The Explosive Child: Case Example and Upcoming Training

Moshe will be offering a parent training group on The Explosive Child by Ross Greene Ph.D.  The 4 week group will teach parents the fundamentals of Collaborative and Proactive Solutions, the methodology Greene developed.  It begins Monday January 25th, 2016 and continue for 4 consecutive evenings from 6:15-7:45 at the offices of ASCEND Pediatric Neurology.  The fee is $300 per individual or $500 for a couple.  Please contact Moshe for more information.  

If you know me, or have read these blogs, you know that I've become quite a fan of CPS.  Here's a recent example (as in all postings, materiel changes have been made in order to protect confidentiality):

Denise is a 7 year old who has no diagnosis of any kind that is discernible at this time, with the exception of a strong oppositional streak.  She refuses to do anything educationally except participate in selected group activities she enjoys through the home schooling network in which her mom has her enrolled.  She's not enrolled in any certified educational school program - parents had begun home schooling and she ratcheted down the expectations to include only social activites.  I educated parents in CPS and when I first met her she was openly hostile to me, even as I took a very "collaborative" position, assuring her that the only thing I was interested in was her input to solve problems that the family might be having.  I followed the CPS recipe carefully, withholding my impulses to put this young lady in her place (ODD kids are able to bring forth those urges in adults.)  I later admitted to parents that this kid actually scared me - she really did.  I wondered how I'd ever get through to her.  

Long story short - we were able to use the model to successfully collaborate on toy clean up and bedtime routines.  And despite her assurance to me that she would NOT attend school, she's begun to do so.  I did tell her we'd be needing to collaborate on a solution about school, adding, for her to consider, that when we did so we would have to address the issue of truancy, as she had not been enrolled in any certified program for over a year.

CPS, a hot knife through the butter of oppositionality.  How's that for a saying?

First Things First: Horses vs. Zebras and Basics

Any discussion of persons in this blog are materially changed for reasons of confidentiality.

We live in a world filled with subtitles and complexities that fascinate us.  The exception, the example that does not fit the rule, the kind of oddity that proves the case that makes for dramatic turns in a Sherlock Holmes story or a TV drama.  It is easy for us to veer to fascinating exotic topics, processes and causalities.  And while I too can be fascinated by them, I also like to remember that "when you hear hooves, think horses not zebras."  What's most common? What's most basic? I've had a run of these topics with kids and parents recently that I believe highlight this principle.

Sleep:  I've had a couple of kids who have been struggling with their morning routines - a common complaint for kids, particularly for kids with ADHD.  I always note that the largest transition we make in any 24 hour period is that from sleep to awake.  It's huge and verges on the traumatic for some of us.  Just think how much cultural time is spent on "Monday mornings" in joke, song, excuses and coffee.

So when discussing the challenges to the AM routine, I first search for the horses: "What's the bedtime routine like?"  I've received some interesting answers.  From one 11 year old child, lets call him Robert, now living with his mother and not his father (which is a whole 'nuther discussion).  On weekends he's been playing video games until 1:30 - 2 AM as his video gamer "friends" (another whole 'nuther discussion) are in different time zones.  Is there any surprise that his re-adjustment to a (still too late) 10 PM weekday bedtime is hard - taking 2-3 days in which to recover?  So despite the mom's and the school's desire to put him on the couch to delve deep into his psyche; his avoidance; his feelings about his father; double checking with his psychiatrist about his medications etc., I think the proper first start is to allow this young man the full compliment of sleep that he needs.  So I suggested the draconian: one bedtime, one wake up time 7 days a week.  Pleasant shock: he suggested a 9:30 bedtime.  My conclusion: he actually does want some structure in his life, it's just been hard - for lots of different reasons - for his parents to exert it.  As I learned years ago from my friend Sarah Ninan, a gifted psychiatric nurse practitioner  - young kids who have a lot of power in the family can become terrified at what they can do with it and the result can be a lot of ambivalence and a lot of bad behavior.

Lenny's morning issues were similar.  He's a 14 y/o boy from a pretty normal family. Mom and dad are married, dad works full time, mom part time to be able to take the kids to their activities etc.  He has anxiety that's pretty well managed by medication, but his waking up and getting ready for school is a notorious flash point for the family.  Alas, as we explored his "issues" his use of his phone/computer at bedtime came up.  You know the rest, texting, Facebook, Snapchat etc all eating away at his bedtime.  More horses.  

School:  Brenda is an engaging if mischievous 12 year old girl with ADHD that is fairly well managed, but she does have a penchant for some impulsive behavior that can get her in trouble.  She's been caught lying at school and more recently was suspected of cheating, which in her upscale private Atlanta middle school was a pretty big violation.  The school's response was, as my old choir professor Dr. Orland Johnson used to say when we over reacted to one of his instructions on how to sing the music "taking out a hammer 'cause there's a fly on baby's head."  Now I don't condone cheating or lying, but I do remember that Brenda has ADHD.  Thus, she's predisposed to impulsive behaviors.  Her folks who are not trained educators or mental health practitioners get this.  I get this. So why does her school not?  She's now in what amounts to detention for the rest of the year, to help her learn the character traits that this school is wanting to instill in its students.  She's close to being asked to leave.  And - how surprising is this - she now is shutting down with the school's counselor and administration, fearing that anything she says will get her in trouble.

Kids with ADHD do not have bad characters by definition.  They have a neurological disorder that effects from 5% to 10% of kids - the most common psychiatric diagnoses kids receive.  More horses.

With Robert and Lenny it's also the basics of what is called "sleep hygiene." Having a set bedtime and sticking to it.  Understanding how much sleep kids and adolescents need (adults as well) and experimenting a bit to find out whether a kid does better with a bit more or a bit less sleep.  The results can be surprising.

In Brenda's case it's about the basics of educating kids.  Given the numbers, this school may have close to 100 kids with ADHD enrolled.  Detention does not fix the basic signs and symptoms of ADHD: distractability, hyperactivity and impulsivity.   Nor would I say a year long detention is the fix for a lack of moral strength, not that a 12 year old kid cheating is a high level of moral defect in my book.  Isn't it more of a teachable moment?  Engage her in a discussion about morals and character.  Explore the context of what was going on for her that led her to the cheating (there was lots of valuable context that the school didn't bother to explore before using the detention stick.)  But they missed the opportunity.  They chose punishment over engagement.

An attending physician I once worked with in a hospital was bound and determined to find a kid with an obscure diagnoses he had read about and then was the focus of a popular movie.  He was all but giddy with fascination of the disease.  It was a good movie, but did it merit the cost of the lab tests he repeatedly performed on the kids on his service?  Did it distract from the other, more obvious and common issues kids have?  To my knowledge he never found one - but who knows, maybe if he continues to look, he'll find that zebra.  In the meantime, I'll continue to be on the lookout for horses before I consider the zebras.

On being "Proactive"

Ross Greene's book The Explosive Child in which he lays out his model of Collaborative Proactive Solutions was initially known as Collaborative Problem Solving.  Due to a legal curiosity that resulted in an institution laying claim to the title Dr. Greene chose for his method of helping kids and adults solve problems, CPS became Collaborative Proactive Solutions.  But I'm not so sure that's bad as far as understanding what CPS is really about.  As much as it's a problem solving methodology, it's also a "proactive" methodology.

We live in a world where being proactive is almost antithetical to the ADHD infused impulsive life so many of us live.  Some describe such poor ability to plan and anticipate as being "spontaneous" as a way of saving face, but it rings hollow.  We may meditate, pray or do yoga, all in the name of finding our "center" our "mindfulness" or our "observing ego" in Freud's terms.  But the nature of our distracting world that peppers us with so much visual and auditory "stuff" makes it quite difficult.  Sometimes it may be trying to fit too much into too little time, aided by the often heard motto of "doing more with less" and the potential to do more with "multitasking" (I write this while eating lunch, listening to my music, answering my phone when it rings.)

For example: while running errands just prior to an appointment recently, not having made a list of what I needed at the store, I (inevitably) left the store without something I wanted to buy.  Sound familiar?

When I discuss with parents the importance of being "proactive" with their kids, it can often be an uphill battle.  So often the response to this is a question inquiring as to how CPS can help once a child has faced problems that are greater than his/her skill level can manage, the point at which bad behavior so often occurs.  And as I learned asking the same question of Dr. Greene, this is a proactive model, not a reactive model.  So when a child tantrums, melts down or misbehaves in some way, the window for proactive planning has clearly passed. What has not passed is the realization that so often the problems being faced are predictable.  Whatever triggered this behavioral problem is likely to reoccur. Planning for the next time is the focus of CPS.  It's one of those things that is simple, but not always easily grasped by parents.

I suspect one of the reasons it's hard to grasp is due to, as mentioned, our distractable world which impedes our lack of planning as parents.  What is critical when parenting a child who has behavioral challenges is remembering that the cost of planning in advance far outweighs the cost to the child without planning when the child is predictably and inevitably faced with a situation in which they don't have a collaborative solution in place to at least try to cope with the situation.  It's impossible to weigh the burden on a child who is yet again facing a situation in which expectations exceed their skills.  How many of our kids struggle with tantrums over and over, and at what cost to their sense of self? And remember, that a collaborative solution is not a solution in which the child has 100% of the responsibility to simply not repeat the behavior.  Collaboration involves spending the time with the child to understand in a much broader way the child's experience of the problems at hand - that process known as the "empathy step" of CPS.  The interested reader is referred to Greene's www.livesinthebalance.com website.

We indeed live in a time where focus, planning and being proactive is very difficult.  We also have children for whom we are responsible.  And having children is a bit of a game of chance, a bit of a Forest Gump box of chocolates. We don't know what we're going to get.  Despite that, we are obligated to give our children all we've got.  It's not too much to include the time to be proactive.

A Path to Collaboration: Saving Face and Listening

As with all descriptions of client encounters, materiel changes are made to protect client confidentiality.

As a licensed professional, I'm required to participate in "continuing education" to keep my license current.  After 33 years in the field, I've seen a lot of CE unit offerings, some interesting, lots boring.  Some of the best were CEU's I constructed myself to address my own interests, including 2 weeks with Peter Fleming in southern Italy studying Contribution Training (see my website for more) as well as the CEU's received in pursuit of certification with Ross Greene Ph.D., author of The Explosive Child and Lost at School and a 5 year NIMH study recently published proving the efficacy of his method of "Collaborative Proactive Solutions."

I'd seen and heard of the "Explosive Child" book, but had no intent to enter Greene's room early last summer.  Getting the CEU's for my license renewal was all I wanted.  So I explored the vacation option, you know, the one where professionals get their CEU's and vacation at the same time.

Cape Cod, early summer, the beach, my wife could come, family in New England I could visit.  The dates worked.  So place and time was set.  Now to pick a class that I wanted to learn.  It was Ross Greene or some other class that I found to be a bit too touchy feely for my taste, so Greene it was.

I read The Explosive Child  on the trip north feeling some obligation to be a responsible student.  Well, I read most of it, it was vacation after all.  I could read the rest through the week of the conference, which is what I did (having little option, being laid up the entire time with a bad back.  It was that or lots of bad TV, so I compromised, reading some and watching some, not lots of bad TV.) When the class began on a high school campus with weathering on its buildings and trees from the thick Cape Cod moisture, the comfortable informality of The Cape was evident, flip flops and t-shirts abounding.

Greene was unassuming - as high end scholars can be.  He had been on faculty at Harvard, what else is there to say - or as so many from that most esteemed institution do, to not have to say.  Confident, soft spoken, not overbearing like some successful creators of methodologies.  Friendly.  I was not prepared to be impressed as he rolled out his experience of working with tough kids.   I thought he might be one of those guys with a great personality, a lot of charisma that can be so influential but so very hard to replicate.  I'd been working with tough kids for decades, so I figured there'd be some reformulation of principles and strategies that have become standard in working with hard kids like: Parents need to be in control and execute a clear behavioral plan centered around "if/then" contingencies such as: "Johnny, IF you clean up your room, THEN you get to go outside and play;"  A behavioral plan that is intuitive, scientifically validated by all of my Applied Behavior Analysis colleagues, the bedrock of family systems theory where the parents function as the "executive branch" of the family, setting the structure for the children.  How does collaboration fit into this?

I started to pay attention as Green repeatedly focused on the importance of carefully and accurately understanding the child's point of view - not from the parents, or the therapist, or the teacher, but from the kid.  I became more intrigued when Greene reinforced over and over the importance of avoiding describing the problem to be discussed in therms of "problem behaviors."  He then (had the audacity to) suggest we not present the child with our "theories" about "why" they are behaving in the fashion that's causing us such discontent. Imagine, denying us, the highly educated, very experienced therapists our moment to enlighten the child about their inner motivations.  Denying parents who know the kids best - why can't they communicate their expert point of view to their own child?!?  Teachers who often spend more time with the child than the parents - they have a real objective point of view to offer the child.  All of us adults know what's really going on. So why NOT allow us our moment to "communicate" our observations with the child?

The reason the Collaborative Proactive Solutions model doesn't encourage the sharing of our erudite "theories" with the child is because what we've done, inadvertent as it may be, is overwhelm and intimidate children with our theories. Theories that are often way over the child's cognitive level to understand anyway.  Theories that often demean or embarrass the child by pointing out in grand style their lack of judgement and lack of restraint.  We haven't left the child behind, we've used shame to attempt to change their behavior.  We repeatedly accuse our children of aggression, irresponsibility, bad intent and disregard for parents and siblings welfare.  The fact that sometimes the theories may be accurate is besides the point.  When the child's being overwhelmed by our power, they are much more likely to respond in a defensive and even hostile fashion, adding more fuel to the fire of the conflict.

Now shame may have some place in child rearing, but, in my view, only when children are very very young and in very proscribed circumstances.  We've all seen a small child erupt in tears when they've done something wrong and a parent simply looks at them in a disappointed fashion without saying a word. That's shaming.  It can have a proper function, when integrated into the child's emotional package, of self reflection. But the level of shaming that we participate in with our kids in the name of helping them is grossly misguided in my opinion. This is exactly what CPS avoids.  By asking children about their behavior in a way that doesn't focus on their behavior (not really as hard as you might think), we lower their defensiveness and heighten their willingness to participate. By dropping our theories, we create a much broader space for the child to tell us their views of the situation.  By validating what they say in a reflective, non confronting way, we encourage them to say more.  By not pressing them about "why" they did or did not do something (see my post of 3/2/15 "The End of the 'Why' Question") we draw them to tell us what's really on their mind.  And isn't that what we really want to know anyway??

Asking the child in a neutral way welcomes participation.  Responding in confirming, supportive and non-judgmental ways will garner us much more information much more effectively.  Using "reflective listening" (which many parents have learned at some point in college or training), in which we reflect back what the child is telling us in a non judgmental fashion allows space for more communication - and isn't THAT our goal?  Remember, parents, listening reflectively isn't agreeing, it's just listening and creating a space for the child to trust and talk.

So I paid more attention to what Greene was saying.  And it was made more and more sense as the week continued.

I returned to Atlanta, much more thoughtful than I'd anticipated being after my mostly bedridden week in New England and gave it the old college try.  An 11 y/o boy with classic high functioning autism who had come due to some new behavioral concerns.  He sat looking at a random spot on the floor, typical for lots of kids on the spectrum who find eye contact difficult.  I asked, open ended questions, hoping for a thread of response to which I could "actively listen."  It was the longest 25 minutes of any session I've ever had.  I was trying to actively listen to shoulder shrugs, to monosyllabic grunts or to the ever present mumbled "I don't know."  Slowly, carefuly, I responded.  He responded. Repeat.  I worked hard; no theory, no behaviors, no "why" questions.  This went on for a while and after responding to concerns that actually sounded like a full thought, he looked up - making eye contact - long, lingering eye contact with me for the first time since walking in the door - and after a dramatic pause said with great emotional affect, "Finally, someone's listening to me!" (emphasis not added)  Well, that pretty much did it for me - I'd interviewed hundreds of kids on the spectrum without getting a response like that.  He's doing great now - really.  He still has autism, but we learned enough to put in place enough that provides him the supports he needs.

I was hooked and soon signed up for Greene's advanced certification program.

If you read this blog, you're likely to hear more.

Marital Jazz - Finding a Couple's Language

As with all postings, materiel changes to any descriptions of clients are made to protect their privacy.

I've been working with Hank and Mary for about a year.  They often struggle due to the confluence of a many challenges between them: diabetes, depression, ADHD, and a history of verbal fights that can be pretty sharp.  Divorce has been in the air, more, I believe, as a signal of desperation than intent.  When they're both calm, they genuinely express their love for one another.  And this has gone on for decades.

After one of their tougher disagreements - they didn't speak much for a couple of weeks following a disagreement on how to manage their business - they came in having reached the predictably calm after the storm state in their marital music. The atmosphere between them was soft and caring, unlike the last meeting we had when they were in the middle of their business argument.  So I made an observation, drawing on their mutual love of jazz - not that I'm a big jazz guy, my tastes go much more towards classical and classic folk, rock, blues - but I know enough about music and jazz to through around a few comments.

Hank and Mary riff back and forth with one another all the time on themes of her sense of guilt and responsibility - honed at the feet of her critical parents - and his accommodation of her penchant to feel guilty, often depressively so, by criticizing her actions, inactions, or whatever tune she throws to him.  One common topic of their conflict is their business - though somewhat surprisingly, given their frequent ups and downs, it's been very successful.

We discussed the subtle ways in which they can go back and forth on the theme of Mary's sense of guilt and the way she over performs in their relationship and business to try to make things better, to try to make Hank happy.  And Hank can be somewhat irascible, so she has a broad canvas (if I can mix metaphors) on which to paint.  The more Hank's unhappy about this or that issue, expressing his riff on their song, the more Mary will play back with her variation of her wanting to make it right by over functioning, trying to come up with a different, better, novel idea in their business or marital life, rarely to the mollification of Hank and, the improv is on.  She struggles to accommodate his dissatisfaction with his topic of the day, and her lack of success in molifying him breeds yet another reprise of the tune of her trying something else, ultimately leading to her fatigue, frequent depression and tears and so often a fight between them.

They've been at this for years, so I don't know if their participation in our discussion using their shared love of jazz might help them see the dance in which they're engaged (mixed artistic metaphor #3 if you're counting).  It's a discussion we've had, in one way or another, a few times already, but they have yet to inhibit their repetition of the chorus.  Maybe speaking their jazz language will help.

Standing In His Truth - A Neurotypical Sib's Strength

As with all postings, materiel changes to any descriptions of clients are made to protect their privacy.

Standing in his truth.  It's a phrase I always found a bit psychobabble-ish, so I rarely use it.  But recently, I sat with an 11 year old boy, Andy, who did so remarkably.

There was, let's say, a difference of opinion between the boy and the child's stepfather about a specific incident.  Andy, his sister Crystal, his biological mother and stepfather and  were reviewing the incident in my office, the mother, understandably, wanting to create an allegiance, a "united front" with her husband of many years.  Crystal is 15 and has high functioning autism and is often a challenge to her parents and step parents, but Andy generally stays out of the fray.  Crystal's done a lot of work on a lot of issues and, generally, is doing well.

Now I have to say, I'm overwhelmingly a fan of parents presenting a "united front" when they're dealing with their kids.  I've long held that parenting can be at risk of devolving to a game of football where the child "splits" the parents as effectively as a good offensive line can split the defense and scores a goal while parents proceed to fuss at one another about who did what when and why.  It's a very well established play that kids call upon given their highly sensitive ability to detect the potential for parental differences.  It also can, in the best of circumstances, help parents sharpen their team playing skills - which are often needed when dealing with kids.

But I'm not so sure that Andy was splitting.  This is a situation where step dad's depression has become worse we've been working in couple's therapy on the challenges that Crystal brings to the family.    Step dad's been using meds to treat his depression, but it's a hard slog, as depression can be, and additionally, Crystal's behavior is indeed a stressor.  Men, classically, can become irritable when depressed, which is what I think happened in this case.  I've seen stepdad's irritability arise in the office and he has a history of his anger flying a bit off the handle.

When reviewing the incident between Andy and stepdad, the conflict was evident and it looked like a "he said she said" situation, with Andy and step dad on either side of the line and mom wanting to support her husband.  Andy impressed me.  He related his version of the incident quietly and calmly - remarkably quietly and calmly.  Admirably, step dad did not raise his voice or try to leverage his adult role to make Andy submit.  He was calm as well, reviewing his view of the incident.  Crystal, mostly quiet sat and listened.

Andy's a typically developing kid, the classic "neurotypical" (NT) sib.  He and Crystal are shuffled back and forth between the mother's and father's home weekly.  There's very little tension between his biological parents and historically, Andy's coped well with the weekly transitions (not as much so for his Crystal), which says a lot for an 11 year old boy with an older sister on the spectrum.  Andy is the classic "opposite" of his sister.  He is well behaved, responsible about his schoolwork, doing well in scouts, active in sports.  Pretty much everything one might want in an 11 year old.  Andy has begun to participate in therapy in an extension of the family work mom and stepdad are doing with Crystal.

What impressed me the most was Andy's calm nature when he said his piece. He wasn't defensive, his story didn't waver or change as it was reviewed (and it had been reviewed a lot by the time they brought it to therapy.)  He just stated his view of what happened.  Strongly, softly.  It was quite a moment - and it left mom and step dad a bit befuddled.  Later it was step dad who walked his story back a bit, admitting that he's been on edge and struggling with his depression and how to deal with other stressors in his life.

Andy remained calm.  It was a bit of a moment, Andy showing his strength of character while mom and step dad re-evaluated what they thought was their united front.

The main thing I took from the exchange was Andy's ability to "stand in his own truth" of what happened.  Mom and stepdad will continue to work on their relationship and coping with a teenage girl on the spectrum - which can certainly be challenging to everyone.  Stepdad's come out of past depressive slumps OK before.

But Andy - won't he be a force to be reckoned with in the coming years - in very good and exciting ways.

King Solomon, Hillel and David Burns: If I Am Not For Myself.

As with all postings, materiel changes to any descriptions of clients are made to protect their privacy.

Pretty disparate title, no? King Solomon lived almost 3,000 years ago.  Hillel, a Rabbi authored many important opinions in the Jewish Talmud lived about 900 years later.  David Burns is a psychiatrist who is still living.  What on earth could they have in common?

Kim hs just started HS and has been working hard on dealing with anxiety.  Anxiety disorders occurs in 25% of all teens from 13-18 according to the NIMH.  That's a lot of kids.  So Kim's situation is pretty common.  Indeed, I see lots of kids with anxiety.

Kim's dad had, dutifully upon my recommendation, bought her a book about anxiety written by David Burns, the psychiatrist who wrote the seminal book Feeling Good about depression.  He's gone on to write about anxiety and panic disorders, and "cognitive behavioral therapy" to which he is a foundational contributor.  It's a well documented treatment for anxiety, depression and panic disorders.  His books have lots of information, worksheets and the like about anxiety - and Kim and I recently embarked on a detailed discussion about her experience with anxiety as she's begun to go through the book.  In the midst of our discussion, I was reminded of comments that seemed so apropos.  Historical comments that took us on a millennial trip.

She first observed that if Burns had known so much of this, there had to be a lot of people with these issues to study.  She noted that she's likely not as alone as she has feared.  I commented reflexively "There's nothing new under the sun," originally stated by King Solomon in Ecclesiastes, commenting upon the pursuits that occupy people's lives.  He didn't use the term "cognitive distortions" but, I dare say, would have understood the term in light of his writings about how we develop meaning.  Yes, Kim, there's been anxiety since we had to worry about being attacked by saber toothed tigers.  Our job is to balance when it makes sense to worry - and when it doesn't.  

We then moved on in our discussion about Burns' musings on anxiety and turned the corner into the burden many of us have prioritizing our own needs over the needs of others, and how, if we focus too much on the needs of others, our own needs become neglected.  Again, reflexively, I stated Hillel's famous comment from about 2,000 years ago:

              "If I'm not for my self, who will be for me?  But if I am only for myself,                who am I?  If not now, when?"

Kim and I discussed that indeed, we are not islands where we never need others, nor do we ignore others' needs.  Neither are we able to be a fountain of unlimited giving to others.  But we do have to connect and contribute to others.  Hillel's goal, if I may be so bold to say, is balance, a skill that many folks with anxiety (and depression) struggle to maintain.

And of Hillel's last statement: "If not now, when?"  I think that brings Kim right back to Burns' book.  He's quite clear in his books that they are not just for reading.  They're for using.  Using the tools, the worksheets and the exercises that are outlined to challenge the preconceived conclusions that we have that keep us anxious or depressed.  This practice enables learning - in the same way kids play catch with a parent - so they can master the skills involved in throwing and catching the ball.  They create muscle memory that sticks with them for a lifetime.  The practice with Burns has to do with creating the neural pathways - the neurological equivalent of muscle memory - in order to successfully address the anxiety/depression at hand.

So, Kim is, hopefully, on her way to the path of creating these different strategies to address her anxiety.  She's a good kid, a hard worker, and I have faith in her desire to challenge the current "cognitive distortions" that keep her anxious.  I was a bit surprised, however, that our discussion of her journey brought us from today, back 2900 years to the days of King Solomon with a short - but meaningful stop some 2000 odd years ago with Hillel.