Locating a Therapist

The way you find a therapist, psychologist or other mental health professional can be crucial to your child’s success, said Dale Masi, a professor at the University of Maryland graduate school for social work. In her recent book “Shrink to Fit” (Health Communications, $10.95), she suggests seeking referrals from mental health workers you know, your primary physician and people in support groups dealing with the same issues.

“You know, most people find a therapist in the telephone book,” she said. “I would not necessarily recommend that.”

Garnette strongly suggests that parents check with their insurance company or HMO for guidelines about what is covered and for how long. When in doubt about a practitioner, she would turn to a trusted friend.

“Your best bet is a friend who operates very much like you do,” Garnette said.

Once you have a few names, Masi suggests meeting with the doctors without your child. Go armed with a list of questions and get answers about their education, experience, expertise with children, and the specific issues or diagnoses affecting your child.

“You should not feel uncomfortable interviewing a therapist,” Masi said.

And think about the office atmosphere. Masi would have doubts about a doctor who claimed to specialize in children, but who had no toys or child-sized furniture in the waiting room.

“Definitely look for an expertise in treating children,” Garnette said. “Children are not all little adults. A lot of it has to do with how you just click with a person because it’s so personal.”

Garnette would also seek someone with a few years’ experience because “you do get better with practice.”

Leman also recommends finding a therapist who wants to help the child, not finish the payments on his yacht.

“Find someone who wants to get rid of you,” he said. “If they’re good, they want the child to be well and take off on his own.”

He would also check with the local mental health society or board for any misconduct cases against a professional you’re considering.

Don’t expect to rely on one psychiatrist, psychologist or therapist alone. Many cases are best helped by a network of parents and professionals working together on different aspects of the child’s therapy.

As a result, Masi suggests asking about affiliations when interviewing the initial professional.

“If she’s not a psychiatrist, ask what psychiatrist she works with and if that person is a child psychiatrist,” Masi said.

For many cases, experts recommend a comprehensive plan, taking in a few professionals. For example, a plan for a child showing severe attention problems in school might include talk therapy with a family therapist, participation in a social-skills group and drug management through a psychiatrist.

“Ideally, you want a situation in which all those people talk to each other and that ‘s really difficult,” Garnette said.

Coverage Concerns

The situation is made more difficult by current practices in health management organizations and insurers that often have definite guidelines regarding length of treatment and the types of professional care covered.

On average, Garnette says, managed-care companies will pay for 10 to 15 sessions, but it’s often fewer. In advocating for her son, she once threatened a vice president of her HMO with a lawsuit before the company agreed to extra care.

“They want to cure everyone in four sessions and it’s just not possible,” Garnette said.

And ask up front how long the therapist expects his or her work with your child to continue. Even a rough estimate can help you plan for expenses and the effect on the child and the family, Masi says.

Traumatic situations don’t always allow for weeks of planning. However, some don’t require a therapist either, Leman says. In the case of a child grieving after a family member’s death, Leman encourages parents to “give themselves more credit.”

“Why would a kid want to see a stranger if they’re grieving?” he asked. “Share your imperfect self with your child. It’s healthy for them to see you cry, pray, be concerned. That’s OK.”

Garnette cautions parents to remain involved in the therapy process so they will see if changes are needed. Her son went through five psychiatrists before he found one that seemed a perfect match.

“It’s worth it when you get there,” Garnette said. “Your gut feeling is often right.”