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Depression
Finding a Great Therapist for Your Child
A great therapist for children shows five special qualities
Posted November 5, 2010
If you take your car to a mechanic, chances are he or she is going to find something to fix. If all you have in your tool belt is a hammer, every problem is a nail.
And my point is? Finding a great therapist for your child when he (or she) is struggling can bring with it some serious risks: labels that stick to your child like glue; stigma among his peers; culturally insensitive recommendations; parent-blaming lectures; even a referral for medication or in-patient treatment when simpler, less intrusive solution are possible.
Just walking into the office of a mental health professional can make the child feel different, like his problem is all inside him and all his fault. Here's a few clues to avoid the perils of finding a good therapist for you child, one who you can be confident will be competent enough to help and sensitive enough to avoid any unintended (what are called iatrogenic) effects on your child or your family.
While I certainly have my preferences when it comes to the type of therapy I'd subject my own kid to, and the kind of therapy I provide in my own work with children, youth and families, I have a great deal of respect for any mental health professional who is passionate, competent and humble about their approach. And there are lots of approaches: cognitive behavioural; family-based; Rogerian; narrative, Dialectical behavioural; milieu; systemic; play; psychoanalytic; and the list goes on. Research shows that good therapists produce good results for most problems if the therapist feels competent to handle them and has enough experience to carry out treatment. For me, it's more important who I find to work with my child, than which approach he or she uses.
That's because every comprehensive review of therapy with children shows that all credible approaches (those that have been researched, or have abundant practice-based evidence) when performed well by a well-trained provider produce almost the same results. About half of all kids will get better. Of those that improve, 80% will show progress in a relatively short time (likely in fewer than six sessions), the remaining 20% will need longer-term support.
So why is there so little difference between types of therapy? Here's what we know about the best therapies for children and what they share in common.
1) It's all about relationships. Some say as much as 85% of change can be attributed to the relationship formed between the therapist and the child and/or the parent. If your kid isn't forming a bond with his therapist, for whatever reason, or doesn't trust the therapist, my suggestion is go looking for another one. A good therapist can usually engage a reluctant child. I'm surprised by the matches that work. I've seen teens engage with a hip younger therapist just as well as they do with a grandmotherly therapist decades out of touch with XBoxes and rap music. What these therapists share in common, however, is a genuine interest in the child, and a willingness to understand the world as the child understands it. If your child isn't engaging, find another therapist.
2) A good therapist, in my books, doesn't pathologize a child. She (or he) sees the child's strengths and is open to hearing the child's (and the parents') possible solutions to the challenges the child faces. The therapist understands that the child's problems are a way of coping (anxiety protects a child from danger; aggression can be a way of exercising control). When there is a real problem like Attention Deficit Hyperactivity Disorder, anorexia, depression, or truancy, a good therapist sees "the problem as the problem." She doesn't ever say, "This is a depressed child." She says, "This is a child struggling with depression." It's a big difference. The child is much more than a few symptoms. The child is, underneath his problems, a wonderful person with potential. A good therapist separates the problem from the child. If you don't feel like your child's strengths are being appreciated, look for another therapist.
3) A good therapist is also an ally with the parent, caregiver, or guardian. She understands that her role as therapist is temporary. The real people who need to be engaged to help the child are the special people already in the child's life. A good therapist is humble enough to realize her contribution is miniscule compared to what the child's social supports have to offer. That doesn't mean the therapist doesn't do what she can to help, but therapy is always understood as simply a step in a process of healing and connection. If your therapist makes her work seem like the only thing that will cure your child, find someone who is more humble and appreciative of the child's natural supports (these supports, of course, include you!).
4) A good therapist doesn't blame others for the child's problem, nor does she blame the child. A good therapist sees problems as complex and knows that solutions are often complex too. Blaming parents or schools or anyone else isn't necessarily going to help a child. But helping a child, family or school take action to make things easier for the child to succeed, that is helpful. Blame settles us in negative thinking. Action encourages us to form alliances and make things better. If you feel like your child's therapist is blaming others for the child's problem, find someone who will be more action oriented and help solve problems rather than creating more of them.
5) A good therapist appreciates the child's culture and the context where the child lives (and the culture and context of the child's caregivers too). If you feel like your culture is being ignored, or worse, disrespected, look for another therapist. That person doesn't have to be from your same ethnic, racial, or community background, but should be sensitive to differences and willing to ask questions about how your culture and values can help strengthen your child.
When you find someone who approaches his or her work with these five principles in mind, you are very likely to have found someone who can help your child. No therapy is guaranteed to work. Don't believe anyone who says he or she has the perfect answer. Instead, find someone you and your child trusts and you are more likely to experience success in therapy, whatever that therapy looks like.
