Photo credit: Pixabay/jojojojo
by Sandy A. Ramirez Sanchez, DSW, LCSW
Pediatric patients seeking mental health care via emergency departments have presented both challenges and opportunities for the health care system. For a social worker in a pediatric emergency department, one of the many challenges faced is building trust that the mental health concern presented (anxiety, depression, self-harming behaviors, suicidal ideation, and so on) can, for the most part, be managed in an outpatient setting. Assuming no imminent risk factors are present to warrant inpatient hospitalization, making a recommendation for outpatient therapy can elicit hesitation, resistance, and—at times—fear. The use of analogies can help address concerns about mental health therapy and provide reassurance that change is possible.
When appropriate for the patient, I reframe outpatient mental health therapy as a process that works toward the development and strengthening of a skill set that mimics the process of “potty training.” I intentionally include caregivers in this analogy to have them understand the process to motivate their child from the sidelines. I begin by asking the patient, “Are you potty trained?” The silly question is typically followed by a “Yes!” with some puzzled looks. I then ask the caregiver how old the child was when they fully became “potty trained.” On average, caregivers report the patient was two years old when starting the process of potty training and ending around three or four years of age. I congratulate the patient for this achievement and point out, “You are so good at this skill that you can even manage your needs while sleeping.”
I then tell the patient and caregiver that, together, they worked toward this goal by learning how to recognize early cues and sensations from the body that would allow the patient to use the bathroom in a timely manner. We talk about the “potty dance” that the patient might unknowingly have done in front of the TV while watching a favorite show or while playing outside. Most caregivers will then have assisted the patient by pointing out the behavior, directing the patient to the bathroom, and reinforcing a job well done. The process of developing awareness before it becomes an emergency, or an “accident,” is what I emphasize.
I use this analogy to show how emotions can also be felt in the body, and addressing these emotions early on can help with early management to lessen the risk of a crisis. We discuss how this takes time, practice, and recognizing that there will be some “accidents” along the way until the skill is acquired. I engage the patient in pointing out other skills they have learned over time with the assistance of a caregiver or teacher: walking, talking, reading, writing—normalizing the process as something that took time and practice.
Emotions will always exist, and feeling them is normal. With the help of a therapist, a child can learn to recognize those early cues (thoughts, feelings) and learn how to “potty train their emotions.”
Sandy Ramirez Sanchez, DSW, LCSW
Sandy A. Ramirez Sanchez, DSW, LCSW, is a social worker with more than 15 years of experience in mental health practice. Sandy completed her Doctor of Social Work in 2018 with a focus on health literacy and pediatric emergency department utilization.