Choosing a Therapist for Your Child
Therapy can alleviate many emotional and behavioral problems for children. It can help them adjust to losses, separations, or traumas; resolve anxiety and depression; improve their behavior; assist them in developing social skills; and even perform better academically. The quality of therapists varies widely. Here are a few considerations in choosing a therapist:- A number of professionals provide therapy, including psychiatrists, psychologists, clinical social workers, psychiatric nurses, and professional counselors. It is important that whomever you choose has graduated from an accredited program (Master's level or above) and is licensed in their profession in your state.
- Make sure that the therapist has training and experience working with children and families.
- No matter how qualified or experienced the therapist, a good "patient-therapist fit" is vital. It is important that both you and your child feel that the therapist is respectful, empathic, and competent. You might want to set up a phone or face-to face interview with the potential therapist. Many therapists, in recognition of the importance of the therapeutic relationship, offer interviews free of charge.
- Make sure that the therapist is committed to involving you in the treatment process and supporting you as a parent. The therapist should communicate frequently and clearly to you, helping you understand your child's concerns and better manage your child's emotional and behavioral difficulties.
- Inquire as to the therapist’s orientation towards treatment and make sure that it fits your child’s needs. (See treatment orientations below).
- Make sure that the therapist is knowledgeable enough about psychotropic medications to know when a medication evaluation may be helpful. Only psychiatrists as well as some nurse practitioners may actually prescribe medicine.
- Remember that therapists on managed care panels generally receive less reimbursement than the going rates. When you pick someone "in-plan" you are sometimes choosing from a pool of therapists who are just starting out and/or have a hard time finding clients. Although you may find an excellent therapist in your plan, you may have better luck with one outside it.
Treatment orientation refers to the philosophic and intellectual framework that clinicians use in approaching treatment. A clinician’s treatment orientation can affect his treatment interventions, which problems he addresses, and how long treatment takes. While clinicians may use a number of techniques, their treatment orientations fall into four broad categories: psychodynamic, cognitive-behavioral, systemic, and solution-oriented.
- Psychodynamic
Clinicians with a psychodynamic orientation view mental health symptoms as representative of underlying emotions such as anger or grief, often relating to experiences early in life. These clinicians usually direct their treatment towards helping children and families express and understand their feelings. While psychodynamic psychotherapists do aim at concrete behavioral improvements, they also attempt to better children’s understanding of themselves, improve their self-esteem, interact more effectively with others, and cope with ongoing and past conflicts. Clinicians with a psychodynamic orientation usually conduct treatment for relatively long periods (at least several months). They may work in individual, group, or family formats.
- Behavioral and Cognitive-Behavioral
Behavioral therapists generally focus on one or two presenting problems. They often work with parents to set up behavior management plans in order to improve their children's behavior. They frequently use specific techniques to address discrete problems such as phobias or bed-wetting. They may also work with children to improve their abilities to cope with stress, and to develop their social skills. Cognitive-behavioral therapists augment behavioral interventions with attempts to modify children's underlying beliefs about themselves and the world that may contribute to their negative moods and behaviors. Cognitive-behavioral therapists, and especially behavioral therapists, often conduct brief treatment (usually less than twelve sessions). They may work with children and families intermittently or meet with them less than one time per week. They may hold sessions with individual children, with parents alone, with families, or with groups of children.
- Family Systems and Multi-Systemic
While therapists of any orientation may hold family sessions, therapists with a family systems orientation focus their energy on improving family relationships, and aim to heal individual children as a result of such improvement (See The Healing Power of Family Therapy). They usually work with as many family members as possible. Therapists with a multi-systemic orientation view children's difficulties within the context of their extended family, school, and community, and may involve several persons or entities outside the family in the treatment. Treatment can be brief or longer-term, depending on the presenting problems.
- Solution-Oriented
Therapists who work from a solution-oriented perspective try to change the focus from "the problem" to "the solution". They explicitly avoid exploring problems in detail and instead help families to develop their own solutions. They usually avoid direct advice, and instead encourage children and families to recognize and build upon the skills they already have. Solution-focused therapists do not delve into the origin of difficulties. Solution-oriented therapists may practice individually, with families, or in groups. Treatment is usually brief, and tends to terminate when the presenting problem is resolved.
What treatment orientations work best?
Successful treatment for children most depends on factors other than treatment orientation, such as the therapist's experience, intelligence, empathy, and willingness to involve the family in treatment. Nevertheless, certain approaches tend to be more effective for certain problems. Therapists with a systemic orientation are usually particularly helpful for children and adolescents with behavior problems. Behavioral therapy can be very effective for children with anxiety (especially phobias), or discrete behavioral problems. Solution-oriented treatment can be very helpful in resolving minor difficulties. Cognitive-behavioral therapy is often very effective in treating children and adolescents who suffer from depression. Therapists with a psychodynamic orientation are usually best equipped at assisting children and families with broad concerns such as self-esteem, self-understanding, and relationship enhancement.
Most effective therapists use a mix of approaches depending on a child’s and family's needs and circumstances. A therapist should be able to clearly explain his or her treatment orientation (s), and how this orientation will affect his or her therapeutic interventions.
Tackling Teenage Depression
Although many pre-teens suffer from depression, full-blown depressive illness usually first presents itself in adolescence. Nearly 15 % of youth experience depression in adolescence.
Early symptoms of depression can be difficult to diagnose because they appear to be a normal part of the difficulties adolescents face. A teen may be depressed if he experiences an unusual degree of the following symptoms:
- changes in eating and sleeping habits
- unexplained drop in school performance
- withdrawal from friends and activities
- lack of concentration or forgetfulness
- rage and irritability
- indecisiveness, anxiety, excessive worry
- lack of enthusiasm, interest, or motivation
- feelings of worthlessness or guilt
- low self-esteem, lack of self-confidence
- preoccupation with death or suicide
Depression can result from a confluence of factors, including personal experiences such as the death of a loved one, conflicts in the family, a move to a new area, a breakup with a boyfriend or girlfriend, abuse and bullying, or an event such as rejection or failure. Teens that have experienced abuse or neglect early in life tend to be vulnerable to depression as they get older. Some people have a biological predisposition to depression, and some medical conditions such as hypothyroidism can contribute to depression.
Depression can contribute to drug and alcohol use as teens attempt to self-medicate their symptoms. It can also result in agitation, aggression, self-injury, and suicidal thoughts or suicide attempts.
Parents can do much to assist their depressed teens. They can let teens know that they are concerned and available to talk, and gently encourage them to become involved in social or recreational activities that they enjoy.
Psychotherapy can be an effective method for treating depression in teens. Therapy typically results in decreased symptoms, increased self-esteem, and enhanced social and academic functioning. Family involvement in the therapy usually generates quicker and greater improvements, and can also improve family dialogue and generate a more healing family atmosphere. Teens can also benefit from group therapy, which can be an excellent method for developing social skills and greater confidence.
Treatment should begin with a complete medical exam followed by an assessment from a qualified mental health professional. It is important to address alcohol or substance abuse in conjunction with any mental health treatment. If a depression is severe, it is also important to obtain an assessment from a psychiatrist to consider the options for treatment with psychotropic medications.