We've learned that things can periodically go awry when working with children. Sometimes this can result in the child or parent being temporarily or even permanently dissatisfied with their treatment. And because parents need to be involved in their child's therapy from both a clinical standpoint and a financial one, multiple parties need to be satisfied for the therapy to continue.
If you are a parent or if you ever plan to be one there is something important you should know. No matter how well-adjusted you are, no matter how many parenting books you read, independent of how many episodes of Dr. Phil you watch, regardless of how little violence or conflict your child is exposed to on television and in real life, even if there is little to no history of psychological problems in your family, there is a viable chance that your child will need to have mental health treatment at some point. This is not the end of the world. School stress, bullies, biochemistry, peer pressure, anything and everything can cause children to have psychological distress. Feel no shame or embarrassment in getting help for your kid.
If and when the day comes that your child goes to therapy, tattoo this advice into your brain:
Do NOT abruptly pull your child out of therapy without closure.
It sounds simple yet is not always heeded. Consider my work with Luke, a 13 year old adolescent with depressed mood and weekly fistfights at school. Luke was a somewhat "goth" type kid with long, dark hair and black fingernails. Despite being a bit below average height and weight it seemed clear that he was winning virtually all of the fights he was in, given that his knuckles were often red yet the rest of his body was always unscathed. We got along well and he was a great conversationalist ("the red fists are my trophy over the vanquished, Doc Rob"). Over many weeks Luke and I would talk about fighting: what does it mean to him to beat up another kid, what is leading up to the fights, does he feel regret afterwards, is there an alternative to this? At one point he said "I just don't want to be on Earth anymore." This scared me a bit and, having had months of unsuccessful attempts to curb the behavior and boost his mood, I advised his mother what had taken place and that a medication evaluation should be considered.
Mom: Medication? But I thought you people didn't believe in drugs.
Dr. Rob: I suppose some psychologists don't, but I believe it's worth considering. Your son is having a very tough time and this has been going on for many weeks now.
Mom: That's why I brought him to you.
Dr. Rob: I understand that, and I think I can still be of service to him, but he might need something more, even if it's temporary.
Mom: Is this because of the whole "Satan" thing he has going on?
Dr. Rob: No not at all. It's about his depressed mood. I've been trying to work with his strengths but he seems stuck.
Mom: What do you think his strengths are?
Dr. Rob: Well he's motivated, articulate, artistic...
Mom: You think he's autistic. At 13 years old. Like we wouldn't have known that by now?!
Dr. Rob: No, 'artistic.'
Mom: Oh. Well I don't understand why you aren't doing your job correctly.
Dr. Rob: What I'm doing right now is my job, Mrs. Luke.
Mom: Then I think we'll follow your advice and take our business elsewhere.
Dr. Rob: I don't mean that you should...
Mom: We're going.
This was not good as Luke and I had a good therapeutic connection despite the need for more intensive services. I called Mrs. Luke three days later to see how Luke was feeling and to discuss continuing our work, but to no avail. I did get a message from her a few weeks later stating that Luke was taking medication and was "doing so-so, no thanks to you. He misses you and the medication only helps a bit, but you clearly have no idea what you're doing. Take some continuing education classes and then we'll talk."
While not every client and therapist will "click" most children and adolescents who come to treatment on a regular basis get comfortable with the routine. The structure and stability can help them. At some level of consciousness the child says "At 5:30 every Monday I see Dr. Rob. I see him for 45 minutes. He is pretty predictable: we play games, we draw, he is nice to me, we talk about my feelings. He tries to help me when I have a problem. Sometimes he is successful and sometimes he isn't. But he is solid because invariably he is THERE for me."
Could Luke's abrupt departure from our work directly and profoundly (and negatively) impact his adult relationships? That's hard to say because so many variables will play a part in his life over the years. But we do know that what happens to us as children plays a role in our futures. We see countless people in their teens, 20's and 30's (and beyond) with attachment issues: people who can't let go of people whom they love but don't love them back anymore, people who can't get close to others or have commitment or intimacy issues. Could abrupt parental reactions toward terminating therapy cause attachment issues? That might be a stretch, but don't think that whisking your child away from a solid relationship definitely won't have any future impact. That's just naïve.
I do not spout out these Pearls of Wisdom (POW!) without doing my field research first. Just in case my experience with Luke was an isolated incident, I considered my own past. I was in therapy when I was an adolescent because I didn't know how to cope with so many hot teenage girls coming on to me all the time. That or I had some social anxiety giving speeches, I can't remember. Anyway, I called my mother to fill in some blanks.
Robert: I wanted to learn more about my experience in therapy when I was a kid.
Mother: Good God what a waste of time.
Robert: Really? How so?
Mother: After dozens of sessions with the therapist are you comfortable with public speaking now, at age 33?
Robert: I'm 36. And no.
Mother: Sounds like the definition of a waste of time to me.
Robert: Do you remember how the therapy ended?
Mother: Other than me writing a check every week to some woman who blamed me for everything that was wrong with you?
Robert: I mean how did you decide not to send me anymore?
Mother: I wanted you to stop once I saw things weren't going anywhere. But you said that you liked the woman and wanted to continue to try. I figured it might mess you up even more than you were if I just jerked you out of there. So I kept paying. And paying and paying. I could have bought a Trans Am for that kind of money! Finally you said that you had had enough and wanted to stop. The therapist said that you two should have a few "closure" sessions or something stupid so that you didn't have even more issues as an adult. I suppose it made some sense so I sent you a few more times and then you stopped and I got to buy nice clothes and the new Kenny Loggins album.
Robert: Wow, that was very insightful of her. And you. I love you Mom.
Mother: Don't patronize me. You're 38 and still don't have children. If I had pulled you out of therapy you might have become a serial killer or something even more neurotic than you are.
Clearly then, taking the stability from a child is not only ignorant, it's basically cruel and will ensure your child becomes the next Charles Manson.
The reality is that practitioners will not be able to help every kid that comes into the office and sometimes they cannot help some children fast enough for the parents' or school's tastes. If this happens and an arrangement cannot be worked out, do not abruptly end the relationship. Let the therapy end with a formal goodbye, even if it means holding off on Kenny Loggins' comeback album, due out this summer.
Posted by Rob Dobrenski at 11:56 AM