By James J. Crist, Ph.D., author of What’s the Big Deal About Addictions?
The last 22 months have been very hard on kids and families. Being cut off from friends, fear of COVID-19 for themselves and family members, frustration with online learning, too much time at home, and stressed-out parents make for significant mental health issues, including anxiety, depression, oppositional behavior, and even addictive behaviors. While many kids and families would benefit from counseling, it can be a stressful challenge to find such resources in your community and make sure that the treatment you receive is a good fit for you and your family. Fortunately, there are many resources that can help you find the right support.
Finding the Right Therapist
Looking for therapists take time. You want a therapist who is a good fit for your situation. Consult your child’s healthcare provider to see if they know of any therapists they recommend. School counselors also may know of therapists in the community who work well with children. Other parents can be a referral source if their child has had a positive experience with a particular therapist. Some parents prefer therapists of a similar faith background.
It helps to be prepared with a list of questions that you can ask a therapist prior to deciding whether they are a good fit for you. This may include asking about a therapist’s training, how many years of experience they have, how they typically work with kids and teens, whether they are providers for your insurance or what they charge for therapy if they are not providers, if they are accepting new patients, and what times they have available for therapy (such as daytime, after-school, or evening hours). You might also ask what they think about psychiatric medication and whether they can refer you to a psychiatrist if needed.
Telehealth—therapy via video chat—has been used more extensively since the beginning of the pandemic in early 2020. While not ideal for younger children (who will have more trouble staying focused), video sessions can be very helpful and convenient for teenagers as well as parents. Not all therapists provide such services and not all insurance companies cover them, so ask about this if it’s of interest.
Be sure to ask potential therapists how they handle confidentiality and how involved they expect parents to be in their child’s treatment. A common concern voiced by parents is that they are not involved enough in their child’s treatment, other than a few minutes before or after a child’s session. Some therapists feel strongly that what a child says in therapy should be confidential. While this is true to some extent, it often leaves parents in the dark and unsure how to best help their child.
Often, a combination of individual and family therapy is most helpful, with separate sessions to include parents as needed. Encouraging children and teens to share in these family sessions at least some of what is talked about in individual meetings can improve the bond between children and their parents. The therapist can then provide guidance to adults on healthy ways to respond to their child’s problems. With teens, most therapists will keep more of what they share private, unless the teen is comfortable sharing more. The one exception to this is safety. If your child or teen is having suicidal thoughts or engaging in risky behavior, such as driving under the influence of alcohol or drugs, a therapist should not keep this from parents.
Child and adolescent therapists can treat a variety of issues. These can range from sibling conflict, school performance, and compliance with home routine to more serious concerns such as ADHD, anxiety disorders, oppositional defiant/conduct disorders, autism, and mood disorders. Dealing with grief over the death of a family member or the break-up of a family due to divorce are common reasons for seeking therapy as well. Addictive disorders such as drug or alcohol abuse are also on the rise, and these typically require a greater level of expertise.
Psychotherapy can be provided by psychologists, clinical social workers, and professional counselors. Psychologists also conduct psychological testing, which can be helpful in diagnosing mental health disorders such as ADHD, depression, anxiety, and autism, among others. Psychiatrists and psychiatric nurse practitioners typically prescribe medication; some also provide counseling.
Different counselors have different therapeutic approaches. Some, such as play therapists, typically work primarily with the child and meet with the parents on occasion. Others, such as family therapists, typically work with children as well as parents. Cognitive behavioral therapy is a popular form of therapy that focuses on changing thinking patterns. Behavioral therapists focus more on incentives and consequences for specific behaviors. Be sure to ask the therapist what approach they use with clients. Most therapists use a combination of methods depending on what they think would work best for a particular person.
The Relationship Is Key
Research shows that most therapies are effective if provided by an experienced and knowledgeable clinician. However, in most cases, the relationship between a patient and the therapist is a key element in successful therapy. If your child doesn’t feel a bond with their therapist, it is less likely to be helpful. A good therapist generally has the ability to connect with patients, even if the child is reluctant at first. Having respect for a child’s opinions, building on their strengths, and not talking down to them are essential elements for successful therapy. As a parent, you also need to feel that you are part of the process.
Family therapy involves working with parents and children together to improve communication strategies and address problems with the parent-child relationship. An advantage of seeing a family therapist is that the focus isn’t just on the child as being “the problem.” Everyone plays a role in the problem, and everyone needs to be part of the solution. This approach makes it more likely that a reluctant child or teen will be willing to participate.
A good therapist also is an ally of parents, recognizing that they have to be part of the solution. The therapist doesn’t place blame on parents. Parenting today’s kids is hard work, and not all kids respond to the same parenting strategies. Therapists can teach parents more effective ways of parenting without making them feel disrespected or ashamed.
Paying for Services
Paying for services is another challenge for many families. In wealthier areas, many providers do not accept insurance. You may need to pay for the services when you receive them and seek reimbursement from your insurance provider, typically at a lower rate than the provider charges. Not all insurance plans cover out-of-network care. Those who do accept insurance may not have openings. To use insurance, you can contact your insurance carrier for a list of in-network mental health providers.
If you don’t have insurance, most areas have community mental health centers, which provide services on a sliding scale, based on your ability to pay. As a result of the Affordable Care Act (often referred to as “Obamacare,”) you may qualify for subsidized insurance based on your income. Medicaid may be another option if you qualify.
What to Tell Your Child About Therapy
It is best to let kids know ahead of time that you are taking them to see a therapist. Some kids are open to the idea (some even ask their parents if they can see a counselor) while others may be resistant, fearful, or angry at the thought of seeing a therapist. If your child is afraid to meet with the therapist alone at first, it often helps if the therapist is flexible on this.
What If a Therapist Is Not a Good Fit?
Sometimes, after meeting with a therapist for a few sessions, it becomes clear that the therapist is not a good fit. Discussing this with the therapist first is usually the best way to proceed. Your therapist may not realize that you are unhappy with how treatment is going. By discussing your concerns directly, you may be able to continue with that therapist if you feel that they are responsive to your input and willing to make changes in their approach. If this doesn’t help, it may be time to find someone new. Most therapists should recognize that this happens and should not be offended if you want a different therapist for your child or family.
Online resources can be helpful for families. While they cannot take the place of therapy with a licensed mental health professional, they can provide support and guidance. Some faith settings offer youth groups that can be very helpful for teens. Examples of self-help websites and organizations are listed below:
- The Centers for Disease Control and Prevention includes information on helping children reach developmental and emotional milestones, as well as how to cope when mental health concerns arise.
- The Child Mind Institute has a search engine for finding resources to support children with mental health, behavioral, and learning challenges.
- Empowering Parents has online information, learning programs, and coaching for managing challenging behavior problems in children and teens.
- Info About Kids provides science-based information on healthy child and family development with monthly blogs and links to helpful websites.
- Love and Logic Parenting offers books, audiobooks, and videos for purchase.
- The Positive Discipline Association has online parenting classes and free downloadable charts and information pages.
- Families Anonymous is a support group for parents who have children with addictions, such as alcohol and drugs.
The following websites provide helpful information about finding a therapist. Some sites list specific counselors and their contact information.
- Mental Health America has pages for finding therapy and finding an affiliate organization.
- Psychology Today has a Find a Therapist page.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online therapy locator.
Dr. James J. Crist is the clinical director and a staff psychologist at the Child and Family Counseling Center (CFCC) in Woodbridge, Virginia, and a substance abuse counselor, working with addictive disorders in teens and adults. At CFCC, he provides psychological testing and individual, couples, and family psychotherapy for children, adolescents, and adults, specializing in children with ADHD, depression, and anxiety disorders. Visit his website at jamesjcrist.com.
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