Working with families

With children: Children live in a family system. Even when the child's behavior is due to biological issues or trauma, it is essential to involve the parents in making sure they are providing the best support for the child and themselves. I start with a behavioral approach: assess family's and child's strengths first, then looking at schedules, rules of the house, food habits, sleep schedule, how the family spends time together, who sets who off and the working relationship with the school.

Some parents need information and support in understanding their child's disability or mood disorder and how this affects their development. Some parents need to realize they are doing a pretty darn good job considering the circumstances. Counseling provides that extra support and perspective to keep up the good work and get the oomph to do a little more which will be hard in the beginning but pay off in the long run.

It's my job, to keep the long term vision clearly stated and cheer the parents on as they make the hard but important decisions to make changes. I usually tell the kids (who are resentful about coming) that as soon as they have gone three months without any major transgressions (which can be redefined along the way- you can increase the expectation), they can be done with counseling. It usually takes 3-4 weeks to establish a new behavior and about 3 months for the new behavior to become more habit. That doesn't rule out set backs, which are a natural part of change. And that's for the parents as well as the kiddo!

With teens, if they over 13, they get to decide how much they want to interact with their parents, if at all. I usually request that the teen allow me to discuss her needs with her parent at least initially. Some teens are relieved to have the therapist provide coaching to their parent while others are opposed to this. It depends a great deal on defining what confidentiality means and that the teen knows that details will not be divulged unless there is a serious concern. Intakes with teens usually include the parent for the first 30 minutes and then the rest just with the teen.