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Children & Counseling

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Finding a Therapist for your Child's Emotional or Behavioral Problem

Lately, your child has been extremely irritable and sad, even when playing with friends and favorite toys. Other parents you know have suggested that it may be "a stage," but your child's behaviors and emotions aren't improving and your gut tells you that something is wrong.

What can you do to help?

The most important steps to take are to recognize that it may be an emotional or behavioral problem your child is having and to intervene as quickly as possible. In many cases, finding a good therapist will be key in recognizing the problem and in treating it effectively.

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Should My Child See a Therapist?

If you've asked your child about what's bothering her & she's reluctant to express herself, a therapist can often bridge the communication gap. Child & family psychologists are specifically trained to work with young children & adolescents, helping even the most timid to open up & share feelings.

On the other hand, maybe your child has shared her feelings with you, but you're not sure how best to handle a particular problem or situation. Or, maybe you & your child haven't been getting along lately & heated arguments or disagreements have replaced the usual dinnertime chatter. In all of these situations, a therapist can offer an objective view & a variety of solutions that may be useful for your family.

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Your child's doctor should examine your child if you have any concerns that he may be depressed or experiencing other emotional problems. Your child's doctor will perform a complete physical exam & may order tests to evaluate whether a medical problem could be contributing to your child's symptoms.

According to Francine M. Roberts, PsyD, RN & author of The Therapy Sourcebook, children who aren't yet school-age could benefit from seeing a therapist if there's a significant delay in achieving developmental milestones such as walking, language development & toilet teaching.

In older children, the best indicator of emotional difficulty may be their school functioning. Behavior that may be tolerated within a family is sometimes recognized as inappropriate when the child enters a school setting, according to Roberts.

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girls whispering about others... is that normal?

Although what's considered normal or acceptable behavior can vary a great deal depending upon your child's age & level of maturity, some of the signs that your child may be experiencing stress include:

  • developmental delay in speech, language, or toilet teaching

  • behavioral problems (such as excessive anger, acting out, or eating disorders)

  • a significant drop in grades, particularly if your child normally maintains high grades

  • episodes of sadness or depression

  • social withdrawal or isolation

  • decreased interest in previously enjoyed activities

  • overly aggressive behavior (such as biting, kicking, or hitting)

  • sudden changes in appetite (particularly in adolescents)

  • insomnia or increased sleepiness

  • excessive school absenteeism or tardiness

  • mood swings (extremely happy 1 minute, crying the next)

  • development of or an increase in physical complaints (such as headache, stomachache, or not feeling well) despite a normal physical exam by your child's doctor

It's also helpful to speak to caregivers & teachers who interact with your child on a regular basis. Is your child paying attention in class & turning in assignments on time? What's her behavior like at recess? Gather as much information as possible to determine the best course of action for your child.

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Finding the Right Therapist

You've determined that your child would benefit from seeing a therapist, but how do you find a qualified clinician who has experience working with children & adolescents? The therapist's experience & education is important, but you must also find a counselor with whom your child feels comfortable.

A good starting point is getting a referral from your child's doctor. Most doctors have working relationships with mental health specialists such as child therapists. The right therapist-patient match is critical in a therapeutic relationship, so you may need to meet with a few before you find one who clicks with your child.

You can also ask friends, colleagues or family members for referrals - word of mouth is often a good way to get helpful information.

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As with other medical professionals, therapists may have a variety of credentials & specific degrees. As a general rule, your child's therapist should hold a professional degree in the field of mental health (psychology, social work or psychiatry) & be licensed by your state. Psychologists, social workers & psychiatrists all diagnose & treat mental health disorders.

Although experience working w/young patients is beneficial, it's also wise to know what those letters that follow a therapist's name mean.

Psychiatrists (MD or DO)
Psychiatrists are medical doctors who have advanced training & experience in psychotherapy & pharmacology. They're the only mental health providers who can prescribe medications.

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Clinical Psychologists (PhD, PsyD, or EdD)
Clinical psychologists are therapists who have a doctorate degree that includes advanced training in the practice of psychology & many specialize in treating children & adolescents & their families.

Clinical Social Workers (LCSW, ACSW, LICSW, or CSW)
A licensed clinical social worker has a master's degree and specializes in clinical social work. An LCSW (licensed clinical social worker) is licensed in the state in which she practices.

Accredited clinical social workers (ACSW) may also be accredited to work in more than one state. An LICSW is a licensed clinical social worker, which is a similar accreditation to the ACSW, which means that these social workers can work in any state. A CSW is a clinical social worker who isn't yet licensed to practice. It's important to note that credential requirements vary by state.

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How Should I Evaluate a Prospective Therapist?

There are a number of factors to consider when searching for the right therapist for your child, but a good first step is to ask a therapist if he or she is willing to meet with you for a brief consultation or to talk with you during a phone interview before you commit to regular visits.

However, not all therapists are able to do this given their busy schedules. Most therapists charge a fee for this type of service; others consider it a complimentary visit.

Consider the following factors when evaluating a potential therapist:

  • Is the therapist licensed to practice in your state?

  • Is the therapist covered by your health insurance plan's mental health benefits? If so, how many sessions are covered by your plan? What will your co-pay be?

  • What are his or her credentials?

  • What type of experience does the therapist have?

  • Has the therapist worked with children & adolescents a great deal?

  • Would your child find the therapist friendly?

  • What is the cancellation policy if you're unable to keep your appointment?

  • Is the therapist available by phone during an emergency?

  • Who will be available to your child during the therapist's vacation or illness or during off-hours?

  • In what types of therapy does the therapist specialize?

  • Is the therapist willing to meet with you, in addition to working with your child?

As you can see, there are a number of issues to consider when seeking the best therapist for your child. Don't rush the selection process & be sure to take notes when interviewing each candidate.

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Types of Therapy

There are many types of psychotherapy. Therapists choose the strategies that are most appropriate for a particular problem & a particular child & family. Therapists will often spend a portion of each session w/the parents alone, w/the child alone & w/the family together.

Any one therapist may use a variety of strategies, including:

  • Relaxation Training
    This strategy focuses on teaching children how to relax their minds & bodies. Relaxation training helps children learn to cope w/stresses & maintain their daily activities. With this approach, children are encouraged to take responsibility for their own care, which can make them feel more in control of their situation.
  • Stress Management
    If stress seems to trigger or worsen your child's condition, this type of therapy may help him learn ways to recognize stress & how to deal w/it.
  • Cognitive Behavioral Therapy
    This type of therapy is often helpful w/children 12 years & older & w/
    children & adolescents who are depressed, anxious or having problems coping w/stress.

Cognitive behavioral therapy attempts to identify maladaptive ways of thinking. i.e., a child may fear test taking because he thinks, "Even if I do my best, I'll fail." This type of therapy restructures negative thoughts into more positive, effective ways of thinking.

  • Individual Therapy
    This type of therapy involves having a therapist work 1 on 1 w/ a child to focus on areas of need such as depression, social difficulties or worry.
  • Family Therapy
    Family therapy can be helpful in many cases, such as when family members are having problems getting along & disagree or argue often, or when a child or adolescent is exhibiting behavior problems.

Family therapy involves counseling sessions w/some or all family members, helping to improve communication skills among them. Treatment focuses on problem-solving techniques & can help parents reestablish their role as authority figures.

The benefit of family therapy is that the therapist can determine if family difficulties contribute to your child's problem & how to address that dynamic.

How Will a Therapist Help My Child?

Therapists can help your child handle a variety of emotional problems. Many children need help in coping w/school stress, such as homework, test anxiety or peer pressure. Others may need help in discussing their feelings about family members, particularly if the family is undergoing a major transition, such as a divorce, move or serious illness.

A reputable therapist can also help your child cope w/the following psychological concerns:

In addition, research suggests that therapy helps children to have higher self-esteem & better problem-solving skills as adults. Therapy can also help your child understand the value of asking others for help.

Before the First Visit....

You may be concerned that your child will become angry or sad when she's told of an upcoming visit w/a therapist. Although this is sometimes the case, it's essential to be honest & forthcoming w/ your child about the session & why she (or your family) will be going to a therapist. The truth will come out once the session has begun, but it's important that your child hear this from you rather than discover it on her own.

Young children can be reassured that a visit to a therapist doesn't involve a physical exam & that no shots will be given. It's helpful to emphasize that this type of professional talks & plays w/children & families to help them solve problems & feel better. Children may also be reassured to learn that the therapist will be helping the parents or other family members, too.

Older children & adolescents can be reassured that anything they say to the therapist is confidential & can't be shared w/anyone (other doctors & parents included) w/out their permission - unless they indicate that are considering hurting or killing themselves or someone else.

Giving your child this kind of information beforehand about the therapy sessions can help set the tone that your family will be working together.

Finding Psychological Help for Your Child

By Meredith Guinness
10 Jan 2001

Ten years ago, Lindy Garnette faced one of a parent's toughest challenges: She had to find psychological help for her child.

Her son, then 5, had bipolar disorder, a diagnosis that might lead to a lifetime of prescriptions, therapy & behavior modification.

"He has his good days & his not-so-good days,'' said Garnette, who is now the director for children & family mental health services for the Virginia-based National Mental Health Association. "It's still a struggle.''

Parents of children who need psychological treatment face a series of struggles. On top of the still-present stigma of mental illness, there's the search for competent & appropriate professionals & the battle with health-insurance providers to fund the sometimes long-term therapy needed.

But, Garnett & others say, a little guidance & a lot of perseverance can make finding a good match for your child easier.

Do You Need Therapy?
Psychologist Kevin Leman's first advice to parents is:
"Don't find a therapist for your child.''

"If there's a problem & you want to seek outside help, you go,'' said Leman, a Tucson, Ariz.-based psychologist, father of 5 & author of 21 books. "Rushing your kids off to the shrink isn't good.''

Leman believes society is rushing to pin psychological labels on kids, a practice that lets parents off the hook & can leave kids feeling abnormal.

Many parents hoping to stem sibling rivalry, fighting in school & other relatively simple behavioral issues might do well to consult a professional for parenting tips they can try at home, rather than signing the child up for sessions on the couch, he says.

"I've turned many a kid around without ever laying eyes on the kid in my office,'' Leman said.

How do you know if your child needs outside help?

Leman suggests a child may truly need attention if "the daily tasks of life aren't being met.''

Experts offer the following warning signs for depression & other common disorders in children:

  • extraordinary shyness

  • developmental delays

  • aggression

  • destructive behavior

  • attention-getting "acting out''

  • sleep disturbance

  • unexplained weight loss or gain

  • perfectionism

Leman uses a second test. If others - teachers, coaches, neighbors or family members - have alerted you to some of the above symptoms & you've already noticed them, it may be time to act, he says.

Locating a Therapist
The way
you find a therapist, psychologist or other mental health professional can be crucial to your child's success, said Dale Masi, a professor at the Univ. of Maryland graduate school for social work. In her recent book "Shrink to Fit" (Health Communications, $10.95), she suggests seeking referrals from mental health workers you know, your primary physician & people in support groups dealing with the same issues.

"You know, most people find a therapist in the telephone book,'' she said. "I wouldn't necessarily recommend that.''

Garnette strongly suggests that parents check with their insurance company or HMO for guidelines about what's covered & for how long. When in doubt about a practitioner, she would turn to a trusted friend.

"Your best bet is a friend who operates very much like you do,'' Garnette said.

Once you have a few names, Masi suggests meeting with the doctors without your child. Go armed with a list of questions & get answers about their education, experience, expertise with children & the specific issues or diagnoses affecting your child.

"You shouldn't feel uncomfortable interviewing a therapist,'' Masi said.

And think about the office atmosphere. Masi would have doubts about a doctor who claimed to specialize in children, but who had no toys or child-sized furniture in the waiting room.

"Definitely look for an expertise in treating children,'' Garnette said. "Children aren't all little adults. A lot of it has to do with how you just click with a person because it's so personal.''

Garnette would also seek someone with a few years' experience because "you do get better with practice.''

Leman also recommends finding a therapist who wants to help the child, not finish the payments on his yacht.

"Find someone who wants to get rid of you,'' he said. "If they're good, they want the child to be well & take off on his own.''

He'd also check with the local mental health society or board for any misconduct cases against a professional you're considering.

Don't expect to rely on one psychiatrist, psychologist or therapist alone. Many cases are best helped by a network of parents & professionals working together on different aspects of the child's therapy.

As a result, Masi suggests asking about affiliations when interviewing the initial professional.

"If she's not a psychiatrist, ask what psychiatrist she works with & if that person is a child psychiatrist,'' Masi said.

For many cases, experts recommend a comprehensive plan, taking in a few professionals. i.e., a plan for a child showing severe attention problems in school might include talk therapy with a family therapist, participation in a social-skills group & drug management thru a psychiatrist.

"Ideally, you want a situation in which all those people talk to each other & that 's really difficult,'' Garnette said.

Coverage Concerns
The situation is made more difficult by current practices in health management organizations & insurers that often have definite guidelines regarding length of treatment & the types of professional care covered.

On average, Garnette says, managed-care companies will pay for 10 to 15 sessions, but it's often fewer. In advocating for her son, she once threatened a vice president of her HMO with a lawsuit before the company agreed to extra care.

"They want to cure everyone in 4 sessions & it's just not possible,'' Garnette said.

And ask up front how long the therapist expects his or her work with your child to continue. Even a rough estimate can help you plan for expenses & the effect on the child & the family, Masi says.

Traumatic situations don't always allow for weeks of planning. However, some don't require a therapist either, Leman says. In the case of a child grieving after a family member's death, Leman encourages parents to "give themselves more credit.''

"Why would a kid want to see a stranger if they're grieving?'' he asked. "Share your imperfect self with your child. It's healthy for them to see you cry, pray, be concerned. That's OK.''

Garnette cautions parents to remain involved in the therapy process so they'll see if changes are needed. Her son went thru 5 psychiatrists before he found one that seemed a perfect match.

"It's worth it when you get there,'' Garnette said. "Your gut feeling is often right.''

Last reviewed: On 13 Feb 2006  By John M. Grohol, Psy.D.

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