Your child is struggling. They are behind in school. They may refuse to even go to school some days. The school district is calling you at least once a week because either your child isn’t going to school enough or did go and needs to leave for the day. They recommend taking your child for therapy, either through the school district or from a private provider.
You may be resistant to this idea at first, possibly for good reason. You, as a parent or caregiver, probably understand more about what is going on in your child’s life than anyone else, possibly including the child themselves. Of course, the problem often is that a family can get so bogged down in a routine that often includes your child struggling in some form or fashion with behaviors that it becomes normal to everyone.
Typically, families only seek help when a child has become so dysregulated or disruptive that seeking outside help becomes virtually your last resort. This often makes the task at hand even more difficult as many of the emotional struggles and behaviors that typically accompany them have become ingrained at some point and are probably helping them cope with whatever problem they are having to some degree.
As a parent you are forced to make a difficult decision. At some point, most, if not all, of the behaviors and emotional difficulties can be alleviated in different ways depending on the combination of factors involved. However, there is a cost to all this. You need to be committed to the fact that there is a process involved that will take time to develop and bear fruit. Although in some cases there may only need to be small changes put in place to get your child back on track, in other cases there may need to be wholesale changes made in many areas. If you are not open and honest with yourself about your own concerns, this can lead to problems in other fronts at home.
The first thing you should always do is make sure to consult with your pediatrician. It always thought to be a best practice at psychdomain.com to make sure there is not any type of organic medical problem at play that is feeding some, or all, of the behaviors. This means actually taking them and actively engaging with the doctor. We have seen many families who took their child’s problems and just assumed it was “puberty” or the time-worn “phase” that children often seem to go through. Waiting to take this step is almost invariably just making the ultimate job harder or could be allowing a serious medical problem to take root.
If you do finally make the decision to engage with a school therapist or outside provider to help your child there are other factors that will come into play that will test your commitment to the process and will often cause many families to lose interest or pull out of treatment when they do not feel there has been significant improvement right away. Obviously, it is of the utmost importance that you find a therapist that fits with your family’s values. Of course, if the therapist fits your qualifications but does not mesh with your child, you will not get much progress either so the balance has to work for everyone.
A good therapist should be able to connect with virtually any child on some level and also be able to have rapport with the parents. Does this mean the therapist needs to share your politics or worldviews? My own thinking is that a good therapist is not working with your child to discuss or judge their politics, religion, or culture unless there is a hint that it may be playing a part in the child’s presentation. Any reservations you have about any area of treatment should be brought into the open before therapy even starts so they may be appropriately addressed by the therapist. If they are not able to address your concerns satisfactorily, that could be a sign that the relationship may not be a good fit.
One of the most obvious obstacles to improvement is the resistance of the child to treatment or interventions of any type. This is usually the largest hurdle to overcome for the family and the provider. As you probably will be feeling in the moment of starting therapy, this will be a large change in the routine of your family and will be painful to everyone in the short term as the whole family will be asked to modify their routine to some degree. When the family makes the decision to have their child enter treatment, it is often a decision that they need to make unilaterally as the child is often unaware of the difficulties their problems are causing for the rest of the family and unable to make that decision with you. This type of child will typically not want to engage in anything that forces them outside their comfort zone.
Of course, there is a decent percentage of children, especially older children, who understand that their problem behaviors or emotional dysregulation is problematic and are more amenable to the idea of treatment as a way of helping them learn new ways of interacting with their environment. With younger children, however, there is very often a level of resistance to change that is very difficult to overcome, at least at first.
This resistance to engagement in treatment often leads to one of the biggest frustrations that families voice in their criticisms of individual therapy. Namely, that the provider will often play games with the child for the first few sessions. This often happens for several reasons.
The first, and most obvious, reason can be as a means of establishing therapeutic rapport with the child. The need for rapport is typically as a means of helping them feel comfortable and better able to be expressive of their problems. Put yourself in their position. If you as an adult feel that you have a problem and choose to seek help, it should not be an issue for you to discuss the nature of your problems with the provider you are seeing. However, if you were ordered by a court to attend some type of counseling against your will you would likely be much less willing to engage right away with the provider you would be meeting with. However, the child is often made to go to therapy against their will, resistant to change and feeling that their current behaviors are simply a part of who they are. If the therapist is not able to build a positive relationship with them from the beginning this can easily lead to a negative experience with the system.
Another reason for playing games early in the relationship is often to gauge how long a child is able to stay seated and focused on a task without needing to move around or needing a new activity to keep them occupied during the session. This is often a very good indicator of many of the surface problems a child may have. If they are unable to sit and focus on a card game for a few minutes that is often a red flag that will need addressed early in therapy between the parents and the counselor.
A further reason for this can be as an indicator of how the child sees the world. Are they able to play a game fairly? Or do they need to bend the rules to ensure they don’t lose? Do they become discouraged easily if the game isn’t going their way or do they persevere and keep playing?
If you as a parent are able to stay engaged during this early period while the child and counselor are building rapport, it is often a sign that portends improvement for the child, and family, during the relationship. If you are hesitant to engage in treatment anyway and find it annoying that your child and the provider only played UNO during the first two sessions, the child will often pick up on your frustration and often use it as a means of trying to get you to end therapy. A good rule of thumb to remember is, any time you decide to make a change, the people around you who did not make the decision will typically be resistant to it.
In the second part of this article, we will look at the next step of the process: making changes in your interactions and interventions with your child.