Different Approaches to Treatment of Children

There are several schools of thought about the best way to approach the treatment of emotional disorders. Treatment may be psychoanalytic, cognitive, behavioral, humanistic, ecological or family oriented; all are accepted approaches to treating mental health problems.

No one treatment technique has been proven definitely more successful than any other. Many therapists use whatever technique or combination of techniques they believe may be helpful to their client.

A Helpful Distinction: It is possible to divide the wide variety of treatment approaches available to children into two categories: (a) those that focus on the child, and (b) those that focus on the family.

To better understand the difference between the two, think of them as different lenses on a camera. The child-focused therapies are like a zoom lens, which allows the therapist to examine closely and in detail a child's feelings, thoughts, and behavior. The family-focused lens is wide-angled. It allows the therapist to look at the child's behavior as he or she interacts with the entire family and/or people who live with the child. Family therapists believe that each person's behavior affects others with whom he or she has relationships, and that everyone must work to overcome problems. Of course, many therapists use a combination of these two approaches.

Key To Success: The important thing to remember is that the key to success of any treatment is not necessarily which theoretical approach is used. Success may depend more on the quality of the relationships among the therapists, the child, and the family; the commitment and skill of the therapist; and the willingness and ability of the child and the family to make changes in their lives.

What To Expect: The therapist or agency intake worker usually will not be able to talk when the first call is made. Be prepared to leave a name and phone number so that the call can be returned. Parents often feel uncomfortable or embarrassed about asking for help and this may make it difficult to remember everything they want to say when calling an agency or therapist. Before making that first call, it is a good idea to make a list of statements and questions to use as a guide. Here are some suggestions:

• Prepare a brief description of your child, including his or her problems and why you are seeking help.
• Be ready to supply background information about your family and its members. For example, who lives with the child and the ages and marital status of all members of the family.
• Ask whether the therapist or agency has time now or in the near future to do an evaluation to see whether treatment is needed.
• If treatment is indicated, will the agency or therapist be able to schedule it in the near future?
• When can the first appointment be made? With whom will you talk, and how long will the appointment take? Which members of the family should come to the first session?
• What is the fee? Does the agency or therapist accept Medical Assistance or payments from your insurance company? Will the Medical Assistance or insurance payments cover the agency's or therapist's fee? Will it cover an evaluation if necessary? If you don't have Medical Assistance or private insurance, does the agency or therapist offer a sliding fee scale, or will it obtain funding for you?

How Long Does Therapy Take: Occasionally, one or two sessions with a therapist will be enough. More often, either short-term therapy (lasting 10 to 12 sessions) or longer-term treatment (continuing for as much as a year or longer) will be recommended. Some agencies have special day treatment programs for children. These are group programs that offer more intensive treatment.

What If You Think Treatment Isn't Helping: If the treatment of your child or family seems to be going well, you probably will have no reservations about continuing therapy. Sometimes, however, progress is not apparent at first and, in fact, problems may seem to be getting worse instead of better. Treatment may not be progressing smoothly for any number of reasons. If you have feelings of dissatisfaction with the way things are going, there are some positive steps to try.

Talk About Your Doubts: It is helpful to first discuss your doubts with your spouse, a friend, or a relative to clarify and understand your feelings. Then discuss them clearly with the therapist.

Talk openly with the therapist, keeping in mind that a competent professional will be eager to discuss reactions to the therapy. Many clients feel at least some discontent during the course of treatment, and it is the therapist's responsibility to help them sort out their feelings.

Get Another Opinion: If discussion with the therapist is not helpful and you are undecided about whether to continue treatment, ask to speak to the supervisor of the agency. If these people cannot help, seek another opinion. This is called a "consultation" and is an accepted practice; the therapist should support the decision. Ideally, the consultant will be a well-established clinician who can be expected to provide a fair opinion of your child's or your family's treatment. Some parents may feel that they do not have a choice once their child has a therapist. If you do not have private health insurance and cannot pay the full fee for therapy you might feel powerless to change the situation. Remember, many clinics have sliding fee scales.

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