How To Find The Right Psychotherapist For Your Child

(Submitted by Rand J. Gruen Ph.D.)
As the Executive Director of a fairly large mental health group practice in Westchester, southern Connecticut, and New York City, I have received hundreds of calls from parents over the last decade asking whether we can see their child in therapy. As consumers, parents don't always know the right questions to ask. Special questions have emerged as a consequence of the pandemic (i.e. regarding telehealth). My goal here is to answer questions that parents have asked over the years and provide a simple guide to increase your chances of finding the right therapist for your child.

What type of therapist should I see? There are many different types of professionals who provide mental health services. These include psychologists, psychiatrists, social workers, mental health counselors, and a myriad of other professionals. While the training each receives is different, there are skilled providers in each category. What you need to assess as a consumer is whether the provider has adequate experience dealing with the problem at hand, the number of years they've been working in the field, and whether they are well trained. For example, at our Center, we don't bring therapists on who have had less than three years of experience seeing patients after getting their degree.

Where should I get a referral from? Families tend to get referrals from friends and other families with children, pediatricians, and internists. The school psychologist at your child’s school can be another source of referrals. One can also look online for viable options.

Should my child be seen in-person or remotely? While the answer to this question will vary depending on the child, we feel that in general, it’s better for children who are under nine or ten years old to be seen in person when possible. Additionally, if a child has symptoms of hyperactivity or inattention, or other characteristics that make telehealth challenging, in-person is preferred. We sometimes try to see kids in person for a period of time to establish the relationship, and then see them remotely if in-person is not possible. In our experience, video calls work pretty well for older children who can focus adequately. Over the course of the pandemic, we have seen hundreds of older teens and adults via telehealth and it has worked quite well. For teens with busy schedules, it can be very convenient. There have been periods of time over the last two years when in-person was not advisable due to Covid, and remote sessions gave us the ability to work with individuals, couples and families who needed help when we might not have been able to otherwise.

Should I look for a team or an individual for my child? You should use the results of the initial assessment (see below) to determine whether you need a team or whether it is sufficient to work with one individual provider. For example, we have individual, couple and family therapists; neuropsychologists; ADHD, education, and executive function specialists; and access to psychiatrists who are located in the Center for medication purposes. If your child needs individual therapy, medication, and/or a neuropsychological evaluation for example, it would be better to assemble a team of people who know each other who communicate well. I have found that it’s hard to get providers to communicate with each other on an ongoing basis if they are not under the same roof.

Is it OK to question a potential provider? Parents should feel comfortable talking to potential therapists they are considering working with and asking them a series of questions. I usually spend around 30 minutes with parents or prospective patients (without charging them) in an effort to understand what the problem is and whether we have the right therapists to help. If we don't, I will tell the family this and suggest that they see someone else. You should expect this level of transparency.

Fees. Parents should ask about fees. If you're going in-network, fees are set by the insurance company, and you pay a copay. If you're going out-of-network, the provider sets the fees. If you go out-of-network, you can get reimbursed by your insurance company if your insurance plan has an ‘out-of-network’ provision. There is often a deductible associated with this and insurance carriers will pay an agreed upon percentage of what they consider ‘reasonable and customary’. Providers who are more experienced and in high demand typically charge higher fees. They often don’t take insurance. From my perspective, it is OK to ask a provider if they can lower their fee. For example, we will lower our fees slightly if a family can’t afford our standard fee if we feel like it's a good fit.

Can I ask a therapist to explain their approach? Absolutely. There are many different types of approaches to psychotherapy. Your potential provider should be able to explain the approach that they would use in your case, and if you don't understand it, give you some background so that you can understand what they are saying. Generally speaking, there are three main approaches in psychotherapy, with many subtypes under each category. These include insight-oriented approaches, systems approaches, and cognitive-behavioral approaches. Insight-oriented approaches seek to identify the underlying causes to symptoms and offer new coping strategies that follow from the insights gained. Systems approaches look at family or couple systems and identify patterns which maintain maladaptive behaviors and lead to symptoms. Again, new coping strategies are proposed. Cognitive behavioral approaches look at cognitions which lead to symptoms and prescribe behaviors which enable healthier ways of living. Another phrase that is often used is “evidence-based approaches” which means that we have evidence that the approach leads to clinical improvement in scientific studies. Evidence-based approaches can include any type of therapy that results in clinical improvement. Having practiced for more than 30 years, I see utility in all of the approaches described above. The trick is to decide when to use each to address a particular problem or set of problems. Evidence to suggest one approach over another should emerge in the initial assessment.

Duration of treatment. It's fair to ask how long a provider thinks treatment will take but it's also fair for the provider to say that they don't know the answer to the question at an early stage. It's very hard to assess this until you've spent time with the patient or family. In addition, you need to understand that things can change and evolve over the course of therapy and new problems can emerge, so that things take longer than originally expected. Having said this, there are certain types of problems that can typically be addressed with brief psychotherapy and others that typically take longer to address. An example of the former is when an otherwise healthy child is exposed to a time-limited stressor (house floods; parent is briefly hospitalized, etc.). An example of the latter is when a child with chronic anxiety, low self-esteem, or depressive symptoms is having trouble coping with a stress-induced exacerbation of the symptom.

Getting started: What to expect. We feel that the most effective approach in terms of structuring things is to start with a thorough assessment designed to identify all the different factors that contribute to a problem. This enables us to create a viable treatment plan. The initial assessment should cover problem areas, relevant family dynamics, outside stressors including sports and academic activities, peer relationships, medical history, medications, family history, school demands and academic performance, extended family factors, etc. Our goal is to assess fit, determine if we have the right people to help, and if so, gather enough information to create a viable treatment plan. You should expect that a provider will tell you if they don’t have the experience or expertise to treat your child. The treatment plan should stipulate the providers needed, the approaches that should be used, and the frequency of sessions necessary. We then share the plan with the family and provide a rationale for the plan.

Finding the right therapist for your child is difficult. It’s important to approach this in a well thought out, informed way. Settling on a therapist who is not a good fit can result in lost time and negatively impact a child’s attitude toward therapy. It’s worth the effort to do this as thoughtfully as possible.

Direct questions to: randgruen@westchestercaps.com

Rand J. Gruen Ph.D. is the Executive Director of Westchester CAPS (www.westchestercaps.com), an interdisciplinary, outpatient mental health center providing individual therapy to children, adolescents, and adults; couple and family therapy; neuropsychological assessment; ADHD and executive function coaching; and medication management. He is also an Assistant Clinical Professor of Psychiatry at Yale University School of Medicine. Dr. Gruen received his B.A., M.A. and Ph.D. in Psychology from the University of California, Berkeley. He was formerly a fellow at Yale University School of Medicine and an Assistant Professor in Psychiatry at New York University Medical Center.