Depression does seem to be hitting people earlier and earlier in life, due both to genetic properties of the disease and changes in society, says Graham Emslie, M.D., a faculty member at the University of Texas Southwestern’s psychiatry department in Dallas.
Few people have the close-knit families and communities of the past. Without emotional support, stress builds up in adults and children.
Kids must deal with the same stressors adults face: divorce, illness, crime, addiction, death. There is no shielding children from these things, and they respond as most human beings do – by being sad, frightened, anxious or angry in varying degrees. When the degree interferes with their success or pleasure in life, action should be considered.
Problems that bring a family into therapy frequently are emotional issues that can be handled in traditional talk and behavioral therapy. Sometimes parents just need a little help understanding developmental issues; other times complicated family problems need untangling.
The role of parents in therapy
Many, if not most, therapists who work with children require at least one parent to be closely involved. Family therapists require one or both parents to participate in the therapy. Martha Edwards, a psychologist in private practice and faculty member of the Ackerman Institute for Family Therapy in New York City, feels strongly about therapists who don’t include parents in the child’s treatment. “It’s practically malpractice as far as I’m concerned,” she said.
As Anna Beth Benningfield, a Dallas psychologist and past president of the American Association for Marriage & Family Therapy, points out, “It’s not that kids can’t benefit from individual therapy, but not having the parents really limits what can happen. It also helps parents to hear their children talk about their concerns. Parents are much more influential than the therapist. They’re going to be there after the therapist is gone. They’ll understand the child better.”
Children often want to protect parents from what they are feeling, says Julia Steele of Dallas. Steele facilitates “A Time for Me,” an American Cancer Society support group for children whose parents have cancer. Steele says many children are hesitant to express fear, sadness, anger or guilt to already troubled parents. A therapist can get this information to parents, either by helping children express it directly or in separate discussions with parents. Then, therapist and parents can figure out how to ease the child’s distress.
Family secrets are the root of many problems
Sometimes, too, children are merely lightning rods for other family troubles. Martha Edwards, a psychologist in private practice and faculty member of the Ackerman Institute for Family Therapy in New York City, recalls one father and teenage daughter who fought bitterly. Family counseling, including the mother and the new baby, revealed to Edwards that the baby had been fathered by a different man, which turned out to be the real source of conflict. The fighting between father and daughter was merely a distraction from the more painful issue.
With secrets like that at stake, it’s not surprising some parents are reluctant or unwilling to get involved in family therapy.
When Denise first called a therapist for her daughter, “I was just saying fix her. Make her not want to kill her brother anymore,” she recalls.
Denise and the therapist met alone first.”We talked about our family, punishment, discipline,” she said. “I knew things would come out that I probably wouldn’t want to discuss with her. My husband and I, our relationship hasn’t been great for a long time.”
The therapist wanted to consult with Denise’s husband as well. He first refused, then agreed but didn’t follow through. Denise finally gave up fighting for his participation. Brittany started seeing the therapist alone, and Denise went into separate counseling.
The therapist kept Denise apprised of what she and Brittany discussed. Therapists do not promise confidentiality to children under 13. They usually include a parent in the first session with the child, to help put the child at ease. And therapist and parent later discuss each session. “Sometimes we would talk for 45 minutes,” Denise recalled. “I’m surprised she didn’t charge me for that time.”