Child Therapy
I work with children and young adolescents in 45 minute sessions and with older adolescents in 50 minute sessions. The frequency of sessions for all three age groups is 1 to 3 sessions per week.
When to consider child therapy:
In childhood—in fact, throughout life—development is not linear. You can expect to see your child struggle as he or she learns to master new challenges. Some back sliding in development is normal, even necessary, as your child grows older. So how can you decide whether your child’s difficulties fall within the normal range or not? Here are some clues that it’s time to see a therapist for a consultation:
• Your child’s symptoms aren’t transient, but persist over months
• Your child’s symptoms interfere with his or her normal functioning (at home,
at school, or with peers)
• Your child’s symptoms interfere with the normal functioning of your family
• You feel angry, exhausted, and disappointed in your child a lot of the time
• You find you don’t like your child, even though you may be too ashamed to
admit it
• You’ve felt for a long time that something is wrong
• Trusted others have expressed concern
• Your child has been physically or sexually abused
Preparing your child for therapy; the Five Key Elements
The idea of child therapy is much more complicated and anxiety-producing for parents than for their children. Most of the children I see are relieved and happy to be here, and don’t have any trouble understanding my role or the nature of our work together. Still, you may have worries about introducing the idea of therapy to your child, and you may encounter some resistance. What’s the best way to break the news?
1) Wait for a calm moment.
Don’t raise the issue of therapy when either of you is angry or upset,
especially following an argument or crisis (such as your child running away). If
she’s riled up, your daughter won’t be able to take in what you’re saying. And
if you’re angry, she’s likely to think of therapy as a punishment.
2) Identify the problem.
Tell your child what you see that has you worried for him. You might say,
“Honey, I know you’ve been getting in a lot of fights at school.” Or: “Daddy and
I have noticed that you’ve been having a lot of nightmares lately.”
3) Offer compassion.
Tell your child you know he’s been unhappy and you want to help. For example,
say “It must be really hard to have the other kids angry at you.” Or:
“Nightmares can be really scary. No one likes to be scared.”
4) Explain therapy.
Once you’ve identified the problem and offered compassion, tell your child
you’ve been to see someone who can help. You might say something like:
“Sometimes when children like you feel scared a lot of the time, it helps to go
to someone whose job it is to help kids understand their feelings and worries by
playing and talking about them. Daddy and I went to meet a person like that last
week. Her name is Ms. Scharff, and she’s really nice. She likes children, and
she has helped a lot of kids like you. We think if you met with her it might
help you to understand better why you’ve been having those nightmares. She might
be able to help us, too, understand how to help not be so scared.”
Answers to common questions about child therapy:
What is play therapy?
If you’re a parent, you know that kids rarely talk about their feelings directly
until they are close to adolescence. Even if they say they’re sad or mad, they
can’t go much beyond the general words. They certainly can’t be expected to sit
in a therapist’s office and converse the way adults and (most) adolescents do.
Children express their inner worlds by playing about them. Besides being fun,
play gives kids a medium in which to work out their conflicts and explore new
feelings and ways of being. The technique I use in treating children is called
“play therapy.” With children, as with my adult patients, I first work to
establish a trusting therapeutic relationship. I’m likely to get down on the
floor with your child and play with the materials in my office, such as a doll
house, puppets, Play-Doh, or crayons and paper. As a play therapist, I’ve been
trained to understand the meaning of your child’s play, and to communicate that
meaning back to them.
Will you report to me on my child’s progress in therapy?
Confidentiality is tricky when it comes to kids. On the one hand, children won’t
feel safe to open up in therapy unless they can be assured that what they say
will be kept private. On the other hand, as a parent, you have a right to know
how your child is getting along. In general, I tell children that while I’ll be
speaking with their parents from time to time, I won’t share specifics of our
work unless the child and I have agreed beforehand. The exception (and I make
this explicit if I have any sense it may be an issue) is that if I ever have
information that the child is suicidal or involved in any dangerous activities,
I will have to inform the parents. But even in cases where I feel I must report
something that a child has told me in confidence, I will inform the child and
explore his feelings first.. Protecting your child’s privacy and keeping you in
the loop are not mutually exclusive. In fact, therapy with your child is a
collaborative partnership between us. After all, I see your child only a few
hours a month—you’re the one he lives with and loves, and you know him best. The
younger your child, the more often I’ll want to meet with you. These contacts
will give you a chance to update me about events in your child’s life (I’ll be
interested in your information and opinions), and to voice any new concerns. At
these meetings, I’ll give you a general report about how your child is
progressing. I may also offer you guidance on how to manage your child better at
home.
What if my child refuses to go to therapy?
You don’t consult your child about medical treatment. If the doctor prescribes
an antibiotic, your kid has to take it, no matter how much she protests. Therapy
should be no different. If you’ve decided it’s important for your child to see a
therapist, then yours should be the final word on the matter. You should prepare
your child thoughtfully (see “Preparing your child for therapy; the Five Key
Elements”), but don’t give her a choice. If she says, “I’ll go, but you can’t
make me talk,” say “fine.” Let me, the therapist, deal with her resistance.
I want my child to learn to handle his own problems. Isn’t therapy a
crutch?
If a crutch is something you lean on as you heal, then, yes, therapy is
a good one. But point of child therapy, like adult therapy, is to foster
independence, not dependence. I work to help my patients—both children and
adults—to figure out why they’re having difficulties managing, and to develop
the skills to manage better. And the good news is that children, because they
haven’t lived as long and are not as fixed in their habits as adults, learn much
more quickly and easily than we do.
Will my child be stigmatized if she goes to therapy? Will she think I
think she’s crazy?
Actually, there’s nothing more stigmatizing to a child than suffering with, say,
anxiety or depression, because:
• Symptoms get in the way of normal social functioning; if your child is
unhappy, the problem will likely show itself in her friendships and at school.
• Children who suffer with emotional problems automatically assume there’s
something wrong with them.
Therapy is private, but emotional problems in kids are public knowledge, even if you wish nobody knew. If you present therapy as something that will help her to feel better about herself, your child will be relieved that you recognize she needs help and that you’re willing to get it for her.
Don’t therapists always blame the parents?
Parenting is a tricky and complicated business, and when something goes wrong
there are always several factors. I’m not interested in blame, I’m interested in
understanding. My job is never to point a finger at you, the parent, and tell
you how you’ve screwed up. In fact, you and I will have to be partners and
collaborators if your child’s therapy is to succeed. And helping your child to
be closer to you (and to the other important people in his life) is a primary
goal of child therapy.
Will therapy put ideas into my child’s head?
Children want, and need, to know why and how. Often, kids won’t bring up certain
subjects, or won’t press them, if they’ve learned that these subjects make you
uncomfortable. For example, if you offer the stork explanation when your child
asks where babies come from, she won’t buy it (at least not for long), but she
might not ask again. Instead, she’ll have to rely on friends or figure out her
own explanation. And whatever she comes up with will be wrong, and probably much
scarier and more confusing than the truth. If your child is unhappy, she’ll look
for an explanation for that, too. And unless you give he a reason not to, she’ll
decide that she’s the one responsible for everything that’s going wrong. Coming
to therapy doesn’t put ideas in children’s heads, it offers a realistic
understanding of the ones that are already there.
What if I suspect my child has ADHD?
The symptoms of ADHD can just as easily be caused by emotional factors as
biological ones. Also, emotional and biological contributions are not mutually
exclusive. Not only can they coexist, but a biological problem often leads to an
emotional one. Children who have trouble controlling their impulses, thinking
clearly, or behaving appropriately often suffer from low self-esteem, anxiety,
or depression as a consequence. Medication on its own is rarely adequate in the
treatment of ADHD. However, it can be a good complement. If I suspect your child
could benefit from medication, I will suggest your child be evaluated by one of
the child psychiatrists with whom I have a collaborative relationship. Then you,
I, and the psychiatrist can work together to determine the best course of
action.
What if I suspect my child has developmental delays or learning
disabilities?
If you, I, or your child himself have substantial worries about any area of your
child’s development or learning, I will suggest your child be evaluated by one
of the child psychologists with whom I have a collaborative relationship. I will
work with you to prepare your child for the testing. Afterwards you, I , and the
psychologist will work together to understand the results of the testing, to
integrate them into your child’s therapy, and to find your child any additional
services he might need (such as occupational therapy, or tutoring).