Separation Anxiety

Separation anxiety is normal in extremely young children up to around 14 months old. As the child gets older s/he can tolerate periods of separation from caregivers. Obvious signals that your child is too anxious about separation includes crying and inability to be soothed after separation, nightmares about separation, excessive obsessive “checking” that parent is there and clinging, constant temper tantrums at separation and reuniting, even bed wetting.

Often a child will pick up on an adult’s anxiety, and sometimes changes in the caregiver’s behaviors can go a long way towards easing the anxiety of the child.

What happens when these issues don’t get addressed? What behaviors linger on into adulthood?

“I notice that I get very anxious when I know the time I’m spending with a friend or on a date is running out and we are about to say goodbye. I know it’s an overreaction but I still feel this anticipatory anxiety and after we part ways I feel immediately a lot of sadness, loneliness and fears of being alone.” At other times this person is fine with being alone.

Another interesting scenario: “I seem to keep getting into long distance romantic relationships. Reuniting is always so dramatic and intense but then when one of us has to leave, it feels almost as bad as if we’re breaking up, and the depression lingers for a few days. During that time I’m excessively calling, texting, chatting online with him/her. Then for a while I feel fine and then it’s time for another visit and the whole pattern starts all over again”

“I hate the beginning of the therapy session. I always feel really uncomfortable. And at the end of the session it’s hard to leave. The worst is when you announce a vacation…”

Some people express their anxiety through needing to control the session, wanting to be the one who alerts their therapist that the session is over every time.

Of course as therapists we constantly see different styles of attachment. Aloof and avoidant: this may be the patient who can only tolerate bi-weekly sessions and/or “misses” sessions often through forgetfulness. It can be very challenging to work with a patient with this attachment style as they have a hard time staying in therapy. They may need to control things so much that they become the patient who suddenly leaves therapy when the therapist is noticing that s/he is finally starting to open up and trust. Next minute the patient leaves with no warning or notice. S/he may be able to send an abrupt text or email saying s/he needs a break from therapy, but in some cases this is the elusive patient who just stops coming to sessions and avoids any contact with the therapist. In these cases I have found it is still a good idea to contact the patient and leave a message voicing concern about this behavior, demonstrating to your patient that you have noticed their disappearance and are concerned about it. Often the “parentified adult”, used to the role of caretaker of absent, unstable or anxious even alcoholic parent is very accustomed to their role and has a hard time being in therapy and admitting they need care and attention.

The “ambivalent” attachment style can be expressed quite differently. This may be the patient who opens up very quickly in therapy, demonstrates many shifts in and dramatic affect states, even starts a fight with the therapist. This person needs a lot of contact but feels conflicted about needing it and how to express that need. The consistency and firm boundaries of the therapist with this type of person can be very effective.

The very neglected child can be very consistent as a patient and respond well to individual psychotherapy. S/he is often punctual and gets a lot out of the consistency and holding support of the therapeutic relationship. While this person may take a long time to trust the therapist, I have found patients like these to be very self aware even if their awareness includes a lack of connection to their feeling states and a lot of intellectualization. The goals of therapy are as clear as the patient is eager to work on his/her self…

Many people oscillate between different attachment styles and feeling states about separation depending on the stressors in their lives.

Personally I have oscillated a lot in my life between feeling overly needy and clingy to feeling overly detached, uninterested in connection with others and when under too much emotional stress, reacting very differently as a teenager versus young adult versus older adult. Most of us have a variety of experiences with separation.

I also find it interesting that having a pet dog or cat can help a person heal from whatever childhood separation anxiety they may have experienced. The unconditional consistency of a dog cannot be matched by a human. While this leads probably to a big topic for another post, I find it fascinating how our relationships with our pets can help repair early anxiety and trauma. Of course there is the other side to this, when people get overly attached to their pets and it affects their relationships with people…

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