Does My Child Need a Therapist?



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Let a professional help guide you through the dark days of growing up.

Within a year of Tessa’s brother Graydon being diagnosed with leukemia, the therapists in Tessa’s “siblings with cancer group” diagnosed her as being depressed.

Does my child need a therapist?Her mother Jacquelyn Waller-Vintar, was surprised, because Tessa, 9, had been rather upbeat in handling the news of her brother. “I had expected her to be sad, but it didn’t seem as if she was,” she says.
Already connected to therapists at Toronto’s Hospital for Sick Children, Jacquelyn turned to them for help with individual therapy for Tessa. In about six sessions, Tessa was able to articulate her worry about her brother and begin to enjoy life again, so the therapy ended. Then a year later, the depression morphed into obsessive-compulsive disorder (OCD), a tormenting form of anxiety that causes people to have obsessive thoughts and perform certain rituals in an effort to block out painful feelings. Tessa would sob uncontrollably, sometimes lying on the floor for as long as an hour-and-a-half, refusing to get up.

“If everything didn’t go exactly as planned, for instance, if I drove her to school, said goodbye and then failed to wave three times or look over my left shoulder, she would break down, and be unable to go to school,” says Jacquelyn. “It was very scary to see your child breaking down and not be able to fix it. All the tricks I’d learned about parenting – how to accentuate the positive, redirect or distract your child when she’s upset – none of it worked. I knew I couldn’t cope with this on my own.”
That’s when Jacquelyn sought out therapy for her child again, this time in a group for OCD at the Hospital for Sick Children.

Who could use help
Deciding whether or not to get therapy for your child isn’t always clear-cut. Sometimes depression can be masked to the extent that even a parent doesn’t recognize it.
“A young child won’t say, ‘I have low self-esteem,’” says Dr. Marshall Korenblum, psychiatrist-in-chief at the Hincks-Dellcrest Centre for Children and Families in Toronto. A child may tell you, however, that he’s having a lot of headaches, or stomach aches or he could start wetting the bed years after being toilet-trained, or not wanting to go to school. Some children might show they’re upset by becoming aggressive or being inattentive at school.
Mental health problems in junior-school children (ages six to 12) are far more common than we might guess. There are likely several kids in a class of 20 with some form of mental health problem. Dr. Korenblum says these problems generally show up in one of two ways:

  • ‘internalizing’ behaviours that bother the child, such as depression and anxiety;
  • ‘externalizing’ behaviours that bother others, such as not doing chores, having a “screw you” attitude at home, bullying kids on the playground, not concentrating or being disruptive at school. 


When to get help
Dr. Korenblum, along with Barbara Lis, formerly a social worker at the Montreal Children’s Hospital and now in private practice, say to ask yourself the following questions:

  • Has the problem lasted a long time or does it seem extreme?
  • Does your child feel compelled to behave in a certain way, and – when asked to stop – feel that she simply can’t, even though it disturbs her?
  • Are you, your child or a teacher really disturbed by the behaviour?
  • Is the problem affecting your child’s ability to make friends, get along in a family or learn at school?

If you answer yes to any of these questions, it may be worth seeking out a therapist – with or without your child – to discuss your concerns.

First Steps
Visit your pediatrician or family doctor to rule out any physical problems that could be causing the behaviour, such as anemia in the case of depression or an overactive thyroid in situations of anxiety, says Dr. Korenblum. Even a common infection like ringworm might cause discomfort that could lead to extreme irritability and inattention. This behaviour could be mistaken for attention deficit hyperactivity disorder (ADHD), says Dr. Korenblum, (though ringworm doesn’t cause a mental health problem).
To find a psychotherapist, ask your family doctor for a referral or ask for recommendations from friends, family members or other professionals you trust, such as a school social worker. (Because there is often one social worker assigned to several schools, it is unlikely that they will be able to provide the one-on-one attention your child may need.)
Psychotherapists can also be found in:
• community health centres
• outpatient psychiatric department of hospitals
• mental health agencies
• private practices

Therapy in public agencies or hospitals will be covered by your provincial health plan, but most mental health practitioners in private practice are not, except for psychiatrists or other practitioners who are also medical doctors.
If you have extended health insurance, find out if you have coverage for a social worker or psychologist, and if so, for how much per year.

What to expect from therapy
Therapy
starts with an assessment. “Many therapists and child psychiatry centres
will have an initial contact with a parent over the phone to discuss
the situation and see what the ‘therapeutic fit’ is like,” says Lis.
They will then do an initial intake session with the whole family to
learn more about the situation and the prognosis.
Unlike a generation
ago, when parents were often excluded from a child’s therapy, parents
are now actively involved. With very young children, the therapist will
generally offer a combination of sessions – one-on-one with the child,
with the family, and with parents. You can discuss your perception of
the problem and how your child is doing at home, to get some suggestions
on what might help. At the same time, the therapist will want “to
protect, within reason, the privacy of the child, so that they have a
‘safe’ place in which to express their thoughts and feelings,” says Dr.
Korenblum.
Generally, therapy with a child will involve play because
young kids express themselves more easily through play than talk. The
room will be filled with what experts describe as ‘expressive toys’:
dolls, felt pens, plasticine, possibly a sand tray, anything that the
child can use to role play or explore issues in her life.
Sometimes, a
therapist will also use cognitive-behavioural therapy (CBT), which
involves exercises, sometimes using a workbook, to help children explore
their thoughts and feelings, and how to cope with them. This might mean
learning relaxation and breathing techniques, identifying situations
that could trigger an anxious or angry or sad feeling, and other
strategies to cope day-to-day.
Dr. Korenblum says that if your child
has externalizing behaviour and doesn’t think he has a problem, then
one-on-one therapy probably won’t work. In these cases, he would
recommend family therapy, parent counselling or possibly involving the
school. The latter really depends on whether the child’s schoolwork or
relationships are being affected. It can be helpful to get input from
the teachers or principal about how the child is acting in the
schoolyard and class, compared to at home, and also for the school to
get insight into what might be causing the behaviour, or what they could
do to help.


What you can do at home

You
aren’t going to find a therapist overnight, and – even when you do –
change doesn’t happen immediately. Try to keep a regular routine at
home, says Dr. Korenblum. Make sure your child gets enough sleep,
physical exercise and down time, and eats at regular intervals.
And
keep communication open, says Lis. Ask about any good or bad news of the
day. And let your child know you are there if she wants to talk. 

Tessa, now 18, just graduated with the Governor General’s Award for having the highest average at her school.
“The
night of her high school graduation, I wanted to take out a full page
ad in the newspaper and say ‘She did it!’” says Jacquelyn. “My daughter
has already faced more mental health issues than many people work
through in a lifetime. From not being able to leave the house to go to
school in Grade 6, to getting the top marks in her high school, she did
it. And from the outside, you’d never know the struggle.”

What to consider when choosing a therapist

  • Meet
    with a prospective therapist before you bring your child: this way, you
    can screen out anyone you think wouldn’t be suitable without subjecting
    your child to needless appointments.
  • Does
    it feel like the therapist is really listening to your concerns, and is
    willing to be flexible about how to work with your child?
  • Can you relate to the therapist?
  • Do you think your child will like the therapist and feel comfortable talking to him
  • or her?
  • Does your child want to see someone of the same gender?
  • What is the therapist’s training?
  • Does the therapist have experience dealing with the kind of problem your child is having and with children of a similar age?
  • How much will the therapy cost, and if you have benefits, is therapy covered?
  • Does the therapist work close to your home or, if not, will it be a long commute?
  • Is there a wait list, and if so, how long is it?


Diana
Ballon is a Toronto-based freelance writer specializing in mental
health issues, and mother of two chidren ages seven and five.

Published in November 2010.

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