CEHL:

Taking Charge of Your Child's Emotional Health

Being a successful parent, raising a happy, healthy child, should be one of the most important and gratifying experiences of adult life.


But the journey isn't an easy one. There are many challenges along the way. You worry about your child's physical problems and how they will be resolved. You also wonder whether your child might develop emotional problems. The following questions will help you to learn how to take care of your child’s emotional health.


Does my child have an emotional problem?

One of the most difficult challenges you may face as a parent is deciding whether or not your child could have an emotional problem. For example, she or he might be afraid to go to school, be prone to "lying," be abusive to a sibling or have difficulty falling asleep at night.


How do you respond? If you have a spouse or partner, you may be able to share your concern and have a thoughtful talk. However, sometimes your spouse or partner may not be able to understand why you are worried. Often, friends, relatives, or even a child's teacher may be helpful in deciding whether your child might have a problem.


One challenge is to overcome the natural tendency to deny there is a problem. You may also find it difficult to overcome guilty feelings that you might have contributed to the problem in some way. Friends and relatives may try to comfort you by saying that "it is nothing" or that "your child will outgrow it." Maybe your child will, but you deserve the opportunity to talk about your child and give yourself peace of mind. You may decide to seek counseling.


How does counseling work?


Counseling is a special kind of talking. It means bringing to your awareness feelings you have kept inside for a long time. Counseling occurs between patients or parents and a professional whom they trust.


A counseling relationship allows you to listen to your own words, and also gives you a way of stepping outside of yourself to see how your way of feeling and thinking about parenting affects how you behave toward your child and others in your family. You may be able to figure out how to solve a long-standing problem in a new, creative way. It also helps you to respond to similar problems in the future.


Who is there to help me?

 


How do you find a professional to help you discuss your fears, decide if there is a problem, and select the kind of help your child and you might need? Whom can you trust?

  • Community Resources. Your community usually provides a variety of resources. Your child's teacher or school counselor may suggest a child psychologist or psychiatrist, a clinical social worker, a behavioral pediatrician, or a mental health center. These are all excellent resources. Since a psychosocial consultation can be provided by different types of professionals, I have labeled such a person with the general term "counselor."
  • Pediatrician. Your pediatrician has known your family over time. He or she has seen your child for regular checkups and has observed your child's growth and development. You may have mentioned, from time to time, worries about other members of your family including issues of health, loss of job, even deaths in the family. Might not the pediatrician be a possible resource, at least initially, to talk with about your child's emotional health? Pediatricians will vary in how they may respond to your concern. Some may be pleased to help you with the initial assessment. Others may prefer to refer you to another appropriate resource within the community.


Remember, seeing a counselor doesn't mean that your child will require therapy. It merely indicates that additional time and expertise is required than is usually available in the routine office visit.


What types of questions do parents ask counselors?

 


When parents visit a counselor for the first time, they may often ask these questions:

1. Why isn't there a quick answer to my child's problem?
It would be wonderful if there was a quick answer. Unfortunately, there are no easy answers. Every child is unique. Both family values and history play important roles in how a child grows and develops. It takes time to address each child’s complex situation. And, the solution must make sense to you after taking time for careful consideration.


2. Why do I have to talk to a counselor? Shouldn’t my child be the one seeing a counselor?
That may happen later on. Helping children often starts with helping parents. That may involve understanding how you, as parents, are doing. It may also include understanding how you (the parents) were raised and understanding your own early life experiences.


3. Should both parents be present? Or is one enough?
Both, if possible. Sometimes you both may have the same perception of your child, and you may not have realized it before. Sharing each other’s views will be very useful in helping to understand the situation.


4. What if one parent is reluctant to come?
That is OK. If one parent comes in, shares her or his concerns and gains useful insights, that will still have a positive effect on the your child and other members of the family.


5. What if I have questions before the visit?
Don't hesitate to call the counselor with any questions or concerns before you meet. Counseling sessions are not meant to be mysterious; they are meant to help you and your child recognize the positive things about your life and to identify the areas that still need some work.


6. What if I'm not comfortable with the counselor?
Even though the counselor you have chosen may be well-trained and well-intentioned, the chemistry between you may be less than ideal. If you feel you have given it a good try, go ahead and get a second opinion. You need to feel comfortable with your choice.


What types of questions will a counselor ask?

 


An assessment of your child's behavior problem will be done either by the pediatrician or by the counselor that he or she recommends. The evaluation of the problem could take as long as an hour in order to get a sense of what is going on.


An evaluation should include:

  • A thorough review of your concerns, including when the problem began, whether it coincided with a recent event or if it has been an issue for a long time. You also may be asked what you believe has contributed to the problem
  • Questions about what you have done so far to resolve the problem
  • If there are two parents, you may be asked if you view the problem similarly or differently, and what each of you think might be the cause.
  • The counselor will usually ask how your child is doing in a variety of areas, such as eating, sleeping, separation, fears and habits (for example, thumb sucking or nail biting).
  • Depending upon the age of your child, the counselor may ask about the developmental history and how he or she does with discipline, other children or school.
  • If you have other children, you may be asked how they are doing, and whether there are any marital problems.

You may be asked about your worries for the future if nothing is done about your child's behavior. Sometimes, you may worry that your child may have "inherited" a problem from some other relatives. Or for many reasons, children may remind you of other individuals in your family including your spouse, your parents, as well as yourself or your siblings, in the past or present.


It may not be easy, but it will be helpful to talk with your counselor about those family members who had an impact upon you, and to talk about the affection and anger that you may have or had toward them. By doing so, you may be able to separate them in your mind from your child, so that you see your child as the separate person he or she really is.


There may have been "losses" (for example, a premature death, a serious illness, loss of a job, or a divorce) that you may feel contribute, at least in part, to the development of the problem. You may be encouraged to share those events and how you feel your family may have been affected.
Finally, a counseling session should also include a discussion of your child's and your family's strengths and successes.

Sometimes there are "family secrets" or worries that may seem related to the development of your child's problem. They may include a family history of alcoholism, abuse or mental illness. Counselors recognize that sharing such concerns may be difficult or painful. I would encourage you to consider sharing this information with the counselor, because a discussion of the family history can be very important in helping you deal with your child's behavior.

Is the counseling session confidential?

 


You should be reassured that such discussions are absolutely confidential in accordance with the law. Don't hesitate to ask the counselor about confidentiality. Personal information will not be shared with the insurance company or managed care plan. From the pediatrician’s standpoint, the only information that needs to be disclosed is that you came in for a consultation, period!


What should parents expect from a counseling experience?


Keep in mind that how the counselor listens to you describe the problem, the questions he or she may ask you, and how they go about helping you consider your next steps, are all important to help you take charge of your child's emotional health.


Whatever you and they choose to do, you should feel that you are being listened to in a thoughtful, compassionate way, that you have time to express your concerns, and that you and the counselor are charting a course to begin resolving your child's problem.


How can you judge the quality of the outcome of a counseling session?

 


At the end of a session with the counselor, you should feel that:

  • he or she was genuinely interested in your family
  • you have not only shared your thoughts and feelings but are feeling more confidence about addressing your child's problems
  • you have choices in confronting these problems, and you have the ability to make good decisions

It is worth remembering, however, that such achievements take time.


Is there time and money available for parent counseling?

 


You may believe that pediatricians do not have time for counseling because HMOs do not reimburse pediatricians for such things. That seems to be changing. Some HMOs are gradually allowing pediatricians to do so. If you are in any doubt whether your health plan supports this type of intervention, check with them to make sure that this is a covered benefit.


Most pediatricians are aware which health plans will pay for this type of counseling. The pediatrician simply needs to tell the health plan that he or she has spent time counseling.


There are additional sources of financial support that are available to families, depending upon the child's age, the nature and the severity of the problem, as well as the family's financial status.


Additional resources include:

  • Early intervention programs for the newborn to age three group including children with developmental or behavioral problems
  • Department of Education funds for children with learning disabilities.
  • If your child is disabled, he or she may be eligible for financial support through Supplemental Security Insurance (SSI). In addition, the state departments of social services, mental health, and retardation may also provide you with support.


Your pediatrician, or the social worker in you community hospital or mental health center, may help you apply for assistance from such agencies and resources.


Remember: The child's problem is an opportunity!
While it is painful to confront developmental issues in your children, problems can also be seen as an opportunity to assess how you and your child are doing, and the earlier problems are identified, the better.


As your pediatrician or counselor listens to you, you may discover that the problem has been bubbling under the surface for some time. By having the chance to examine how your family is doing, you may find ways to help your whole family not only address the current problem but also become stronger in the long run.

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Support

I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center,  and the families of my medical practice. 

I hope you find this site useful and encourage any comments.


- Dr. Howard King, M.D.