SPACE (Supportive Parenting for Anxious Childhood Emotions) Workshop by Dr Eli Lebowitz: A practitioner’s experience of integrating into practice.
There has been an increase in childhood anxieties and the paralysing effects it has had on our children and young people’s transition towards independence as well as the experiences of loss and being trapped by siblings and parents. Outside witnesses such as school, neighbours, family, and friends watch on not being able to know how to help. It is because of this increasing phenomenon that the SPACE training was organised and hosted by PartnershipProjects and indeed the sellout of all places on the training was indicative of the need and demand for practitioners and parents alike.
In April 2023 PPUK hosted an in-person, two-day Space workshop, both in London and in Birmingham with Dr. Eli Lebowitz, director of the programme of anxiety disorders at Yale Child Study Centre.
In writing this piece I seek to explore aspects of the SPACE training that I have begun to use in my clinical practice and reflect as a Seasoned NVR Practitioner on the similarities and distinctions with NVR.
Chana Hughes reviews the content of the SPACE training in the Family Therapy Context 188, August 2023 and describes her experiences with the training that it is a great resource which I would certainly recommend.
As a summary of the theory of SPACE for those unfamiliar I have included some key elements of the training that are a premise to the work. In essence:
- Parents, by accommodating their child with social anxiety in a multitude of ways are unintentionally communicating that their child is not able to cope or tolerate fear or anxiety which in turn increases the anxiety over time. This is described as the accommodation cycle.
- The practitioner contains the parents through compassionately and sensitively recognizing that this accommodation is a parent’s hardwiring instinct to protect their child from fear. Thus, anxiety is an interpersonal relational phenomenon.
- Practitioners help parents to offer an alternative to demanding or overprotective statements by giving supportive statements to their child that both validate the distress through acceptance and show confidence that their child can handle the distress.
- A structured approach in mapping out the different accommodations that parents become caught in and plan to reduce accommodation in target areas one at a time.
- Using NVR methods such as Announcements and Resistance to tackle each area in which the parent will no longer accommodate.
The workshop also provided some excellent resources through Workbooks that provided step-by-step processes and explanations of the SPACE methods and how to communicate them to parents giving confidence to practitioners beyond the training.
Following on from the training I was curious how my practice would change and develop. I had the opportunity to use this approach with a family who requested help to support their child who had selective mutism and had retreated to their bedroom. I was interested in the overlap between the practice of NVR, my Systemic Psychotherapy Approach, and the new learnings from SPACE.
The struggles and desperation experienced by parents who have children with severe anxieties are tantamount to what practitioner’s experience from all our parents who in spite of all their efforts, love, and commitment have become stuck in trying to help their child to make changes. In this case, understanding that accommodation is the hardwired mammalian parental response (that Eli and the SPACE training illustrated so eloquently) to protect ‘one’ child helped to externalize this pattern away from the parents or the child and to locate the problem within this pattern. The sharing of this biological response of accommodation enabled a speeding up of the therapeutic alliance. Being able to unpick with parents their relationship with accommodation and support and recognising that we would have entered the same pattern to solve our child’s distress (indeed all parents have!) enabled validation and confidence of support to parents. For parents to see that scoring high on Accommodation in fact resulted in low Support was an eye-opener. The preference for goals and future planning enabled very quickly a plan of action in practising supportive statements- acceptance and confidence from parents to their child which gave parents a sense that they can take immediate action.
Whilst the early use of the SPACE approach helped to create an alliance, there was a need to deepen the experiences that the parents were experiencing in terms of erasure, exhaustion, and a search for understanding. Thus, opportunities to use other understandings around adolescent mental health, exceptions to problem narratives and ideas around reaching their child through one-sided actions of reconciliation gestures were important and enabled the supportive statements to be unique and nurturing. Ideas from NVR around coming in peace, we mean no harm and we will not go away enable an anchoring of presence which was essential upon which the SPACE focus of accommodation planning was possible.
Charting the accommodation was an extremely useful tool for parents. Noticing the ways in which daily activities were organized to accommodate the anxiety and distress was again eye-opening. Read the huge list of ways in which parents have responded to their children shows the depth of love, care, and fear that parents experience when their child refuses to leave their bedroom, engage with the world and feel trapped. Whilst the list may look overwhelming, paradoxically it gave freedom to choose what to do next, it broke the taboo of what was happening in secret and of what could be possible.
Trying to choose which task to de-accommodate was a challenge. What we had noticed was that change was happening organically both by parents and their children. The parents were able to withstand the anxiety as their child started to re-engage with the world through visits outside the home as well as people coming to the home. Parents also started to notice the impact on themselves as a whole family and by placing their gaze on other parts of their lives perhaps it alleviated some of the pressure. What I am saying is that something was happening between the structure of the SPACE approach and the real experience. This is suggestive of practitioners trusting their own practitioner and therapeutic abilities and using the SPACE framework as a guide and not as a manual. Certainly, I imagine that would be the spirit and compassion in which Eli Lebowitz and his team created this approach.
We still have to make decisions about target areas in which the parents are de-accommodating, and we are still working on the announcement. This will be done using carefully chosen words that provide the balance of praise for the changes and abilities that they have seen in their child whilst also expressing what they, as parents are going to stop doing that accommodates the anxiety. We also still have work to do once the announcement has been delivered and the impact of deaccommodation that the parents will have to weather with the practitioners and supporters.
What I hope to have shared is that the resources provided through the SPACE training, the workbook, the reminder of the accommodation pattern that maintains the problem and a systematic method of deaccommodating is a very versatile approach with tools that can be interlaced for practitioners already well versed in NVR. The opportunities for supervision are essential to give practitioners a sense of reflection around pace and what to do during both setbacks and unanticipated improvements. I would also say that whilst the two days of SPACE training were invaluable and Eli Lebowitz’s personable and engaging style was excellent, the opportunity for practitioners to regroup following some SPACE practice with families to explore the nuances of change, the distinctions between the SPACE approach and NVR would have embedded and deepened my practice and understanding. However, I would encourage all practitioners to use their training in SPACE and to lean on the resources as a guide. There are many families and young people out there who will benefit and experience some sense of freedom and hope.
Written by:
Shila Desai
PartnershipProjects Family and Systemic Psychotherapist / Supervisor, Senior Clinician & Trainer
NVR Association (NVRA) Accredited Practitioner and Supervisor
You can find out more information about SPACE here >