People have asked about what makes therapy sessions "good". The idea of "good therapy" hinges on sessions that are ultimately beneficial to the child. Children are expected to bond with their therapist, discuss their thoughts and feelings, work on coping skills, and make gains in therapy. However, it doesn’t always play out that way.
All too Often…
When meeting up with parents for an evaluation of the child, it’s not uncommon that the child will already have been in therapy. However, it’s also not uncommon that the therapy “didn’t go so well” and the parents decided to discontinue. Clearly, that is unfortunate given the hopes and expectations of enrolling your child in therapy in the first place. How can you avoid that from happening to your child? How can you better ensure that your child has a positive experience in therapy and a positive outcome?
Let’s Talk About the ‘Structure’ of Therapy
In this post, I’m going to be targeting the structure of therapy, not so much the mechanics of therapy in regards to technique or clinical matters. To learn about what specific techniques a therapist will use with your child during the therapy process, and how those decisions are made, please see my prior post "The Formula for Successful Therapy". When I refer to ‘structure’, I am targeting how the therapy is conducted, with who, and how often.
What Else Happens All Too Often?
Before we can closely consider what constitutes “good” therapy, let’s take a look at what may be perceived as less-than-optimal approaches. In that regard, it’s all too common that a parent brings a child to the office, the therapist picks up the child in the waiting room, takes the child back to the therapy room, meets with the child for 45 minutes to an hour, brings the child back out to the waiting room, and says “goodbye” to the parent and “see you next week.” It could be argued that this approach is all too common and not entirely advantageous. In fact, I would strongly advise against it.
Who is the Client?
When working with children, the situation gets a bit complex. As a parent, you are typically the one who initiates therapy for your child. In that respect, it’s rather uncommon that a child requests to go to therapy to talk about their problems and work on coping skills. Clearly, it’s the parent who gets the ball rolling in that regard. Consequently, from a therapist’s perspective, the child is the “client” but, in lots of ways, the parent is too.
I found that, almost invariably, a parent brings a child to therapy because there are challenges at home regarding the child’s behavior, emotions, noncompliance, or something that is disruptive or difficult in some way. There are those instances where a child is brought to therapy purely because they seem down or anxious. But even that typically manifests in some type of agitation or social avoidance, panic, or something that too is behaviorally problematic. In any case, the bottom line is that you, as the parent, are seeking help with and for your child. You need guidance, suggestions, and a sense of 'what to do' when your child is having a hard time.
Working With the Whole Unit
I tell our therapists at Community Psychiatric Centers that is vital to work intensively with the parent as well as with the child. Consequently, there is an expectation that the parent will be significantly involved in therapy sessions. Of course, the child will have an opportunity to work individually with the therapist, but the parent must be involved to discuss situations and work on problem-solving with the child. This is a vital aspect of therapy and is something that you, as a parent, should expect in the therapy process.
Of course, when dealing with a teenager, the situation changes a bit. A teen aged 14 or older has to sign permission for the therapist to talk with the parents. Most teens are acquiescent and it’s not much of a problem. In fact, it’s especially vital to work with parents when the client is a teenager because often there is much to discuss, negotiate, and compromise in regard to problem-solving in the home
Another Pitfall to Successful Therapy
One of the pitfalls that affect whether sessions with a therapist will be successful is how often the sessions occur. At Community Psychiatric Centers, sessions are conducted every week. We find that it’s necessary to conduct weekly sessions to gain traction and more quickly get moving in the right direction, especially at the outset. As things begin to improve and stabilize, we can move to every other week and then, as we are beginning to fade, move to monthly. However, I’ve heard of some clinics providing therapy, from the outset, on an every-other-week basis. That is simply too infrequent, especially for children. In fact, at times it’s even necessary for twice-per-week sessions to address difficult times and periods of extra stress.
Something Else You Should Expect
Therapy is all about communication – working toward better communication with your child and as a family. However, it’s also important to have open and regular communication with the therapist. In that respect, it’s vital that the therapist is regularly inquiring about your thoughts and feelings regarding the process. You need to express any concerns about the therapy direction, and whether you believe it is effective. Otherwise, the direction does not change and then most parents just stop taking their child to see a therapist. That’s unfortunate because with some open communication, that outcome could have been avoided. Consequently, expect and ask for such communication with the therapist.
When Considering Therapy for Your Child
Good therapy entails a positive and solid rapport between your child and his or her therapist. But significant parent involvement, weekly sessions, and regular communication about ‘how everything is going’ is also important. In the absence of any of these, the therapy will likely be less effective. If you’re seeking therapy for your child and have concerns about the process, feel free to email me at DrCarosso@aol.com. I wish you and your child the very best. God bless.
