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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 child 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

Tips for preparing your child for therapy:

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.”

Tips for helping your child succeed in therapy:

1.  Don’t “grill” your child after sessions. It’s a tall order, but try to resist the urge to ask your child for reports on his therapy. Questions like “What did you and Dr. Kelly talk about today?” are likely to meet with either silence or an answer designed to please you. It’s much better to let your child’s therapy be a private place, and to use your meetings with the therapist to get the information you need.

2.  Remind your child that she has therapy as a resource, but don’t harp on it. When  difficulties come up for your child, there’s nothing wrong with gently suggesting that she talk about them in therapy. For example, if your daughter gets in a fight at school you could say “You know, Honey, if you feel like talking with Dr. Kelly about what happened, she might be able to help you with the problems you’re having on the playground.” But try not to bring therapy up too often, or your child will feel you’re intruding. If there’s something you want your child’s therapist to know, the best bet may be to call her yourself. It’s best to inform your child beforehand, though, so he won’t feel the adults are conspiring.

3.  Don’t use therapy as a threat or form of discipline. A comment like “If you don’t start cooperating I’m going to tell Dr. Kelly” is counterproductive. A better one would be: “Lately it’s been really hard for you to cooperate with me and Mommy. I think it would be a good idea for us to talk to Dr. Kelly about ways we can all get along better.”

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 the tips above), 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, organizational coaching, or tutoring).


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