By Robin F. Goodman, Ph.D.
Every child experiences emotional difficulties from time to time but at some point, a child’s problems may warrant professional attention. Yet parents are usually less familiar with, or feel confused about, obtaining mental health care. When a child is sick with the flu or breaks a leg, parents usually head straight for the doctor. And as a parent, you are well versed in the standard routine doctor visits for everything from vaccinations to ear aches. Physical symptoms seem more obvious and unfortunately, may get more professional attention than mental health symptoms.
But just like physical problems, the prognosis is better when the mental health problem is treated early. Surprisingly, many problems seen by medical doctors have a psychological component.
It is estimated that over 15 million children and teens have a mental health or substance abuse problem. Sadly, only one in five of the children with a mental health problem gets treated – a figure far smaller than the number of children being treated for a medical ailment. What accounts for the disparity? Parents may not readily recognize their child’s symptoms as a mental health problem. They may feel embarrassed or ashamed, think they should handle the problem on their own, feel the situation is hopeless, disagree when others suggest the need for outside help, or dismiss or misunderstand a child’s problem. Unfortunately, misconceptions and shame may delay or prevent adults and children from getting the help they need. When parents are concerned about a possible mental health issue they can benefit from seeking guidance from a professional. In fact, once addressed, parents may be reassured that their child’s experiences are developmentally appropriate, and that alone can ease discomfort. Or, they may decide to engage in a course of treatment that will result in better functioning for both the child and family.
When should you seek help?
Many physical and emotional signs suggest a possible mental health problem. Problems can range from those of serious concern, for example, when a child or adolescent has lost touch with reality or is in danger of harming himself, to those of less concern, for example, when a child or teen experiences a change in eating or sleeping, feels frustrated, or is particularly fearful of something. But any problem that is personally bothersome warrants evaluation. Further investigation may be warranted when a child seems out of step with peers or exhibits changes or problems in any of the following areas:
· School work
· Activity level
· Relationships with family or friends
· Aggressive behavior
· Return to behavior typical of a younger child
· Developmental milestones such speech and language
In general, any of the above symptoms would first be evaluated with respect to the:
· age appropriateness
· interference with the child’s and family’s life
Where do I start?
Looking for information can be a crucial first step. Parents may not be sure their child has a mental health problem, not know exactly what it is, or wonder whether it is serious enough to seek help. All of these questions can be discussed with a professional.
A variety of obstacles may get in the way of seeking mental health treatment – all of them can and should be overcome. Some of the roadblocks are real; some are due to common myths and misinformation about what it means to need help and what will happen. The following are some typical concerns and solutions.
“I’m embarrassed and uncomfortable about the problem”
Solution Feeling uncomfortable talking about personal problems is not uncommon. This can stem from feeling guilty and blaming oneself or believing certain issues should remain private. As a way to avoid addressing a problem, parents may ignore it, hoping the child will “outgrow” it. Like many things in life, individuals often imagine far worse than is the reality. Mental health professionals have experience with the issues, are familiar with your concerns, and are trained to put parents and children at ease.
“My child won’t go”
Solution Children and teens rely on and require the confident, clear thinking of their parents to get them involved in treatment. Talking directly and honestly with the children can also allay their concerns. Forcing someone into treatment is usually unsuccessful. But an attitude of concern that transmits understanding of how difficult it is to accept help will be appreciated. It may be useful to point out how the problem interferes with enjoyment of life. If parents have a positive attitude about getting help they will enable their child to follow suit. Approaching the issue as everyone’s problem and involving everyone in the solution will foster cooperation.
“I don’t know any mental health professionals”
Solution As in seeking help from any professional, it is useful to employ some tried and true strategies.
1. Talk things over with the child’s pediatrician, school teacher or guidance counselor. Not only do they know you and your child well but they should also be involved in any assessment of the problem.
2. Get a recommendation from a trusted friend or family member.
3. Check with a clinic affiliated with a local hospital or medical school.
4. Contact national or local professional organizations.
“I don’t know how I would fit it in”
Solution it is important to make time available for treatment and to adjust your family’s schedule. Be realistic about the logistics of getting to treatment. If the best professional is an hour away you must decide whether you are willing to make the necessary arrangements or prefer to ask the professional for a comparable referral nearby, thus increasing the likelihood of your engaging in treatment.
“I can’t afford treatment”
Solution There are a variety of lower cost clinics, often through graduate training programs or hospitals. Unfortunately most insurance companies do not yet reimburse or pay for mental health services on par with services for physical illness. Most providers however, cover some form of treatment. Insurance companies also usually have a list of approved providers in your network. If you find someone who is not covered by your insurance plan, or whose fees are beyond your means, it is worthwhile to ask the professional if he/she has a sliding scale, and/or ask your insurance provider if it can make a one time exception and add the professional to the provider list for your individual case.
“If I need help it must mean I’m a bad parent”
Solution Unfortunately mental illness is stigmatized in our society. Media images and news stories may portray distorted images of those with a mental illness as being violent and out of control and parents as being uncaring and uninvolved. But mental illness is real, it can be treated and should be considered similar to any illness. Certainly no one would avoid treatment for diabetes or cancer, but the same person might feel ashamed of having a mental illness. The greatest harm comes from leaving mental illness untreated.
“I heard that treatment lasts forever”
Solution Certain myths generated by popular culture are outdated. Treatment only lasts as long as is necessary. The goal of any mental health treatment is for the individual to function independently and to feel successful and fulfilled in life. Different problems require different types of treatments for differing amounts of time. Certainly the sooner treatment is begun the better – the sooner the improvement and the better the prognosis.
“All they do is give drugs”
Solution Medication is only one option among many for certain disorders. A wide variety of treatments is available. The use of medication is dependent upon the individual, the problem, and his/her preferences. Once options are explained, any treatment decision is best made between the professional and the parent. Some treatments are carried out alone, some in combination with medications. With children, the treatment can involve talking and/or playing as a way of understanding the child’s concerns and working out solutions. Some of the more common non-medication treatments include:
1. cognitive behavior therapy: this helps the child learn new ways of thinking and behaving
2. verbal psychotherapy: one’s current problems are discussed, perhaps in light of past difficulties, and options for coping with different feelings and behavior and for engaging in different relationships in more effective ways are developed
3. marital or family therapy: the professional helps members of the couple or family understand how their behaviors affect one another and the children, and provides instructions and strategies for making changes
4. group therapy: issues are explored within a group setting with individuals who share similar problems
5. interpersonal psychotherapy: feelings and responses are explored within the context of different interpersonal or social relationships and situations
“Other people will find out and think there’s something wrong with me or my child”
Solution A therapist and a client engage in a confidential relationship. Licensed professionals are bound by both a code of ethics and state laws which allows information told to a therapist to be kept confidential between the client and therapist. A mental health professional’s main goal is to protect both the physical and emotional well being of the client. In certain situations, however, action must be taken or information revealed. In the interest of client and public safety, mental health professionals are obligated to report any instances or information they have about abuse of children, the elderly, mentally or physically handicapped. In addition, action must be taken when there is a risk of danger to the self or others, e.g. by suicide or by threats on someone’s life. Other instances in which certain information can be revealed include giving specific information to an insurance company as stated by their policy, to collection agencies, when involved in legal matters concerning the person’s mental health, and when involved in legal complaints against the professional.
Who does the treatment?
Individuals might consider the following checklist of questions to ask and issues to consider when deciding on a professional and a type of treatment.
· Professional’s credentials and training: consider the training of the professional and inquire as to his/her experience or expertise with the problem. If the professional is licensed in your state make sure the professional has the appropriate credential. The most common licensed professionals are:
· Psychiatrists, have an M.D. degree and can provide therapy in addition to prescribing medication
· Psychologists have a Ph.D. or Psy.D. degree and can provide therapy in addition to conducting psychological tests
· Social Workers have a masters degree and are identified by the LCSW license
· Marriage and Family Counselors usually have a masters degree and are identified by the MFCC license
· Other possible licensed professionals include Pastoral Counselors and Mental Health counselors.
· Some professionals, without state licensure, may be certified by their own professional organization.
· Experience: the professional should have experience with children and expertise with the particular problem of concern.
· Involvement: it is important to understand how parents are involved in the child’s treatment.
· Type and format of treatment: parents and children should understand the scope of the treatment, the procedures used and the frequency and duration of the sessions.
· Cost, insurance policy: it is the parents’ responsibility to know their own financial resources and any insurance requirements and limitations
· Location, ease of accessibility: treatment must balance convenience with availability of the professional
How do I decide if this is the right professional?
Once a parent has decided on a therapist, it is important for the child or teen and parents to feel comfortable with the treating professional or agency. Having confidence in the person is essential for establishing a positive working relationship and important when facing difficult moments or decisions. Parents often benefit from having an initial consultation or one or two sessions before making a decision about ongoing treatment. The “fit” must be right in order to establish a good working relationship. What may work for one person may not feel right for another. However, if the parents or child feel uncomfortable after a few sessions, this should be discussed in order to assess the source of the problem. For example, is the difficulty due to embarrassment about discussing the problem, a child who is resistant due to being angry at the parents for suggesting treatment, or is it incompatible styles between the professional and the client?
What is the role of the parent?
The initial session or two, with the parents and/or the child, is usually used to evaluate the problem. This is typically done by interview and may also involve questionnaires. In the case of a child, the professional will need information from the parents about the family history, home environment, child’s physical and emotional development, friendships, and may consult other relevant medical and educational professionals for information. Soon after the evaluation phase, the professional should discuss the assessment and outline a plan of treatment. Parents should be informed about their role in treatment, preferred method of communication with the professional, schedule for feedback and updates, coordination with outside resources or professionals, strategies for helping their child participate in treatment, alternative treatments, risks and goals.
Successful therapy usually requires an investment of time and energy on the part of both the professional and the client. The therapist may act as a guide, instructor, cheerleader, sounding board, and confidante. However, the parents and child must also participate and take responsibility for putting the learning into practice. It is important for everyone involved to monitor change and progress.
About the Authors
Robin F. Goodman, Ph.D., is a clinical psychologist specializing in bereavement issues.