The idea that a little kid needs to see a therapist -- or "worry doctor," as they are known among the nursery-school set -- can be very scary for the child but may be even more frightening for the parent.
"Parents come with a lot of guilt," says clinical psychologist Jane Annunziata. "They think, 'What have I done wrong? How come I did my best, and I failed, and now my child needs this -- and what is this anyway?' "
Many parents are terrified that their unhappy 4-year-old might be showing early signs of serious mental illnesses such as schizophrenia, a problem that rarely surfaces until late adolescence. In many cases, children who need therapy are having far more benign and normal problems. Others have difficulties coping with a divorce, a move, a long separation from a parent, a death in the family.
Parents often regard the fact that their child needs therapy as stigmatizing. "Some will come in and say, 'Oh, I'm embarrassed to come here,' or "I don't want my friends to know my kid is in therapy,' " says Annunziata.
Marc A. Nemiroff, a clinical psychologist with a private practice in Maryland who is coordinator of Youth and Family Programs at the Woodburn Center for Commmunity Mental Health in Annandale, has also found that the stigma about mental illness in general and about therapy for children in particular is difficult for parents.
The two psychologists have written a children's book about play therapy, the preferred method of treating children who tend to act out their feelings and experiences. Designed for children ages 4 to 7, it is also for their parents.
"When kids play, the therapist can understand their feelings and their worries. Child therapists help them understand their feelings while they play." -- "A Child's First Book About Play Therapy"
"It isn't just the child who wants to know what play therapy is," says Annunziata. "Parents are liable to say, 'Well what are you doing in that room? I'm giving you all this money, $90 an hour, and you're playing in a sandbox?' "
Says Nemiroff, "Youngsters show their distress in the way they behave, not in the way they speak. They need to play with a trained therapist who can understand what their underlying concerns are and can help them very gradually turn it into words."
"Have you ever noticed how some kids have problems? They might get into fights a lot. They might have trouble sharing. They might feel very shy and nervous around other kids. Or maybe they worry a lot. Doing one of these things a lot means that kids have problems.
A problem is a thing you worry about or feel bad about. Sometimes, a problem makes you want to cry. Or hit someone. Or be all by yourself. It's hard to keep having these problems. It bothers children. They don't know where the problems come from. So, they can't make them go away. Then they need help."
According to a survey by the National Institute of Mental Health, there are as many as 14 million children who suffer from mental or emotional disorders. Only about 25 percent are being treated, although many more could be helped. Most of them, especially in the early years, are not seriously and certainly not permanently disturbed. For many, a few weeks with a therapist can prevent years of unhappiness. It is often just a matter of "getting over some life-event hurdles," says Nemiroff. Some kids do it easily; others need a little assistance.
One of the book's goals, says Annunziata, is to let a child know that "having a special helper" is not a punishment. When she first sees a child, she asks if they know why they're there. Too often, they will say, "I was bad" or "I hit my brother too much."
The book, published by the American Psychological Association, should also be helpful to children with more serious problems, says Annunziata. "I don't mean that you rush the child in with the first bad dream or the first fight at school," she says, "but for some children, the conflicts just become more entrenched as the years pass. And then someday an adult will tell a therapist, 'It all started when I really hated my baby sister . . .' "
For information on ordering: American Psychological Association order department, P.O. Box 2710, Hyattsville, Md. 20784. (703) 247-7705.