When a child is struggling with anxiety, it doesn’t just affect them — it ripples through the entire family. Parents often find themselves balancing their need to protect their child and struggling to know how to help without making things worse. They often struggle with finding ways to help their children manage their emotions and symptoms and frequently end up feeling helpless. The instinct to step in is natural and powerful, but over time, these well-intentioned actions can unintentionally feed the anxiety and make things worse.
That’s where SPACE (Supportive Parenting for Anxious Childhood Emotions) comes in. This innovative, evidence-based treatment flips the traditional model of child therapy on its head by focusing on parents. While the child or teen is the “patient”, it’s the parents who attend treatment sessions. SPACE empowers parents with the tools and strategies to create lasting change at home, building their child’s confidence while reducing the patterns that keep anxiety stuck in place.
What Is SPACE Therapy & Who Is It For?
Developed by Dr. Eli Lebowitz, director of the Program for Anxiety Disorders of the Yale Child Study Center, SPACE was developed to help treat children and teens with anxiety and OCD. SPACE can help tackle anything from separation anxiety, generalized anxiety, social anxiety, fears and phobias, panic disorder, agoraphobia, selective mutism, and avoidant restrictive food intake disorder (ARFID).
To understand the foundations of SPACE, think of the concept of “fight-flight-freeze”. As an adult, when faced with a threat, you may sprint away, stand up to the danger, or simply become paralyzed. Children, however, have a different first instinct: via mechanisms ranging from crying to pleading or refusing, they communicate their feelings to their caregiver, who is an intrinsic part of their support system and defense mechanism. What this tells us, Lebowitz proposed, is that anxiety in children is “not a one-person event — it’s really an interpersonal event.” The child sends distress signals to the parent. The parent picks up the signals and responds appropriately.
Why Is The SPACE Approach Important To Therapy?
Given the significance of parents to the child’s anxiety — and the natural reliance of children on parents in coping with difficult situations — SPACE is a novel parent-based approach that takes a “systemic view,” giving more prominence to the role of the family system in the child’s symptoms. SPACE aims to modify the parents’ behavior through psychoeducation about anxiety, monitoring current parental behaviors, and equipping parents with strategies and detailed plans designed to best support the child’s treatment.
What Tools Will Parents Receive In SPACE Therapy
SPACE treatment focuses on two primary changes in parents: increasing supportive responses and decreasing accommodating behaviors. Intrigued? Let’s break it down.
In SPACE, parents will learn to respond more supportively to their child’s anxiety. A parent conveys support by showing two things: “acceptance” — acknowledging and validating a child’s feelings — and “confidence” — telling a child that they will be okay despite their anxiety, said Lebowitz. Importantly, at the same time, parents will aim to decrease accommodations they’ve been making to the child’s anxiety symptoms.
Accommodations are wide-ranging: If a child has anxiety about being alone, for example, a parent may opt to sleep in the child’s bedroom each night. If a child has worried thoughts, a parent may answer dozens of questions in an attempt to reduce distress. If a child has social anxiety, a parent may step in to speak on their behalf during social situations.
In the short term, accommodations can prove helpful. But research has shown that parental accommodation is associated with worsening symptoms over time, Dr. Eli Lebowitz explains. Accommodations often sustain patterns of anxiety by encouraging avoidance and reinforcing the child’s perception that they are not capable of managing distress. SPACE therapy helps parents identify the accommodations they already make and gradually and systematically reduce them.
Is SPACE Therapy Effective?
In several published research studies and detailed case studies, SPACE is shown to be an effective approach — one that reframes childhood anxiety in the context of family dynamics. In a study conducted by Lebowitz and a team, the novel SPACE treatment proved to be just as efficacious as the well-established cognitive behavioral therapy in reducing child anxiety. SPACE can also be used alongside direct child-based therapy, particularly in cases where a child has difficulty directly participating in therapy.
Let’s consider the following example. For a child with contamination OCD, a child may repeatedly ask their parent if items are clean or to check their hands for cleanliness. To help ease their child’s distress, a parent might reassure the child that the object is clean or repeatedly help them clean the item. In SPACE, parents learn to respond with a supportive yet firm message like, “I know it feels uncomfortable to not be sure if your hands are clean, and I know you can handle that feeling.” The treatment includes a short letter to the child explaining the change in a loving and confident tone— acknowledging their anxiety while clearly outlining the plan to stop participating in the rituals. This helps interrupt the OCD cycle and strengthen the child’s ability to tolerate anxiety and distress.
SPACE treatment requires specialized training from Dr. Lebowitz and his team. Georgetown Psychology clinicians have completed this training and offer SPACE in-person and online–individually and in small groups. We can work with parents in our McLean, VA, Bethesda, MD, and Georgetown (Washington, DC) offices, and the surrounding areas, as well as over 42 states including California, Pennsylvania, Delaware, North Carolina, and Florida. For more information, contact our Client Services Specialist at (202)333-6251 or make an appointment online.
We offer psychoeducational evaluations, psychological testing, adult ADHD testing, autism assessments, independent school entrance testing, developmental assessments, and neuroaffirming evaluations. Contact Sarah Smathers at sarah@georgetownpsychology.com to schedule an appointment or for more information.
