What to Expect When Sending Your Child or Teen to Counseling

What Is Child and Youth Therapy?

Child and youth therapy is psychotherapy that centers around the needs and concerns unique to children and young people, providing support, guidance, and coping strategies for them. Youth therapy may focus on any issue that affects their mental health, generates distress, or is causing difficulties related to academics, family interactions, peer relationships, self-esteem or other challenges.^1,2

The cost of counseling can fluctuate, and the fee often depends on the provider’s level of expertise, their therapeutic approach, if you have health insurance coverage, and where you live. The length of therapy can also vary based on the specific issue being treated, the child’s age, therapeutic modality, among other factors. Therapy will end upon successful completion of treatment goals (generally between 15-20 sessions). Chronic or severe issues may require more care and consequently more time. Additionally, it is not uncommon for a child to return to therapy should other stressors arise.^1,2

What Is a Child Psychologist?

A child psychologist refers to a professional who has completed a doctoral degree in psychology specializing in the mental and developmental health of children, including infants, toddlers, and adolescents. Child psychologists possess extensive experience in clinical practice or psychological research and are generally licensed by licensure boards in each state.³ These doctoral-level experts employ a variety of therapeutic interventions to treat children and provide them with strategies to healthily cope with behavioral difficulties, mental or emotional concerns, and other life stressors. They are also qualified to perform additional services such as psychological testing to establish a mental health diagnosis and/or learning deficit.³

Who Can Benefit from Child & Teen Counseling?

Therapy can be beneficial for children and teens with a wide range of issues:

• With a Diagnosis: Some children and adolescents entering therapy have a mental health diagnosis previously clarified with another provider.
• Without a Diagnosis: Others are searching for that clarification, so they begin treatment without a diagnosis.
• With Stressors: Some solely seek therapy to help manage a stressful external situation, whether time-limited or lifelong, or to navigate a major life change.

It seems rather obvious that children with mental health diagnoses from the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V), can enter therapy, but children without a mental health diagnosis can also benefit from therapy.

A child may experience some symptoms of a disorder, but they may not have enough to be classified as clinically significant. This could be a child who feels too anxious to raise their hand in school to answer a question, for fear of being wrong. Their behavioral inhibition may impact their verbal participation at school in that particular regard, but overall they are doing well at school, both academically and socially.

Here are several other situations in which child or teen therapy may be appropriate:

• Their parent is getting remarried (and even if the child accepts the step-parent, it’s still an adjustment)
• The family dog passed away
• Their parent found a new job that has different hours, so the child has to help younger siblings more often with homework or cooking dinner
• They feel excited, yet nervous, to start middle school/high school/college
• Their parent got relocated, so the family had to move to a new state
• Their grandparent moved in with their family long-term
• Their sibling has a mental health issue that significantly disrupts the family unit
• They are an only child and struggle with feelings of loneliness
• They became injured and can’t play their preferred sport this season
• Their significant other broke up with them
• They are having trouble sleeping
• They feel unmotivated to do school work

Types of Psychotherapy for Children & Youth

Most therapists specialize in a specific approach to therapy. Common therapeutic approaches used in child and teen counseling can include:

Cognitive Behavior Therapy (CBT)

CBT is based on a cognitive theory in which a child’s thoughts regarding situations in their lives can negatively or positively influence their emotional, physiological, and behavioral reactions.^1,2 Therefore, if their thought patterns can be adjusted, their feelings can be adjusted, and then their behavioral reactions can be adjusted. CBT works best for children ages seven and older due to the abstract nature of this type of psychotherapy.

Dialectical Behavior Therapy (DBT)

Dialectical Behavior therapy (DBT) is used to help with emotional regulation, distress tolerance, and interpersonal effectiveness, so the child or teen can function better at home, school, and community settings. DBT uses positive reinforcement to motivate change, emphasizes the child’s strengths, and helps translate concepts learned in therapy to the child’s everyday life.

Exposure Therapy

In exposure therapy, the child or adolescent is challenged with gradual exposures to something that makes them uncomfortable. Then, they are positively reinforced for meeting those challenges. Next, their challenges are gradually increased as they habituate and desensitize to their anxiety, so it doesn’t feel as uncomfortable. This process can help them function more effectively at home, school, and in community settings, and is commonly used to treat phobias and other forms of anxiety.

Acceptance & Commitment Therapy (ACT)

This form of therapy has a flexible framework that centers around acknowledging unwanted experiences and feelings while also being able to make positive life changes. ACT can help children and teens better understand and accept their inner emotions and use this insight to commit to move forward in a healthy manner.⁴

Family Therapy

Family therapy is a structured modality that involves multiple family members along with the child and focuses on enhancing communication skills, learning healthy ways to settle conflicts. Family therapists draw from a wide range of techniques while providing support, guidance, and psychoeducation conducive to creating a healthier family dynamic and home environment.⁵

Play Therapy

Play therapy uses drawing, toys, games, etc. to encourage a child to express their experiences, emotions, and/or complex themes they aren’t fully equipped to vocalize. The therapist observes how the child engages with the play materials and interprets the themes and patterns that emerge to see where the child is struggling. Play therapy can help a child learn to identify their emotions and express them even when they are uncomfortable.⁵

Parent Child Interactive Therapy (PCIT)

PCIT is designed to promote positive parenting practices that will enhance a child’s development and wellbeing. During a session the parent is taught and guided through a particular skill while being observed by the therapist in real-time (usually through a one-way mirror). The counselor also offers feedback and effective strategies to manage the child’s behaviors and other concerns.⁵

How Does Therapy Work for Children & Teens?

For a child or adolescent to learn counseling strategies to manage thoughts, emotions, and behaviors, it takes time. The child will not be learning these strategies immediately because the first few sessions are focused solely on building a relationship. Therefore, the parent can’t expect major changes right away. With that said, research shows up to 50% of success in therapy is the therapeutic relationship, so it’s important the child feels comfortable with the therapist.

The Therapist Won’t Tell Your Child What to Do

When the therapist and child are working together, the therapist will self-disclose minimally. They won’t impose their values on your child, and they won’t judge yours or your child’s values. Therapists also don’t give advice. They can offer pros or cons to situations and help the child come to their own decisions. If the therapist gives advice, there’s liability involved. If the therapist offers pros or cons, this is legal and it allows the child to take more ownership of their treatment, and create tools to make better choices in the future.

Don’t Expect to Participate During Sessions

If the parent would like to communicate issues ahead of time so the therapist is aware of some things to work on, let the therapist know with a phone call, voicemail, or email ahead of time.

They May Need Situational Changes to Improve

If the child is in therapy due to the distress from an environmental circumstance, be aware that their issues may not just resolve when their situation changes for the better. The long-term effects of a situation may still require treatment after the actual problem has been solved so they can continue to function optimally across settings.

Common Child Therapy Interventions

There are a range of therapy interventions that can be effective and adjusted according to the child’s age, needs, and setting.

Common interventions used across a variety of child and teen therapy models include:⁶

• Active listening, unconditional positive regard, and warm acceptance: Helps to build a trusting relationship between child and counselor.
• Psychoeducation: For the child to learn more about their condition, problems, and symptoms.
• Cognitive restructuring: To replace negative thoughts with positive self-talk.
• Role Play: Can be used to practice healthy responses to a particular situation.
• Homework: To keep the child engaged like completing a worksheet and discuss it in session.
• Relaxation techniques: Counting from 1-10 when feeling angry; breathing exercises to deal with frustration.
• Token economy: A sticker or slip is given to reinforce positive behavior and then exchanged for a reward.
• Modeling or social skills training: Skills are taught for problem-solving and managing conflicts to promote appropriate social behaviors.
• Mood charts: To help the child identify and be more in tune with their feelings.
• Anger checklist: To identify things or events that trigger angry responses.

The Importance of the Child / Therapist Relationship

It’s important to realize a child will not work on their own issues and their role in situations if they don’t feel heard and understood first. Once the child feels supported by the therapist, the therapist can then confront them and challenge their perceptions and thought distortions. The therapist can only confront the child as much as they have supported them.

What the First Therapy Session With a Child Looks Like

The focus of the first session is generally geared towards gathering background information, understanding the reason for therapy, completing forms, building rapport with the parent and child, understanding the child’s needs, conveying how treatment can help, and answering any questions and concerns the parent may have.⁷

Some counselors may see the parent first and then the child, while others may see the parent and child together. This typically depends on the age of the child, type of setting (private practice, mental health clinic, etc.) and the therapist’s judgment. Due to the variables and objectives mentioned, the first session may be lengthier than the other therapy sessions.¹

How to Introduce Your Child to a Psychologist

You can start by creating a safe and validating environment where you can best be heard and understood by your child. Choose a moment that is calm when you feel your child will be most receptive. Make sure that you communicate openly, clearly, lovingly, and in a way that normalizes therapy while including the benefits for seeing a therapist. Most importantly, be cognizant of your child’s age, personality, and cognitive level.¹

Consider the following before introducing your child to a psychologist:¹

• Timing: When you’ll choose to discuss therapy with your child. For instance, choosing a neutral time of the day and not after a conflict. You should also think about how much time you want between discussing therapy with your child and their first session, as well as how often to reinforce the message.
• Where: This includes a location where you’ll be arranging to have the discussion with your child. For example, will it be over dinner or during a time that is free of distractions? Will both parents be present?
• Method: How will you convey your reasoning for therapy? Have you thought about the questions your child may have? How they’ll react, or the possibility that they’ll refuse to go? Do you feel in a good headspace to have the discussion?

How Long Will My Child Stay in Therapy?

Expect therapy to last a minimum of 3 months to many years, depending on the diagnosis or combination of diagnoses or the distressing external circumstance. It can also depend on other external factors that are not the actual presenting factor, in addition to gender, age, desire, commitment level, parental buy-in, medication and medication compliance, and the child’s ability to learn, retain, and utilize information.

Confidentiality

Expect that the therapist will hold to the laws of confidentiality. Confidentiality creates a psychologically safe environment for the person to express their thoughts and feelings.

Minors ages 12 and older hold their own confidentiality.

The parent cannot receive actual content of what the child reports in session, unless the child (12 and older) gives the therapist permission. How these progress updates will be administered should be communicated at the beginning of treatment as to how and when these will be delivered (and if there’s extra cost for this.)

Confidentiality laws were put in place for a reason. They are meant to help the child progress in treatment. If there was no assurance of confidentiality, most children would be reluctant to share certain critical information, and therefore, they would actually benefit less from the therapy (that the parent is paying for).

When Might Confidentiality Be Broken?

Other than if a child allows the therapist to break confidentiality to a parent, there are a few other reasons a therapist can and will break confidentiality to the parent:

• The child has intent, plans, and means to hurt themselves
• The child has intent, plans, and means to hurt someone else (or an animal)
• Someone in the child’s life is hurting them or threatening to hurt them.

There are also situations when therapists will break confidentiality to outside parties. Some examples of these scenarios include:

If the child alleges abuse or neglect with a family member with whom they live, therapists are mandated reporters and will break confidentiality to DCFS (the Department of Child and Family Services). Even if a therapist does not fully believe the child, the therapist is still mandated to call. An ethical therapist will let the child know ahead of time that they will be calling DCFS. This is to help keep the child’s trust.

At What Age Can a Child Enter Counseling?

Children as young as toddlers can obtain a mental health diagnosis and can enter therapy. Treatment will look different across the lifespan.

Ages 2 – 7 Years Old

Children ages 2-7 will rely heavily on antecedent management. This is to proactively and reactively adjust their environmental circumstances, in an effort to help them manage their emotions and behaviors, while building relationships. Some examples are Dr. Sheila Eyberg’s Parent-Child Interaction Therapy and Dr. Ross Greene’s Collaborative Problem Solving Model, both of which have skills that can be taught to parents and teachers, and the child will engage in more play-based therapy in the therapist’s office.

Older Children & Teens

Once a child reaches somewhere between ages 7-12, their brains are more ready for abstract thought, so these children can participate more in traditional psychotherapy (talk therapy) with the clinician, like CBT or DBT, versus play-based therapy.

How to Obtain a Mental Health Diagnosis for Your Child or Teen

To make a diagnosis, a therapist will gather past history, conduct a clinical interview, discuss present symptoms and how they are interfering in the child’s home-life, social functioning, and academic functioning. An accurate diagnosis can take time. If the therapist doesn’t feel the information is comprehensive enough to make an accurate diagnosis, they will recommend a more formal psychological testing procedure.

Should My Child See a Psychologist or Psychiatrist?

Psychologists are doctoral-level professionals trained on all aspects of mental health. You may seek a psychologist specializing in children’s mental health if you suspect that your child may have a condition affecting them socially, academically, and/or in other important areas of their life. A psychologist can thoroughly evaluate your child and provide a suitable treatment according to their needs.⁷

Although some states allow psychologists to prescribe and manage medication, a psychiatrist is generally the appropriate professional to provide pharmacological treatment. Consulting a psychiatrist, particularly one specializing in children, could also provide a more comprehensive approach as in some cases physical issues could be impacting the psychological health of your child.^8,9

How Much Does Child Therapy Cost?

The cost of therapy for children and teens is typically between $60-150 per session. Most people with insurance can expect to pay 10%-30% of the fees as a co-pay. If the therapist or counselor does not accept insurance, you’ll be responsible for the entire bill. If your insurance covers out-of-network providers, ask for a superbill from the therapist to submit for reimbursement.

How Much Will Insurance Cover?

• First, call your insurance company to see what mental health providers are in-network.
• Find out what level of treatment is covered- outpatient therapy, partial hospitalization program, intensive outpatient program, inpatient treatment, residential treatment.
• Find out the level of coverage you have in terms of copays, limits of visits, and annual or lifetime maximums.
• Find out if the insurance company covers only medically necessary treatment (and how that decision is made).

Other Coverage & Payment Options

There may be other options for covering the cost of child and teen counseling besides out of pocket and private insurance. These options include:

• Public School Counseling or Social Work Services: These services are free of charge to the family, if the student qualifies for these services.
• Medicaid Eligible Clients: Some therapy offices take Medicaid, and all of the county health departments take Medicaid.

Other Costs to Consider

• Find out if (and how much) the therapist charges to communicate with you over the phone or email with a progress update
• Find out how much it costs for the therapist to call the school’s psychologist, counselor, social worker, or teacher to coordinate treatment, and for them to attend your child’s school meetings.
• Find out how much the therapist charges to write summaries for your child’s school staff with recommendations for school interventions.
• Find out how much is charged for psychological or neuropsychological testing (if needed).

How to Find a Therapist for your Child

Finding a therapist for your child can take time. It will likely take several different phone calls and time on internet searches.

• Contact your insurance company to find a list of in-network providers.
• Talk to your child’s pediatrician, as they may have a referral, even if you don’t require a referral. Many times, pediatricians work in collaboration with mental health professionals.
• Consult the department of psychology, counseling, or social work at a local college or university, as they may have graduates practicing in the community.
• If you read a positive review on a therapist, you can begin cautiously hopeful, but don’t expect a miracle. If you read a negative review, take that with a grain of salt. A therapist isn’t good or bad based on a child’s outcome or progress or regression of symptoms. There are many variables to take into consideration, which will be explored later.

Questions to Ask Your Child’s Prospective Therapist

• How long have you been practicing as a licensed therapist?
• What age-range do you treat?
• What insurance do you accept? (Make sure you don’t need a pediatrician referral first, but if you do, obtain a referral).
• My child was diagnosed with _______. Do you treat this?
• What evidenced-based approach do you use to treat this?
• How often will you need to see my child?
• How many sessions do you typically do for this particular situation?
• My child doesn’t have a diagnosis. How does that work?
• What is your cancellation policy if we can’t make a scheduled appointment?
• Can you explain confidentiality to me, including what you can/cannot tell me, and whom you can communicate with about my child?

Once you make a decision to have your child see a particular therapist, that’s not necessarily a final decision. A positive rapport with a therapist is essential, so the first appointment should be a mutual interview between the therapist and the child.

• In the first session for your child, ask if they are going to make a diagnosis.
• If you do not want your child to be diagnosed, make the therapist aware. However, the therapist may be required to give a diagnosis if you are using insurance. Sometimes this might be adjustment disorder because they are struggling with the adjustment of a new situation.
• If you don’t agree with the therapist’s approach to diagnosis, you can receive a second opinion elsewhere, or you can ask the therapist for a psychological-testing referral.
• If you feel uncomfortable with the therapist in general, you can start the process over and can choose another therapist.

Final Thoughts on Child & Teen Therapy

If your child is struggling with their mental health, reaching out to a qualified therapist is likely to help. It’s important that both you and your child feel comfortable with the therapist, so be sure to get all the information you can before beginning treatment.