May is #MentalHealthAwarenessMonth, and May 1-7 was #ChildrensMentalHealthWeek. So this is the perfect opportunity to talk about therapy for children and teens. The American Academy of Pediatrics has declared a mental health crisis for children and adolescents. Within the past year, the need for therapy for this population has become much greater than the number of available therapists and psychiatrists. That is a crisis in itself; however, not one that is easily resolved. If you are a parent who has been fortunate enough to find a therapist for your child, you have accomplished an important step in addressing their mental health challenges, but now the work really begins.
I often hear similar stories from parents: “My child didn’t like being in therapy,“ or “the therapist just played with my child. Their behavior didn’t change at home or at school.” I’ve also had parents who, after a few sessions, declare they don’t think therapy is working, and they’re going to stop for now.
Unfortunately these responses often reflect a disconnect between parental expectations, child understanding, and therapeutic reality. For example, I’ve had some young clients who have barely said a word the entire session, but I have worked hard to engage them in a conversation or an activity. As children or teens enter therapy, it’s important to have a conversation about what therapy looks like for kids, what makes it successful, and how parents can support their child or teen as they enter therapy.
This blog offers suggestions for ways to maximize therapy for children and teens.
But first, I need to clarify that children have different needs in therapy than teenagers. While the long term goal of improving their mental health is the same, the journey together looks quite different. Parents must adjust their expectations of what they will be told and how much they will be involved in therapy for an adolescent as opposed to a younger child. This is because adolescence is its own stage of development, where they are achieving greater independence from their parents and forming their identity. The psychological term is “individuation,” and it’s critical for parents to allow their teen the opportunity to explore their sense of self.
Talking to parents about this sometimes compromises their confidence in me as a provider because that’s not what many parents want to hear. Parents become anxious about the choices that their teenager will make, which is understandable. I’m not suggesting they resort to free range parenting because that is another extreme on the parenting continuum. I am suggesting that parents form good boundaries with their teenagers, allowing them to have space and privacy. Proactive discussions around safety are important, as are opportunities to hold space for teens when they want to talk to their parents about what’s on their mind. But asking them what goes on in their therapy and expecting the therapist to give substantive details violates therapeutic trust and often significantly decreases the teenager’s willingness to go to therapy.
On the other hand, younger children benefit from more involvement from their parents in supporting their therapy. This does not mean the therapist divulges the details of conversations with the child, because trust in the therapeutic relationship is still important. However, younger children may need additional practice with coping skills learned in therapy at home, which the parents can reinforce. They may need parents to read books with them, for example, about how to manage anxiety or help practicing strategies for calming down when their big feelings result in emotional meltdowns.
Therefore, the suggestions below will be executed differently, depending on your child’s age, and the modifications appropriate for adolescence are indicated.
Talk to your kids about therapy before you take them. I can’t tell you how many times I’ve had a child say in my office that they had no idea they were coming. Their parents told them they were taking them to see a special teacher or doctor. It’s important to be honest with them because if you are uncomfortable with mental health professionals, they observe your discomfort. Talk with them about your concerns by saying things like “I am worried about how sad you’ve been feeling,” or “I know that you’ve been struggling lately.” Many children and teens now go to their parents asking for therapy. If your child has requested this, do your best to honor their request and to look for a therapist who is a good fit together.
Allow your child or teen to have input in choosing a therapist, and choose a therapist that you trust. Do your research when investigating therapists. Many people who have not previously been in therapy default to looking at a list of providers in-network with their insurance panel. While I understand that some people have financial constraints that do not allow them to go out of network, I would not recommend this being the only step to choosing someone to work with your child. The therapeutic relationship and the ability of your child to connect with the therapist will make the difference between them building rapport and trust. My practice does a parent intake first, so the parents can ask as many questions as they want, and I can gather background regarding the situation. We can both decide if it’s a good fit, and then I meet the child. I do recommend that children have input: for instance, if they really dislike meeting with the therapist. But I also think they should give it a few sessions before deciding. Many kids are understandably uncomfortable going to therapy because it’s not an experience they’re familiar with. So sometimes it’s the discomfort with being there at all rather than the therapist. Giving it a few sessions will allow time for rapport to build, or not. Ultimately, you and your child should trust the therapist if you continue working together.
Talk about goals with the therapist. If you are taking a child under the age of 12 to therapy, the parent intake is a great opportunity to explain to the therapist what your concerns are and what your child has expressed. Some children talk openly about their feelings while others do not, but they internalize their emotions and begin to withdraw. Be specific and detailed with the therapist about what you have observed and what others have observed. You should in turn get a good understanding of how the therapist plans to address the issues. Some therapists use play therapy to work with younger children and often with teens as well through video games. If this isn’t something that you’re comfortable with, you need to be honest with yourself and with them about it. Allow the therapist the opportunity to educate you about how they use this modality, because you may change your mind if you initially are skeptical. If you are taking a teenager to therapy, let them join the intake session, and you can both ask questions and get a sense of how they would work with your teen. Your teen will feel included as part of the process, and they are more likely to trust the therapist if they are part of the process from the start.
Develop realistic expectations of therapy with the therapist. Talk directly with your child’s therapist about what you hope to accomplish. For example, taking your teen to therapy and expecting the therapist to address behavioral issues at home is not a realistic expectation if your teenager doesn’t see that as the priority. If they are anxious, depressed, or having problems with peers, they may want to focus their therapy on that. Therapists can’t take the same role as parents, in terms of telling kids what is right and wrong and directing their behavior. Family therapy may improve communication between kids and their parents, but that is separate from your child’s individual therapy and should not overlap with the same provider.
Understand what kind of therapy your child needs and who is best to provide it. Beyond forming a trusting relationship with your child, some therapists specialize in children with anxiety, some have expert knowledge in ADHD, and some specialize in trauma. When you are doing your research, look for providers who are knowledgeable in areas of concern to your child. If you aren’t sure why your child is struggling, starting with a psychological evaluation might be wise. Those are conducted by psychologists who have expertise in thoroughly investigating the underlying sources of emotional distress and difficulty functioning in every day life. Having a clear and comprehensive understanding of why children struggle will allow them to get the help they need faster. This process can also identify the types of therapy that would most benefit your child and help create an active plan.
The common factor in the above suggestions is to do your research in finding the right fit to address your children’s mental health struggles; ask questions of potential therapists; find someone with whom your child connects; and build your own trust with therapist so that you feel comfortable taking their advice and learning from their insight. Your confidence and comfort level in the care that your child receives are central factors to a successful outcome in their treatment.
We’ll pick up here next month to discuss ways parents can support their child once their therapy has gotten off to a good start.
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