Published: Oct. 24, 2022, 8 a.m.
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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\\u2019s 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\\u2019s 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 \\u201cnarcissistic.\\u201d 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 \\u201csaved him\\u201d 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\\u2019 suggested, the many advantages of his symptoms, such as \\u201cI don\\u2019t have to go to school,\\u201d \\u201cI get extra attention this way,\\u201d and more.
After this intervention, the boy decided that it just wasn\\u2019t 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\\u2019t be permitted to go on sleep overs at his cousin\\u2019s house until he outgrew his bed-wetting problem. But when he \\u201clistened\\u201d and encouraged the boy to talk about his distress, the boy explained that his cousin had a \\u201ccreepy dog\\u201d that frightened him, so he actually didn\\u2019t 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\\u2019t 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\\u2019s 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\\u2019 support, she confessed that her life was dominated by school, study, and going to tennis tournaments, with no free time to be a \\u201cnormal teenager.\\u201d She finally confided that she was just \\u201ctennissed out\\u201d 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 \\u201cI don\\u2019t want to do this anymore.\\u201d But by developing a symptom, she could continue to be nice and say \\u201cI can\\u2019t do this,\\u201d rather than saying \\u201cI don\\u2019t want to do this anymore.\\u201d
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\\u2019s complaints are real\\u2014they\\u2019re not making up the symptoms, and they need empathy and support, and the chance to tell their story. Parents are nearly always focused on \\u201cpushing\\u201d and \\u201chelping,\\u201d efforts that just make the problem worse because the child pushes back.
Although parents do this out of love, their misguided efforts to \\u201chelp\\u201d can actually be a barrier to successful treatment. Jeff said he often does what he respectfully and affectionately calls a \\u201cparentectomy,\\u201d 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\\u2019s actual motives the \\u201cHidden Emotion Phenomenon,\\u201d and it\\u2019s equally common and powerful with adults with anxiety disorders as well. Essentially, anxiety prone individuals, including children, teens and adults, tend to be exceptionally \\u201cnice,\\u201d 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\\u2019s mouth cannot say!
Instead of trying to solve the problem, you can view the symptoms as a subconscious solution to a problem that\\u2019s 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\\u2019d like to learn more about Jeff\\u2019s fascinating clinical work, and perhaps learn more about this \\u2018Hidden Emotion\\u201d 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\\u2019d like, you can contact him directly at JeffLazarusMD@gmail.com.
Thanks for listening today!
Rhonda, Jeff, and David
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