Child Therapy

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Psychotherapy for children refers to techniques used to help children who are experiencing difficulties with behavior, thinking or emotion. There are a number of different types of therapy, but each relies on the communication and the relationship between the child, the family and a therapist.In children psychological problems can manifest themselves in a variety of symptoms, such as:

  • Depression, sadness or tearfulness
  • Anxiety or fearfulness
  • Problems controlling his or her anger
  • Getting into trouble at home or school
  • Problems interacting with peers
  • Attention and/or learning difficulties
  • Changes in appetite, sleep
  • Social withdrawal
  • Self-destructive behavior

Children often have difficulty dealing with a major life change, such as a separation, divorce, death, or relocation.

The child’s parents or school teachers may observe the child exhibiting emotional, learning or behavior problems that interfere with his or her adjustment, success, and self-esteem.

It is normal for children to go through short periods of unhappiness or difficulties with family, friends or school.  However, when problems are severe, or persist, it’s time to get help.

How should parents decide if they should be concerned enough about their child’s behavior to consult a professional?

Bonny Forest, Ph.D. (who leads Project SKIP: Screening Kids for Intervention and Prevention) suggests the following criteria for parents to use to assess the seriousness of their child’s troubling behavior:

Duration: Has the behavior that concerns you continued to occur over weeks or months?

Intensity: Is it occurring in several settings (e.g., at home and in school) or only in one setting? Are the problems getting more severe as time goes on?

Overall impact on the child’s development and his or her family: Is your family changing its behavior to accommodate the child’s behavior? For example, do you find yourself needing to leave work to pick up your child from school?  Is your child unable to function in school or other social settings?

The more extreme a behavior’s duration, intensity, or overall impact, the more reasonable it is for parents to seek help now, Dr. Forest advises (and I agree).  As parents apply these guidelines, Dr. Forest suggests, three ideas are important to keep in mind:

First, it’s better to evaluate if there is a significant problem, and to address it, sooner rather than later.  Early intervention saves unnecessary suffering.

There are effective treatments for most mental health issues, including issues troubling children, teens and their families. Just as we must treat other health issues such as diabetes promptly, we need to treat psychological problems as early as possible.

Meta-analysis of therapy outcomes with children and adolescents (meta-analysis is the procedure for combining the results of many studies, in this case hundreds of studies) suggests significantly better outcomes for children who have been treated with psychotherapy than controls who received no treatment.  The size of the effects of psychotherapy are defined as “medium” to “large” according to statistical techniques designed to measure effect size.  This applies to anxiety and depression, as well as to conduct and disruptive disorders, somatic (psycho-physiological) disorders, as well problems with compliance with medical treatment (e.g., treatment for diabetes).

Second, some behaviors— such as a child saying they want to hurt or kill themselves— are so serious that, even if they happen just once, they must be taken seriously. Parents should speak to their pediatrician or a mental health professional immediately or, if the situation warrants, go to an emergency room.

Third, Dr. Forest notes, children undergo stresses that may manifest themselves differently at different ages:

  • Even infants and preschoolers can get depressed or anxious. Children in this age group frequently express those issues through increased temper tantrums or irritability.
  • Elementary school age children can start to manifest fears or anxieties about school or interacting with other kids. They can also have difficulty (understandably) sitting through long days without breaks. They might have difficulty making friends in the early school years, and may need extra support in social situations.  They may find school very frustrating, especially if cognitive or academic skill deficits have not been diagnosed or addressed.  Some children this age have developed chronic problems with defiance and oppositional behavior.
  • Pre-teens are vulnerable to bullying, and may have difficulty coping with increased academic and social demands.  They may become anxious, withdraw or give up on school, especially if they have problems with attention or need assistance with academic skills.  At this age, defiance and rule-breaking are often a sign of inner turmoil, and of problems with self-esteem.  Some children at this age try to act like their concepts of teens (in terms of sexuality, substance use, defiance or rule-breaking).
  • Teens can get in over their heads sexually, and abuse of alcohol and drugs can be major concerns for parents. It can be difficult to tell whether behavior is normal experimentation or something more serious.  Other teens can display similar problems (e.g., anxiety, depression, defiance, social withdrawal, rule-breaking) to children at younger ages.  Their greater physical and mental maturity can make their emotional or behavioral problems more risky.

At all ages, Dr. Forest’s guidelines of duration, intensity, &  overall impact can be used to distinguish temporary behaviors that are a normal part of growing up and behaviors that warrant a closer look by a professional.

I want to add that a thorough assessment of a child or adolescent’s difficulties must also address their strengths, abilities and coping skills.  Such a balanced approach to assessment helps to identify potential solutions to problems, sources of feelings of competence, mastery and self-esteem.

The Assessment

An assessment with a psychologist can help to clarify the situation, determine if professional assistance is needed, and develop a plan of action. Depending on the issues, services such as parent guidance, individual child therapy, or family therapy may be very helpful.

If your child has a problem it does not mean you are a “bad parent.”  It means that your child is hurting and needs to get help.  Getting help early can prevent long lasting problems.

As part of the initial assessment, the psychologist will determine whether there is a need for psychotherapy.  A treatment recommendation will be based upon the child’s current problems, history, and environment.  Psychological testing may be useful to pinpoint the nature of a child’s emotional, behavior or learning problems.

Treatment

Psychotherapy can help children in a variety of ways. They receive emotional support, learn to resolve conflicts with people, understand feelings and problems, learn to regulate their emotions, and try out new solutions to old problems.In children, playing, drawing, building, and pretending, as well as talking and listening, are important ways of sharing feelings and resolving problems.  By observing and interpreting the use that the child makes of these communication techniques, it is possible for the therapist to help the child understand some of their feelings and to come to terms with their environment.The process by which insight is achieved and behavior is changed is often a gradual one.For older children (preteens) and adolescents, psychotherapy is more similar to therapy with adults, that is, it typically focuses on the patient and the therapist talking, with the therapist actively listening.Treatment sessions last 45-50 minutes. The frequency and number of sessions needed depends on the child’s needs, the complexity and severity of their problems, and the stresses experienced by the child and the family.The relationship that develops between the therapist and the child or teen is very important. The child or adolescent must feel comfortable, safe and understood. This type of trusting environment makes it much easier for the child to express his/her thoughts and feelings and to use the therapy in a useful way.

The First Visit

Before the first visit:  Check your mental health benefits with your insurance company.

My office manager, Lynn Walstad (at 248-626-4622) can check with your insurance company for you.

Most psychologists meet with the parents prior to the child’s first visit.  With an adolescent, I typically meet with the teen before I meet with the parents, and offer them the option to sit in on the meeting with the parents.

Make a list of your concerns and questions.

The psychologist will probably meet with your child twice or more before a feedback/planning meeting with the parents.

Several days before the child’s first appointment, tell your child that he/she will be going to a psychologist.  Be honest and open with your child about the reasons for the visit.  The goal is to enlist the child’s awareness of their difficulties and willingness to look into them.

Your psychologist will help you to explain these reasons, if you are uncertain.

Explain to your child or teen that what they say to the psychologist will be kept confidential.  This is necessary for the child to trust the psychologist, to be open and candid.

The psychologist will tell you their diagnostic impressions and recommendations, but not what the child said, unless the child has indicated that they are in danger (e.g., contemplating self-harm or being abused), in which case the psychologist a legal and ethical duty to protect the child.  I also explain the limits on confidentiality to your child.

Resistance is normal for some children. Initially, your child may not want to go to a psychologist.  You should ask your psychologist for suggestions about how to talk with your child about the first visit.

After your child’s visit:

Some children will talk about their visit. Others, especially teens, may say very little. Don’t push, criticize or cross examine. Psychologists usually meet with parents after a few visits, which make up the initial evaluation, to discuss their impressions and recommendations.

Recommendations may include…

  • New strategies at home or in school.
  • Individual or group psychotherapy.
  • Referral to a physician for a medication evaluation.
  • Psychological testing of your child, to clarify some diagnostic or treatment issues.

A Good Therapist:

According to research cited by Bruce Wampold, Ph.D. at the APA Annual Convention, the data suggests that an effective therapist:

  • Has an excellent set of interpersonal skills.
  • Builds trust, understanding and belief from the client.
  • Has an alliance with client.
  • Has an acceptable and adaptive explanation of the client’s condition.
  • Has a treatment plan and allows it to be flexible.
  • Is influential, persuasive and convincing.
  • Monitors patient progress.
  • Offers hope and optimism (realistic optimism, not ‘Pollyanna-ish’).
  • Is aware of a client’s characteristics in context.
  • Is reflective.
  • Relies on best research evidence.
  • Continually improves through professional development.

These qualities, in my opinion, are as important to a child and adolescent patient as to an adult patient.

Finding a child or adolescent therapist

If you are located near me (Oakland County, Michigan), call or email my office to see if I accept your insurance and have appointments available.  If I can’t see your child, I will direct you to another professional.

If you live in Michigan, search the Michigan Psychological Association‘s website for a child or adolescent psychotherapist.  Search by the child or adolescent’s age.

Otherwise, you can search on the American Psychological Association‘s website or on Psychology Today‘s website for a psychologist or other mental health professional to evaluate and/or treat your child.