Ten years ago, Lindy Garnette faced one of a parent’s toughest challenges: She had to find psychological help for her child.
Her son, then 5, had bipolar disorder, a diagnosis that might lead to a lifetime of prescriptions, therapy and behavior modification.
“He has his good days and his not-so-good days,” said Garnette, who is now the director for children and family mental health services for the Virginia-based National Mental Health Association. “It’s still a struggle.”
Parents of children who need psychological treatment face a series of struggles. On top of the still-present stigma of mental illness, there’s the search for competent and appropriate professionals and the battle with health-insurance providers to fund the sometimes long-term therapy needed.
But, Garnett and others say, a little guidance and a lot of perseverance can make finding a good match for your child easier.
Do You Need Therapy?
Psychologist Kevin Leman’s first advice to parents is: “Don’t find a therapist for your child.”
“If there’s a problem and you want to seek outside help, you go,” said Leman, a Tucson, Ariz.-based psychologist, father of five and author of 21 books. “Rushing your kids off to the shrink is not good.”
Leman believes society is rushing to pin psychological labels on kids, a practice that lets parents off the hook and can leave kids feeling abnormal. Many parents hoping to stem sibling rivalry, fighting in school and other relatively simple behavioral issues might do well to consult a professional for parenting tips they can try at home, rather than signing the child up for sessions on the couch, he says.
“I’ve turned many a kid around without ever laying eyes on the kid in my office,” Leman said.
How do you know if your child needs outside help?
Leman suggests a child may truly need attention if “the daily tasks of life are not being met.”
Experts offer the following warning signs for depression and other common disorders in children:
- extraordinary shyness
- developmental delays
- destructive behavior
- attention-getting (“acting out”)
- sleep disturbance
- unexplained weight loss or gain
Leman uses a second test. If others teachers, coaches, neighbors or family members have alerted you to some of the above symptoms and you have already noticed them, it may be time to act, he says.
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.
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.”