How to Treat Child Separation Anxiety

Telling a child you will return means nothing to them if they feel they'll never see you again.

As a child, being told someone will return means nothing if you feel you’ll never see them again. Words do nothing to ease the aching longing, inconsolable panic, and wretched sobbing.

Imagine for a moment the feelings of utter helplessness and abandonment a child might feel in this situation. Experience the emotions as if they were your own.

To truly empathise, this is what we must do. We need a certain level of imaginative capacity to get a taste of another person’s reality from the inside.

Gloria was six years old, and she would cry inconsolably whenever her mum, Sally, even so much as looked like she might leave her, be it at school or anywhere else.

“Gloria’s just always been like that,” Sally told me. “Even before she went to school. I work from home, and it’s just the two of us. I’ve been keeping her off school because I just don’t know what else to do. Nothing seems to help!”

Sally was a single parent, and fun times with her daughter were melting away.

“All we seem to do is fight. I spend so long trying to get her to stay at school or at my mother’s, and she just pushes back all the time. We love each other, but if you saw us every day you’d think we didn’t at all!”

It was a painful story, but it was far from unique.

When parting is such bitter sorrow

Separation Anxiety Disorder (SAD), a fear of being separated from a significant person, affects 4-5% of children and adolescents and can persist into adulthood.¹

My young client’s anxiety would reach such a pitch that her mother and even her teachers felt she needed time at home to de-stress. She was just unmanageable when she was left at school, and right now she clearly wasn’t in a position to manage her own feelings. Could I help?

I could try.

Abandonment issues and personal development

Fear of separation – of being left alone and apart from someone significant (often a parent) – is a normal developmental stage many of us go through.² But when the anxiety is severe, or if it doesn’t start to fade naturally past the age of four or five, help may be needed. If not managed properly, separation anxiety can last a lifetime.³ The more independent a person can become while they are still young, the better the outlook for their future mental health.

Separation anxiety can, of course, track alongside all kinds of other manifestations of anxiety in young people, such as:

• bedwetting
• nightmares
• school phobia (which may, in fact, be the flip side of separation anxiety)
• difficulty making friends.

Gloria had few friends, as she couldn’t bring herself to stay away from her mum at all, let alone for the duration of a party or playdate. She also suffered a recurring nightmare in which her mother died.

Parental separation, innate proneness to stress arousal, and other emotional disturbances at home or elsewhere can all contribute to SAD. But there’s something else we need to consider first, which leads me to my first strategy for treating separation anxiety in children.

Strategy one: Look to the parent

Fear of separation can cut both ways.⁴

“I must admit,” said Sally, “I cried when I first took Gloria to school. I was inconsolable. I think she picked that up from me.

“I just kept saying ‘sorry’ to her over and over as I left. I think I was crying more than she was back then!”

Children are constantly observing and learning from the behaviour and emotions of those around them, and they use that information to decide how to react, behave, and feel.

Of course, Gloria might have picked up this anxiety even if her mother had been totally relaxed about leaving her at kindergarten. Still, obvious parental agitation doesn’t, of course, help the child.

But that certainly doesn’t mean we should blame the parent. More recently Sally had made great efforts to hide her own distress at leaving Gloria. But it’s really useful to ask your young clients’ parents how they feel about leaving their child and, perhaps more importantly, how much their emotion may have impacted, and be impacting, their child.

Useful questions might include:

• How did you feel the first time you left them in the care of someone else?
• If we saw a video of you taking them to school and leaving them, what would you look like? Would you be smiling? Spending a long time reassuring them? Would you look calm or upset? What would we see?
• When has it been okay? When, if at all, did you leave them and find it wasn’t too much of a problem? The answers to exception questions like this can give us clues as to how to construct therapy for the child.

Helping a child with separation anxiety isn’t just about changing the child’s mindset and behaviour. It’s also important that we help the parent, or primary caregiver, behave in ways that will help their child.

So what adult behaviours can help the child?

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Strategy two: Give the parent some simple pointers

This is far from rocket science, but when you are close to a child it can be hard to have the clarity of mind to act in ways that best serve them.

After talking with Sally about how she acted towards Gloria when leaving her, and helping her manage her own feelings around that, Sally and I devised a behavioural plan. I asked her to:

• Act normally. I suggested to Sally that she chat with Gloria on the way to the drop off, but not overdo it with reassurance and soothing, as this implies there is something threatening. I suggested she talk about what Gloria had to look forward to at the drop-off place, but without making it seem like a big deal.
• No long goodbyes. I asked Sally to say goodbye quickly and go. She had been spending up to 20 minutes trying to separate from Gloria, who would become increasingly hysterical. Of course, Sally was to continue being loving and give Gloria affection, but leave with a clear “I’ll see you later.” Children (okay, adults too!) quickly come to know whether they can control us with emotion.
• Be true to your word. As far as possible, we need to let the child know when we’ll see them again and stick to those times. If Sally was going to be unavoidably delayed, she was to call the teacher’s phone and speak to Gloria.
• Don’t over-reward. Once Gloria had successfully stayed somewhere, I suggested Sally not make out like it was a huge achievement. Congratulations are merited when we have done something difficult or out of the ordinary. This desired behaviour was normal and expected, and needed to be treated as such. Sally was to say something like “There, that was fine, wasn’t it!” then move on.
• Practise separate time. Sally said that Gloria liked to think of herself as “a big girl”. I suggested Sally utilise this by sometimes telling her daughter that they were going to practise her “being a big girl” by dropping her off at her grandmother’s or at a friend’s. In this way, Gloria would start to see a positive aspect – “being a big girl” – to being apart from her mother.
• Offer distractions. Sally, like many parents, had found that the more distracted her daughter became with a game or other children, the easier it was for Sally to ‘creep away’.

These were just a few practical ideas, and certainly Sally had been trying some of them already. But now she was even more determined to stick to them. We even had her role-play what she’d say and how she would say it to Gloria, and I helped her hypnotically rehearse feeling strong and calm in these times of farewell.

But we still needed to help Gloria directly so she could start feeling calm and relaxed about her burgeoning independence (as I liked to think of it!).

Strategy three: Help the child find a place of calm

We adults like to complicate things. That unique brand of intelligence we possess as children – the kind that simplifies and accepts things as they are – seems to be gradually stripped away as we age, and we may start to feel that obvious solutions must be wrong solutions.

Therapy may come to be seen as a long, complex, arcane process, but at the heart of all wellbeing sits – quite comfortably, I might add – simple calm. The antidote to fear is relaxation. And Gloria needed to relax more when physically independent of her mother.

Of course, there are important caveats when working with children. We need to build rapport and speak with their understandings about the issues that matter to them.

But, ultimately, we need to teach children how to relax more in the situations that have been bothering them.

So how can we do that? Well, all the therapy we do should be encouraging, gentle and calming, including the steps I outline below. But as we’ll see there are some specific ways in which we can help children feel calm and more confident.

Here’s the approach I used with Gloria.

Strategy four: Agree on a goal with the child

At six, Gloria was old enough to benefit from therapy. Sally sat in with us at first, and Gloria initially seemed shy and diffident with me – not at all surprisingly!

I asked why she thought she was here.

“Because I cry when Mummy leaves me at school.”

I asked if she’d like to be happy at school, and feel like a big girl. She actually laughed as she said yes. So now we had some kind of aim. I told her I knew a way of helping her feel better, “like magic”.

Strategy five: Tap into the child’s imagination

Children live within and through their imaginations. (Actually, this is true of adults too!) And imagination is exactly what we need to utilize when doing therapy.

I talked with Gloria about what it’s like to “feel really sleepy” when you’re going to sleep and what it might be like to have “really nice, happy dreams”.

Now I told her a therapeutic story about a little squirrel who thought she was lost one day while she was out playing. In fact, she was being looked after by some rabbits while Mummy was collecting nuts in another place. The squirrel wasn’t happy at first, but she started to become happy as she realized that she was getting bigger and becoming more grown up. Then the squirrel met some friends, who were getting to be bigger squirrels and didn’t need to be with grown-ups all the time. I described some of their adventures and the fun they had.

I kept my voice gentle and soothing, and used plenty of hypnotic language patterns to convey greater levels of unconscious meaning.

I suggested Gloria close her eyes and imagine seeing herself on the screen of an iPad (yes, that is a sign of the times!). I asked her to watch herself going to school and being a big girl, feeling happy, with time going quickly, and then seeing Mummy later. I then had her view herself looking happy in all kinds of other scenarios in which Sally would leave her.

Research has found that when we imaginatively observe ourselves engaging in a desired behaviour from a third-person position, we are more likely to engage in that behaviour.⁵ As Gloria engaged her imagination to see herself as a “big girl”, she looked totally calm and relaxed.

I saw Gloria twice more with her mother. Each time she seemed more relaxed, and I found I could make her laugh. On the final visit, Sally popped out for 20 minutes to run an errand and Gloria was fine.

A better future

Gloria enjoyed the sessions. She said she felt better about being left alone, and pretty soon her mum reported she was, more or less, sticking to the practical guidelines we’d outlined together during a Skype session early on. She said Gloria liked the sessions, and would come back if she needed to. But she didn’t seem to need to right now.

Gloria had started going to school again. She’d been a little anxious at first, but had “settled in amazingly quickly.” She was making more friends and appeared more happily distracted when her mum left her each day. She also seemed to be sleeping better and hadn’t reported any nightmares lately.

“We are both happier now,” Sally said.

If we start by gathering information about both the parents’ and the child’s behaviour (not just their feelings) and making behavioural suggestions, we can be better prepared to then work on calming inflamed emotions in the child and the adult.

With Facetime and so forth, separation anxiety may seem easier to manage than ever before: it’s easy for the parent to keep tabs on the child, and vice versa. But to truly help a child develop and mature, we need to help them become as emotionally independent as possible.

It’s one of life’s great paradoxes that those we love should be the easiest to be apart from, because love itself transcends both time and space.

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About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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