Falls Church mom Elizabeth McMahan is in the middle of a divorce, and while her son Brendan, 5, is "functioning fine," she says, she recently started taking him to a psychotherapist who specializes in family issues.
"It's preventative," McMahan says, adding, "I want an evaluation of how the divorce is affecting him."
Liz McMahan and her son Brendan, 5, above and working on a puzzle at left, go to a family therapist to help cope with a recent separation from her husband. "We call him the doctor of feelings or the happiness doctor," she says.
(Ricky Carioti -- The Washington Post)
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A few decades ago, someone in a position like McMahan's might not have sought out psychological care for her son. But today more parents and therapists are aware of a wide range of emotional and mental health issues that can occur in children. "It's not just depression or anxiety" that therapists see children for these days, explains Gene Beresin, associate professor of psychiatry at Harvard Medical School and medical director of the Outpatient Child Psychiatry Clinic at Massachusetts General Hospital. Beresin estimates that 10 to 20 percent of children and adolescents have an emotional or psychological disorder serious enough to require professional attention. "When you lump together all the problems kids have, the numbers add up," he says.
Of course the first step is figuring out that there might be a problem. Besides taking note of shifts in mood and behavior, including changes in eating and sleeping habits, parents can also consult other people in the child's life, from siblings to clergy to school counselors. Pediatricians may also be of great help. "Pediatricians are becoming better trained and more sophisticated in being able to spot psychological issues early on," says Alvin Rosenfeld, a New York-based child and adolescent psychiatrist and co-author with Bruno Bettelheim of "The Art of the Obvious."
"Always look at multiple sources of information," suggests Beresin.
If you conclude that you need the assistance of a therapist -- a psychiatrist, psychologist or social worker -- the next challenge is finding the right one. Finding the right counselor for your child isn't like looking for a plumber. "Competence is necessary but not sufficient," Rosenfeld says. Personal chemistry also plays into the equation. "Because you're entrusting your child to someone else, you have to feel comfortable with whom you're trusting with this responsibility; it's a very special kind of coaching."
Fortunately, the task is easier today than it once was. "For a long time, the patient had to fit into the mode of treatment," Taffel says. "Thank God that's changing. There are more options for different kinds of therapy than there used to be."
But where do you look? Not in the Yellow Pages, advises Rosenfeld. Instead, he and other mental health professionals recommend taking several steps when looking for a counselor.
Begin by asking around for referrals. "Word of mouth is a good place to start," Beresin says. Pediatricians and guidance counselors are good resources. In addition, in-person or online support groups may offer some guidance. "Those do not replace treatment but may inform you where to look for it," says Adelaide Robb, medical director of inpatient psychiatry at Children's National Medical Center in the District.
Focus, of course, on therapists who have special training in working with children or even a specific age group. "It's very different from working with adults," says Beresin, noting that children go through huge changes in thinking, reasoning, understanding and relationship-building from toddlerhood to adolescence. "The difference between 3-, 5-, 15- and 18-year-olds is huge."
Once you've made a preliminary selection, go for one or two consultations with any potential therapists. Rosenfeld advises parents to always meet in person. Bring young children along so that the professional can evaluate whether therapy is the right move, or whether the child can be better served by something such as tutoring (for a school-related problem) or other medical help (for a physical problem, such as Lyme disease).
With adolescents, parents may do better to attend the first consultation alone and act as "a filter, a headhunter who can describe what's going on to the counselor," recommends Taffel. Teens are typically resistant to begin therapy, so it's good to be sure the counselor is the right match for them before forcing them to go. "There aren't too many 13-, 14- and 15-year-old kids lobbying to get into therapy, but they may need it," he says.
Fundamentally, says Rosenfeld, confidentiality rules apply for children, but vary by the age and development of the child.
All therapists must have a relationship with parents, adds Beresin. However, confidentiality issues apply equally to kids and parents. Therapists often ask a child's permission to talk things over with parents, he says.
