Finding the “Right” Treatment
Once you have decided to explore therapy for your child, you are probably wondering how to weigh the trade-offs in choosing a clinician. There are myriad considerations: how important is their degree, years of experience, clinical orientation and expertise, personality, proximity to your child’s school or home, affordability including affiliation with health insurance providers, availability, and their reputation.
As you conduct your search, look for a clinician who can forge a strong therapeutic relationship with your child; the clinician needs to be emotionally present, collaborative, genuine and empathetic. The knowledge and experience of any clinician is only as effective as their ability to be an agent of change in your child’s life. To motivate your child, the therapeutic bond is critical.
Steps in Identifying a Clinician
Naturally, the appropriate clinical expertise for your child’s disorder is paramount as is the clinician’s dedication to supporting you and your child throughout the therapeutic process.
Given these considerations, the following are key steps in identifying a clinician that can partner with your anxious child on their journey of recovery.
1. Create a list of clinicians who utilize cognitive behavioral therapy (CBT), and specifically exposure therapy. This method requires the child to identify their fears and their underlying triggers and to learn to how to build courage and resilience to gradually face them.
2. Screen the clinicians by phone to assess their interpersonal style and experience with CBT. Also, it is important helpful to determine their availability, pricing, and insurance policies. For promising candidates:
- Inquire whether the clinician creates a treatment plan, that has clear objectives, and methods to measure progress and outcomes.
- Ask at what level parents and family members are involved in your child’s treatment.
- Determine the protocols around access to the clinician outside of your child’s scheduled appointment. Look for someone who will communicate with the collateral care providers (doctors, school, parents and child as necessary), and field the occasional important call outside of regularly scheduled appointments.
3. Schedule a meeting for you and your child to meet the clinician. After a preliminary discussion, let your child meet solo with the clinician to assess if your child perceives the clinician is genuine, empathetic and emotionally present during their discussion.
Setting Appropriate Expectations - Typical Phases to the Recovery Process
Now that your child is in therapy, resist the urge to ask about what your child discussed in their session. Give your child time to establish a bond with their clinician. Try to be patient as your clinician may use storytelling, activities and motivational interviewing to establish this connection.
The therapeutic journey may be rocky, where it may look worse before it gets better. During treatment, anxiety will likely increase as the mere thought of confronting anxiety and fear deliberately will amplify the very same symptoms. Evasive strategies such as minimization, denial, or reactiveness are not uncommon to maintain the safety of the status quo, and the relative comfort found in hiding. Remember: therapy is an opportunity to turn skills into habit, and where resiliency and courage is a secondary benefit to the psychological and behavioral strength conditioning.
The following are some common phases of recovery that many clients exhibit in their therapeutic journey.
Doubt and Fear
Exposure therapy helps the client learn to manage the anxiety-provoking thoughts and situations at a gradual, agreed-upon pace. Facing these thoughts and situations can be very scary, but a compassionate and experienced clinician will help your child face those fears in a gradual way.
Resistance is common at the beginning of therapy. Your child may have seen numerous clinicians and not made much progress, so they may doubt that the new clinician will be any different.
The Anxiety Institute treatment manual provides useful responses that parents can use to overcome their child’s objections. These may include:
“I’ve tried lots of things what is different about this?”
You have to trust that this is different. We have done our research; we think this is right for you. We don’t want you to regret not trying something that could have made a difference.
“I can fix it myself.“
We all want to fix our own problems; we know that if you could control this you would. Sometimes we need the help of an expert and we know that if you were going to get help for this, you would want an expert.
“This is a waste of time or money and I feel so guilty.”
These things take time. It took a while for your anxiety to get this bad and we all have a lot to learn about how to change our thoughts and behavior. There’s nothing more important to me than your recovery.
“I feel sick. I can’t go today.”
I want you to go to your session today see how you feel when you get there; I believe you, but I don’t want you to have to discover that it was your anxiety that was making you feel sick. If after being there for an hour you still feel sick I want you to come home so we can assess your symptoms.
There will be times when you may feel like your child is taking two steps forward and one step back. Treatment takes time. Remember: therapy is an opportunity to turn skills into habit, and where resiliency and courage is a secondary benefit to the psychological and behavioral strength conditioning.
Trust the process
Rushing in and “saving” your child deprives all of you of the opportunity to realize the situation is tolerable and that your child is capable. Of course, if you have concerns about your child’s treatment certainly speak to the clinician but avoid having the conversation in front of your child, as it can sabotage the therapeutic relationship and process.
Learn to see anxiety as an opportunity to develop tolerance of perceived threats. It’s a process requiring courage and resilience for your child and family members. The work is difficult and takes time and sustained effort. Focusing on the effort, not just the result, can build motivation critical for long term growth and sustain your child through the valuable cycle of trial and error in therapy (and in life!).
Developing mastery and self-advocacy will increase your child’s confidence and self-esteem. Aftercare is a critical phase in recovery as your child begins to model for others the value of self-awareness, self-disclosure, and self-advocacy. Show that you believe in them; they are capable and can manage the challenges and consequences of moving forward with their lives. For most people, anxiety is a condition they may struggle with for the rest of their lives. To maintain the progress requires facing, eliciting, and experiencing anxiety every day, and pushing through it. CBT teaches the skills needed to successfully manage anxiety and fully participate in life.
About this Article
This article is the second of a series to help kids and their families address challenges with anxiety. The first article: “Is my child’s anxiety ‘normal?” offers tools to decide if your child’s behaviors are beyond what is typically expected for these trying times. It offers advice for finding treatment and the treatment process. The third article will address the roles and levels of involvement of each family member to enhance the efficacy of therapy.
Written by Daniel P. Villiers, Ph. D. and Alexander W. Merrill, M.A.Yes, I know it was inevitable, but it is human …