By Melissa Martin, author of  Tessie Tames Her Tongue

Imagine your child is experiencing intense emotional distress that vacillates between crying spells and episodes of explosive anger. His sleep is restless, and he’s having nightmares. His appetite has decreased. He refuses to attend school, and the teacher is texting you at least three times a week to report disruptive behaviors. The days turn into weeks, then months, and you learn your child is becoming aggressive toward classmates and siblings. His mood bounces up, down, and all around. He will not talk about the problem. Eventually the school counselor recommends therapy outside of the school setting.

Many parents feel stunned or intimidated by this recommendation. They don’t know what to expect or where to begin. But children can benefit greatly from therapy, and it does not have to be a mysterious process.

Begin by contacting your health insurance company to get a list of mental health providers. If you don’t have health insurance, ask your child’s school counselor about low-cost or no-cost options that may be available in your area. Next, ask the school counselor, your pediatrician, or other trusted adults for names of child therapists in your area whom they recommend. Finding a qualified clinician who has experience working with kids is important. Third, check out the therapists’ websites and review their offered services.

Choosing a Therapist
Think about these practical questions when comparing different therapists.

• Is the therapist covered by your health insurance plan?
• What mental health benefits does your plan cover?
• How many sessions are covered by your plan?
• What is the co-pay?
• What are the cancellation policy and fees for missed appointments?

Get answers to these questions about individual therapists.

• Is the therapist licensed to practice counseling in your state?
• What are his or her credentials?
• Is the therapist experienced in child therapy?

Once you choose a therapist, call the office staff and ask any questions you still have. Then schedule an initial assessment appointment.

The child does not usually attend the first appointment. Parents attend to sign forms and fill out paperwork about the child’s symptoms and behaviors. You will meet the therapist, and he or she will help you understand the purpose, benefits, risks, expected outcomes, and other treatment options so you can give informed consent—permission to proceed with therapy. The therapist will also discuss confidentiality, crisis intervention services, and the process of assessment, diagnosis, and treatment. He or she will ask you to sign release forms for consultation with the child’s teacher, school counselor, pediatrician, and other necessary professionals.

Preparing for the First Session
To get ready for your child’s first session, collect the following information and materials.

• A list of concerns about your child’s symptoms and behaviors
• Any classroom reports from teachers
• Any reports or feedback from the school counselor
• Recent report cards to show any effects on academics
• Any educational evaluations or testing results

Assessment
When you meet with the therapist, he or she will listen to the story of what has been happening and ask questions. The therapist will ask about your child’s birth, development, medical history, eating habits, and sleep habits. Questions about mental illnesses in the family will be explored. He or she will ask about your child’s relationships at home, at school, and in the community, as well as a history of the problem. The therapist will explore mental, emotional, and behavioral symptoms and will discuss impairment and functioning. You will talk about history of trauma. You will also receive other questionnaires and inventories to fill out so the therapist can gather a plethora of information on your child.

The therapist will spend time assessing and observing your child in future sessions. Depending on the age, the child may fill out questionnaires, draw pictures of the family, or talk to the therapist. The therapist may refer the child to a pediatrician for a medical exam to rule out any medical conditions. Together, you and the therapist will discuss a treatment plan with goals and objectives for therapy.

Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health-care professionals to diagnose mental disorders. The DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. Health insurance companies require a diagnosis in order for payment of therapeutic services.

Treatment
After a diagnosis is made, treatment begins. The therapist will discuss different types of therapies: behavioral therapy, cognitive behavioral therapy (CBT), play therapy, expressive therapies, family therapies, and other modalities.

• Behavior therapy is a structured approach that focuses on changing disruptive behaviors and increasing positive actions. Therapists use behavior modification, role playing, and behavior contracts to manage and change behaviors.
• Cognitive behavioral therapy is a form of psychotherapy that emphasizes the significant role of thinking in how we feel and what we do. CBT therapists teach children that thoughts cause feelings, which can influence behavior.
• Play therapy utilizes a child’s natural ability to play as a way to resolve problems and make changes in cognitions, emotions, and behaviors. Therapists use sand trays, puppets, games, toys, and picture books.
• Expressive therapies include art techniques, music therapy, and dance or yoga.
• Family therapies include family members in the therapeutic processes of communication, emotional regulation, problem solving, and making and maintaining changes.

Conclusion
Significant life events (such as divorce; the death of a family member, friend, or pet; a traumatic experience; a major physical or mental illness in the family; abuse; a change in schools; and bullying) may cause distress for children and changes in their emotional, social, and academic functioning. Kids can experience separation anxiety, test anxiety, and social anxiety. Sometimes, what caused a sudden change in emotions or behaviors when a child withdraws and isolates or reacts with rage or crying is not clear, but counseling is an avenue for help and hope.

Stay active in the process. Ask questions during each stage of therapy. The child, the parents, the therapists, school staff, and medical professionals are partners in a teamwork approach to mental illness.

Melissa Martin, Ph.D., is a clinical child therapist with experience as a play therapist, adjunct professor, workshop leader and trainer, and behavioral health consultant. Her specializations include mental health trauma treatment, EMDR (eye movement desensitization and reprocessing), and expressive therapies. A self-syndicated newspaper columnist, she writes on children’s mental health issues and parenting. Melissa lives in Ohio.

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Resources
National Institute of Mental Health
KidsHealth: “Taking Your Child to a Therapist”
American Psychiatric Association
Association for Play Therapy

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