What questions should i ask my child’s therapist

Deborah C. Escalante

You’ve made the decision to get your child help, and chosen a psychiatrist, a psychologist or some other mental health professional. Next up on your to-do list is figuring out what you can expect of the therapist  and what’s expected of you. Here we will walk you through how to form a solid working relationship, set appropriate expectations and understand your role in helping your child make progress. And we’ll give you pointers on how to work through obstacles to good care.

Getting started

“The best relationships start with transparency,” says Wendy Nash, MD, a child and adolescent psychiatrist. She suggests coming to your first meeting prepared to talk not only about your child’s issues but also about their background, what they were like before you became concerned, key stressors or events that may have triggered a change, and what your priorities are for treatment.

“It’s helpful if you can explain what you’ve already tried, what has worked and what hasn’t,” Dr. Nash says. “The more context you provide, the better.” Information from schools can also be valuable, and the therapist can guide you on ways to request it without disclosing why it is needed.

Another good move is to iron out logistics up front. Misunderstandings can be avoided if you have clarity on matters like what you will (or won’t) be billed for, how quickly the therapist will return calls, and the kinds of incidents that merit a heads-up call before an appointment.

Expectations for treatment

Worried parents want to know how long treatment will take, and how soon they will start to see progress. Being aware of the factors that affect results can help you form realistic expectations and keep frustration at bay.

Some types of talk therapy are open-ended but some, like cognitive behavior therapy, which uses skill-building techniques that have been rigorously tested, have been found to show results over a specific timeframe. That doesn’t mean all kids make progress at the same rate, notes Jerry Bubrick, PhD, a child and adolescent psychologist at the Child Mind Institute, but it gives you a frame of reference, and it’s appropriate for parents to ask what the estimated time frame is. It’s also appropriate to ask about specific goals for treatment, and how you will measure success.

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How quickly your child makes progress will depend on the complexity of their challenges as well as how long the problem has had to take root. A child who is severely anxious, for instance, may have difficulty participating in therapy, and need medication to get to the point where they can benefit. A depressed teenager may resist treatment, and need help to see how they might benefit from it. “A family move, divorce or traumatic incident can slow things down a lot,” notes Dr. Bubrick. Missed appointments and conflicts between parents over the need for therapy can also undermine treatment. One overwhelmingly positive influence is having a supportive and involved family.

Parents are pivotal

Even the best therapist in the world gets only a snapshot of a child’s behavior and mood in 45 minutes a week. To round out the picture, clinicians usually set time aside for regular check-ins with mom or dad. How are anxiety management skills translating from therapy to playground? How is your child responding to the medication? Do you see signs of their depression worsening? Was there a major meltdown your child may not have mentioned in therapy? Parent feedback provides the therapist with a richer and more accurate picture of your child’s needs.

“Whether or not parents sit in on sessions depends on the age of the child and the nature of the treatment,” Dr. Bubrick explains. “But parents are still the coaches, the ones who drive treatment at home.” The takeaway: For your child to get the most out of treatment, you’ll need to monitor them closely, know which skills are being worked on and how to reinforce them outside the office in everyday life.

When a five-minute meeting or phone call with the therapist isn’t enough, ask about background reading material, online resources and parent support groups. You can also ask to meet for a full session without the child present. These “collateral” sessions may be covered by insurance, allowing you to discuss issues and care in greater depth.

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Strategies for building teamwork

Although parents and therapists have a common goal of helping your child get better, you each see them from a different perspective. Effective communication depends on many variables, including your own stress level, how receptive the therapist is to input, how well you articulate your concerns and the personal factors that play into any kind of relationship. Here are five parent-tested strategies to help you work through the challenges.

  • Respect your own knowledge. Your child’s therapist is the expert on therapeutic interventions, yet you are the expert on your child. You have spent more hours with them in more settings than anyone else. That knowledge matters, as does your gut feeling for what’s going on. Don’t be afraid to speak up! The therapist needs to know what you see, sense, and think is happening.
  • Plan what you’ll say ahead of time. The more you can pinpoint your worries, the easier your concerns will be to convey. Focus on observing changes in your child’s behavior, mood and social interaction and see if you can identify what it is that’s causing your spidey sense to tingle. It may help to keep notes about the frequency, intensity and duration of symptoms. If confusing new behaviors emerge, it’s okay to tell the therapist, “I’m not sure what this means, but here’s what I’ve been seeing.” You can puzzle it out together.
  • Don’t be embarrassed to ask for help. Raising a high-maintenance kid can toss parents into situations in which they feel very vulnerable to the judgment of others. Do you admit to your son’s therapist that you yelled at your kid? That you find your daughter’s cutting revolting? That you are mortified when people stare at your child’s tics? Instead of avoiding these kinds of issues, try asking the therapist for advice on how to handle them. You can begin with something like, “I need help with strategies for how to defuse them when…” or “Can you suggest ways to deal with…?” The therapist may not have an answer for you right away, but if you open the discussion you may make progress.
  • Tell a story. Sometimes a child presents differently in the therapist’s office than at home or school. This can create a disconnect between your impression of what’s going on and the therapist’s. Anecdotes help. Instead of summarizing the week with, “Mornings have been rough,” try including detail so it’s clear exactly what you mean. “She had a 40-minute scream-fest that included flinging books and shoes, and left a dent in the wall,” for instance, gets an entirely different message across.
  • Use curiosity to express a different opinion. Intelligent people can and do disagree, and occasionally your child’s therapist may reach a conclusion you think is off base. Instead of launching into a debate, probe for more information. This honors the therapist’s expertise without putting them on the defensive. You might try something like, “Can you tell me more about why you think that’s what’s happening? I have a very different take on it” or, “Hmmm. Are there other possible explanations?”
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What to do about bumps in the road

Any relationship has its rough spots, and occasionally people say things that are inconsiderate or hurtful. When this happens with a therapist, parents may feel blamed, unheard or angry. “The key question is whether what was said indicates there’s a problem with the relationship, or if this is simply a communication bump to get over,” advises Dr. Nash. She suggests a face-to-face meeting to discuss the issue directly. “You can ask ‘When you said ___ I heard ____. Is that what you meant to imply?”

Dr. Bubrick agrees. “It’s okay to say, ‘I felt dismissed when you said ___’ or ‘I didn’t appreciate the way you responded when ___.’ Addressing the problem directly is the fastest way to move forward.”

If after trying to resolve the issue you decide you are unhappy with the provider or with your child’s progress, it’s okay to seek a second opinion on treatment. It’s generally a lot easier on the current relationship if you let your child’s therapist know that you’re exploring other options.

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