Getting Effective Therapist or Counseling Help For Your Child

“Getting Effective Therapist or Counseling Help For Your Child”

By Bill Schacht, MS, LCSW

Family separation and divorce create many complex challenges for children. The two most common experiences children report are…

  • Scary thoughts and feelings.
  • Being distracted (i.e. in school, etc.) because of uncertainty of the future of family life structure.

Children experiencing such fears and worries will begin to show symptoms both physical (i.e. headaches, insomnia, stomach aches, etc.) and psychological (i.e depression, anxiety, short temper, lack of participation or finding pleasure in activities which they previously enjoyed.

When children show theses signs of distress, parents, other relatives, and professionals with whom they are in contact (i.e. teachers, school counselors, clergy, pediatricians, etc.) will come to a conclusion that they need help from someone who has professional expertise in such cases (i.e. a psychologist or psychotherapist,etc.).

Let us all be clear that bad therapy is worse than no therapy just like a bad back surgery is much worse than no back surgery.

Psychotherapy is a service provided for people who have a clearly diagnosable mental health disorder. Most children showing symptoms from family change and divorce are have well within normal range of response to complex and massive family and residence changes. They are not “mentally ill” (see posted article on POD, “RED ALERT”).

Determining if they have a diagnosable condition or not is critical.

If you are going to seek an evaluation and possible treatment from a licensed mental health professional use the guide below to ensure that you child will be getting appropriate, safe and effective treatment.

Guide for Parents and Guardians Seeking Psychological Services For Children

Copyright 2006 -William D. Schacht, MS, LCSW

Your child may have been referred or recommended for psychological evaluation or counseling to an agency outside of your school system by a school psychologist, school social worker, counselor, or teacher. The following information can be used as a guide to assist you in helping your son or daughter secure psychological services that are useful and meet his or her needs. For further support, call Performance Enhancement Behavioral Health & Counseling Services at (414) 427-7347.

Question: Do you know for what reasons and services your child is being referred?

Points:

Ask what reasons the referral source is suggesting your child requires additional evaluation and/or service. Attention deficit, depression, anxiety, family situation adjustment are examples of such conditions.   The agency or mental health professional will ask you why you are seeking services for your child. This gives the therapist a starting point with your child. If you describe in writing a set of symptoms or behavior observations and how long your child has been experiencing these problems will be helpful to the therapist.

Your child could be referred for the following services…

Psychiatric Evaluation

Psychological Evaluation

AODA Assessment

Individual Psychotherapy

Family Counseling

Psychological Testing

Drug/Alcohol Counseling

What agency and mental health professional you choose should be skilled in the area assessed as the problem for your child. For example, if your child is being referred for adjustment issues due to a divorce, ask the therapist about his/her experience in dealing with marriage, family, and divorce adjustment issues. How many cases of this type have been seen?

Question: How do I know which therapist will be best for my child?

Points:

Word of mouth referral is a good process. School professionals, your primary care physician, your attorney (in divorce situations), and friends can be a good place to start. If you hear one agency or therapist name come up consistently, that is meaningful.

Make sure the therapist and agency are properly licensed. When choosing an agency (or clinic) ask if it is “State Mandated.”   This means it is accredited by the State of Wisconsin.

Ask the therapist if they are “licensed.”

Ask the therapist to tell you what his/her definitions are for…

“Psychological Evaluation” (Answer should include “accurate diagnosis, prognosis, and treatment plan with concrete measurable treatment objectives and measures of success and failure for each objective”).

“Psychotherapy”   (Answer should include “your child will learn how to make changes in his/her thinking patterns, emotional responses, and behaviors consistent with his/her treatment objectives”).

Therapist should communicate his/her philosophy on using psychotropic medications as part of treatment (medication masks symptoms, but many times does not address the underlying cause of the child’s problem).

Ask therapist how he/she will communicate with school personnel and the child’s primary care physician in regards to your child’s diagnosis and treatment. Good therapists see treatment as a team approach with other professionals who provide care and support for you child.

Question: How does treatment begin?

Points:

All treatment must begin with an effective evaluation. A good therapist should inform you of evaluation findings including…

  • Diagnosis
  • Prognosis
  • Treatment plan with concrete measurable treatment objectives and a projected number of sessions for each objective.
  • Measures of treatment success and failure and what adjustments to treatment will occur if treatment fails.

If the therapist cannot tell you these things, consider finding a different therapist.

Good therapy and medicinal treatment can only occur with accurate diagnosis. Inaccurate diagnosis can lead to improper treatment.   For example, if a child is diagnosed with ADHD when, in fact, the child is experiencing anxiety from a potential divorce situation, treatment can be detrimental, rather than useful. If a child is diagnosed with depression when, in fact, they are smoking pot twice a day and this is not known, treatment will not be useful.

Question: What is a “concrete, measurable treatment objective?”

Points:

For example, if your child is referred for social or performance anxiety, a vague, useless treatment goal would read’ “Reduce anxiety symptoms.” Of course! That is obvious!

A concrete measurable goal would read like these…

“Will attend speech class on every day he is scheduled to give a speech.”

“Will initiate social conversations with two other children in school she does not know within 6 weeks.”

“Will identify and eliminate obsessing about negative self thoughts in 4 weeks.”

These are real, meaningful type of objectives that are of immediate value to your child and you.

If treatment goals are not being met on projected timelines, ask the therapist for an explanation.   If you are not satisfied, seek a second opinion.

Question: What should I be willing to pay for my child’s treatment? What is good value?

Points:

Insurance benefits in mental health are rapidly decreasing for most health insurance plans.   Deductibles and co-pays are increasing.   Some quality providers choose not to be part of insurance panels that have low reimbursements. So, getting quality care at good cost value can requires good therapist selection and savvy consumerism.

Bad therapy is worse than no therapy.   Make sure your child has an effective therapist for his/her problem(s).

Consumers are trained that treatment cost should be assessed by fee per visit. This is not an accurate measure of true cost or consumer value.

Cost should be calculated by the therapist’s projected cost for your child’s entire treatment, rather than the cost of an evaluation or a therapy session.

For example, a $30 co-pay for 25 sessions is more than a $60 co-pay for 8 sessions if the resulting therapy outcome is the same.

Also consider how expensive it may be for you child not to receive effective treatment for his and her problem.   Marriage counseling that may cost you $3,000 out of pocket is less than $6,000 of attorney fees and family turmoil of a divorce.

For more information on selecting good psychological services for your child, call Performance Enhancement Behavioral Health & Counseling Services at…

(414) 858-1014

 

 

 

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What To Do About the Mental Health of an Ex?

“What To Do About the Mental Health of an Ex?”

By Bill Schacht, MS, LCSW

 A POD member asked for information about his ex-spouse having a substantial and sudden change in mental condition.

It is obvious that whether we are considering a commitment in a pre-marriage situation, a current marriage relationship, or in divorce situations in which minor children are involved, the mental health of both partners is essential to the health and joy of relationship interaction.

A relationship can only be as good and satisfying as what the individuals bring into it.  In my clinical practice, over 85% of the couples who come to me for marriage/relationship counseling involve mental illness in one or both of the partners.  What is most shocking is that over 50% of those who present with such disorder report that they have never been psychologically evaluated, diagnosed, or treated!  And, a vast majority of these folks are in significant denial that there is anything wrong with them.

When these couples come for counseling, they tell the therapist that the relationship is “the problem.” What emerges in the therapy is that the problems are caused by the mental disorder existing in one or both of the partners.

Psychologically unhealthy humans rarely create healthy relationships over time.  Undiagnosed and untreated physical illness can also lead to relationship breakdown.

Any psychological disorder can and will negatively impact relationship.  The relationship killer in people with psychological disorders is FEAR.  Fear negates the experience of LOVE.  It is impossible to allow one’s self to be vulnerable in a relationship when frightened.

The most frequent diagnoses that I observe people in couples’ counseling present with…

  • Undiagnosed and untreated or ineffectively treated post traumatic stress.  This usually manifests from  sexual, physical, and/or emotional abuse, in soldiers with battle experience, in police and other law enforcement personnel and firefighters who witness trauma and/or have near-death experiences,  and in EMT’s, Emergency Room and other health care professionals who are exposed to patient trauma.  These individuals find it very difficult to feel safe in relationship and have trouble being emotionally present/available in relationship because their pattern of suppressing the painful emotion of the unresolved trauma will present as either emotional avoidance or instability/volatility.
  • Addictions.  Alcohol, drugs, gambling, sex/porn, food, shopping – whatever.  These patterns consume time and resources and cause people to be inattentive in relationship.  The addiction is presented as more valuable than relationships.  Remember, many addictions, especially drugs and alcohol, are self-medication efforts for other conditions.
  • Anxiety of any type.  People who suffer from anxiety make choices based on what worries and frightens them.   Social anxiety, which makes it impossible for a person to enjoy interactions with people who are unfamiliar, will quickly breakdown a relationship in which their partner enjoys social interaction and meeting new people.
  • Chronic Pain/Pain Disorders.  Enjoying anything is hard when a person is in pain.  To the extent a person is consumed by pain, they cannot be present in relationship.  When pain increases during sexual activity, it is difficult for people to fully engage and enjoy a sexual encounter.

Psychological health can deteriorate quickly as our associate has noticed in his ex-spouse.  Trauma, grief (over the loss of a loved one, job, etc.), financial problems, post-partum depression, and physical conditions including pain, thyroid dysfunction, hormonal imbalances, and many other situations can cause sudden psychological distress which results in change in relating.

As POD’s, our first concern of mental health should be our own.  If I know I am psychologically struggling, I must have the courage to be evaluated by a qualified and competent mental health provider, ensure accurate diagnosis, and get effective treatment.  It is irresponsible to try establish and maintain a pleasurable love relationship if we are not psychologically healthy.

When dating, it is imperative that we are certain of our potential partner’s psychological health.  I meet too many people who enter committed relationships knowing that their partner has a psychological disorder not under control.  Many engage with the false hope that the relationship itself will make their partner better, only to learn later that the responsibility of performing well in the relationship causes them to get worse.

If you are in a relationship in which you know your partner is suffering from a diagnosable mental disorder, do not choose the path of relationship counseling first.  Focusing the problem on the relationship will distract your partner from what is their primary responsibility – to get themselves healthy.  Their pathology that shows up in the relationship counseling, if not individually treated, will cause the relationship counseling to fail.

In a divorce situation, an ex-spouses mental health deterioration, especially when that results in abusive, inattentive, negligent, or unhealthy parenting of minor children, must be addressed.  May times the healthy spouse will balk at addressing the issue with the ex to avoid generating increased conflict.  But, this is a situation in which the well-being of the children must be priority.

A progressive process of getting your ex’s attention to their psychological condition can be followed:

  • A direct attempt to get our ex’s attention to address the issue is the best first move.  A private, face-to-face disclosure of your concerns is optimal.   A letter that defines your concerns can be effective also.  Remember to be empathic and compassionate – not blaming or accusatory.  Do not speak or write about psychological diagnoses.  It is best to communicate actual observations of behavior and/or mood (i.e. excessive anger, etc.) and the negative impact that was observed on others (i.e. the children, etc.).
  • If a direct communication fails, securing the attention and support of ex-in-laws can be an effective next step.  It can be much easier to “hear it” from loving family members.
  • Securing the support of clergy that has a good relationship with an ex is another option.
  • If an ex refuses to address unhealthy behavior and mood and children are being negatively impacted, the involvement of a Guardian Ad Litem (GAL) through the family court system may be necessary.  Communicating the situation to your family law attorney to get advice on how to proceed or contacting a recommended GAL in your county is recommended.

In such a situation, the only thing that is not recommended is doing nothing.  It may take several attempts and much effort and expense, but having the children and your ex at increasing risk due to mental illness in not acceptable.

We will have many conversations and discussions about mental health as we support one another in our goal of…

Never Again!

Adult POD Children, Holiday Complexity

“Adult POD Children,  Holiday Complexity”

Family separation and divorce bestows upon the involved children unforeseen, complex, life challenges for most of their remaining lives.  These inevitable situations many times get dumped into the laps of the kids with the divorced parents oblivious to the negative impact on the children’s lives and relationships.

There is no manual for these situations; no protocols, no “right way” to go about it.  Even as adults, these children are afraid to seriously discuss such situations with their parents.  And, when they marry, their spouses often adopt that fear and avoid addressing the issues, even when they cause serious problems within their marriage.

As members of PEOPLE OF DIVORCE – The Association, our value to each other is to report and discuss these complex situations.  This allows the membership to share what remedies they have tried that have succeeded or failed.

Consider the current situation of Elisha and James.  This married, 30ish couple has two young children.

James’ parents divorced when he was 8 years old.  But, the family was always very close and spent much time together.  Even after his mother and father remarried, gatherings in both new households continue to host weekly family interactions. Elisha will say that there is so much socializing within James’ family that, if unchecked, every weekend and some week nights would be spent in the company of his mother’s or father’s extended families.

Elisha’s parents married young and have a solid marriage of 40 years. Her family gets together, but not nearly as much as her husband’s.   Elisha’s family members enjoy their interactions, but are they are not as close and interdependent as James’ family.

James’ wants to spend as much time with his family as possible.  Elisha says she fights all the time with James for time to spend with him alone, together with their kids, and with her family.  The amount of time they spend with James’ family also has reduced their socialization with other couples and friends to almost zilch.

So, where is the real complexity?  Christmas.

James asserts that, because his mom and dad have different families, Christmas Eve and Christmas Day time should be split 1/3 – 1/3 – 1/3.  Elisha demands that this time be a 50-50 time divide between her family and his two.  Elisha asks James why her parents should be penalized by losing time with their grandchildren at Christmas for maintaining a happy marriage. She asks James to consider if her parents were also divorced and remarried, would he not be agreeable to splitting the holiday 25-25-25-25 across the four parent households?

Neither will budge on the issue.  Lack of resolution has resulted in other aspects of their relationship to break down.  The problem extends to children’s birthdays and other holidays.

Because  James and Elisha refuse to discuss the issue with their parents, they are clueless to the impact of it on their kids’ marriage.

Elisha is to the point of believing that, if James’ cannot “let go” of his family a little bit and they don’t crack this nut, it could cause them to divorce.

Imagine that two more kids could end up becoming children of divorce because their parents could not agree on with whom they will spend Christmas!

Sounds silly, doesn’t it?  But, it is a real example of the unintended consequences and natural complexity of POD children.

If you have had a similar experience, post a comment.  Share what you have done to remedy such situations.  What do you think should be the protocol in this circumstance?  Let’s talk about it in the POD community and help Elisha and James work it out!

Co-Parenting & having “the talk” with your kids

Parenting collaboratively from two household is difficult and complex.  This story illuminates that reality.

When Tomas, a divorced dad of a 12 year-old daughter, Anna, had Saturday placement, his daughter had her first period.  She chose not to tell her father – not a peep.

The next day, dad rode with the mom to drop Anna off at camp for a week.   When they were alone on the drive home, mom shared with dad what had occurred at his home the day before.  Suddenly, the blood stains on Anna’s bed sheet made sense to Tomas.

Dad chose not to ask mom why she did not call him on Saturday with a heads-up after Anna called her with the announcement.  Mom suggested to the dad that Anna may have been too embarrassed to tell him or talk about it with him.  Tomas asked mom what “product” Anna was using so that he could make that available in his home.  Mom said that Anna was given product and not to worry, suggesting again that Anna may be hesitant to discuss the topic with Tomas.

Tomas pondered the events and process that just occurred for his POD family.  Tomas knew this was a big deal in Anna’s maturing process and, somehow, he felt on the outside looking in.  He was not being viewed as a valuable resource to Anna in the situation and, without notice, was not included.

This is sad.

Not that it is always so, but within an intact family, there is more opportunity for mom to immediately inform dad of Anna’s development and to collaborate how to discuss the issue with her from numerous perspectives.

Parents tend not to discuss sexual issues with their “of-age” children nearly enough.  Being in two households makes it even easier to avoid the discomfort and work of deciding what to say, what to teach, and when.

To Tomas’ credit, he wrote mom a letter declaring that he wanted to be more involved with Anna about her physical maturity.  He wrote that he would share with Anna that now he knew and to inquire with Anna into what she had learned about the actual physiological purpose of a woman’s menstrual cycle and, even more importantly, what having her period now meant to her sense of self.

In the actual conversation, Anna shared that she knew her body was going through a “monthly cleansing” and Tomas was able to add more facts about how her body prepares itself for egg fertilization and regroups through the menstrual cycle when no pregnancy occurs.  Anna was not shy or uncomfortable in the conversation and told Tomas that her period signals that she is “growing up” and is now capable of becoming pregnant.

Tomas asked Anna to consider that the arrival of her period should have her reflect upon the ability that God has given her to grow one of her fertilized eggs into a baby.  And, that she should always honor and respect her body within that miracle potential.

Anna seemed to welcome her dad’s interest and appreciated his insights. Anna and dad agreed that, within the coming years, they would have many conversations about her growing up, sexuality, and dating.

Effective collaborative parenting requires awareness and the willingness to collaborate on a level with parents and children who reside in one home.

Please share your collaborative parenting successes and failures on the POD community social network.  We can learn so much from one another!