In Part 3 of a Parents’ Guide, I characterized three core principles (working as a team, recognizing layers of complexity, and collectively joining in a reflective process of exploration and understanding) that govern the process of child psychotherapy. In this fourth post I consider what you as parents should expect of the relationship with your child’s therapist.
In my experience psychotherapy with children has a high likelihood of failing unless the parents and the therapist join and work well together. What then nurtures a successful working relationship between you and your child’s therapist?
From the beginning you as parents should assume that you will have an ongoing relationship with your child’s therapist. There are two main goals for the therapy. The first is to help your child with her difficulties. The second is to promote and strengthen the relationship between you and your child.
The particular characteristics of a parent-therapist relationship grow out of and are adapted to the child’s and family’s challenges and needs. There is no one correct approach. Instead there are a range of possibilities that you as parents and your child’s therapist consider and together determine to be an approach that is most likely to be helpful. Here are some examples, all of which have been part of my experiences as a therapist.
Some parents want and need help in figuring out how to make sense of and respond to their child’s problematic behaviors and troubled states of mind. In such instances, I meet frequently with parents, and we brainstorm ways of thinking about what is going on and how best to understand and respond to the difficulties.
Sometimes parents ask for cookie cutter explanations/solutions, but this is seldom useful. What works are back-and-forth exchanges that are both creative and collaborative. And of course these exchanges should be laced with the therapist’s offering valuable insights and observations.
Other parents feel less of an imperative to meet frequently with their child’s therapist. In these instances we might get started meeting weekly and then taper to monthly meetings to keep one another up to speed. I would want to know how you are seeing your child and what is happening at home, in school, with peers, and you in turn want to know what I am seeing in my sessions with your child.
With more intermittent meetings, it is always helpful to learn from your texts, emails or phone calls about an incident or some unfolding events you think I should know about. Since your child will seldom bring up a concerning event on her own, I take the lead. “Your mom mentioned that … What do you think that was all about? It will probably be useful for us to talk about it. Are you OK with that?”
Regular family meetings, attending school conferences with parents, speaking with the pediatrician and other providers – all are types of meetings that can be folded into your child’s care, again depending on the specific circumstances and what is needed.
On rare occasions, I have found myself deciding on limited contacts with parents – this because maintaining such involvements would significantly interfere with the child’s therapy. However, almost always there are clear benefits to parents being actively engaged in and aware of what is unfolding in the child’s therapy and for their child’s knowing that her parents are actively involved.
It is vital that your parent-therapist interactions are comfortable and safe, that you have the he-gets-me feeling, that you “feel felt” and not criticized or judged. As parents you should resonate with the sense that your child’s therapist is invested not only your child’s growth and mental well-being, but also in facilitating and strengthening your relationship with your child.
I have found that I can be most helpful to a child and her family if I gather not only information about the presenting issues but also a thorough history. How did you as parents meet and start your family? What was it like to be a child in your families of origin? What is it like now that the roles are reversed – you are the parent, not the child? What are the noteworthy events in your family’s history and your child’s developmental narrative? Without this information, I always feel like I am flying blind without being sufficiently aware of the forces at play in your family members’ lives.
Some parents are susceptible to two misguided and excruciatingly painful and toxic ways of thinking about themselves as parents. The first is, “I failed. It is my fault that my child is experiencing psychological distress. If we had just done a better job, our child wouldn’t be struggling, and we would not have had to ask for help.” The second is the vision that the present problems will remain static and persist unchanged. In this nightmare an aggressive six year old boy becomes a young adult criminal incarcerated for his violent acts. If you are not so afflicted, you are fortunate, and you are exercising good judgment.
These kinds of negative feelings and thoughts are never helpful. Why? First, guilt and self-condemnation do not facilitate kindly self-regard and empathic understandings, either of yourselves or your child. Instead they turn your reflections away from exploring the issues and from arriving at new insights and ways of engaging a child’s difficulties. Second, the vision that nothing will change dramatically fails to consider the vast changes that unfold in a child’s developing mind. There is no way that what you see at six will remain fixed and the same in your young adult offspring. I have often found myself helping parents push back against these commonly held but deforming ideas.
Parents wanting to get their child into therapy often wonder how to introduce the idea. They also frequently anticipate the child’s resistance. So how do you broach the idea? And how do you as a parent respond to the resistance?
The first approach is to share with your child that you have seen her struggle with difficult feelings and behaviors. You might say something along these lines, “As your parents who love you more than anything in the world, we want to see you gain some relief from your distress. We want you to see a ‘feelings doctor’ to help with the awful feelings. And you are not alone. We are going to see him too, because this is a family thing. We are all in this together. ”
I have found that a child resists seeing a ‘feelings doctor’ primarily when she feels blamed, like she is broken and the cause of the problems in the family. She thinks she is being sent to a therapist to be fixed, like a broken clock. And at an unconscious level the experience feels like proof that she is damaged or crazy.
There are two responses to this resistance. First, to reiterate, it is not just you. It is us too. We are all in this together. Second, seeing a “feelings doctor” shows strength, not weakness, because working on and thinking about difficult feelings is what strong people do.
In the next post I will take up the question of how a therapist gets off to a good start with a child.
I invite you not only to read my posts but to leave comments. Let me know what you think. Also what issues interest you? What are your questions? I will do my best to respond in a timely way. Please don’t dismiss my requests. I really mean what I am saying! Please offer your thoughts and questions.