepting and acknowledging all of their child's feelings, even the ones that make parents feel uncomfortable, the child is able to learn 'in the moment' and be supported and prompted by their parent to apply evidence-based strategies to manage their anxiety. 

“This process of generalisation speeds up the learning of new skills so, in theory, it could reduce the course of treatment for the child.

“We often explain to parents that we don’t have a magic wand as psychologists, and while we can provide our expertise in our given areas to support their child’s anxiety, the best outcomes are achieved when the family unit is running smoothly and towards the same goal for their child.

“For this to happen, we need a cohesive approach that often, but not always, involves including a parent or caregiver in part of the child's sessions, or having their own dedicated sessions to discuss their child's challenges openly," said Ms Able.

If parents don’t participate in sessions, Ms Able encourages individual counselling sessions for the child (generally in children of school age), and follow-up communication with parents with the child’s consent.

“We would provide written notes, phone calls and summaries for the parents so that they are aware of the tools they can use to help their child in between sessions.

“Often the best gains occur between sessions when children can apply new skills to real-life situations, and this has a greater chance of occurring if the parents are aware of the child's anxiety triggers and the best ways to prompt the use of strategies,” said Ms Able. 

Clinical Psychologist Dr Sarah Hughes is a passionate advocate for parent counselling because research shows that certain parenting styles, such as over-protection, are associated with childhood anxiety disorders.

The direction of this relationship, whether overprotective parenting causes childhood anxiety or anxious symptoms in children elicit a more protective style of parenting, isn’t clear, explained Dr Hughes.

“There’s at least some research to suggest that it’s a child’s symptoms that elicit overprotective styles of parenting. 

“Regardless, the fact that there’s a link between parenting styles and childhood anxiety means that parents are key to positive treatment outcomes in childhood anxiety disorders.

“Even if parents aren’t parenting in an anxious way, kids with anxiety are often too young to take responsibility for their own symptom management, so parent involvement is still key. 

“If parents learn skills to help practice at home, they can function as anxiety coaches and speed up treatment progress.”

Parent counselling is particularly important to support children under seven, as at this age, they generally can’t identify their worries, explained Dr Hughes.

Case study of parent counselling for Emma, Age 9*

Nine-year-old Emma worries about everything and anything.  You name it, she worries about it, but one of her main worries is the safety of her parents, particularly her mum, said Dr Hughes.   

“Emma finds it hard to separate from her parents at school, so to help, her parents sit with her in the playground until the bell.  On really bad worry days, Emma also calls her parents from the office, just to make sure they're ok.

“Emma's parents sit with her and take her calls through the day to try to help Emma to feel less anxious.  Their intentions are good, but unfortunately, their actions are making Emma's worry worse, because they're inadvertently reinforcing Emma's threat perception and her fear of separation.

“In a case like this, Emma can be helped with child-focused strategies like detective thinking and emotion-focussed skills for managing anxiety, but for treatment to be effective, her parents need to be involved in sessions so they can alter how they respond to Emma when she's anxious and distressed.

“It might mean more distress in the short-term, but gradually working towards not sitting with Emma until the bell and not taking calls through the day is ultimately what will help Emma to feel less worried and anxious.

“So, providing Emma’s parents with the skills they need to achieve this is key,” said Dr Hughes.    

A mother's experience of parent counselling

Christina, * a single mother of twin girls, sought counselling after the emotional and physical trauma of brain tumour surgery, which also affected the mental health of one of her daughters.

As a result, Christina* began parent counselling for her daughter, who had post-traumatic stress disorder and anxiety. 

“We have both been in counselling with a psychologist since late last year, together and apart, and I finally see some positive change in both of our anxiety behaviours.

“Our sessions were definitely focused toward me understanding her anxiety, changing my behaviour and reactions as well as developing strategies to help her through the difficult times,” said Christina.

*Names changed to protect privacy.