Lately, your child has been extremely irritable and sad, even when playing
with friends and favorite toys. Other parents you know have suggested
that it may be "a stage," but your child's behaviors and emotions aren't
improving and your gut tells you that something is wrong.
What can you do to help?
The most important steps to take are to recognize that it may be an emotional
or behavioral problem your child is having and to intervene as quickly as
possible. In many cases, finding a good therapist will be key in recognizing the
problem and in treating it effectively.
Should My Child See a Therapist?
If you've asked your child about what's bothering her and she's reluctant to
express herself, a therapist can often bridge the communication gap. Child
and family psychologists are specifically trained to work with young children
and adolescents, helping even the most timid to open up and share feelings.
On the other hand, maybe your child has shared her feelings with you, but
you're not sure how best to handle a particular problem or situation. Or,
maybe you and your child haven't been getting along lately, and heated
arguments or disagreements have replaced the usual dinnertime chatter.
In all of these situations, a therapist can offer an objective view and a variety
of solutions that may be useful for your family.
may be depressed or experiencing other emotional problems. Your child's doctor
will perform a complete physical exam and may order tests to evaluate whether
a medical problem could be contributing to your child's symptoms.
According to Francine M. Roberts, PsyD, RN, and author of The Therapy
Sourcebook, children who are not yet school-age could benefit from seeing a
therapist if there is a significant delay in achieving developmental milestones
In older children, the best indicator of emotional difficulty may be their school
functioning. Behavior that may be tolerated within a family is sometimes
recognized as inappropriate when the child enters a school setting, according
Although what's considered normal or acceptable behavior can vary a great
deal depending upon your child's age and level of maturity, some of the signs
that your child may be experiencing stress include:
- developmental delay in speech, language, or toilet teaching
- behavioral problems (such as excessive anger, acting out, or eating disorders)
- a significant drop in grades, particularly if your child normally maintains high grades
- episodes of sadness or depression
- social withdrawal or isolation
- 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 (extremely happy 1 minute, crying 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 child's doctor
It's also helpful to speak to caregivers and teachers who interact with your
child on a regular basis. Is your child paying attention in class and turning
in assignments on time? What's her behavior like at recess? Gather as much
information as possible to determine the best course of action for your child.
Finding the Right Therapist
You've determined that your child would benefit from seeing a therapist, but
how do you find a qualified clinician who has experience working with children
and adolescents? The therapist's experience and education is important, but
you must also find a counselor with whom your child feels comfortable.
A good starting point is getting a referral from your child's doctor. Most doctors
have working relationships with mental health specialists such as child therapists.
The right therapist-patient match is critical in a therapeutic relationship, so you
may need to meet with a few before you find one who clicks with your child.
You can also ask friends, colleagues, or family members for referrals - word of
mouth is often a good way to get helpful information.
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.
Although experience working with young patients is beneficial, it's also wise to
know what those letters that follow a therapist's name mean.
Psychiatrists (MD or DO)
Psychiatrists are medical doctors who have advanced training and experience
in psychotherapy and pharmacology. They are the only mental health providers
Clinical Psychologists (PhD, PsyD, EdD, or DSW)
Clinical psychologists are therapists who have a doctorate degree that includes
advanced training in the practice of psychology, and many specialize in treating
children and adolescents and their families.
Clinical Social Workers (LCSW, ACSW, LICSW, or CSW)
A licensed clinical social worker has a master's degree and specializes in clinical
social work. An LCSW (licensed clinical social worker) is licensed in the state in
which she practices. Accredited clinical social workers (ACSW) may also be
accredited to work in more than one state. An LICSW is a licensed clinical social
worker, which is a similar accreditation to the ACSW, which means that these
social workers can work in any state. A CSW is a clinical social worker who is
not yet licensed to practice. It's important to note that credential requirements
vary by state.
Types of Therapy
There are many types of psychotherapy. Therapists choose the strategies that
are most appropriate for a particular problem and a particular 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:
This strategy focuses on teaching children how to relax their minds and bodies.
Relaxation training helps children learn to cope with stresses and maintain their
daily activities. With this approach, children are encouraged to take responsibility
for their own care, which can make them feel more in control of their situation.
If stress seems to trigger or worsen your child's condition, this type of therapy
may help him learn ways to recognize stress and how to deal with it.
Cognitive Behavioral Therapy
This type of therapy is often helpful with children 12 years and older and with
coping with stress. Cognitive behavioral therapy attempts to identify maladaptive
ways of thinking. For example, a child may fear test taking because he thinks,
"Even if I do my best, I will fail." This type of therapy restructures negative
thoughts into more positive, effective ways of thinking.
This type of therapy involves having a therapist work one-on-one with a child
to focus on areas of need such as depression, social difficulties, or worry.
Family therapy can be helpful in many cases, such as when family members
are having problems getting along and disagree or argue often, or when a
child or adolescent is exhibiting 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 reestablish their role as authority figures.
The benefit of family therapy is that the therapist can determine if family
difficulties contribute to your child's problem and how to address that dynamic.
How Should I Evaluate a Prospective Therapist?
There are a number of factors to consider when searching for the right
therapist for your child, but a good first step is to ask a therapist if he or
she 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. However,
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
Consider the following factors when evaluating a potential therapist:
- Is the therapist licensed to practice in your state?
- 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?
- Has the therapist worked with children and adolescents a great deal?
- Would your child find the therapist friendly?
- What is the cancellation policy if you are unable to keep your 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?
- In what types of therapy does the therapist specialize?
- Is the therapist willing to meet with you, in addition
to working with your child?
As you can see, there are a number of issues to consider when seeking the best
therapist for your child. Don't rush the selection process, and be sure to take
notes when interviewing each candidate.
How Will a Therapist Help My Child?
Therapists can help your child handle a variety of emotional problems. Many
children need help in coping with school stress, such as homework, test anxiety,
or peer pressure. Others may need help in discussing their feelings about
family members, particularly if the family is undergoing a major transition, such
A reputable therapist can also help your child cope with the following
- learning disabilities
- developmental disabilities
- anxiety or phobias
- life changes
- eating disorders
- attachment disorders
- self-esteem issues
- chronic illnesses or conditions, such as diabetes
In addition, research suggests that therapy helps children to have higher
self-esteem and better problem-solving skills as adults. Therapy can also
help your child understand the value of asking others for help.
Before the First Visit
You may be concerned that your child will become angry or sad when she's
told of an upcoming visit with a therapist. Although this is sometimes the
case, it's essential to be honest and forthcoming with your child about the
session and why she (or your family) will be going to a therapist. The truth
will come out once the session has begun, but it's important that your child
hear this from you rather than discover it on her own.
Young children can be reassured that a visit to a therapist does not involve
a physical exam and that no shots will be given. It's helpful to emphasize
that this type of professional talks and plays with children and families to
help them solve problems and feel better. Children may also be reassured
to learn that the therapist will be helping the parents or other family
Older children and adolescents can be reassured that anything they say to
the therapist is confidential and cannot be shared with anyone (other doctors
and parents included) without their permission - unless they indicate that
Giving your child this kind of information beforehand about the therapy sessions
can help set the tone that your family will be working together.
How Can I Help My Child?
You can help your child to deal with emotional issues by listening in a caring,
nonjudgmental manner. Willingness on your part, patience, and a trusting
relationship are the main requirements when helping your child cope during
a difficult time. Children need their parents to listen to them through positive
times as well as challenging ones, and patience is critical as many young
children are unable to verbalize their fears and emotions.
It may be helpful to set aside a specific time to discuss your child's worries or
concerns. During this time, turn off the TV and let the answering machine
record your phone messages. This will let your child know that she is your
Listed below are more guidelines that may help you to foster open communication
and problem solving within your family.
- Talk openly and frequently with your child and let him know that you care.
- Set a positive example for your child 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.
- Join a support group for parents.
- Improve communication by having regular family meetings.
- Set limits on inappropriate or problematic behaviors.
Ask your child's therapist for some strategies to
encourage your child's cooperation.
- Communicate frequently with your child's therapist.
- Be open to hearing all types of feedback from your child and from her therapist.
- Spend time with your child and participate in her favorite activities or hobbies.
Remember that early intervention and recognition of a problem will help
you get the best care for your child's emotional problems.
KidsHealth www.KidsHealth.com is a project of The Nemours Foundation which is dedicated to
improving the health and spirit of children. Today, as part of its continuing mission, the
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the nation, including the Alfred I. duPont Hospital for Children in Wilmington, Delaware, and the
Nemours Children's Clinics throughout Florida. Visit The Nemours Foundation to find out more