How do I know if my child needs therapy?

Dealing with a child’s emotional and behavioral problems can be difficult. It’s hard for parents to judge how serious their child’s problems are or to decide how to handle them. Some upsetting behavior may be temporary, due to circumstances such as a move or the birth of a sibling. Some problems, particularly ones affecting schoolwork, can be resolved after an evaluation by a school psychologist. Other troubling behavior patterns indicate deeper, ongoing problems that require therapy.

Complicating the issue of treating emotional problems are parents’ questions and fears. Although parents wouldn’t hesitate to contact a pediatrician about their child’s physical illnesses, they’re often quite reluctant to talk to a therapist about emotional difficulties. Many parents don’t know what’s involved in child therapy and fear the unknown. They may worry that their child will be stigmatized or labeled. They find his problems too complex to deal with, and they avoid therapy out of a sense of frustration or helplessness. There are parents who can’t look at their child’s behavior objectively and miss problems that are obvious to others.

The tendency for parents to resist child therapy is natural. They usually blame themselves for their child’s problems: “Maybe I should have spent more time with her.” “I should have set firmer limits.” They feel guilty and may avoid seeking help rather than face their uncomfortable feelings.

Although parents sometimes decide on their own to seek a child therapist, the initiative often comes from a pediatrician, teacher, or school counselor who’s noticed troubling symptoms in the child. His schoolwork may be poor, he may be disrupting the class, or he may show physical signs of stress. Parents who are initially upset by a recommendation to seek therapy sometimes feel relief at the prospect of finding answers and help.

It’s hard to generalize about the severity and nature of emotional problems, but there are signs parents can look for when evaluating their child. Does he have a difficult time expressing his anger? Does he seem especially angry? Is his home situation stressful? Has there been recent family trauma? Are his behavior patterns significantly different from his peers’? Does he get into fights at school? Do neighborhood parents report that he’s too aggressive? Does he work below his potential at school? Does his teacher report negative behavior? Is he withdrawn? Does he have a poor self-image? Has anyone suggested he take medication for behavioral reasons?

Parents should remember that all children display some of these behavioral problems at times, particularly when they are adjusting to changes in their lives, such as school pressures, parents’ new work schedules, or tensions in the home. Parents need to worry only when consistent patterns of troubling behavior affect their child’s social life and schoolwork.

Most eight- and nine-year-old children begin “talk” therapy while most six- and seven-year-olds begin with “play therapy.” Since these younger children usually have a hard time verbalizing their feelings, therapists have them communicate through play sessions. Kids literally play out their feelings. While a child pretends with toys or uses clay or drawing materials, his therapist observes and talks with him. If he sets up a mock battle with two figures, the therapist may say, “They must be really angry with each other. Does that kind of fighting remind you of other fights you’ve seen?” A good therapist knows how to interpret play and how to help a child work through difficult issues in the one-on-one setting of a therapy session. One eight-year-old said that his “feelings” doctor helped him stop thinking about robbers and monsters at night.

If you feel your child needs professional help, seek recommendations from your pediatrician or a school counselor. You could consult a clinical social worker, psychologist, or child psychiatrist. Just be sure whoever you select has expertise and experience working with children. You can call your local AMA or American Psychological Association chapter to verify a therapist’s credentials.

Consider interviewing at least two therapists, either by phone or in person, to find out about their practices, fees, personalities, and approaches. Ask about the therapist’s training and about what goes on during a session. Ask how therapy will help your child and how the therapist will keep you informed. Will she observe your child at school? Will she do testing? Does she have a sliding payment scale and does she submit statements to insurance companies? Ask how she suggests you talk to your child about therapy.

When you’ve chosen a therapist, tell your child what the initial visit will be like and explain that the therapist is someone who helps children feels happier and more comfortable with their family, school, and friends. You child may develop a strong attachment to his therapist. The therapist is someone he can trust and someone who accepts his feelings—good and bad—without passing judgment.

Throughout the course of treatment, keep in close contact with the therapist. If you don’t see the progress you expected, talk to her. She should be willing to answer all your questions.

Although it may be difficult for you to accept that your child needs therapy, you’re doing the right thing if you seek help when he’s young. It will be easier for him to alter his behavior and work through problems now than it will be when he’s a teenager. And even at his young age, change may be slow and gradual. Focus on the progress he makes. It’s never easy to alter a child’s behavior or self-image, but with time and patience, you and he should find therapy a remarkably positive experience.

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