Friday, May 7, 2010

Finding a Good Therapist: The First Session with Children or Adolescents


“Then little children were brought to Jesus for him to place his hands on them and pray for them.”

Matthew 19:13a

The initial session with a minor is different from an adult's session in a couple of ways. First, one or both parents need to accompany the minor to the appointment since in most states children under the age of 13 cannot legally consent to treatment. During this first appointment, the parent(s) will also be the main source of the child's history considering that there are many details that children don't know, such as, the parent's marital history, any unusual issues during the pregnancy, labor and delivery of this child, and the child's early developmental history.

Obtaining consent and gathering history may occur in the child's presence or during a separate appointment. Either interviewing style is appropriate and varies among clinicians. Treatment circumstances will also determine the interviewing process. There are some instances when taking a history in front of the minor is painful or uncomfortable. If treatment is being sought because of a sensitive issue or a traumatic event, then this information is best obtained privately with a parent. In such circumstances, it is helpful to speak to the counselor by telephone ahead of the appointment to make sure that the clinician is aware of the special condition.

Secondly, few teenagers or children ask for counseling. Usually an adult notices a change in behavior that suggests that the child is emotionally or psychologically struggling and then initiates treatment. As a result of this dynamic, minors may be ambivalent and reluctant to engage in counseling. They may be unsure of the role the counselor is to play in their life and uncertain as to how to use therapy. Clinicians who specialize in the treatment of children are aware of this issue and will know how to draw children or teenagers into the use of therapy. But these issues affect treatment and results may be subtler and slower when compared to an adult's treatment experience.

Not all minors will voluntarily engage in counseling and some under aged clients will resist treatment. There are therapists who will patiently counsel such clients whereas others will not. In such circumstances, a change in treatment focus can be helpful. It may be beneficial to help parents learn new ways to deal with the child's issue, or to engage the whole family in treatment. A good child therapist will have suggestions as to how to best address any particular child's needs and issues. These methods may vary from play therapy, traditional talk therapy with the under aged client, therapy with parents only, or some form of family therapy.

For more information about obtaining counseling for children, please also visit:

"Children and Counseling: What to Expect"
"Can Your Child Benefit From Counseling?"

Next week we will address what happens in counseling after the first session.

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