How to Know When Your Child Needs Therapy
Should you consider therapy for your child?
As a School Counselor for students in Kindergarten through 8th grade, I have the privilege of guiding kids through all kinds of social and emotional milestones and obstacles. These can include their social interaction, emotion regulation, and self-concept.
While a big part of my job involves short-term and goal-focused individual counseling, I don’t meet with kids for long-term therapy. When I recognize that a child would benefit from outside treatment, I work with families to determine the best options and provide them with resources.
It’s been my experience that some families are hesitant (and sometimes flat-out opposed) to the idea of therapy for their kids. They don’t want their child labeled as a “problem kid” or ostracized by friends. Parents worry about bringing more attention to the child’s issues. They reason that the issues are developmental or “just a phase.” Some fear that their kids will be in therapy for years (although I have found that it takes an average of 12-20 weekly therapy sessions to resolve the problems of a typical child referred for treatment).
I've seen many parents wait far too long before acknowledging that their child could benefit from some kind of mental health service or therapeutic support.
Here are some of the signs and symptoms that I look for when determining whether a child might benefit from therapy:
Signs and Symptoms
Acts or Threats of Self-Harm
These include suicidal preoccupations (drawings, writing, watching videos) and ruminations (“I want to die,” “The world would be better off without me”), suicidal attempts with clear lethal intent, burning, scratching, picking at skin, and cutting oneself.
Extreme Acting Out Behavior
This includes severe angry outbursts, frequent uncontrollable tantrums, extreme mood swings or crying episodes, frequent fighting, use of or preoccupation with weapons, expressing a desire to hurt others, and aggressive behavior such as hitting, biting, or kicking others.
Sudden Changes in Behavior and Mood
These include changes in your child’s sleeping or eating habits, increased clinginess, withdrawn or isolated behavior, school refusal, lack of interest in things they used to enjoy, and a drop in school grades.
A Major Life Change or Loss
Children may need help coping with major changes such as moving, parents’ divorce or remarriage, or death of a loved one (including pets). While some disturbance of behavior or emotional distress is expected in response to these life stressors, seek treatment when difficulties linger or impact the child’s daily functioning.
Other Signs to Watch For
Unexplained, frequent physical complaints, few meaningful social relationships, obsessive rituals, unexplained weight loss, difficulty focusing or sitting still.
Always Consult Your Child’s Pediatrician
Some social, emotional, and behavioral problems are caused by underlying medical conditions, so rule those out first. Sleep apnea, for example, may be misdiagnosed as attention deficit disorder or depression. Gather information from teachers, friends, and caregivers to bring to the pediatrician to get the most accurate diagnosis and treatment recommendations.
Finding the right therapist
This may be the hardest part: knowing where to begin your search. You can start with your insurance company’s website, to see whether it allows you to filter providers by location and specialty. You can ask for referrals from friends or look in local online forums for recommendations. Psychologytoday.com can locate therapists by zip code.
Be patient and persistent. Finding the right therapist can take time. If you notice after several sessions (about three) that your child and the therapist still haven’t seemed to connect, consider finding someone else.
Types of therapists
There are several different kinds of mental health providers, which can sometimes be confusing when choosing a new one. Here are the most common types of therapists and the differences among them.
Psychologists have earned a doctoral level degree in psychology (i.e. Ph.D. or Psy.D.). Students in Ph.D. programs conduct academic research and complete dissertations, while those in PsyD programs get more hands-on clinical training. In addition to providing therapy, psychologists administer, score, and interpret psychological tests. These tests (e.g. intelligence, personality assessments) can help rule out and diagnose mental health illnesses and learning disabilities.
According to the American Mental Health Counselors Association, Licensed Mental Health Counselors (LMHCs) “combine traditional psychotherapy with a practical, problem-solving approach that creates a dynamic and efficient path for change and problem resolution.” They offer a full range of services, including (but not limited to) assessment and diagnosis, treatment planning, solution-focused therapy, alcohol and substance abuse treatment, and crisis management.
Licensed Clinical Social Workers
There is often a lot of overlap between the job descriptions of Psychologists, Counselors, and Licensed Clinical Social Workers (LCSWs). All three can diagnose, assess and make clinical evaluations, conduct research, and provide direct therapy in private practice. LCSWs often use a strength-based approach to therapy, which emphasizes a client's resourcefulness and resilience in the face of adversity. Social workers are also trained to take into account the societal and environmental factors impacting clients, in addition to their emotional and psychological well-being.
Psychiatrists are medical doctors, and are the only mental health professionals who prescribe medication. They may or may not be trained to provide therapy in addition to writing prescriptions. In other words, you may rarely actually see a psychiatrist after an initial consultation. Some people rely on combining an MD’s medical treatment with another professional’s talk-focused therapy.
Types of Therapy for Kids
In addition to considering academic credentials, look for a therapist who has special training and experience working with kids. You might also want to find someone who specializes in treating your child’s particular problem — inattention, anxiety, mood disorder, etc.
When interviewing a potential therapist, ask what kind of therapeutic approach they use. There are several different kinds of therapy, and many therapists use a combination of approaches. Here are five of the most common ones for kids:
Kids under 12 often express themselves better through play activities than through verbal communication and might benefit from Play Therapy. During the sessions, it may appear that they’re “just” playing games, but therapists are trained to look for clues about how the child communicates, solves problems, and interacts socially.
A picture's worth a thousand words. Art therapy can be perfect for kids with limited vocabularies or who find it challenging or threatening to express themselves verbally in a clinical setting. Creating art in and of itself can be used as a coping strategy to relieve stress, and the therapist helps kids interpret their art to discuss any underlying issues and reflect on the thoughts and feelings the art represents.
Behavioral Therapy focuses on how certain unwanted behavior may be inadvertently reinforced. The goal of treatment is to increase the child’s positive-reinforcing behavior. Behavior modification plans are often utilized to help reward the child for desired behavior.
Cognitive-Behavioral Therapy (CBT) is based on the idea that how you think determines how you feel and behave. Using the cognitive model, the therapist helps the child identify irrational thought patterns and replace them with new, healthy alternatives.
The focus of Family Therapy is on relationship patterns and communication styles among family members. The entire family is considered the “client,” rather than one child being singled out as the “identified patient.”
There is much to consider when deciding whether your child needs therapy, but it doesn't need to overwhelm you. All of therapy has the same goal — to help your child feel and function better. There's no one “right” way to do that, so pick one and see how it goes. You can always choose something different later.
I'd love to hear your comments, questions, and feedback on this post. Just leave a comment below. For information on how I can help you help your child, click here.
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