Crissy Fishbane: Today we are thrilled to have Sara. She’s going to be talking specifically about a topic that personally affects me.
My husband and I were driving in the car and I just found myself thinking, I’m so anxious in life now with everything going on. Am I imparting this on my daughter in some way? How is this impacting our child? Clearly there are so many people who are also interested in this topic.
Sara Thatcher has a very impressive resume. She is the owner and founder of Oak City Counseling. She is a licensed clinical social worker, a certified trauma specialist, a registered play therapist supervisor, and a registered yoga teacher, with over 18 years in the mental health field.
Sara specializes in play therapy for children age birth to 12, talk therapy and creative expression with tweens and teens, and parent support and coaching. I know that Sara is going to have a wealth of knowledge to share with us today so without further delay I am going to go ahead and turn this over to you, Sara. Thank you so much for being with us today.
Sara Thatcher: Thank you so much. I really appreciate it, Crissy, for asking me to be here today. I’m honored.
As you know, I do work with children and I‘m a trauma specialist. One of the things that I was thinking about is that the pandemic and coronavirus is a really traumatic event for everyone. I think one of the things I want to normalize for everyone is this situation is very unique. Most of us have not experienced anything like this in our generation, so we are experiencing this at the same time as our children. I think it is really normal that we are going to be very anxious. There’s a lot of information coming out. There’s a lot of confusion and a lot of frightening things happening. Normalizing that we are all feeling a sense of anxiety about this.
Our children are little barometers for how we are doing. They are going to be soaking up what is happening in their environment and soaking up what we are expressing to them. I think what is the most important thing is that we as parents remember that old adage – putting the oxygen mask on first. We need to be able to be calm and regulated and emotionally supporting of our children during this time, because when we’re talking to them about things, if we’re feeling really, really reactive and really dysregulated, they are going to experience that as well.
The other thing is that our goal is not going to be eliminating anxiety in our children. I think that we’re just going to be having a certain amount of anxiety for a period of time while this is happening. The goal is not to eliminate the anxiety, it is to manage the anxiety. What we want to do is help them through these natural feelings that they are experiencing.
One of the things that is really important is to be honest with our kids, to a degree. We don’t want to say to them, “You know you’re fine. Everything is going to be fine. It’s ok. Don’t worry about it.” We have a natural inclination to reassure our kids and say “It’s ok, you’re fine. We’re not going to get coronavirus.” The fact of the matter is that’s not really congruent with what’s really happening and we don’t want to be dishonest about what is really happening. Our children can really sense that incongruence in us. Incongruence in what we are saying, what is really happening, and how we are really feeling can actually increase anxiety.
What we really want to be able to say is, “This is really scary. I know you are really worried and it’s ok to be worried. I’m worried too. We are going to be together and we are going to do the best that we can.”
Part of what we are doing is validating what they are experiencing. We can talk in simple terms about the virus. “There is a virus. People are getting it. You want to wash your hands.” In a way, being pretty simplistic, and diplomatic about it.
I don’t think we need to get dramatic, necessarily, “People are dying in hospitals and it is out of control!” Obviously I wouldn’t say that to children. But I would be honest that this is happening and that’s why we are doing these things. It’s a really hard time.
I think that for us as parents, we need to be really genuine with children by saying, “I’m stressed too. This is really hard on me too. We don’t really know exactly what is going to happen next, but we’re all going to be in this together.” I think that reassuring, validating that these emotions are real and exactly what they should feel.
We are all experiencing a threat, basically. Our brain is experiencing a certain level of threat that is causing us to have this “fight-or-flight” reaction and one of the things that is happening a lot is when we as parents are watching the news media, or seeing things over and over again, it’s reminiscent of 9/11, when we kept seeing those images over and over again. That is in some ways traumatizing and retraumatizing the brain. Seeing images and hearing these things over and over again, there’s a certain level of threat that the brain goes into. As you come down from that, if you introduce it again, it goes back up and it goes back up [again].
I think we want to be careful as parents to be limiting the media that our children are exposed to. I wouldn’t have the news on in the background. I wouldn’t have a lot of information for them that’s newsworthy about the virus. I think that the news is going to be talking a lot about the terrible things that are happening and for the kids to hear this over and over again or to be inundated with images of people dying and hospital beds or things like that in itself could be really frightening and traumatizing. So one recommendation right off the top is to not expose them to the media.
Validating and being able to regulate our own selves in relationship to what is happening, There’s a lot of unknown here, and when there’s a lot of unknown, it can be really frightening for everyone.
I also suggest having a structured day as much as possible with activities, predictability and routine. The brain gets really out of control when there is no predictability and it is kind of a free-for-all. Structure, routine, predictability, and a schedule is really helpful during these times. This might be more relevant when we were all doing virtual home school, but I think it’s still relevant because you are not necessarily going out and doing all the things you were doing. So having a plan, having some predictability at this time is going to be really important.
Another suggestion is in regard to our self-care as parents. We need to make sure that we are getting the support that we need so we can effectively respond to our children. As best as we can, practice good self-care. I know that that’s really hard in the midst of a pandemic. A lot of people are home with their kids, we’re trying to work and trying to do a variety of things, but eating healthy, exercising, doing things that are helpful to us as parents so that we can be present with our kids in a way that is modeling self-care and self-regulation.
I’d like to address the idea that I’ve seen a lot on social media that we have to be the perfect parent in the pandemic and being able to have the perfect schedule and really doing it right. I think we have a lot of that in our society about being a really, really perfect parent and having good kids. I just want to say that’s not normal, or real. The reality is that our kids are going to be having a hard time. We are going to see an increase in emotional disregulation, behavior issues, defiance, tearfulness, worry; all of those things are really normal right now, If you are not seeing them, I would be surprised.
As we are all feeling this level of emotion and stress, our children are feeling it too. Validate for them how hard and scary this is. Helping them realize how to recognize the feelings is going to be the most important thing. “I see you”, “I hear you,” all of those kinds of words are really important for our kids to hear.
Be creative in terms of your ability to be with other people. It’s really important for us to have social interaction, especially for our kids. It’s something that they crave. It’s something that they need for brain development. It’s something that really helps to regulate and stabilize. That’s often how we get our needs met, is through our people, the people who are closest to us. That’s our emotional support system. When you think about teachers, friends, and people that they are not able to see right now, that is going to have an impact on them. As much as possible, in a safe way, being able to create socially distanced play dates, or take walks together with friends and try to keep distance. It’s not ideal and it’s strange to have to say to our kids, “yeah, we can’t touch our friends” and “don’t jump on them” or do all the things we used to do, but I think it’s really important and vital for them to be able to have contact with their peers and with familiar people as much as possible.
Zoom and video connections are great and they’re the best we can do right now but we do miss physical contact. Physical touch and physical contact is huge for children. It’s regulating and it’s how we connect with other people. As much as possible, if we have people we can interact with, I’m thinking grandparents, extended family, or people that are safe in some way, allowing those people to have access, if it is safe, to the children. It is going to be a huge benefit to their emotional and mental health right now.
Any kind of normalcy, any kind of predictability, anything that is going to help with grounding our kids right now, such as having a predictable routine, doing some of the things they used to do…Obviously a lot of that is going to be really difficult, but I think as much as possible being able to implement some of those things.
They recently opened our neighborhood pool. We need to stay socially distant, have our masks on and it’s very limited, but it is one of the things that has brought my 6 ½ year old son so much joy over the last couple of months. Having something that feels normal by being able to go and swim at the pool as he did last summer is really powerful and a great experience for him.
Having some of those limited interactions is difficult because it’s hard to know how much interaction we can have with people, or what we are able to do. For some people who are compromised can’t do that at all. There are a lot of levels to this that are important to recognize.
We are all doing the best that we can. As parents and mothers, I know that we feel a lot of pressure at times to be able to be the best parent and give my child everything they need. The fact of the matter is that this is a time that’s so stressful, so unexpected and unknown, that we need to give ourselves a little bit of grace around the fact that we are not going to do everything right. There are going to be a lot of issues that are going to come up. We’re going to get frustrated with our kids, especially being in close quarters with them and that is normal for what we are experiencing.
When we talk about attachment, even though we can have these normal moments with our kids that are really tense, stressful, and we lose our patience, the most important part is being able to repair that. That’s called relationship repair, where we come back in and say to our kids, “I was having a really hard time. It’s a really difficult and stressful time.” Being able to voice that to our kids and show them that it’s ok to have emotions. The reality is we all have emotions. We all have these feelings and we don’t want to tell them that it is not ok to have those feelings. We want them to be able to say, “I’m scared.” And I think the response can be, “I hear you, It’s ok to be scared.” “I’m scared too.” I know we think we should probably clean that up with “Everything is going to be ok,” but that’s not reality and that’s not congruent. Children are able to feel validated when you’re able to match what they’re saying and say “I hear you and I feel scared too sometimes.” “And I’m right here.”
Physical touch is going to be incredibly important during this time. As much as possible, we want to be able to connect with our children physically — more physical affection than you normally give. Physical affection is very regulating to the nervous system and it’s going to help us regulate, too. Being able to cuddle, hug, squeeze, tickle, interact and engage physically with our children as much as possible, that’s really going to help all of us regulate through this.
Those are the majority of the points I wanted to make before I started with a question and answer. I know that people have a lot of questions, so I would love to start that process whenever we can.
Crissy: I have a lot of anxiety around things like germs, and washing hands and things like that, and I’m interested in ensuring that we’re safe with my daughter, but I’m also concerned about imparting anxiety onto her.
Sara: That’s a very valid question because we do have to communicate some of this stuff to kids depending on the child’s age level. But if we are talking about children who are under the age of 7, I think we have to give them factual information about “OK, we do need to wash our hands, because this is how we get the germs off” “wash them for 20 seconds,” however, how we are thinking, reacting and responding is going to be the most important thing.
If we are coming across to our children like we are really stressed and “you really need to wash your hands” and “I need you to put hand sanitizer on,” our level of reactivity is really going to be communicating to our children how scary this is, or how much anxiety we should feel about this. A lot of this is going to be about communicating, but communicating in a way that is silly and fun. Having that level of interaction with our children, playful, gentle and non reactive, versus frenetic and stressed. Again, this is much easier said than done, but being able to regulate the anxiety that’s going on for ourselves is going to be huge in terms of being able to communicate that effectively to our children.
Member: What about little kids? I have a daughter who is six months (who just woke up). What is the implication for them not being able to see anyone, like grandparents who live out of town. It’s early for her life, so she doesn’t really get that anyway. She doesn’t go to school but what are some of those implications?
Sara: That’s a really good question. So this is what I would say to parents of children under a year. It’s really your relationship with your child that’s going to be the most important relationship that they need in the next year. Your attunement to your daughter and your responsiveness to her, and your holding her and your cooing with her. Those are where we get our neurons firing in our brain and that is where we begin to form those really important structures in our brains that have to do with social, emotional development and regulation. You are going to be the most powerful co-regulator for your daughter. And the same with anyone else who is with her constantly in your house. You holding her right there is exactly what she needs.
While I think it is really unfortunate that we can’t see some of our extended relatives, we have to keep some of these people safe and at a distance for a while. Thankfully for our children that are very young, maybe under two years, I don’t think they will be as affected as we will be. We are going to be affected by not seeing our extended family and that’s going to be really hard for us. It will be more difficult for older children to deal with not having that personal interaction and not being able to see and spend time with those family members. While it will be a hard time, I don’t think it’s going to negatively impact children long term. We are all experiencing a lot of changes and things that are very difficult, but I don’t think that not seeing their friends and family members will necessarily have long term effects on their development. It will be more of a short term difficulty, a short term frustration by missing the interaction.
Cindi Michaelson: A question in the comments asks, “How to deal with over-saturation of TV, etc?” Yes! I’m feeling that as well. Our children want to escape by watching TV and we have to really regulate it. They are constantly asking, “Can watch something?” We’ve made it so the morning has to be “learning” television where they are watching animals, or national geographic, and then in the evening if they watch it they have a little more flexibility. Do you have any feedback on TV and over-saturation right now?
Sara: One thing off the top, I would not have any news media going on, I know I already said that, but just to reiterate, I would not have them watching CNN or CNN in the background while you are doing stuff.
In terms of kids wanting to watch TV, I do experience that quite a bit. I think that with the lack of social interaction and with the fact that a lot of us as parents have had to work and attend meetings while our children don’t have any childcare, that we are allowing our kids to watch a lot more TV than we normally would were we not in a pandemic.
On one level, I want to normalize that and go back to that whole “ I want to be a great parent, I don’t want my child to be messed up with all of the TV.” I think we have to pick our battles here. The most important thing, in my mind, is my child’s mental health. Being able to say, “My child is probably going to watch a lot more TV than I’m normally comfortable with.” Having some structure around it is really important. “We’re going to watch TV for a hour and then we’re going to do [this].” Putting a timer on so we can be really predictable about that.
Being able to monitor what they are watching is really helpful as well so they are not just spiralling out of control watching something that we really don’t want them to watch. Limiting it to a certain extent will be helpful, and also giving ourselves some grace around the aspect that they are going to be watching more TV than usual.
Again, I don’t think this period of time that we’re in (I know it’s been four months or so and I don’t know how long it will be), but I don’t think that this period we are in and increasing our children’s TV watching will negatively impact their brain development. I will say this though, I think we need to increase, as much as possible, while the TV or screen are going that at the other end of that, we are spending real quality time with our kids, like physical touch, close interaction, cuddling, being there for them, lying in bed with them, just being with them and hearing them.
It doesn’t mean we have to be going on crazy excursions everywhere and finding all the places that are open. I think what’s more important is the interaction that we have with our children.
Cindi: I’m going to go off of another question that was in the chat. I know that you have a background in play therapy, so perhaps this will be around that. How do we help our children use their creative side? Do you have any type of play that would help parents and children, to help nurture the quality time together for those of us who might not be that creative with the play?
Sara: One of the most important things for kids to do right now is to play. It doesn’t have to be any sort of fancy type of play or anything particularly creative like artistic interpretations, or modeling clay, or things like that.
Our children are going to be playing out what they are experiencing with their toys and one of the most important things we can do as parents is to be a part of that and to say “I’d love to play with you” and to allow your child to lead the play. There’s a lot more within this, I could do a whole presentation on how to do an effective home “play session” with your child, but one of the most important things is to let your child lead. Saying something to your child like, “I’m here for you. Let’s play for the next 20 or 30 minutes and we can play whatever you want to play.” Allowing them to have that control, and that ability to lead can be really powerful, very regulating.
It can really help in our relationship with our child because one of the things we do with our child is setting up all these activities and we are constantly doing things, and saying, “C’mon, now!” and we’re doing this and going there. Giving them this time that is really free for them to engage with us in the ways that they want to engage with us is really helpful. During the play, and again this is a very simplified version, to be curious and reflective and to not say “I’m going to do this with my person”, but the allow the child to lead and say “I want to do this and I want you to do that” so you are in their world and just experiencing it with them. We might get more communication with something like that rather than sitting around and talking to them about coronavirus, or asking, “How are you feeling?” Mainly because that’s how children really do express themselves is through their play.
Cindi: One of the viewers has asked about conflict and I’m noticing that with my young children, as they sit down and start to play, they start having good fun interaction, but then it quickly goes south and they start to argue. I want them to be able to have interaction where they are using their creative side, but I always feel like I need to jump in and monitor what is happening with the sibling rivalry.
Sara: Can I ask how old are your children?
Cindi: Yes, this has been going on for quite some time, but, our oldest is 10 and the youngest is 7-½.
Sara: On the one hand, I think that sibling rivalry is really normal and I also think that being able to have some one-on-one time with each child is really important. Oftentimes our kids are vying for our attention or wanting to be the most important kid in the room, which I think is really normal. My son is 6-½ and I have an 18-month-old. When we are doting on the 18-month-old, he is starting to get all high energy and “look at me” and “I’m over here!” and so I think that in terms of sibling rivalry and without knowing all of the dynamics in your family, normalizing what’s going on and being able to honestly talk about it. So, in my situation saying, “We’re giving a lot of attention to the baby. I wonder if you feel like you are not getting enough attention.” To normalize that and not necessarily go and dote on him, but to say “That’s normal to feel that way.” Being able to provide one on one time with each child so they both feel that they are getting equal attention.
Crissy: I have a question and this is actually going off of a question that was put in the chat too. I was listening to a podcast recently and it’s about the socialization piece. My daughter is almost 3 and you think about that age being so important for socialization. I’m interested in what your response is, by covering the spectrum of toddlers to older ages, of how this is going to impact their social development. I think about 3 as being an important age for developing those skills for sharing and interacting with other kids. My daughter is an only child, it’s just me and my husband and we are both working. There’s a lot of fear that something is not going to work out correctly with all of this.
Sara: I don’t think that we know exactly what the long term impacts will be but what we do know is how important our relationships are with our children. Depending on whether you have an infant, or a toddler, a school aged child or teenager, our relationship with them is probably the most effective and important tool for helping them to regulate and care for their mental health.
For toddlers it is really important to have that social development and we want them to have that social interaction with other children but it’s also very hard to ask a 2 or 3 year old to socially distance. So, we will need to think of creative ways to accomplish this. I’ve seen people do parking lot parties and I’ve seen people have their kids in strollers and stroll alongside each other. It is not going to be the same as being up close, interacting with someone and having that reciprocal interaction which is really important.
Unfortunately, I don’t know that there’s going to be long term impacts, it’s really hard to say. What we can do is the best we can and use our relationship as much as possible to be able to help them feel regulated during this time.
Being realistic with our expectations. Understanding that our kids are going to have some struggles academically and they might be behind. Realistically, we aren’t able to teach our kids everything that they need to learn being at home. Our kids do need a level of social interaction and presence that happens when you’re face to face and in close proximity to people. They do need that, but in terms of if they are going to be at a disadvantage, or are they not going to develop appropriately, I don’t think that’s the case. I think it will be more of an emotional impact especially for older kids, I’m going to say over the age of 5 and teenagers. I think that’s where there’s going to be an emotional component of, “I want to be close to my friends. I want to do what I used to do.” That’s going to result in a lot of emotional breakdowns, tantrums or defiance. That’s what kids do when they’re frustrated. For teenagers, the same thing, more acting out, defiance, and more emotional struggle.
I wish we knew more about what the impacts were going to be and we’re all kind of monitoring closely and listening to the experts in the field, but unfortunately, we don’t know all of the impacts developmentally that this is going to have and it is hard say, and I think, Crissy, what you are talking about is that age range, that three to four age range is a really important and critical time. So I do think it is a valid question. I don’t think that children are not going to be able to develop because of this. Or that they are going to be at a complete disadvantage, but I think it’s going to be a struggle, emotionally. So again, I hope that answers your question somewhat.
Cindi: You mentioned that we were likely to see quite a bit of an increase in anxious behaviors, etc. So if our children do start to show an increase in twitches, tics, OCD behavior, anxiety, things of that nature, as a professional, can you give us some advice as to the path to take to help them? Do we immediately go and try to get them tested? What should we do? This is such an uncertain period of time.
Sara: In terms of when to seek help, I would ask, “How much is the behavior impacting the child and the family?” If we are constantly having multiple times a day tics, checking or repetitive behaviors, then I think that would be more significant than the child who is often saying “Is everything ok?” ”What’s going on?” That level of anxiety is really normal.
The level of checking and “What’s going on?” and “What’s happening?” Kids are seeking some validation and the brain is seeking a response to the threat. The brain is at a level that is a fight-or-flight response. We are seeking for ourselves some normalcy and “I need to feel that things are going to be OK.” Our kids are thinking the same thing. In response to them, being able to reflect and respond honestly: “I know you are really worried. It’s ok to be worried.” A lot of times we see some of these behaviors in our children like worry and anxiety and we want to stop it. “OK, there’s nothing to be worried about. Don’t worry. Stop worrying.”
Even with anger in our kids, a lot of times we are told as a society that kids shouldn’t be angry. Yes they should. Absolutely! They absolutely should be angry. That is a normal emotion that we want them to be able to express. When these things happen, rather than shutting them down and saying, “There’s nothing to worry about,” We can respond and reflect what you are seeing. “I can tell you are really worried about this.” “It is ok to be worried. It is ok.” Part of it is putting some of that back onto the child if they are constantly asking questions. “What about this, what about that, what about this.” I would answer once. Give them the answer. If it is something that you can give an answer to, “We’re going to go to the pool at noon.” “OK, when are we going, when are we going?”, I would say, “Well, we’ve already talked about that and I will let you know when we’re going to go.” “We’ve already talked about that. I’m not going to keep answering” Don’t feed into anxiety when it’s constant repetitive questions. I would answer once.
When we are responding to our kids who are anxious, we have to be monitoring our own level of regulation and anxiety. If we are reacting to a child who is saying “I’m really worried, I’m really scared.” and we are saying (with the same hyper energy) “It’s OK, It’s all right,” We are feeding right into that anxiety. You know, our words are not matching what is going on in our bodies. We are thinking what’s going on with my kid? Why are they acting this way? So our level of threat and dysregulation is rising and our kids are just responding right back at that. We want to tell them “It’s OK”, “It’s all right (with that same hyper energy) but that doesn’t do anything for the brain. It actually validates that there is something here. “My parents are really anxious too. There is something going on.”
Bringing ourselves down to a really calm space, getting regulated ourselves, talking in really calm ways, being close physically when we talk to our kids, is really going to help regulate our nervous system and their nervous system. To them, communicate: “I know you are worried, and it’s ok to be worried” (in a calm voice). The biggest thing we want to communicate is that “I hear you and I see you and what you are experiencing is valid.”
Too often we say to our kids that what they are doing or saying is not appropriate. That is one of the biggest issues that we have with our kids is wanting them to be and act in a certain way and telling them what they are feeling. “You can’t act that way.” “You can’t do that” “You can’t feel that way.” What we need to say and respond is “I can tell you are worried. I hear you. I can see you.”
It sounds really simplistic and I know. A lot of times parents say, “…and then what do I do?” There is nothing left to do. There’s the ability for our child to regulate. We are going to be able to co-regulate with them through how we are feeling and how we are reacting. It is not really about your words. The words don’t matter so much as your physical actions and reactions to our children. Tone of voice. Eye contact. Touch. All of those ways that we connect with our children. The way we connect with a baby. How we nurture our children is really through emotional and physical regulation. It’s not through your words, or saying the right thing, if that makes sense.
Sara: There are a lot of questions in the chat about younger children. Some of the questions I think I answered when I said I think we are going to see an increase in emotional dysregulation, anger, potentially aggression, because it depends on how a child expresses their emotion.
Anger is a normal emotion for children who are stressed or who are experiencing a pandemic. I think all of the things we are going to see from our kids right now are pretty normal responses to a very abnormal, strange, unusual, difficult, stressful situation. We don’t want to rush and say “oh my gosh, my child has a mental health disorder, or a problem.” We just want to normalize what is going on. I’m not saying that you shouldn’t seek help, I’m not saying that at all! I always think professional help is usually helpful. I just think in terms of normalizing what we are experiencing and not pathologizing our kids, with something like, my kid has OCD, or anxiety disorder. I think a lot of kids right now have an “anxiety disorder” in the typical sense of the word. It’s not something that necessarily needs to be pathologized in that it is a problem or bad. It’s pretty normal as a reaction when we are under threat, when we are under a situation of extreme stress, anyone is going to have a reaction that is not typical, that is going to be heightened. If we already had a child who had difficulty expressing their anger or had some aggression, we might see an uptick in that during this time. I think we are going to absolutely see an uptick in tension and conflict in our families. As best as we can, get through this time and give our families some grace as we give our children and ourselves some grace. This is a really hard time and we are going to have tension, difficulties and arguments that we didn’t have before.
Crissy: That was great. Thank you Sara. We are so very appreciative of your time. I know this topic was of interest to a lot of people. If anyone has any further questions, are they able to reach you in any way?
Sara: Yes, absolutely. I don’t know if my email address is listed on there, but if not, it is firstname.lastname@example.org and certainly shoot me an email and I will do my best to answer.
Crissy & Cindi: Thank you so much, Sara!
Sara Thatcher is the owner and founder of Oak City Counseling. Sara is a Licensed Clinical Social Worker, Certified Trauma Specialist, Registered Play Therapist-Supervisor and Registered Yoga Teacher, with over 18 years of experience in the mental health field, specializing in Play Therapy for children aged birth-12, talk therapy/creative expression with tweens/teens and parent support/coaching. Sara is one of 14 therapists in Raleigh who have obtained the Registered Play Therapist (RPT) credential, which requires 150 hours of play therapy training and 50 hours of play therapy supervision. Sara is one of three therapists in Wake County (and the only therapist in Raleigh) who have received the Certified Trauma Practitioner certification from the National Institute of Trauma and Loss in Children. She created Oak City Counseling in 2007 as an individual private practice and began growing the practice in 2013 to include additional clinicians. Sara is devoted to the practice as both a teaching/mentoring space for clinicians to learn and grow as play therapists and also to provide the community with knowledgeable and competent child therapists.
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