Special Editorial: Does your child need therapy? Thoughts on parental fears and why we need you involved
· You cuddle your kids too much
· You don’t love them enough
· You are too strict
· You are too permissive
· You are too emotional
· You are not emotional enough
· You give too much freedom
· You hover over them
· You don’t praise them enough
· You praise them too much
1. If your kid’s behavioral or emotional difficulties are such that his functioning at home, school, or with peers is impaired, he may need help. You may ask, what is impaired functioning? There is no standard definition, but we usually become concerned when a child is unable to fulfill many of the basic tasks of being a kid: going to school, getting at least Cs in his courses, developing and maintaining friends, regulating his emotions, keeping himself out of trouble with the law, understanding and following basic rules, etc.
2. Getting help may simply involve an evaluation to determine what intervention, if any, may be beneficial to your child. So it is often less scary if parents think that the first step is simply to seek an evaluation or consultation, without any commitment to go beyond this initial consult. The process should not be any different than when taking your child to the pediatrician for an evaluation if your child is having some physical symptoms. If your child needs help, most of our current interventions are relatively short (20-30 sessions) and the times of keeping kids in never-ending years of therapy are gone (at least mostly).
3. I am always reluctant to say anything negative about other professionals, but the reality is that many pediatricians have little training in child psychology and psychiatry and especially in the proper evaluation of child psychological conditions. This is not just my perception. A of pediatricians revealed that about 70% of pediatricians feel that they lack appropriate training in diagnosing and treating mental health conditions and over 60% felt that they were not competent in proper diagnostic practices . So if you don’t agree with your pediatrician’s opinion that your child is just fine, request a referral for a consultation with a child mental health provider, such as a psychologist, psychiatrist, or clinical social worker.
4. This is likely a controversial statement, especially with some traditional therapists, but I say it because parents are frequently overly concerned about finding out what “caused” their kid’s OCD or ADHD. Often parents feel guilty and want to know if they caused the problem somehow or they are seeking answers that help them understand and accept why things turned out this way. The reality is that in most cases the “cause” will never be known. Although good clinicians will have a deep understanding of the historical and current context (family dynamics, peer group, thinking style, etc.) that may contribute to some of the difficulties, what matters right now is what we do from this day forward to help your child improve. Remember, we can’t change the past but we can improve your child’s future.
5. There is very little we can do in one hour of weekly therapy without getting parents, and often teachers, involved in the treatment process. This is because the most effective interventions usually require that we make changes at home and in some cases at school. On that note:
6. There are many, many parenting styles that are effective for most kids. In fact, some researchers even use the term “good enough parenting” to refer to the phenomenon that most kids will be fine regardless of what you do as a parent. But we also have extensive research suggesting that in some cases, such as when a child has a specific disorder, some parenting behaviors are more helpful than others. In addition, the most effective treatments for some conditions require that parents implement specific discipline plans that may be very different from what comes naturally to some parents. So we may ask you to change how things work at home, but not because we are judging your practices or skills, but because we need you to help us implement a treatment that may involve doing things differently. It is really not any different than if your child had a food allergy and the pediatrician recommended that you change your cooking. You were not doing it wrong. You did not cause the problem. But you can help your child by making the changes that need to be made.