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Why do children come to psychology offices?

Usually, children and adolescents are “brought” to our office by their parents

Children often find the experience valuable (and even fun), but adolescents are not always pleased to come

• The problems that are presented tend to be social, behavioral, or academic, i.e.
• The child can't get along with other people, fights a lot, or avoids people
• The child has some difficulty in school, usually with adequate performance
• The child displays behavior that is challenging or even incorrigible
• The child displays a mood disorder like depression or anxiety

Sometimes children are brought because parents want to rule out a diagnosis, e.g.:

• Autism or Asperger’s disorder
• ADHD or ADD
• Thought disorder
• Neurological disorder

What is the process of examining a child/adolescent?

Initial evaluation

• Social history, developmental history, and symptoms from parent(s)
• Any report from school or other agency
• Visiting with the child/adolescent

Complete evaluation

• Personality assessment
• Intellectual/neurological assessment
• Strengths based assessment

Consultation with parent(s) and recommendations

What constitutes treatment of a child?

• Play therapy.  The essence of this procedure is playing a variety of games with the child.  A child’s basic modality of engagement with the world is play, so it is with play that the therapist can engage the child most successfully.
• Earning trust and development of a relationship with the child
• Periodic consultation with parent(s) regarding progress
• Consultation with any other professional (medical or therapist)

What are we trying to do with “play therapy?”

We are trying to engage the child in a nonthreatening way

Play will ultimately demonstrate how a child relates to the world

• She is passive or aggressive
• She is cooperative or resistant

The play format allows for intervention with the child in a real way

• Helping a child to win and lose, as we must do in life
• Helping a child trust appropriately
• Helping a child develop self-confidence

What is different about adolescents?

Treatment with adolescents is usually challenging

• They don’t want to do “counseling”
• They are in a transitional time of life
• Social life is usually central in their lives, and often problematic
• They haven't found and developed their giftedness

Parents are a key with adolescents

• Many parents are too permissive, indulging their adolescents
• Other parents are too restrictive with their adolescents
• Parents are often too punitive, and do not use natural consequences

Treatment of adolescents is often without benefit

• The adolescent continues to be resistant to the process
• The adolescent feels that the therapist “sides” with parents

Treatment, if successful needs certain ingredients

• Effective evaluation focusing on strengths
• Earning of trust of the therapist
• Lots of freedom of expression
• Minimal contact with parents

How can a parent have ongoing communication with the therapist?

• Email is by far the best means of such communication.  Weekly, or even daily reports can keep the therapist apprised of progress.
• The therapist needs to guard the privacy of the adolescent (not so much the child), and can speak clearly by email
• It is best not to have the parent visit with the therapist during the therapy hour, as it can appear to the child or adolescent that parent and therapist are colluding.