When Your Child Needs Therapy: Tips for Breaking the News and Smoothing the Way

It's counterintuitive, but in my experience children in emotional pain often have less trouble accepting or understanding the need for therapy than their parents do, and have less concern for any potential stigmatizing effects.
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Some months ago I posted "You're Getting Divorced: Does Your Child Need Therapy?"-- a guide for those wondering whether their child's emotional problems are of the ordinary sort (likely to resolve on their own with family support) or more serious (requiring outside help). Since then I've had inquiries from lots of worried parents posing various versions of the same question: "We think it's time: So do you want to tell our kid they're going to a shrink?"

Especially if your family has adult-generated problems (like those accompanying divorce), you may be anxious about your child's reaction to the idea of therapy. Will your daughter become angry? Defensive? Will your son worry that you see him as unfairly at fault or in need of "fixing?" If your child is very young, will he or she even understand what therapy is, or what it's for?

It's counterintuitive, but in my experience children in emotional pain often have less trouble accepting or understanding the need for therapy than their parents do, and have less concern for any potential stigmatizing effects. Still, there are better and worse ways to break the news to your child that you think they need help. Here are some tips for a smoother experience:

Introducing the Idea of Therapy

1) Wait for a calm moment
Don't raise the issue of therapy when either of you is angry or upset, especially immediately following an argument or crisis (such as suspension from school). If she's riled up, your daughter won't be able take in what you're saying. And if you're angry, she'll view therapy as a punishment.

2) Identify the problem
Tell your child what you see that has you worried. Try, "Honey, I know you've been getting into a lot of fights at school," or "Seems like you've been having a lot of nightmares lately."

3. Offer compassion
Tell your child you know he's unhappy and you want to help. For example, say "It must be upsetting when the other kids are angry at you," or "Nightmares can be really scary. No one likes to be scared."

4) Explain therapy
Once you've identified the problem and offered compassion, tell your child you've found someone who can help. You might offer "Sometimes when children feel scared a lot of the time, it helps to go to a person whose job it is to help kids understand their feelings and worries by talking and playing about them. Mom and I went to meet a person like that last week. Her name is Dr. Kelly and she's really nice. She's a doctor for feelings, not for your body. We think if you met with her a few times it might help you understand why you've been having those nightmares. Then you won't have to feel scared anymore."

5) Don't get discouraged
No matter how gentle you are, your child may growl "There's nothing wrong with me!" or "I don't get nightmares anymore!" Remain calm and stay the course with an answer such as "Ok, if you and Dr. Kelly decide you're not scared anymore Dad and I will be very happy. But we love you, and for now this is what we think is best."

Once Therapy is Underway

6) Don't "grill" your child after sessions
It's a tall order, but resist the urge to ask for reports. Questions like "What did you and Dr. Kelly talk about today?" are likely to produce either silence or an answer designed to please. Let your child's therapy be a private place, and use your meetings with the therapist to get and share information about how things are going.

7) Remind your child that she has therapy as a resource, but don't harp on it
When difficulties arise, there's nothing wrong with gently suggesting that your child talk about them in therapy. If your daughter gets in a fight at school you might say "You know, Honey, if you feel like talking with Dr. Kelly about what happened she might be able to help you with the problems you're having on the playground." But try not to bring therapy up too often, or your child will feel you're intruding or using her therapist as an ancillary parent. If there's something you want the therapist to know, the best bet may be to get in touch directly. But inform your child beforehand, so she won't feel the adults are conspiring.

8) Don't use therapy as a threat or form of discipline
A comment like "If you don't start cooperating I'm going to have a talk with Dr. Kelly" is counterproductive. Here's a better approach: "Lately you seem angry whenever I ask you to help out, and we haven't been able to talk about it. Fighting is no fun. I think it would be a good idea for us to talk to Dr. Kelly about ways we can get along better."

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