When someone in your family has PANS or PANDAS, figuring out what kind of therapeutic support they need isn't always straightforward.

You may be looking for help with OCD, anxiety, rage, separation anxiety, school avoidance, sensory sensitivities, eating difficulties, or sudden changes in mood and behavior. For teens and young adults, PANS/PANDAS can also disrupt friendships, college, work, relationships, and independence.

But the person with PANS/PANDAS isn't necessarily the only person in the family who may need support. And depending on where they are medically and emotionally, direct therapy may not always be the most helpful place to begin.

Sometimes therapy with your child, teen, or young adult makes sense. Sometimes working with parents can be more helpful. And sometimes parents need a therapeutic space of their own.

The right support can change over time—and it may look different for every family.

Therapy for PANS and PANDAS New York Connecticut Delaware

PANS and PANDAS Affect the Whole Family

Although one person receives the diagnosis, PANS/PANDAS can change life for everyone around them.

A previously independent child may suddenly be unable to separate from a parent. A teen may stop attending school or seeing friends. A young adult who had been managing college, work, or greater independence may suddenly need significant support again.

Meanwhile, parents may be navigating medical care, treatment decisions, school or college concerns, intense symptoms at home, and the uncertainty of not knowing what tomorrow will look like. Siblings and family relationships can be affected too.

That's why therapeutic support sometimes needs to look beyond the symptoms of the person who has been diagnosed.

What is happening to the family around them matters, too.

Sometimes Direct Therapy Isn't the Best Place to Start

Symptoms—and the ability to participate in therapy—can change significantly with PANS and PANDAS.

Something a child, teen, or young adult could manage a few weeks ago may suddenly become extremely difficult during a flare. Skills they previously had access to may become much harder to use.

I see this in my own virtual practice. Some children, teens, and young adults engage very well in virtual therapy. Others may have difficulty staying engaged on a screen, tolerating the demands of a session, or using therapeutic strategies when their symptoms are particularly intense.

In those situations, pushing direct therapy simply because that person has the diagnosis may not be the most useful place to begin.

That doesn't mean therapy has nothing to offer. It may mean we need to think differently about who could benefit most from support right now.

Supporting Parents Can Be Part of the Work

Parents of someone with PANS or PANDAS face difficult questions every day.

When should I encourage my child to do something that's hard—and when should I reduce the demand?
Am I accommodating anxiety or OCD, or recognizing that my child genuinely can't manage this right now?
How should I respond to rage or explosive behavior?
What do we do about school, college, work, friendships, or independence?

Parent-focused work can help families think through these questions.

Depending on what's happening, therapy might focus on responding differently to anxiety or OCD, supporting regulation, reducing conflict, adjusting expectations during a flare, or gradually helping someone return to things they haven't been able to do.

Different approaches—including CBT, DBT, ACT, ERP, parent-based approaches, and work focused on regulation—may be useful at different times. There isn't one therapy that is right for every person with PANS/PANDAS at every stage.

Timing matters too. ERP, for example, can be very helpful for OCD, but symptom severity, medical status, and the person's ability to participate all need to be considered before beginning exposure work.

The goal isn't to fit someone into a predetermined treatment plan. It's to choose support they have enough capacity to benefit from right now.

Parents May Need Support for Themselves, Too

Sometimes what a parent needs most isn't another strategy for helping their child.

Sometimes the parent needs a place where the focus is finally on them.

Watching someone you love change because of PANS or PANDAS can be deeply painful. Parents may spend months or years anticipating another flare, researching treatments, navigating medical care, advocating for their child, and wondering whether an improvement will last.

Even when things begin to stabilize, it can be difficult to stop waiting for the next crisis.

There may be grief about what your child and family have lost, fear about the future, anger about what has happened, or guilt about decisions made during incredibly difficult circumstances.

For parents of teens and young adults, there can also be the complicated experience of expecting increasing independence while illness has created a need for greater support again.

Those experiences deserve attention in their own right.

Therapy for a parent isn't simply another way to help their child. Parents deserve support, too.

The Right Support May Change Over Time

There isn't one therapeutic roadmap for a PANS/PANDAS family.

At one point, direct therapy with your child, teen, or young adult may be helpful. At another, working with you as the parent may make more sense. Sometimes you may need individual therapy to process what you've been through.

And as symptoms improve or flare, medical treatment progresses, and capacity changes, therapeutic support can change too.

Therapy and medical treatment can also play different but complementary roles. A therapist doesn't need to be a medical provider to recognize that sudden changes in psychiatric or behavioral symptoms may be important information about what is happening medically.

The goal isn't to find the one “right” therapy and stick with it no matter what. It's to keep asking what kind of support makes sense for your family right now.

Finding the Right Therapeutic Support for Your Family

Not sure what to ask when talking with a potential therapist?

I created a free guide, Finding the Right Therapeutic Support for Your PANS/PANDAS Family, with six questions to ask, along with green flags and potential red flags to consider as you decide whether a therapist may be a good fit.

Looking for More Support?

If you're navigating PANS or PANDAS in your family and are looking for additional support, I provide therapy for children, teens, young adults, and parents. Depending on what's happening right now, our work might focus on supporting your child directly, helping you navigate symptoms and challenges as a parent, or giving you space to process the impact PANS/PANDAS has had on you.

Learn More About PANS/PANDAS Therapy

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