Children and Families
Frequently Asked Questions
How do I know if my child has problems?
Signs and symptoms vary for different conditions (and for different children). Certain symptoms and/or behaviors may indicate particular concerns, though it is also crucial to consider a child’s age. Developmentally, certain behaviors are normal for 5-year-olds, but not for 10-year-olds. It is imperative to consult someone knowledgeable in order to determine whether there really is a problem or whether what your child is exhibiting is transitional and/or a developmental expectation. For example, temper tantrums are a normal occurrence for children of various ages. However, it is how and to what degree the tantrum behavior occurs that may help to determine whether treatment is indicated.
What are potential signs and symptoms of concern to watch for?
• Your child has demonstrated substantial changes in his or her sleep or
• Your child has often been making negative comments about him or herself
(e.g., I hate myself, I am so stupid, etc.)
• Your child has been bullying other children
• Your child has continually been bullied and/or picked on by other children
• Your child has been acting out in ways that are not socially acceptable
• Your child and his/her siblings chronically act-out in highly negative ways
toward each other
• Your child continually demonstrates oppositional behaviors toward adults
• Your child exhibits chronic lying behaviors
• Your child expresses hopelessness or helplessness
• Your child never seems to smile or enjoy things
• Your child has irrational fears that seem unreasonable for his or her age
• Your child engages in certain behaviors over and over and cannot seem to
• Your child struggles to separate fantasy from reality, yet is old enough to
• Your child sees or hears things that are not there
• Your child has learning problems which cannot seem to be adequately
• Your child chronically hates school
• Your child cannot seem to make/keep friends and/or does not seem to
• Your child has chronically struggled with attention, concentration,
organization, memory, learning, speech and/or communication, specific
academic skills, reasoning or comprehension, and/or behavioral outbursts
or emotional concerns.
What is an evaluation and is this different from therapy?
Yes, evaluation and therapy are different. Evaluation or assessment, generally refers to a clinician seeking additional information regarding an individual. An evaluation could be quite brief or could last several hours, depending on the reason the individual was referred. Evaluations occur in order to answer questions regarding difficulties an individual is having (e.g., concentration problem in school…due to attentional difficulties, and/or anxiety difficulties, etc.). Evaluations generally involve a combination of questions regarding an individual’s background, their thoughts, their feelings, any specific symptoms/concerns, etc. For children, this generally means input from family and possibly educational staff as well. Evaluations generally also involve testing to determine a given skill level or to better define specific concerns (e.g., areas of anxiety). Therapy generally involves the individual, and/or their parent(s) or caretaker(s), their sibling(s), and/or others in their lives. Therapy can involve the individual meeting alone with the therapist, meeting together with one or more family members/caretakers, and/or a combination of the two. Therapeutic interventions are designed in a manner most suited to the needs of the individual and/or family. Sometimes individuals have both evaluations and therapy.
What happens during a therapy session anyway?
Although therapy generally involves talk between the therapist and the individual (child and/or family member), therapeutic interventions can involve more non-verbal means such as therapeutic games, role-playing, and other therapeutic exercises. Other interventions include initiatives such as learning appropriate social skills and practicing these skills, working with family members, or identifying areas of conflict and/or difficulty with the family and working out solutions, developing behavioral plans to address specific parental concerns, learning and practicing parenting skills (e.g., giving effective time-outs), etc. Therapy can even involve helping to explain the child’s needs to educational or other professionals and coordinating efforts in order to facilitate gains on behalf of the child and family. Again, the therapeutic intervention(s) are designed with the needs of the child and family in mind. Often with children, a given session may include a combination of interventions in order to meet their needs.
How would therapy help my child and/or my family?
Childhood is a very important time in everyone’s life. With the help of their family/caretakers, children lay the groundwork for their lifetime expectations of relationships with others, their beliefs in themselves and their self-efficacy, and their understanding of the world. If something is amiss, say the child’s self-esteem or difficulties with fears, the remainder of the child’s development may be hampered or skewed to some extent (and, subsequently, will be their beliefs and functioning as adults). Sometimes, therapeutic interventions are brief, but quite important in terms of setting a child up for success, rather than failure. Sometimes therapy can help families communicate better with one another so that they can enjoy time spent with each other, rather than endure this time.
Do we have to come for therapy several times a week?
No. A reasonable and therapeutically effective therapy schedule can be worked out between yourself and your therapy professional. Sometimes, it can be beneficial for children and/or families to come weekly initially, but this is not a given. Also, as therapy proceeds, it may be contraindicated to meet too often.
Does coming for therapy mean committing to a year or more?
No!!! Sometimes, individuals or families come in for one or two sessions and find resolution to their concerns. Sometimes more sessions are needed. It is important to note that no one is required to come for a specified number of sessions or to a specified therapist. This is always based on personal preference and the amount of therapeutic gains made.
Do we always have to use insurance?
No. Particularly when individuals or families believe that they will only need one or two sessions, they sometimes choose to pay privately rather than using insurance.
What if I don’t like the therapist?
Therapy is a very personal thing. Everyone has different preferences, e.g., people sometimes ask for a male or female prior to even beginning the therapy process. Regardless, no one is obligated to continue with the therapeutic process if personal differences or even personal preferences seem to be interfering.
What if I have trouble talking about what is bothering me?
Believe it or not, this is one of the most common reasons that people come for therapy. One of the primary goals, especially in work with children and families, is working on identifying feelings and learning how to communicate feelings and needs to one another. Additionally, it is important to note that it is not an expectation for individuals to open up about everything immediately. It is normal for individuals participating in therapy to want to “get to know” their therapist before revealing highly personal information. In order to be effective, therapy needs to be based on comfort level, at least initially.
If I talk about my personal business, will everyone find out?
This is a concern that most individuals have, at least at some level. Therapeutic professionals are bound by a code of ethics which focuses to a great extent on confidentiality. Of course, there are limits to confidentiality, but therapeutic professionals do their utmost to protect the confidentiality of their clients. This is one of the primary considerations of the therapy process.
I know therapy is supposed to be confidential, but I am the parent…how does that work?
Older adolescents are entitled, for obvious reasons, to a higher degree of confidentiality than younger children. The age of 14 years is generally determined to be a place at which the reasoning skills of adolescents may be such that additional confidentiality may be important therapeutically. However, the issues involved and the children themselves are always determinants as well, one way or another. However, parents and/or caretakers need to understand that if the therapist reveals everything the child has said in a given session, the child may lose trust in the therapist, severing the therapeutic relationship and hindering the capacity to gain from the experience. These issues are worked out, in advance, so everyone understands the ground rules (e.g., children know that they can talk, but that the really crucial issues will also need to be discussed with their parents).
We are considering adopting a child, what is covered in adoption counseling and how can it help?
We will be able to address all of the following issues with you regarding adoption:
• What information do we need to make an informed choice?
• What type of help and support will we and the child need?
• How will we know that the child will attach to us?
• How will the child benefit from therapy?
• How do we deal with the child’s aggressive, noncompliant, or inappropriate behaviors?