Finding a Therapist for Your Child's Emotional or Behavioral Problem
August 16, 2004 -- KidsHealth.org
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.
Should My Child See a Therapist?
If you've asked your child about what's bothering her and she's reluctant to express herself, a therapist can often bridge the communication gap. Child and family psychologists are specifically trained to work with young children and adolescents, helping even the most timid to open up and 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 and your child haven't been getting along lately, and heated arguments or disagreements have replaced the usual dinnertime chatter. In all of these situations, a therapist can offer an objective view and a variety of solutions that may be useful for your family.
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 and may order tests to evaluate whether a medical problem could be contributing to your child's symptoms.
According to Francine M. Roberts, PsyD, RN, and author of The Therapy Sourcebook, children who are not yet school-age could benefit from seeing a therapist if there is a significant delay in achieving developmental milestones such as walking, language development, and 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.
Although what's considered normal or acceptable behavior can vary a great deal depending upon your child's age and 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 and teachers who interact with your child on a regular basis. Is your child paying attention in class and 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.
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 and adolescents? The therapist's experience and 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.
As with other medical professionals, therapists may have a variety of credentials and 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) and be licensed by your state. Psychologists, social workers, and psychiatrists all diagnose and treat mental health disorders.
Although experience working with 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 and experience in psychotherapy and pharmacology. They are the only mental health providers who can prescribe medications.
Clinical Psychologists (PhD, PsyD, or EdD)
Clinical psychologists are therapists who have a doctorate degree that includes advanced training in the practice of psychology, and many specialize in treating children and adolescents and 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 is not yet licensed to practice. It's important to note that credential requirements vary by state.
Types of Therapy
There are many types of psychotherapy. Therapists choose the strategies that are most appropriate for a particular problem and a particular child and family. Therapists will often spend a portion of each session with the parents alone, with the child alone, and with the family together.
Any one therapist may use a variety of strategies, including:
This strategy focuses on teaching children how to relax their minds and bodies. Relaxation training helps children learn to cope with stresses and 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.
If stress seems to trigger or worsen your child's condition, this type of therapy may help him learn ways to recognize stress and how to deal with it.
Cognitive Behavioral Therapy
This type of therapy is often helpful with children 12 years and older and with children and adolescents who are depressed, anxious, or having problems coping with stress. Cognitive behavioral therapy attempts to identify maladaptive ways of thinking. For example, a child may fear test taking because he thinks, "Even if I do my best, I will fail." This type of therapy restructures negative thoughts into more positive, effective ways of thinking.
This type of therapy involves having a therapist work one-on-one with a child to focus on areas of need such as depression, social difficulties, or worry.
Family therapy can be helpful in many cases, such as when family members are having problems getting along and disagree or argue often, or when a child or adolescent is exhibiting behavior problems. Family therapy involves counseling sessions with some or all family members, helping to improve communication skills among them. Treatment focuses on problem-solving techniques and 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 and how to address that dynamic.
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 and adolescents a great deal?
[*]Would your child find the therapist friendly?
[*]What is the cancellation policy if you are 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, and be sure to take notes when interviewing each candidate.
How Will a Therapist Help My Child?
Therapists can help your child handle a variety of emotional problems. Many children need help in coping with 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 with the following psychological concerns:
[*]anxiety or phobias
[*]chronic illnesses or conditions, such as diabetes
In addition, research suggests that therapy helps children to have higher self-esteem and 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 with a therapist. Although this is sometimes the case, it's essential to be honest and forthcoming with your child about the session and 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 does not involve a physical exam and that no shots will be given. It's helpful to emphasize that this type of professional talks and plays with children and families to help them solve problems and feel better. Children may also be reassured to learn that the therapist will be helping the parents or other family members, too.
Older children and adolescents can be reassured that anything they say to the therapist is confidential and cannot be shared with anyone (other doctors and parents included) without 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.
How Can I Help My Child?
You can help your child to deal with emotional issues by listening in a caring, nonjudgmental manner. Willingness on your part, patience, and a trusting relationship are the main requirements when helping your child cope during a difficult time. Children need their parents to listen to them through positive times as well as challenging ones, and patience is critical as many young children are unable to verbalize their fears and emotions.
It may be helpful to set aside a specific time to discuss your child's worries or concerns. During this time, turn off the TV and let the answering machine record your phone messages. This will let your child know that she is your first priority.
Listed below are more guidelines that may help you to foster open communication and problem solving within your family.
[*]Talk openly and frequently with your child and let him know that you care.
[*]Set a positive example for your child by taking care of your own physical and emotional needs.
[*]Enlist the support of your partner, immediate family members, your child's doctor, and teachers.
[*]Join a support group for parents.
[*]Improve communication by having regular family meetings.
[*]Set limits on inappropriate or problematic behaviors. Ask your child's therapist for some strategies to encourage your child's
[*]Communicate frequently with your child's therapist.
[*]Be open to hearing all types of feedback from your child and from her therapist.
[*]Spend time with your child and participate in her favorite activities or hobbies.
[*]Remember that early intervention and recognition of a problem will help you get the best care for your child's emotional problems