Does My Child Need Therapy?

Sometimes kids, like adults, can benefit from therapy. Therapy can help kids develop problem-solving skills and also teach them the value of seeking help. Therapists can help kids and families cope with stress and a variety of emotional and behavioral issues. Many kids need help dealing with school stress, such as homework, test anxiety, bullying, or peer pressure. Others need help to discuss their feelings about family issues, particularly if there's a major transition, such as a divorce, move, or serious illness.

Should My Child See a Therapist?
Significant life events — such as the death of a family member, friend, or pet; divorce or a move; abuse; trauma; a parent leaving on military deployment; or a major illness in the family — can cause stress that might lead to problems with behavior, mood, sleep, appetite, and academic or social functioning. In some cases, it's not as clear what's caused a child to suddenly seem withdrawn, worried, stress, sulky, or tearful. But if you feel your child might have an emotional or behavioral problem or needs help coping with a difficult life event, trust your instincts.

Signs that a child may benefit from seeing a psychologist or licensed therapist include:
•developmental delay in speech, language, or toilet training
•learning or attention problems (such as ADHD)
•behavioral problems (such as excessive anger, acting out, bedwetting or eating disorders)
•a significant drop in grades, particularly if your child normally maintains high grades
•episodes of sadness, tearfulness, or depression
•social withdrawal or isolation
•being the victim of bullying or bullying other children
•decreased interest in previously enjoyed activities
•overly aggressive behavior (such as biting, kicking, or hitting)
•sudden changes in appetite (particularly in adolescents)
•insomnia or increased sleepiness
•excessive school absenteeism or tardiness
•mood swings (e.g., happy one minute, upset the next)
•development of or an increase in physical complaints (such as headache, stomachache, or not feeling well) despite a normal physical exam by your doctor
•management of a serious, acute, or chronic illness
•signs of alcohol, drug, or other substance use (such as solvents or prescription drug abuse)
•problems in transitions (following separation, divorce, or relocation)
•bereavement issues
•custody evaluations
•therapy following sexual, physical, or emotional abuse or other traumatic events

Kids who aren't yet school-age could benefit from seeing a developmental or clinical psychologist if there's a significant delay in achieving developmental milestones such as walking, talking, and potty training, and if there are concerns regarding autism or other developmental disorders.

Talk to Caregivers, Teachers, and the Doctor
It's also helpful to speak to caregivers and teachers who interact regularly with your child. Is your child paying attention in class and turning in assignments on time? What's his or her behavior like at recess and with peers? Gather as much information as possible to determine the best course of action.Discuss your concerns with your child's doctor, who can offer perspective and evaluate your child to rule out any medical conditions that could be having an effect. The doctor also may be able to refer you to a qualified therapist for the help your child needs.

Finding the Right Therapist
How do you find a qualified clinician who has experience working with kids and teens? While experience and education are important, it's also important to find a counselor your child feels comfortable talking to. Look for one who not only has the right experience, but also the best approach to help your child in the current circumstances.
Your doctor can be a good source of a referral. Most doctors have working relationships with mental health specialists such as child psychologists or clinical social workers. Friends, colleagues, or family members might also be able to recommend someone.
Consider a number of factors when searching for the right therapist for your child. A good first step is to ask if the therapist is willing to meet with you for a brief consultation or to talk with you during a phone interview before you commit to regular visits. Not all therapists are able to do this, given their busy schedules. Most therapists charge a fee for this type of service; others consider it a complimentary visit.


Consider the following factors when evaluating a potential therapist:
Is the therapist licensed to practice in your state? (You can check with the state board for that profession or check to see if the license is displayed in the office.)Is the therapist covered by your health insurance plan's mental health benefits? If so, how many sessions are covered by your plan? What will your co-pay be?What are his or her credentials?What type of experience does the therapist have?How long has the therapist worked with children and adolescents?Would your child find the therapist friendly?What is the cancellation policy if you're unable to keep an appointment?Is the therapist available by phone during an emergency?Who will be available to your child during the therapist's vacation or illness or during off-hours?What types of therapy does the therapist specialize in?Is the therapist willing to meet with you in addition to working with your child?The right therapist-client match is critical, so you might need to meet with a few before you find one who clicks with both you and your child.
As with other medical professionals, therapists may have a variety of credentials and specific degrees. As a general rule, your child's therapist should hold a professional degree in the field of mental health (psychology, social work, or psychiatry) and be licensed by your state. Psychologists, social workers, and psychiatrists all diagnose and treat mental health disorders.
It's also a good idea to know what those letters that follow a therapist's name mean:
PsychiatristsPsychiatrists (MDs or DOs) are medical doctors who have advanced training and experience in psychotherapy and pharmacology. They can also prescribe medications.
Clinical Psychologists(PhDs, PsyDs, or EdDs) are therapists who have a doctorate degree that includes advanced training in the practice of psychology, and many specialize in treating children and teens and their families. Psychologists may help clients manage medications but do not prescribe medication.
Clinical Social Workers
A licensed clinical social worker (LCSW) has a master's degree, specializes in clinical social work, and is licensed in the state in which he or she practices. An LICSW is also a licensed clinical social worker. A CSW is a certified social worker. Many social workers are trained in psychotherapy, but the credentials vary from state to state. Likewise, the designations (i.e., LCSW, LICSW, CSW) can vary from state to state.

Different Types of Therapy
There are many types of therapy. Therapists choose the strategies that are most appropriate for a particular problem and for the individual child and family. Therapists will often spend a portion of each session with the parents alone, with the child alone, and with the family together.
Any one therapist may use a variety of strategies, including:
Cognitive Behavioral Therapy (CBT)This type of therapy is often helpful with kids and teens who are depressed, anxious, or having problems coping with stress.
Cognitive behavioral therapy restructures negative thoughts into more positive, effective ways of thinking. It can include work on stress management strategies, relaxation training, practicing coping skills, and other forms of treatment.
Psychoanalytic therapy is less commonly used with children but can be used with older kids and teens who may benefit from more in-depth analysis of their problems. This is the quintessential "talk therapy" and does not focus on short-term problem-solving in the same way as CBT and behavioral therapies.
In some cases, kids benefit from individual therapy, one-on-one work with the therapist on issues they need guidance on, such as depression, social difficulties, or worry. In other cases, the right option is group therapy, where kids meet in groups of 6 to 12 to solve problems and learn new skills (such as social skills or anger management).
Family therapy can be helpful in many cases, such as when family members aren't getting along; disagree or argue often; or when a child or teen is having behavior problems. Family therapy involves counseling sessions with some, or all, family members, helping to improve communication skills among them. Treatment focuses on problem-solving techniques and can help parents re-establish their role as authority figures.

Preparing for the First Visit
You may be concerned that your child will become upset when told of an upcoming visit with a therapist. Although this is sometimes the case, it's essential to be honest about the session and why your child (or family) will be going. The issue will come up during the session, but it's important for you to prepare your child for it.
Explain to young kids that this type of visit to the doctor doesn't involve a physical exam or shots. You may also want to stress that this type of doctor talks and plays with kids and families to help them solve problems and feel better. Kids might feel reassured to learn that the therapist will be helping the parents and other family members too.
Older kids and teens may be reassured to hear that anything they say to the therapist is confidential and cannot be shared with anyone else, including parents or other doctors, without their permission — the exception is if they indicate that they're having thoughts of suicide or otherwise hurting themselves or others.
Giving kids this kind of information before the first appointment can help set the tone, prevent your child from feeling singled out or isolated, and provide reassurance that the family will be working together on the problem.

Providing Additional Support
While your child copes with emotional issues, be there to listen and care, and offer support without judgment. Patience is critical, too, as many young children are unable to verbalize their fears and emotions.
Try to set aside some time to discuss your child's worries or concerns. To minimize distractions, turn off the TV and let voice mail answer your phone calls. This will let your child know that he or she is your first priority.

Other ways to communicate openly and problem-solve include:
Talk openly and as frequently with your child as you can.Show love and affection to your child, especially during troubled times.Set a good example by taking care of your own physical and emotional needs.Enlist the support of your partner, immediate family members, your child's doctor, and teachers.Improve communication at home by having family meetings that end with a fun activity (e.g., playing a game, making ice-cream sundaes).No matter how hard it is, set limits on inappropriate or problematic behaviors. Ask the therapist for some strategies to encourage your child's cooperation.Communicate frequently with the therapist.Be open to all types of feedback from your child and from the therapist.Respect the relationship between your child and the therapist. If you feel threatened by it, discuss this with the therapist (it's nothing to be embarrassed about).Enjoy favorite activities or hobbies with your child.By recognizing problems and seeking help early on, you can help your child — and your entire family — move through the tough times toward happier, healthier times ahead.