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Regine Galanti: Childhood: Addressing Children’s Mental Health

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SUMMARY

Our mental health series is sponsored by Terri and Andrew Herenstein.

This episode is sponsored by Twillory. New customers can use the coupon code 18Forty to get $18 off of all orders of $139 or more. 

In this episode of the 18Forty Podcast, we talk to Regine Galanti—a licensed psychologist who specializes in treating anxiety, OCD, and behavior problems in children, teens, and adults—about mental health treatment among today’s Jewish families.

It’s a relatively recent phenomenon in Jewish history that our material needs are largely taken care of. While this is a tremendous blessing, it’s redirected our attention to the psychological needs toward the top of Maslow’s hierarchy. This is a kind of suffering that many of us are still learning how to handle, and that we anguish over figuring out how to address in our children. In this episode we discuss:

  • What is going on with young people and mental health, and how can we help our children thrive?
  • How can we contend with the mental health blessings and curses that come with modernity?
  • What should we do when we are depressed or anxious?
Tune in to hear a conversation about how we might go from doom-scrolling about mental health to taking meaningful action.

Interview begins at 19:48.

Dr. Regine Galanti, Ph.D. is a licensed psychologist who specializes in treating anxiety, OCD, and behavior problems in children, teens, and adults. She is an expert in Cognitive Behavioral Therapy (CBT) and Parent-Child Interaction Therapy (PCIT). Dr Galanti is the founder of Long Island Behavioral Psychology, a therapy practice in Nassau County, Long Island, and is an Educational Consultant in the Psychiatry Department of Mount Sinai Hospital. She is the author of Anxiety Relief for Teens: Essential CBT Skills and Mindfulness Practices to Overcome Anxiety and Stress, as well as When Harley Has Anxiety: A Fun CBT Skills Activity Book for Overcoming Worries and Fearsand, most recently, Parenting Anxious Kids: Understanding Anxiety in Children by Age and Stage.

How Anxiety Became Content” by Derek Thompson

Breaking Free of Child Anxiety and OCD by Eli R. Lebowitz

The Explosive Child by Ross W Greene

The Happiness Trap by Russ Harris

10% Happier by Dan Harris

David Bashevkin:
Hi, friends. Just a quick message from our episode sponsors at Twillory, T-W-I-L-L-O-R-Y are offering now a credit to all 18Forty listeners. Just use coupon code 18Forty, 1-8 F-O-R-T-Y, get $18 off all orders of $139 or more, open to all new customers. I love their clothes. Honestly, I wear them. I sometimes get made fun because I wear their scarves too often, even when it’s not cold outside. But you can get $18 off all orders of $139 or more open to all new customers and use coupon code 18Forty, 1-8 F-O-R-T-Y at checkout.

Hi, friends, and welcome to the 18Forty Podcast where each month we explore different topic bouncing modern sensibilities with traditional sensitivities to give you new approaches to timeless Jewish ideas. I’m your host, David Bashevkin, and this month we’re exploring mental health. Thank you so much to our series sponsors, Andrew and Terri Herenstein. I’m so grateful for your friendship and support. Horofei lishvurei leiv umechabbeish le’atzevosom. Together, let’s continue healing all those who are in pain or suffering. This podcast is part of a larger exploration of those big juicy Jewish ideas, so be sure to check out 18forty.org. That’s 1-8 F-O-R-T-Y.org. Where you could also find videos, articles, recommended readings, and weekly emails. I was not at all surprised by the feedback. The heartfelt feedback that we have gotten since the beginning of this series, I’m very grateful is a topic that is near and dear to my heart. Much of the feedback as you can expect are people who are exploring or dealing with their own issues and using the language and ideas that we’ve described to find a path in their own lives.

But there was a different feedback, and this is unusual. So many listeners who I am so grateful for sent me a different podcast, an incredible podcast. You know how much I hate plugging other people’s podcasts out here, but she doesn’t need my help at all and that is Barry Weiss’s podcast called Honestly. So many friends … my sister sent it to me. A lot of people sent this to me and I’m grateful to all of them, but they were reaching out and sharing an episode with me, a very important episode that, of course, we will link to that was entitled, Why The Kids Aren’t Alright, which is an exploration of mental health but actually in a very different and important direction. Which questions are we a generation that is overpathologizing what should normally be deemed regular mental health problems?

On this episode with Barry Weiss, she sat down with an author named Abigail Shrier who just published a book called Bad Therapy: Why the Kids Aren’t Growing Up. She explores the mental health industry, the world, and her basic idea is that many therapeutic approaches have serious side effects, few proven benefits, and we are overpathologizing. We have a generation where everyone is walking around saying, “I have this diagnosis, I have that diagnosis.”

When we overpathologize normal behavior that can have a very bad effect. We don’t want that. We don’t want people walking around thinking that, “I am a label, I am depressive, I am anxious.” That is all they are the summation and basically pathologizing slapping a name onto what is very normal worry, very normal types of sadness. I think this offers a very important perspective. Because it’s worth reading and exploring, but I do want to mention a few caveats because it’s not like I was unaware of this perspective.

I was deeply aware of this perspective. I think very often I have seen people who have become overpathologized, walk around, and use this for… I think most dangerously in the age of social media, you have people who are using their social media platforms just to talk about their own mental health at all times, oversharing in a way that can just perpetuate a problem that needs a different form of help. Abigail Shrier is not the first person to raise this issue. There’s somebody else whose articles I find extraordinarily thoughtful. His name is Derek Thompson, who’s a staff writer at The Atlantic, and he wrote something over a year ago an article that actually gave me great pause as part of the reason why it took so long to even discuss this topic.

That article is called How Anxiety Became Content. The way we commonly discuss mental health issues, especially on the internet, is not helping us. He offers a thesis that I find extraordinarily compelling. I have seen it with my own eyes. He turns to two researchers, Lucy Foulkes and Jack Andrews who coined the term prevalence inflation to describe the way that some people, especially young people, consume so much information about anxiety disorders that they begin to process normal problems of living as signs of a decline in mental health.

If people are repeatedly told that mental health problems are common and that they might experience them, they might start to interpret any negative thoughts and feelings through this lens. That’s what they write, this is part of his article, and it’s absolutely worth reading. Then Derek Thompson in this very same article quotes, a clinical psychologist at the University of Southern California named Darby Saxbe also is a mother to a high schooler. She said there’s a unique danger in the nexus between this prevalence inflation.

Everyone’s talking about it. Everyone is making a big deal and pathologizing what could be normal worries and that intersects with something else, which is social media. This is what he writes. “This is just one way in which our society popularizes the language of therapy while eviscerating the substance of it.” Saxbe says, “We all and young people in particular too often use our phones to withdraw and avoid.” Even if we’re getting insightful therapeutic content, we’re often getting it while we’re in bed and on our phones. So it could really just compound the problem and allow you to withdraw more from the very content that you think is helping you, you’re actually withdrawing more and more and encouraging more people to go online.

They see the clicks that it gets and just pour their hearts and souls out without getting the proper therapeutic help. I remember reading this article when it came out, it was over a year ago, and my own hesitance, I am an oversharer, not because I think it’s a good thing.

I think you sometimes are forced into oversharing or I don’t know, you’re sharing a lot if you’re running a podcast, so you’re forced into it. But even that, one of my students, I was in class and was commenting on the episode that I did about my own mental health journey and said, “Wow, I can’t thank you enough.” He was thanking me for opening up so much like, “I really know you now. I really know your story.” I corrected him right away. I said, “I love you. You’re wonderful. I’m so glad you listened to it. I’m so glad it resonates. You do not know me at all. I did not share really anything if you go back to listen to that, so much of the formative, really heavy experiences I either fully glossed over or the really intense stuff I didn’t share at all because I didn’t think it would be helpful.”

So it is something that I’m sensitive to, but I want to address that larger thesis of bad therapy, what Derek Thompson talks about. He’s talking about specifically a mental health angle in this article. But has the pendulum swung too far in the way that we are discussing this? I think one very helpful thing to keep in mind, and I’ll say just three things on this and then we’ll go into our episode today. Because I think it’s extraordinarily relevant in our conversation with Regine Galanti who’s written so many important books on childhood anxiety and the role parents can play, et cetera. But I think it is really important to talk about number one, the difference between a type one and a type two error. This is something I’ve spoken about a lot and it is just so essential whenever we analyze information like this, there’s a difference between a type one error and a type two error.

What is the difference? You formulate a hypothesis. We are not talking about mental health enough. We’re talking about mental health too much. A type one error leads to a false positive. That means that our hypothesis is now too broad, that we think something is there, and it’s really not. That is very dangerous. It is also dangerous to have a type two error where you get a false negative. That means your hypothesis is so narrowly constructed that there are people who would fit into your hypothesis who are now either not getting help as it relates to mental health or being looked over. I think, and this is somebody who’s dealt with these issues my entire life, I don’t think we’re ever going to have it perfect in between a type one and type two error. You’re only going to get perfection in laboratory settings that are usually almost impossible to repeat.

Societally, we do swing back and forth between type one and type two errors in the way that as a society, we think about mental health problems and perhaps we are at a moment where we have a type one error where we have a lot of false positives. People who are inappropriately using the language of anxiety, depression, OCD, whatever it is to describe really commonplace, issues of worry, sadness, being ambitious. These are not necessarily illnesses, but I don’t think the corrective measure is to swing so fully into the other direction, which I think previous generations very much lived with, which is a generation of type two errors where people who are in very need of very real help are unable to seek it because they’re like, “Oh, come on now, come on now. This is normal, this is regular.”

What we need is to allow people to educate people and everyone needs to educate themselves and everyone needs to take responsibility for their own families to make sure that they are as balanced as possible. That you are not committing type one errors in your mental health life, that you are surfacing things and assuming that this is pathological, this is not okay. I see this all the time and it’s a very real issue. But type two errors are also a very real issue. People who go through their entire life carrying around a heaviness, not knowing, and not understanding that this can be addressed, this can be resolved, you don’t have to live this way, I think is equally dangerous.

Sometimes it takes very serious thinkers to go up and maybe a book called Bad Therapy will wake people up if you’re struggling with type one errors. But it is also important that we do not swing too wildly to the other extreme and have type two errors, which is why it’s so important to have a good infrastructure, a good network people in your life, and listening to the friends in your life.

I think so much of this negotiation between the type one and type two errors related to mental health informed the way that we shared on 18Forty. We didn’t speak to that many mental health professionals. We spoke to my dearest friend, Yakov Danishefsky, but the opening episode was really just me and at the very end I spoke to our favorite friend Jay Richmond. He’s not a mental health professional. I think I mentioned about a thousand times he sold us our toilet. There’s a reason why I centered him in that initial discussion because I don’t want attention to mental health to be an equation of you need medication, you need therapy.

There are ways to address your mental health even through conversation, even through friends to tend to yourself to allow yourself the very basic needs of self-care without falling into the trap of overpathologizing that type one error. Secondly, I was so insistent and he was so gracious in opening up his time and his journey to speak to Elie Schulman, somebody who used therapy and somebody who speaking to him. If you listen to that episode closely, somebody who I think used therapy for all the right reasons and really developed a very, very healthy sense of self in the healthiest way possible and being able to go through that journey, not through the eyes of the professional but through the eyes of the patient, I think is so important to understand what a healthy journey looks like and that it is possible.

The people I’m speaking to, our listeners, our community, the goal of talking about mental health is not to get everybody to go to therapy. It’s not to get everybody to take medication. The goal of this conversation is to allow yourself to give yourself permission to take your own temperature and focus on your own self-care to have the conversation that doesn’t mean that you are jumping to a diagnosis. That doesn’t mean that you need medication. It doesn’t mean that you need therapy. You may need nothing. You may be perfectly fine. But to allow yourself to ask those questions without any preconceived notion for good or for bad of what the right intervention is, I think is very healthy.

I had somebody come to my house once, this is an absolutely true story who sat down with me. I’ve met with many, many countless listeners and he sat in my house, he was opening up, he said, “I really find your podcast helpful.” I was very moved and very touched by that. I was going through a particular issue. I asked him, “Did you ever try therapy?” He looked to me very clearly like somebody who would benefit from this and you should really speak to a mental health professional.

He told me, “I don’t believe in that. I don’t believe in therapy. So I’m not even trying that avenue.” The next thing I did is absolutely crazy and I wouldn’t blame you for criticizing me, but I happen to think it was the right thing to do. With a great deal of love, I kicked him out of my house. I said, “I love you. I appreciate that you reached out.”

He drove here quite a distance, but I said, “You are so fixed in what the right way to do it, and you’ve come to this conclusion that therapy does not work. It never works. I can’t do it. I’m not going to spend another minute with you. Because you are so fixed in what you think your intervention is and what you need and you speak so broadly. I don’t think whatever I’m going to tell you is going to be helpful either. I have a lot of people I can meet with. I care about you. I’m going to keep in touch with you. You can email me again, but I want you to examine that. I want you to examine your certainty in a very real way.” Without something as disruptive of saying, “Meeting’s over, I want to walk you out, and I want to explain why.”

I don’t think he would ever reach that conclusion. I followed up with him after. I think every once in a while we’re still in touch, but sometimes like that tough love to somebody is also necessary. Tough love to say, “Not every conclusion that you are so confident and certain of is correct, and allowing yourself the self, give yourself permission to at least see the options. Give yourself permission to discover what you actually need.” Number one, I think we have to be very careful that we negotiate properly between type one and type two errors.

Number two is I think our generation is a very different generation. That doesn’t mean that we all need to be pathologized, but we need to understand that part of the ills of modernity, the access to choice that we have very much plays a very real role in people’s mental health and the way that we experience anxiety, the way that we experience our own future is so much more mysterious than previous generations. Previous generations grew up in the same town. Travel was much more limited. Their concerns were much more existential, their concerns were much more, “Are there people who are trying to kill me? Am I going to have food on the table?”

I think that when we open up and the gift of modernity comes with the curse, it becomes much more harder to reconstruct a healthy sense of self in this world where we have so many possibilities. Who are you going to marry? What career are you going to have? What community are you going to live in? Where this access to choice actually makes it harder to fashion our own sense of self? Because the only tool we have to individuate and craft our own sense of self is through the decisions we make. So many people are paralyzed by decisions in this generation. I think it is a product where our access to choice itself makes it harder to become a person, to feel a sense of self.

We’re always looking over our shoulder. Social media obviously compounds this looking at other people’s lives and that undoubtedly has a negative effect on our anxiety. Now what’s the right answer to that? Everyone needs to figure that out for themselves. But to not allow ourselves to acknowledge that our generation has a very unique struggle in finding a healthy way of life and finding a healthy path when constantly, every time we open up our phones, we are introduced to the best moments, the highlight reel of everyone in our community.

When we have access to so much choice of who we’re going to marry, what’s our career going to be, what community can we live in. These are choices that previous generations simply did not have 100 years ago. They simply did not have it. I think in many ways, dating was easier, career was easier, community was easier. It is our access to choice it has eroded our sharpest tool for fashioning and sculpting our sense of self. That is our confidence in our choices, confidence in our deciding, confidence in our decisions. Number one is the difference between type one and type two errors. Number two is I think we have to acknowledge that there are very real struggles that have emerged as a part of the gift of modernity. That is literally at the heart of what 18Forty is all about, confronting the gifts, the blessings, and the curses of modernity and what role they play in how we fashion our very sense of self.

Then finally, I would say, and this isn’t a criticism that’s directed at Abigail Shrier, but you got to sell copies. Who am I to criticize somebody for picking a provocative book title? The author of a book called Sin-a-gogue: Sin and Failure in Jewish Thought spelled S-I-N, which so many of the people who I shared the book with who like the content but said, “I hate this title. It is so unserious for a serious topic.” I said, “God bless you, just trying to sell a couple of books here.” So I’m not criticizing her for that, but I think the title Bad Therapy exists. But I think very often what it is really bad therapists. I think there is such a thing as a bad therapist. There’s no question that exists or the bad therapist for you, someone who’s not working for you. It’s not at the same pace, the same timeline, the same direction.

There is such a thing as bad therapy. But if there is bad therapy, there’s also such a thing as bad parenting. If there’s such a thing as bad therapist, there’s such a thing as a bad community. The community you live in is not the right community for you. For us to think that we can point the finger with so many things that contribute to the way that we experience the world and just point the finger at mental health, I think that’s almost unfair. The way we treat mental health is a product of so many other societal changes. People need to realize that we have to make choices in all of these areas to find what is healthy and works for us. Maybe you’re not in the right community. Maybe the way you’re parenting your children is not working. Maybe the way you’ve been parenting wasn’t the right style for you.

I think we need a little bit more flexibility and a wider spectrum of choices in how we diagnose our ills. The one thing that I think we all agree on is that something is amiss in this generation. Something is amiss. I believe it. I see it with my own two eyes. I think sometimes what’s amiss is how amiss our generation feels. But modernity is scary. We are witnessing an unfolding of millennial changes in society. I mean things that in this lifetime in the last 30 years, the emergence of widespread access to the internet, social media, artificial intelligence, we are witnessing changes that have occurred in young people’s lifetimes that they did not suffer this type of global change.

Again, I know people are going to say, “What about World War II?” Those are a very different type of change that is existential, that is there’s a very clear enemy that is coming to attack you. This is the very way in which we move about in the world. This is affecting our ability to make choices and decisions. This generation, young people growing up today are faced with an onslaught of both blessing and curses that emerge from the unique quality of the modern period in which we live.

We need to face it. We are living in a transformative generation. As Rav Kook says in his essay on Hadar, “It is a wondrous generation, but one that is also beset with very real difficulties and very real challenges. A generation that is completely pure and holy and a generation that is entirely guilty.” That’s what Rav Kook writes about that emergence of modernity. I think we see it even more clearly today, which is why I think this conversation is so important because so much of the way that we contend with our own mental health issues really begins in childhood. The way that we explore in our own families or in our own selves really emerges from that beginning and beginnings endure.

It is those early years of childhood that continue to shape our entire life, which is why I am so excited to share our conversation with Dr. Regine Galanti. I am so excited to have Dr. Regine Galanti, who has a thriving practice in Long Island that focuses a lot on children, teens, and in the mental health space. I’m sure you also do adults, you could correct me on that. But I really wanted the focus to be specifically on identifying and how to respond when you see children, specifically young children who are struggling with mental health issues within our community, I think very often the people who get the strongest interventions, particularly with therapy are adults. Because we have the language to describe what we’re dealing with. What are the most common reasons why a parent decides to bring their child, in this case, let’s decide a child somebody below the age of 18, and say, “I think my child needs a psychological intervention”? What are the most common identifiers that you deal with of why a parent is bringing a young child into the practice?

Regine Galanti:
Right. I’m going to take your question and I’m even going to comment on what you just said in terms of we think of adults accessing mental health care. I think that’s often because the problem gets so bad that there’s no other solution except to seek outside intervention. Often, especially, in our community, people wait too long to access care and the reasons why parents are bringing their kids into therapy is actually like I would say too late. They’re not accessing care for the reasons that I as a therapist would want them to access care. They’re doing it because they see big problems, something happened, their anxiety is getting in the way. The kid broke a door and they’re realizing like, “Hey, my five-year-old shouldn’t probably be breaking stuff in my house. This is a huge problem.”

But they’re missing all the lead-up to that. That is what as a child psychologist, I want them to be accessing care beforehand. Because the sooner we can help parents and help kids, the more we can weed out these issues and teach parents what to do in a way more reasonable and effective way.

David Bashevkin:
I couldn’t agree more. I think for myself, I was fairly young when I entered therapy. I think the first memory I have is fifth grade. That’s reasonably young. It may have gotten even younger now, but what do you think are the impediments for why our community waits longer, particularly with children? I find in general there’s a lot more attention to mental health care and I wonder if that attention is more focused on adult interventions, that we have a lot more language around the importance of adults leading emotionally healthy lives. Have you seen that trickle down towards younger children? Or is there just generally a skepticism that for young kids because of the language barriers like, “This is not going to help”? You’re imagining a seven-year-old lying prone on a couch talking about their relationship with their parents, like, “My kid’s not going to be able to go in therapy. So instead we substitute out and we go to other types of maybe occupational therapists or learning specialists and other areas instead of focusing head on.” How would you diagnose, so to speak, the communal hesitance of bringing young children to psychology practices?

Regine Galanti:
Right. I think that there’s two major factors. One is mental health literacy and the second is stigma. On the first one, often people don’t know what mental health problems look like in younger children and they change and they morph as development changes, which is something that we know from physical health. We know that your kid is supposed to have different OT milestones when they’re a year versus 5 years versus 10 years versus 15. When you see them lagging, you tell the pediatrician, “Hey, my kid can’t hold a pencil, what should I do?” But if we don’t even know what we’re looking for, how can we change it? So I know that anxiety, anxiety is my specialty. We’re looking for different thoughts, feelings, and behaviors.

If your kid is complaining about a stomach ache every single day for a week, but then on weekends the stomach ache magically goes away. But on Monday, it comes back. In my mind, as a psychologist, my red flags are going up all over the place. That kid is probably anxious, but parents don’t know that. We need to start at zero to say this is what anxiety looks like, this is what problematic behavior looks like, this is what depression looks like. Because we know that depression in teens looks like irritability and teens are irritable in general. So how do you distinguish between a kid just going through their normal teenage hormonal self and depression?

These are skills that psychologists know and parents don’t. So I think we need to increase through conversations like this one, helping parents know these are what we look for. Again, the second part is just the stigma that being able to say, “Hey, my kid needs help that I can’t provide them,” is hard for parents. It’s hard for parents because of their own stuff and also because it’s acknowledging that your kid isn’t perfect, which you know maybe in an academic sense, but it’s hard as a parent.

David Bashevkin:
For myself, I think about this a lot because it’s something I’ve dealt with my whole life and when you raise children, there is a dread where it’s like, “Are we going to have to go through that same journey?” In reality, the answer is of course, yes. Of course, everybody is going to go through a lot of the roadblocks and difficulties, and maybe ones that you don’t have are different, but there’s a scariness as a parent watching a child who’s now going down a path of the difficulty of life that you know how difficult it could be. But watching a young child do it can be really hard. But before we get to teens, I really want to focus because in my experience it is not spoken about enough, which is like preteens, elementary school age, young children, young, young children.

If you’re comfortable in your own professional experience, really sitting on this for a moment, because I meet adults and in the back of my head very often I am like, “There is a child beneath this adult that did not get the psychological guidance that they so desperately needed to really be able to function and interact and build relationships, et cetera, et cetera.” So maybe you could start by giving a little bit more language or description. We have words like anxiety and depression, which maybe for me are so linguistic to describe that dread or that uneasiness or that feeling of helplessness or agency. I associate it because I’m a very verbal person, which is a very rich description of your inner world. What does that mean for a seven-year-old? What does that mean for a nine-year-old? Maybe they might say, “I’m sad.” That would be easy. “I always feel sad.” But beyond that, what are the ways that anxiety is manifest in young children that we should be looking out for?

Regine Galanti:
First of all, anxiety, we know in terms of the mental health disorders is the one that comes up the earliest. We know that 30% of kids will have one anxiety disorder diagnosis before the age of 18. So we’re talking about a huge amount of kids that can fit the criteria whether or not they go to a psychologist and most kids will not access care at all even when they need it, and the number of kids who access care, who get good care, evidence-based care is even smaller than that. The numbers are horrific in general. But when I am looking for anxiety in a kid, I am looking for those thoughts. It could be kids who are very verbal. Sometimes you get those very verbal kids who will say, “I am worried I don’t want to go to school because I’m scared of what the teacher is going to say.”

They’ll express their worries. But you also might get a lot of physiological symptoms. Anxiety comes with fight or flight. That is from the time we’re born to for the next 120 years, your heart’s going to race when you feel anxious, your breathing speeds up, your muscles get tense. Those are the physiological ways that our body tells us that we are anxious, which is a good thing because if there’s a dangerous situation, it is good to have that automatic response that gets us to run. But we see that even in little kids. If I even take a baby like I guess a 10-month-old, that’s already dealing with some stranger anxiety and I pick up a stranger’s baby, they’re going to have that fight or flight response, they’re going to start to cry and wail and flail and that is our normal adaptive response to anxiety.

But when you are seeing that in a young child in the absence of threat, there’s no tigers, there’s no strangers coming to abduct them. That is a signal, “Hey, my kid is anxious.” I think the trickiest part of anxiety is because it is adaptive. Sometimes you’re going to have a real dangerous situation and then sometimes it’s going to happen when your child has to talk to strangers or go off to school or take a test. When you’re seeing it in a non-dangerous situation, it starts to get in the way of their functioning. Like you’re fighting homework battles for two hours a night because your kids are racing through the paper. That’s a signal like, “Hey, this is something wrong.” Then so we have the thoughts, we have the physiological feelings, and then the third part I look for is their behaviors. We know that anxiety specifically pulls for avoidance.

I don’t want to do the thing I’m anxious about, which again is adaptive because there’s a tiger at my door. It shouldn’t open the door. It should, I don’t know, go out the back door, do something else. Good thing if there’s a tiger. If I’m afraid of public speaking and I walk off the stage at my siddur play, that is not adaptive, that is not helpful. It’s actually causing more attention to the anxiety. I look for those avoidance responses that really… It’s hard for parents not to notice them. Parents notice them, but often parents get pulled into the trap of, “I need to save my kid from this feeling. They can’t feel this way. It’s so uncomfortable for them. They don’t have to go on the play date. They don’t have to study for their bar mitzvah. They just won’t do it.” Once it’s impacting functioning, then I’m going to say, “Hey, this is a problem.”

David Bashevkin:
I want to reflect a little bit about the structure, especially for young children within the orthodox community where most children are being sent to yeshiva, a full-time school. There are kids in public school as well, of course. But in the yeshiva system, there’s like a blessing and a curse. The blessing is that they’re stronger than ever institutionally. I can’t even think of a school that doesn’t have some counseling center or some resources that really help kids, especially as they’re struggling with educational issues that sometimes can be wrapped up with psychological issues. I don’t want to call it a curse, but there’s also a difficulty where it’s a very homogeneous world that we are constructing where we’re coming from similar communities, we have similar backgrounds, we have similar calendars, and schedules, and all this stuff. Sometimes what is motivating a parent is not their kid, but the sense that every parent has that I want my kid to be normal, I want them to fit in.

It’s more social, it’s more image-conscious, and that doesn’t have to be a bad thing. Every parent wants their kid to have friends and fit in and be normal. At least, the way we use the word normal colloquially, not every kid is normal. Not every kid is going to make friendships the same way. I wonder if you could reflect, given your practice on what role does the social universe that we emerge from play either positively and/or negatively, and I’m sure there are aspects of both in the way that our children develop in terms of their own mental health.

Regine Galanti:
I think you nailed it in terms of there are positive factors here too, like communal support, and being able to access that level of support for people who need it is amazing. Then on the other hand, there’s a lot more pressure because everybody knows what everybody else is doing and how you get this built-in comparison group, “My kid doesn’t like this. My kid isn’t doing sports the way his friends are.” I remember when one of my kids was little, she was a little bit slower in terms of being able to be dropped at birthday parties and everybody else was doing it. As a parent, my thoughts then go to what’s wrong with my kid.

David Bashevkin:
You have to catch yourself as a parent. Meaning am I motivated from concern for my child, or am I motivated about what family are we? Are we the easy family, or the not normal family? I’ve caught myself countless times like, “What’s really driving my concern?” In your practice, how do you divide attention that the child is needed and the universe because that age is so putty, it’s so impressionable, and the issues of the home, meaning do you meet with parents?

Regine Galanti:
I wanted to get back to what you were started with of that image of a seven-year-old sitting on a couch talking through their stuff. That’s not how child therapy looks. It’s not.

David Bashevkin:
I want you to take me through child therapy. Take me through that first meeting, demystify it, make it not so scary. I Google you online, you recommended it. What’s the number one way that people usually find you? Most people don’t find psychologists out of the phone book. Where do most people find you?

Regine Galanti:
I think that often people find psychologists by word of mouth. I’ll get Google hits and my practice is in the Five Towns, Long Island Behavioral. I think has a positive reputation. I also write books so people find me that way and will find me on Instagram. It’s important to me to talk about these things. I am anywhere that you can find me and I’m trying to put out as many resources as I can because I believe strongly that the more parents know about this, the more they can access the tools that they need even if those tools are not therapy.

Parent schedules the first meeting, I’m not seeing the child yet at all. The parents are coming in and both parents are coming in because often one parent is a little bit more hesitant about therapy than the other. “Can’t we just talk to our kid? I don’t understand. This is not a big deal. I was anxious. They’ll grow out of it, so we’ll get that.” So I need both parents in the room because I need both parents to see that I am not the scary monster that’s out to completely change their lives and we’re all on team kid here. I’ll meet the parents for an hour or two hours sometimes depending.

David Bashevkin:
What are you trying to find out during that parent meeting aside from making yourself and the process less scary? What are the questions that you’re trying to uncover? Are you taking their own family history? What’s the line of inquiry in that first parent meeting?

Regine Galanti:
I want to know, one, why they called and why they called now, what are they seeing. I want to know when this started, “Was your kid always anxious? What other issues came up?” We will ask a question. “What are the top problems that you are dealing with now?” I am very practical as a psychologist. The approach I take is cognitive behavioral therapy. It’s a very practical goal-oriented approach. Especially, with young kids, I’m not out to find deep dark secrets. Not everything is trauma.

David Bashevkin:
Is that deliberate that your orientation in CBT, cognitive behavioral therapy? Is that because of you think it’s the most effective or you think it’s the most effective for this age?

Regine Galanti:
It is the most effective for anxiety and it is effective for younger kids.

David Bashevkin:
Okay. That’s helpful. You have this first intake meeting, you talk to the parents. I’m sure sometimes you realize that an aspect of the child’s problem is both hereditary, the anxiety that the parent says, and also the chaos of every home has its own culture of chaos.

Regine Galanti:
Right. But I go right at that. I am very transparent and I will say anxiety comes from somewhere. It is not your fault, but it is in your genes. So which one of you is anxious, right?

David Bashevkin:
Let’s cut to the chase, demystify this.

Regine Galanti:
Right. Often one parent will say, “Well, I don’t go to events with over 50 people at them, but I’m not anxious.” I’ll say, “Okay.”

David Bashevkin:
I’ve been at such intake meetings and I come with my hands already raised. I’m just like, “Whatever you’re going to ask probably from me.” So you have that first meeting. In between, how do you advise parents how to explain to a child what they are meeting you for?”

Regine Galanti:
I will tell parents to say something along the lines for little kids of, “Dr. Galanti is a doctor. She’s not the doctor who gives shots. She’s a feelings doctor.”

David Bashevkin:
That’s very important to cut off the shot component, get that right off the table. Your first meeting with a child is what?

Regine Galanti:
Depending on the age of the child, I have a very huge parent involvement piece in my practice going from two-year-olds to honestly, if an adult lets me bring in their spouse, I’m happy. Whoever wants to be involved in treatment can be involved in treatment. Because parents have their own skills that they need to learn. It doesn’t matter how many skills I give an eight-year-old, unless I am involving the parents, they are not going to be able to generalize their skills to the real world. It’s like I don’t know what my kids are learning in school half the time it’s no knock to their teachers.

But unless there is a strong homeschool partnership, it’s going to be very hard. If the teacher tells me, “Hey, you need to practice five minutes of reading every day,” like I’ll do it. But even that’s hard. We have to prioritize as parents where we put our attention. If someone is showing up to therapy, I’m going to make it very clear that I need them to prioritize this for now if they want to see the changes that they want to see.

David Bashevkin:
Tell me about the first meeting with the child. Let’s talk about a nine-year-old. Are they sitting down? Is it play therapy? Do you have a set opening question to a child? I’m just curious how they enter this universe.

Regine Galanti:
I introduce myself again. I often have the parents in the room. I’ll say, “Hey, this is who I am, this is what I’m here for. This is what your parents told me, but I’ll keep it very top-line.”

David Bashevkin:
Sure.

Regine Galanti:
“Your parents said you’re struggling with going to sleep at night and I want to get to know you a little bit.” My office is fun. I have a basketball hoop on the door. I have a giant dry-erase marker. Obviously, I want to prime myself for success, so I’m going to ask the parents like, “Hey, what does the kid like to do?” They like Legos. We’re going to have Legos out. If they like art, we’re going to have art stuff out. I have a basket of fidgets, I have stickers. Sometimes we’re sitting across from each other, sometimes we’re on the floor, sometimes we’re in the playroom. Child psychologists I think in general are very active. I don’t do play therapy. Again, I’m very goal-directed in my therapy, but you can do therapy while playing.

David Bashevkin:
Interesting. That’s a different thing than play therapy. Meaning play therapy is through the playing, you are revealing parts of yourself as opposed to having therapy while you play is let’s talk. But while you can be distracted to some degree and almost like let your guard down.

Regine Galanti:
Right. Or just that’s who kids are. Kids move, right? I know in school we expect them to sit in front of desks and pay attention to the teacher for how many hours a day. But I think kids’ natural state is just much more up and moving.

David Bashevkin:
Sometimes it does feel like in the world of psychology where if every problem is a hammer, then all you’re going to see are nails. I think one of the issues is the question of medication. I know you’re a psychologist, not a psychiatrist so you have training and you’ve worked in psychiatry departments in hospitals, but how do you approach the question of whether or not this child needs to be medicated?

Regine Galanti:
Right. At least for anxiety, I am a person who blankets myself in the research, we know that there was a very large-scale study called the CAMS study in the late 1990s, early 2000s.

David Bashevkin:
Can you spell that? The CAMS study.

Regine Galanti:
C-A-M-S, Child Anxiety Multimodal Study.

David Bashevkin:
Okay. CAMS. Great acronym.

Regine Galanti:
I might be missing a letter, but 488 kids in three different sites. We compared cognitive behavioral therapy to placebo to meds to a combination of CBT and meds. What they found is that everything worked better than nothing, surprisingly.

David Bashevkin:
Okay.

Regine Galanti:
CBT worked, medication by itself worked, and CBT plus meds worked also.

David Bashevkin:
Did one work best?

Regine Galanti:
They did a follow-up called CAMELS. Because again, psychologists like acronyms.

David Bashevkin:
Okay, that’s good to know.

Regine Galanti:
That showed that the group that had CBT alone seemed to not regress as much as the other groups.

David Bashevkin:
Even more than CBT plus medication?

Regine Galanti:
Right. Which is interesting. There’s a lot of hypotheses as to why. These kids were also getting very good medication management, like meeting with the psychiatrist once a week.

David Bashevkin:
Wow.

Regine Galanti:
That’s not real life.

David Bashevkin:
When do you tell a parent and how do you guide a parent to the decision of whether or not to medicate?

Regine Galanti:
Right. It really depends on what parents want. Some parents come in looking for medication, not very many. I’ll say, “Okay, the research shows that’s an effective way.” I would look at only SSRIs, do not use any fast-acting anxiety medication. We know that those get in the way of treatment and they’re very addictive.

David Bashevkin:
Like Xanax.

Regine Galanti:
Benzos, specifically. Those are not good anxiety treatments. Those are band-aids. More often parents are telling me, “I will do anything for my kid, but put them on meds.” That’s often something that parents come in with.

David Bashevkin:
Why do you think that medication has the reputation of anything but medication?

Regine Galanti:
I don’t know. Stigma, I guess.

David Bashevkin:
Just general stigma, like it’s going to change how they are, their energy, or now they’re medicated.

Regine Galanti:
How are they going to get a shit up if they are on medication? That’s often what I hear from the parents of a four-year-old.

David Bashevkin:
Really?

Regine Galanti:
We have a little bit of time.

David Bashevkin:
Have you heard parents say, “I’m not comfortable with medication?”

Regine Galanti:
Yes, all the time. My line is always, “I have no skin in this game. I think you have to weigh the drawbacks of not considering medication. You’re thinking, oh, maybe this medication will have side effects and maybe not medicating will have side effects. What happens when the anxiety gets bad and it leads to depression? That can potentially lead to substance use and all the social ramifications, the occupational ramifications of not medicating your child.” It’s something we don’t think about in psychology or in statistics they call it type one versus type two error.

David Bashevkin:
Sure. I’m always curious about the entry and the exit. When it comes to our physical health, I grew up in the house of a oncologist. It is much clearer what the beginning, middle, and the end is. I guess the exit is so much more ambiguous. In fact, I don’t know that there ever is an exit where it’s like, “Okay, cured.” Because what you are addressing is the very lens through which you see the world and it’s almost like cleaning your glasses and then saying, “Okay, I guess I never have to clean my glasses again.” But on the flip side, people don’t like doing things without, there’s no end date to this. There’s also a, “I want to surface something that,” I obviously don’t mean as any offense to you, it’s more general, “The financial incentive of is this person going to have the discipline to tell me that we no longer need therapy once a week?” Because this is a good gig, this is whatever it is, 250 bucks.

Just you know that it’s coming. I think that sometimes the financial relationship with a psychologist sometimes either prevents people from entering either for themselves or their children, “Am I going to have the guts to break up with this person?” They talk about it in different ways than they talk about other professions. I’m never worried when I see a specialist or a doctor like, “Am I going to have the guts to stop seeing this person?” Because the end is a lot more clearer, the diagnosis is a lot more clearer. So how do you navigate the interminable? I think that’s the right word without end that I think psychology has. How do you almost wean somebody off or change or say it’s time to see a different psychologist? How do you approach a lot of those changes where the very nature of our relationship to therapist, I think in many ways, necessarily differs from our relation to our primary care physician?

Regine Galanti:
Well, I will start off saying I think the oncology example is the wrong health metaphor here.

David Bashevkin:
Tell me why?

Regine Galanti:
We’re talking more about high blood pressure or asthma. We’re talking about chronic conditions, we’re not talking about acute conditions. With asthma, there are flares, and there are times one of my kids has asthma and we’re like, “Oh, is this a problem? I don’t know, do we need to go to the doctor?” If we treat it early, then it becomes not a problem. But there are times that even with good treatment, she’s going to have a flare and we’re going to have to go to the pediatrician. But as long as we manage that, then often we get to avoid the hospital. Then there are times that no matter what we do, even if we do everything right, there’s going to be a flip.

David Bashevkin:
What an excellent distinction and I so appreciate you beginning in between a chronic versus acute condition. Mental health by nature is something chronic like, “This is your mind, this is the way that you conceive of your own sense of self.” There are flare-ups obviously in everyone’s life. That is an excellent starting point. So with that starting point, tell me about do you walk into therapy with a timetable? Have you ever told a patient, and if so, why, “You need to be seeing somebody else”?

Regine Galanti:
All the time. I am the first to fire myself. I love firing myself. Anyone who is concerned that the therapist is only in it for the money should see the wait list that good therapist have. Don’t worry if you are not taking my spot, then somebody else is. I understand that is something that weighs on people’s brains and I’m always encouraging people to talk to me about it.

David Bashevkin:
Meaning when I said that, were you offended? I didn’t mean to…

Regine Galanti:
No, not at all. It’s so expensive and you should have a good relationship and be able to trust the person that you are entering in that relationship to. That also means calling them out and saying, “One, I can’t afford this, the life changed, or whatever, but I want to keep doing it. Or how long is this going to take?” Those are valid questions that people hesitate to ask because they’re like, “Oh, am I going to insult you if I ask you that?” I often encourage my friends to ask those questions upfront, “How long does therapy take? How are we going to know when it ends?” Again, I am a CBT therapist, which is a different modality and it doesn’t have to last forever.

Because the therapy I do is goal-oriented. So when we meet our goal and you have the tools, you are welcome to say, “Okay, see you later.” Often because I do have a waitlist and there’s so much pressure I think on therapists to solve the mental health crisis, which is totally unreasonable, even in my own brain, that’s my anxieties of I stay awake at night saying, “How can I see more patients? What can I do differently?” Which is not very useful, but when someone is petering out and doesn’t need me anymore, I’m the first to say, “Do you want to take a break? It’s okay to take a break.”

David Bashevkin:
Do you have a ballpark of what is a… I hate using the word normal, it’s such a loaded term when we’re having a mental health conversation I know.

Regine Galanti:
Average.

David Bashevkin:
Average. What is the average duration that for a child struggling with anxiety that you think makes sense that you would give as an answer?

Regine Galanti:
No, I give this answer all the time. I tell people 12 to 20 sessions, but we’re talking about per issue. If your kid comes in with OCD and social anxiety, then you should expect 24 to 40 sessions. It’s just like a rule of thumb.

David Bashevkin:
12 to 20 per-

Regine Galanti:
Per thing.

David Bashevkin:
As a parent, you want to group everything together. It’s only one thing, I promise. Then it’s a bunch of things.

Regine Galanti:
It’s a bunch of things. But each one, a cycle takes that 12 to 20. So we’re talking about four to six months. The therapy I do, you should be able to see progress within six months. Not like, “Whoa, my life is different.” But, “Hey, I’m on this path and I see how this could be a path that would change things for me.”

David Bashevkin:
Towards something. There’s a mental health crisis. You mentioned it. It is affecting adolescents tremendously, both within the Jewish community and really with the world. It is always something that I have found so strange in the Jewish community, particularly in the United States, things in many ways have never been better. We are materially more comfortable than we have ever been. Our schooling system has never been stronger. Religiously, we have people who just like their level of observance and their religious lives are in sync and rabbis have so much more language to talk about these issues. How can it be during a time of such comfort that we are simultaneously dealing with a mental health crisis? From your vantage point, what do you think is animating this very modern crisis?

Regine Galanti:
I like to think about almost like Maslow’s hierarchy of needs. People learn about this in intros like that there’s the basic needs on the bottom. As you move up, the needs get a lot more psychological like security, housing, food are all on the bottom. You need to have those needs met before you can start focusing on your psychological needs.

David Bashevkin:
Self-actualization.

Regine Galanti:
Right. That’s top of the pyramid. But you want to get to self-actualization, you really need to have your basic setup. So if we’re going to talk about American Jewry as mostly an immigrant society, everybody moved, had to get themselves settled, learn the language, develop the school system that’s doing better than ever before. Now they’ve given their children the privilege of being able to focus on their mental health, which causes problems. It’s not that our parents, our grandparents didn’t have mental health issues. It’s just more like when you’re trying to figure out how to feed yourselves, the mental health issues get pushed to the side. There’s no room. Now we have room, thank God. Now we can all be anxious.

David Bashevkin:
I believe that’s very true. It’s why I called it a very modern problem. Meaning I don’t think in 17th century Russia or Italy or Lithuania, wherever Jews were living at that time, were not anxious. But if you’re losing blood, if you don’t have food on the table, being able to focus on your anxiety and your inner world is a luxury of sorts that we should appreciate and we should have gratitude to have space in our lives, the exact term that you used to even be able to address these issues. Let’s talk broadly. You do write a lot of books to parents. A great deal of your clientele I can only imagine are within the Jewish community, if not all of them, given where you’re located. What do you think are the most common mistakes that you see parents making aside from what you had mentioned earlier about starting too late? What are the things that you wish parents would just stop doing or just start doing?

Regine Galanti:
Allowing their kids to be uncomfortable? That is probably the number one thing that I would want every parent to do.

David Bashevkin:
Explain why that was the first thing that came to your mind. That’s such an interesting response.

Regine Galanti:
All we want to do is parents is make our children’s lives easier for them. But in the end of the day, I think this is something you started with. Life is uncomfortable where people are going to die, bad things are going to happen. If we don’t give our children the tools to handle feeling uncomfortable, what are they going to do when you can’t save them anymore?

You can save your three-year-old. You can say, “Oh, it’s okay, don’t cry here.” But you can’t save your 20-year-old who’s really dealing with a loss of a friend or a heartbreak for the first time, “Then what?” Because we need to build that foundation from when a child is little to be like, “It is okay to feel anxious. This is part of the spectrum of life feeling sad, feeling anxious, feeling lonely, and validating that feeling.” I always think of this, when something bad happens to you and you call a friend, do you want that friend to say, “No, it’s fine, everything’s going to be fine”? Or do you want a friend who’s just going to sit with you in it to be like, “No, that really stinks, I’m sorry you’re handling that, let me be there with you”?

David Bashevkin:
I love that. I’m curious about things that parents could do actively. I reflect a lot on my own life. I was born in the ’80s, grew up in the ’90s, and a lot of this was just starting. Prozac Nation was just starting to get attention to this world of mental health. For some reason, I associate that Gen X, Jenna with Winona Ryder. She was an actress who represented the angst of our generation in a lot of ways. I’m fairly well-adjusted for somebody who grew up with a great deal of anxiety and lord knows my parents made as many mistakes as any other parent who did not have all of the things and the tools and the books and all this stuff.

What do you think accounts for why some children who have a predisposition to anxiety end up thriving and some fail to launch? They get frozen. I think we see a lot of this emerge in our 20s because they experience discomfort for the first time, they experience problems that aren’t going to go away or disappear. What are parents doing that are allowing their kids to thrive long term and some kids are stuck? They get stuck and I’ve seen it.

Regine Galanti:
My rule for parents and in the book I just put out Parenting Anxious Kids, I laid this out that there are three big areas that I want parents to focus on. One is building relationships. If you have an open relationship, which in a young child means spending one-on-one time with your kid, could be even five minutes every day and following their lead and playing along with them. As they grew up, just creating zones of open communication without judgment, which is so, so hard. I have a teen and sometimes she says things that are holding my tongue and not reacting is really difficult, but being able to do that to maintain the relationship is the foundation I think of parenting work for resilient children.

Then specifically for anxiety what I also want parents to know is that helping your kid avoid anxiety makes it worse. So how can I help my child by not being complicit in their anxiety? By helping them do the opposite of what their anxiety wants them to do.

David Bashevkin:
Not being complicit in their anxiety. I find that to be a very moving imagery. I’ve probably made the mistake. That’s a very real thing. What does it mean to be complicit in your child’s anxiety?

Regine Galanti:
That parent is, their kid is freaking out that they don’t want to get on the bus because who knows their anxiety is just sky-high in that moment, and they’re afraid to get on the bus. As a parent, again, you want to protect your kid from that negative feeling. So you’re saying, “I’ll just drive this kid to school, it’ll be easier.” It is easier. This morning it’s easier, but long-term, it’s harder because what are you going to do next time when you have a meeting and you can’t drive your kid and now your life revolves around driving your child and they haven’t learned the skills they need to get on the bus. So it’s about their lives, but it’s also about yours that when often I think about adults can be anxious by themselves, you don’t bring so many people down with you, maybe your spouse, but kids require the village that takes care of them to be anxious with that everybody’s lives are changing.

David Bashevkin:
You’re saying that’s being complicit. You sometimes want to allow them to experience that. Again, number one was…

Regine Galanti:
Was a relationship building.

David Bashevkin:
Relationship building, open communication, especially with that early age. I think that’s a place where particularly my mother really excelled at trying to model that. Like having real conversations with your children every night. I happen to love it. Number two, not being complicit. What was number three on your list? I love this list.

Regine Galanti:
Number three is actively helping kids become more independent, meeting independence milestones. So it could be going on play dates, it could be making a phone call by themselves, checking when the restaurant closes if they want to pick something up. Things that often we don’t even think about in terms of being almost like a part of a kid’s anxiety that if they don’t do something because of anxiety, there’s often other things that they’re also not doing because of their anxiety. They’re not maybe texting their friends or going out. Often I hear a lot of people, we look around the same age saying, “Well, in our day we just didn’t have cell phones. We just had to randomly meet people on street corners and somehow it generally worked out, but it’s crazy that it did. I can’t believe that we found our friends and we didn’t get murdered in the process or something.”

But as a psychologist now it’s more like we are protecting our kids to not do that stuff, right? It’s okay to have your kid go out with a cell phone so they can reach you. But the fact that nothing happened to us was probably just because these things don’t happen as frequently as we… Bad things don’t happen as frequently as we imagine that they do. Being able to push your kids to do the things that their friends are doing is actually a good way to help them face anxiety and grow up to be more resilient to say, “Oh, most kids at this age are able to walk around the block themselves are learning how to drive, but my kid doesn’t. Why doesn’t my kid want to drive? I should push that a little bit.”

David Bashevkin:
Pushing independence I think is one of the unspoken Achilles heels of our community and as I think it’s in many ways it’s a product of our success. I think already when I was growing up, it became less common, but it was seen where you saw high schoolers working and now it has become so rare to see high schoolers behind the counter having jobs. Some of that accounts for wealth. “They don’t need the money. Why would my kid work?” I lament the fact that I think a lot of that independence has been lost and why I see a lot of people who come from affluent homes or affluent families, they can get stuck because they’ve never really had to do things on their own. The scrappier kids who didn’t have a paid village surrounding them, they have a lot more capacity.

That’s a word that we talk about a lot in my home about developing capacity to do that stuff independently really helps us. So just repeat those three again because I really liked all three and I just want you to run through them one more time. Number one was…

Regine Galanti:
Was build the relationship.

David Bashevkin:
Number two.

Regine Galanti:
Don’t be complicit in your child’s anxiety.

David Bashevkin:
Number three.

Regine Galanti:
Number three is build independence.

David Bashevkin:
Actively building independence, finding those opportunities. Give them chores, give them jobs, give them things to do. Do you like rewarding kids for independence?

Regine Galanti:
I am fine with rewarding kids. I don’t think a kid has ever gotten addicted to stickers or little prizes.

David Bashevkin:
I cannot thank you enough and I just appreciate the insight. To me, there’s a lot of glamour in the insight and depth of I guess adult psychology and you have all these fancy theories and language and it’s the books that I personally like to read. But I think where the real action is taking place in our development where we really need healing are in those childhood years. That’s both parents and the children really figuring out and helping people develop through those years. My last question, I’m just curious, you could answer on any level that you’d like. Why did you choose to go into child psychology, both psychology, and specifically children? I find a lot of people like, “It’s more fun talking to adults, you can really dig deeper, you can analyze in ways that you can’t with children.” What drew you to the field that you are in?

Regine Galanti:
I really like being effective. I feel like if you can catch kids young, then you have such an opportunity and a gift to be able to change literally the course of their lives. With an adult, adults are more stuck in their ways. Actually, I find a lot easier to do adult work. I get to sit in one place, just relax my body, and not move around and not constantly taking the temperature of the room in terms of what other things do I have to bring out to entertain this kid. But with child’s work and especially anxiety, I’m drawn to treating anxiety specifically because I know that I have skills that I can give this kid that will change their lives.

Like I said, the therapy I do is time-limited, but I’m finding that the longer I practice, the more these kids come back when they need it and it’s so gratifying to see someone I saw when they were five get married and have jobs and have children. It’s pretty amazing to watch that and see their growth.

David Bashevkin:
I don’t want you to give away all of your trade secrets, but you had mentioned it and I realize I never even asked about this, but I’m curious, is there a specific coping skill that you think has the most general applicability that you could share with us now? Something that you impart some coping mechanism for anxiety. Obviously, I would understand if it’s something that could really only emerge and work, but is there a specific coping mechanism that you in particular are drawn to, or mechanisms plural?

Regine Galanti:
I believe very strongly that the way emotions work is they rise and then they fall. So it’s more about how do we get to that falling zone, how do I help people handle the worst of it, knowing that even if they do nothing, it’s going to get better. That being said, one of the biggest mechanisms that I believe is a driver of treatment and anxiety is being able to help people act opposite. Literally, I would say it’s as simple as it sounds, but it sounds simple and then it’s complicated in action. What that means is being able to notice. Number one, notice that you feel anxious, like, “Hey, I am anxious right now. What is that trying to get me to do? What response is that pulling for?”
Often it’s going to be escape or avoidance. “What am I trying to get out of here? When I’m procrastinating, what am I trying to push away?” The actual work comes in and what is the step that I can take towards the feeling I’m feeling instead of away from it? Let’s say in the procrastinating example, “Can I do five minutes of work? Then I can go back to procrastinating. Often I don’t want to, but can I make a dent in that avoidance and let’s see what happens when I do that.

David Bashevkin:
I love the idea of acting the opposite, which is what you began with. It reminds me in some ways I struggle a lot with competitiveness and jealousy. It’s natural, normal. I wouldn’t call it dysfunctional, but I get an anxiety from my jealousy. What I try to do, I don’t want to give this away live in case anybody receives this. When I feel that feeling, I try to do the opposite. If I’m jealous of somebody for some accomplishment, I will try to actively text them and say, “Wow, that was amazing what you just did, what you just accomplished,” and act as if I had the capacity to not be jealous and compliment them on that thing. I’ve done that before.

I have felt hurt and sometimes I’ll text somebody, “Oh, thank you so much. That was so lovely. That was so amazing.” I’m trying to act the opposite of my hurt. I don’t know if it’s always healthy if I’m executing it as the way that you would want it, but I like that idea of doing the opposite of what your emotional inertia or your emotional momentum where it’s leading you to in that interim before the emotions eventually fall, and they do. You’re exactly right. They do always fall.

Regine Galanti:
But, David, I also love that because that’s values-driven. The situation you described, you saying, “I don’t know if that’s healthy.” That sounds as healthy as could be. Because here you are, you’re feeling jealous, but you’re doing something that’s more in line with your values instead and acting the opposite to say, “I want to be a person who congratulates people, so I’m going to do that even if I don’t feel it.”

David Bashevkin:
Yeah, just allow me to make a disclaimer. If you’ve received a nice text from me, that does not necessarily mean that I am pathologically jealous of you. Sometimes I just send a nice text for no reason. Those are the easier ones to send. It’s always easier to be nice to somebody who you don’t feel in competition with. It’s so much easier. That’s a piece of cake. When somebody succeeds in the very area you are striving for. That is something that I don’t know why. It’s a real trigger for my own anxieties and I guess I’ll think of it next time doing the exact opposite. I cannot thank you enough. This is such an important topic and there is so much more to discuss and thank God you’ve written a whole bunch of books about it that we, of course, will link to.

You had mentioned one. I always wrap up my interviews with more rapid-fire questions. If you will allow me, the first question you’ve mentioned some of your own books. I’m curious, what are the books that you would recommend parents? You could mention some of your owns. I would love if you threw in a couple others as well, just to expand the palette, get some more names in circulation. Books for parents about identifying or thinking about the mental health needs of their children.

Regine Galanti:
Right. I really like Eli Lebowitz’s book, Breaking Free of Child Anxiety and OCD. There’s also a really good book for parents of kids with disruptive behavior problems called The Explosive Child by Greene. For parents, I also think that one way into your child’s mental health is taking stock of your own mental health, so I really like The Happiness Trap by Russ Harris, which is just a really nice values-driven adult book.

David Bashevkin:
The Happiness Trap for grownups. Is there any other grownup books that you’d recommend for our… I love that. I’ve actually never read the… I’m pretty well-versed in that universe and I’ve never read that. Is there another recommendation you could make in just adult mental health happiness books in your pantheon? I feel bad putting you on the spot. You could say pass.

Regine Galanti:
Well, I’m trying to think. I know there’s a book, but I’m going to get the title wrong. What’s it called? Thinking it’s called Happiness for Two, which is a weird name for… Yes, it’s called Happiness for Two by Wilson, I believe. It’s also a good book for adults to take stock of where I am.

David Bashevkin:
I love that. I love that both of your books had some version of the word happiness. I usually stay away from those books. Because I think they’ll be too poppy and too la, la, la, but I will check both of these out. The only book that I’ve ever read with the word happiness in it that I love is I love Dan Harris’s 10% Happier. I love the idea of we’re not going to make you actually happy. That’s crazy. But we’ll make you 10% happier and he really does do it. I’m curious, we spoke about what drew you to the field of child psychology. I’m curious if somebody gave you a great deal of money and allowed you to take a sabbatical for as long as you needed to go back to school and get a second PhD, what’s the area, field, subject of your dissertation that you would want to do?

Regine Galanti:
It would probably be something creative and completely different. I don’t know if it would be creative writing or just a non-PhD in interior design or something visual.

David Bashevkin:
I love that. I could see your walls behind you and I think you do have a little bit of interior design coursing through your veins. What is the actual title of your published dissertation?

Regine Galanti:
That was a long time ago. It’s error management theory. It was about type one and type two error and whether people who are anxious keep doing something for longer than people who don’t like what the role of anxiety is adaptively.

David Bashevkin:
That actually sounds fascinating. I’ve always been fascinated by how we cope and deal with failure and our mistakes. What a fascinating thing to study, how we adapt. Does anxiety affect our adaptability? Absolutely, fascinating. My final question, I am always curious about people’s sleep schedules. What time do you go to sleep at night and what time do you wake up in the morning?

Regine Galanti:
I’m probably like 11:30 to 7:00, but only because my kids have to get on the bus. I would be asleep in person if I could be.

David Bashevkin:
Once you enter that stage of getting your kids on the bus every morning is just like pure chaos, a joyful chaos. Dr. Regine Galanti, I cannot thank you enough for taking the time to speak with me today.

Regine Galanti:
Thank you. Thank you for having me.

David Bashevkin:
I think in many ways when I asked her about what are the best ways to parent when somebody who has anxiety or somebody who’s struggling with this, I couldn’t agree with her more, and it relates so much to what we spoke about in the introduction, is letting a child actually experience a little bit of failure, let a child experience a little bit of difficulty. There are two stories, both of which are very real, very true stories. It doesn’t matter who they occurred to, but I am promising you that these are real stories. One is a story of a parent who went to their child’s counseling center. Their child was really, really struggling and they had been through evaluations and this and that. They actually even got a medication for the child, which was very necessary. They went and they said, “The one thing that we’re struggling with is we don’t have a clear diagnosis. We don’t have a diagnosis.”

The person who’s the head of that mental health center in the school looked them in the eye and said, “Why do you need a diagnosis? You have the right intervention. Your child is doing much better. What will the word give you? What word are you searching for?” A diagnosis can sometimes make us feel confident and make us feel like, “Oh, I know what’s going on.” But very often with mental health issues, especially when they obstruct learning and development. Diagnosis, look, if you want to use the word, then great. We shouldn’t stigmatize certain words if that’s in fact what our child is dealing with. But we should also be okay with we’re not on a discovery to find a word. We’re on a discovery to allow ourselves and our children to effectively grow and develop in this world.

The diagnosis can sometimes give you the confident that you are really addressing the symptoms in the right way, but ultimately, what we’re looking for is not a name that we can slap onto our forehead so we know what we are because none of these things are defining what we are. What we really need is to find the right interventions that work for us that allow us to address the dysfunctional thoughts or behaviors that prevent us from really thriving on a day-to-day basis.

There’s another story that I found incredibly powerful, really, really powerful, and I want to share it with you. A parent had a child who was being teased in school, came home crying, maybe bullied is the word that we would use, and the parent asked the child, “What were you being bullied for?” He said, “There’s a boy in class who keeps making fun of me that I am not good at math.” The parent was obviously outraged and called up somebody and said, “How could you be doing this? How could this be happening? We got to make sure that there’s no teasing.” All of that is 100% true. We’re not going soft on teasing and bullying. That is totally inappropriate. But the person who this parent called, asked them one question that is so important. They asked this parent, they said, “Well, what did you tell your child?”

They said, “I told my child how outrageous and inappropriate bullying was and how you can’t listen to such people and they shouldn’t be your friend.” This person said, “Well, one thing that may have been helpful is did you ask your child, do you think you’re good at math?” That I thought was such an illuminating response. Because it does a few things. Number one, it allows our self-conception to emerge not from our worst bullies or being teased or what we feel is really hurting us. You could ask, “That’s an okay question. Are you good at math?”

In fact, in this case, this child was not that good at math. It does a second thing. Aside from extricating our self-conception from our critics, it does a second thing, which just allows us to admit that maybe you’re not good at everything and you shouldn’t be bullied, you shouldn’t be teased, but it’s okay to admit that you’re not great at everything. It’s okay for a child to admit that you are not great at everything. There is so much that is driving us that we want excellence across the board. I live in a community where it’s not uncommon for parents to hire basketball tutors for their child so they can be good in their elementary school leagues.
I mean, we want excellent children. The problem is no child is excellent at everything and we should allow our children to admit to themselves, “Yeah, there’s something I’m not so good at. There’s something I need work at.” It shouldn’t just be our bullies reminding us this. The people who need to remind our children about this are the ones who care about them the most. You don’t need to knock them down, but you need to put it in perspective. Well, what are you good at? Maybe you’re not so good at math, but you’re so great at so many other things.

Allowing that conversation to come up with a generic and holy way I think is the best form of parenting where you actually instead of just serving as a protective layer from all of the bullying and teasing in the world, and we should prevent that. We don’t want bullying. Just to be clear. We don’t want bullying. But to use some of those moments to actually open up a real conversation with a child and with ourselves. Let’s be honest, to the adults listening, and we’re mostly talking to adults, bullying doesn’t end in elementary school. We just stop calling it bullying.

But there are people who remind us of things that we are not good at and to instead of pause and put all of our attention on the way we were reminded of this, the way the message came across to give ourselves the freedom to number one, say, “Well, maybe I’m not so good at it. That could be okay. That’s okay. Maybe I need more work on this. Maybe I need to become better at it. There are other things that I am really good at.” But I think that response was very, very thoughtful. Did you ask your child do you think you’re good at math to allow himself to be extricated from the perception of the bullies and really have an honest conversation with a parent, with a friend.

This is something that not just children need, but I think grownups as well. I just want to conclude with this article that I thought was very powerful from Derek Thompson, which is an examination of overpathologizing, the language of anxiety. Again, the article is called How Anxiety Became Content, and he concludes with the following. “The solution begins with the principle of opposite action.” Saxbe said, “The best thing we can do for ourselves when we’re anxious or depressed is to fight our instinct to avoid and ruminate rather than getting sucked into algorithmic wormholes of avoidance and rumination.”

The best thing one can do when they’re depressed is to reject the instinct to stay in bed, basking in the glow of a phone and instead step outside, engage with a friend, or do something else that provides more opportunities for validation and reward. “I would tell people to do what’s uncomfortable, to run toward danger,” Saxbe said, “You are not your anxiety. You’re so much more.” I couldn’t agree with that more.

We’ve all had those nights in bed where we’re consuming, I don’t know, the parenting Instagram content that my wife always sends me that I always laugh at. I love it. The dynamics of husband and wife, the dynamics of raising children, the mental health content. But very often what we think we are doing, which is feeling seen and giving language and just consuming and devouring this content is actually having the opposite effect.

We are avoiding the real relationships, the real closeness that ultimately hold the path to our healing. Thank you so much for listening. This episode, like so many of our episodes, was edited by our dear friend Denah Emerson. Thank you again to our series sponsor, Andrew and Terri Herenstein. I am so grateful for your friendship and support. Horofei lishvurei leiv umechabbeish le’atzevosom. To continue finding those partners to heal the hearts of Amcha Yisroel.

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