BY AMANDA JENSEN-DOSS, PH.D.
The world of child and adolescent mental health is unfamiliar and often bewildering. Deciding whether your child would benefit from therapy and then finding the best treatment can be a difficult undertaking because it is hard to know who to trust with your child’s wellbeing and whether the treatment prescribed will be effective. On top of that, many parents do not even have access to therapists because they lack insurance coverage or because there just are not enough licensed therapists available.
According to the National Institute of Mental Health, around one of every five children in the United States will meet criteria for some form of serious mental illness currently or at some point in their lives, and many more have less severe symptoms that are still impairing. The most important thing to remember is that many children would benefit from therapy because the techniques and behavior strategies apply to so many life situations.
Here are some questions that parents can ask before deciding whether therapy is right for their child, and, if so, which therapist will be the best fit. Most child therapists should be completely open to answering these questions, so do not be afraid to ask.
IS THERAPY RIGHT FOR YOUR CHILD?
Often, parents struggle with deciding whether their children need therapy. They frequently are concerned about what other people will think, or whether seeking therapy means that their child is “crazy.” Deciding to take this step for your child can be tough, but there are some guiding principles you can use to help make a decision. Psychologists refer to using the “Four Ds” when deciding if someone warrants treatment. These signals are indications that a child’s problem may be severe enough to warrant the evaluation of a mental health professional. Not every situation that needs treatment will meet all four of these Ds, and not everything that meets one of these Ds necessarily needs treatment, but these criteria can help you think through whether a problem is big enough to seek help.
The first D to consider is whether a particular symptom or behavior is different from what we would expect from another child of the same age and background. For example, wetting the bed is quite common for a three year old, but would be unusual for a child who is 11. Not every behavior that is different requires treatment; but if a behavior seems outside of what is expected of your child, it might be a sign that further assessment is needed.
The second D is whether a symptom or behavior is distressing to your child or your family. For example, a child might be extremely anxious about tests, to the point where he/she cries and asks to stay home from school. Even if the child is able to take the tests and do well in school, this level of distress might suggest that treatment would be helpful. Some types of distress, such as being upset after a significant loss, might be expected and might not call for treatment. But, if something seems to be really upsetting your child for a long period, particularly when it is different from what other children might experience in that same situation, then it might be time to consult a mental health professional.
The third D is whether a given symptom or behavior is dangerous to your child or to others. Most of the time, children suffering psychological distress pose no harm to others, but they more often do pose a threat to themselves through risky or intentionally self-harmful behavior. This D is probably the one that will apply least often to a child’s behavior, but if a child or teen expresses a wish to harm themselves or others, this is a definite sign to consult a mental health professional immediately.
The fourth, and in my view, most important D is whether a symptom or behavior is causing dysfunction. If something is interfering with a child’s daily life, that’s definitely a sign that it’s time to address the problem. Having difficulty in school, not making friends, and not getting along with family members are all clear signs of dysfunction. However, there will also be times when a child does not experience dysfunction yet may still need treatment. In the example I gave above about test anxiety, that child might still be getting straight As, but his or her level of distress outweighs the fact that the anxiety is not bringing down their grades.
WHAT TO LOOK FOR WHEN CHOOSING A CHILD THERAPIST
Choosing a therapist and a course of treatment can be one of the most intimidating tasks that a parent has to face. Arming yourself with the knowledge to be able to ask the right questions and know what to look for in a therapist – and what to avoid – will help to clear up some of the murky waters of mental health treatment.
Are They Licensed?: This is a fundamental question for every parent to ask. It is misleading for someone to call themselves a “therapist” without the proper licensing and training, but many continue to do so. While some providers declare themselves therapists, in reality, they lack the professional license that deems them fit to treat children’s mental health disorders. Without this license, there are no assurances that they have received any kind of training. A professional license not only ensures that the therapist has had formal mental health training, but it also ensures that they are following your state’s ethical and legal codes.
You can determine whether a therapist is licensed by looking at their description on their web site or alongside their name and title. Every state also has licensure boards for every type of mental health license where you can confirm that your therapist is licensed and see whether the board has ever taken any action against your therapist for ethical violations. Parents should look for someone titled:
• Licensed psychologist • Licensed psychiatrist
• Licensed social worker • Licensed counselor
• Licensed marital and family therapist
This is the first step in determining whether the therapist is fit to serve your child, though it does not automatically mean that they will provide high-quality care. It is also important to look into the kind of training they received. Do they have either a master’s or doctoral degree in mental health? Have they completed supervised clinical training? While this information may not be readily available, you can ask the therapist about this before moving forward.
What Treatments Do They Provide?: Children’s mental health professionals offer a variety of treatments, but it’s important to know that not all therapy is created equal. Research supports the use of particular therapies over others for various behaviors or disorders. That’s why parents should ask whether a treatment is supported by scientific evidence.
One of the most effective treatments for children’s mental health disorders is cognitive behavioral therapy. Cognitive behavioral therapy (CBT) is the most common and the most highly recommended for many childhood problems. It is a catch-all term that includes a number of psychological therapies that are usually short-term and involve teaching children specific coping skills. CBT focuses on the connection between thoughts, emotions, and behaviors and how they affect one another. CBT is based on scientific evidence and has been proven very effective for various disorders, particularly anxiety and depression.
In addition to CBT, the following types of treatments are based on scientific research and recommended by the Society for Clinical Child and Adolescent Psychology, an organization that promotes scientific inquiry, training, professional practice, and public policy reform as a means of improving the welfare and mental health of children, youth, and families:
Behavior Therapy varies in approach, depending on the disorders, but overall, it addresses the fact that some problematic behaviors may accidentally be rewarded, which can lead to the child exhibiting these behaviors more often. Behavior therapy typically involves teaching parents or teachers strategies for rewarding the behaviors they want children to display, while setting up appropriate punishments, like time-out or loss of privileges, for problematic behaviors. Behavior therapy has been found to be effective for a range of childhood problems, particularly ADHD and disruptive behavior.
Interpersonal Psychotherapy for ailments such as depression is usually more appropriate for adolescents, and is based on the idea that in addition to a child’s biology or genetics, their interpersonal relationships with family or peers may impact, and be impacted by, the child’s depression. A therapist uses interpersonal psychotherapy to help the child build skills to improve relationships, to communicate his/her feelings, and to learn problem-solving skills to improve these relationships.
Finally, there are a number of treatments focused on families and communities that are particularly effective for adolescents with serious disruptive behaviors or substance use. These treatments are based on the idea that many serious problems that teens face are influenced by multiple factors, including individual, family, peers, school, and neighborhood; so traditional treatments may fall short. At minimum, these treatments involve working with the child and parents, and sometimes also involve teachers and other members of the community.
Multisystemic Therapy is a recommended treatment for children suffering from serious disruptive behaviors. It is based on the idea that many serious problems that children face are influenced by multiple factors, including individual, family, peers, school, and neighborhood; so traditional treatments may fall short in helping the child. Multisystemic therapy is family-focused and features the therapist working closely with the child and parents in their home and community.
Not all therapies will work for each child but it is helpful to be aware of the treatments available. If you are considering a certain kind of therapy but are not sure whether it has been proven effective, you can easily check at EffectiveChildTherapy.com. This website is a great place to see whether your child’s therapist is using a form of treatment that is backed by research. The site organizes information about treatments by problem areas, like depression or anxiety, so that you can see if the treatment proposed is appropriate.
Once you’ve determined whether you want to move forward with a particular treatment, you will most likely sit down with the provider to go over your child’s background, their issues, as well as their strengths. This process is important to informing the therapist of your child’s unique characteristics and personality so they can provide a more tailored and effective treatment.
Are They Willing to Provide a Treatment Plan?: A therapist should outline a detailed treatment plan that includes everything they plan to do, and how the treatment will specifically address your child’s difficulties. This plan should clearly show the benchmarks for progress throughout the treatment and provide information on how long it will last. Tracking progress will help determine whether the treatment should be continued or modified. If your therapist does not provide you a treatment plan, you can simply ask how they plan to determine whether the treatment is effective.
POSSIBLE RED FLAGS IN CHOOSING A CHILD THERAPIST
If it Sounds Too Good to be True, it Probably is: Parents should look for various warning signs when choosing a therapist. First, if a therapist promises that they can use one form of therapy to treat many varied disorders, it’s most likely too good to be true. For example, one therapy website claimed that it could use the same approach to treat ADHD, depression, marital conflict, and dementia – four very different problems. This kind of statement is not likely to be based on truth.
Second, are they claiming to know something that no one else knows? If a therapist makes claims that they hold the secret to ridding your child of anxiety and no one else can provide the same form of treatment, it is most likely a misleading sales tactic. Additionally, it is a red flag if their treatment plan seems to be working against conventional wisdom, or if they are recommending treatments that are not supported by science. For example, statements like— “The pharmaceutical companies don’t want you to know about this treatment because it will make their profits drop” or “Scientists are conspiring to keep you from knowing about this treatment”—are misleading and usually untrue.
They Promise the World: Most therapists enter this profession because they want to do all that they can to help children with mental health disorders; however, some may make empty promises to patients and families. If a therapist is promising quick, dramatic results, it would be a good idea to step back and take a look at what they are offering. Most likely, these kinds of promised results are not practical or achievable, so it is best to stay away from them.
Another possible “danger” sign is if a therapist suggests that a certain therapy will take years to show progress. While some childhood conditions, such as autism-spectrum disorders, do require long-term treatment, many research-supported treatments last only 12 to 16 sessions. If a therapist is offering treatment that lasts longer, a parent may want to ask more questions about why it will last that long, the particular benchmarks their child will meet along the way, as well as the cost.
They Don’t Rely on Research: Another cause for concern is whether the therapist relies mostly on testimonials instead of research. For instance, instead of research support for their treatment, some therapists will provide quotes from clients as evidence that their treatment works. While it is always nice to hear that former clients were happy with treatment, it is difficult to know how many unhappy clients are not being quoted.
KNOWLEDGE IS POWER
If you have a child dealing with a mental health condition, it can be exhausting and stressful trying to find the right treatment. Arming yourself with knowledge about the variety of therapies available for your child’s mental health needs, as well as knowing the right questions to ask, can make a world of difference for your child and your family. •
ABOUT THE AUTHOR:
Amanda Jensen-Doss, Ph.D., is Associate Professor of Psychology at the University of Miami, where she is a member of the Child Division and Clinical Psychology faculties. She is the author or co-author of numerous research publications and book chapters on youth assessment and treatment. She currently serves on the board of the Society of Clinical Child and Adolescent Psychology.