You and Your Child’s Psychotherapy You and Your Child’s Psychotherapy The Essential Guide for Parents and Caregivers Michael O. Weiner, LCSW and Les Paul Gallo-Silver, LCSW-R 1 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2015 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Weiner, Michael O. You and your child’s psychotherapy : the essential guide for parents and caregivers / Michael O. Weiner, LCSW, and Les Paul Gallo-Silver, LCSW-R. pages cm Includes bibliographical references and index. ISBN 978–0–19–939145–5 (paperback) 1. Child psychotherapy—Parent participation. 2. Parent and child. 3. Psychotherapist and patient. I. Gallo-Silver, Les Paul. II. Title. RJ505.P38W45 2015 618.92ʹ8914—dc23 2015007876 9 8 7 6 5 4 3 2 1 Printed in the United States of America on acid-free paper To our loving wives and the remarkable children in our lives CONTENTS How to Use This Book ix Introduction: A Framework and Rationale for This Book 1 1. A Holistic Perspective of Child Psychotherapy 11 2. Systems-Based Approach to Child Psychotherapy: Working Together 19 3. Seeking Out a Child Psychotherapist 31 4. The First Session: Consultation and Intake Meetings 44 5. Taking the Next Steps: Moving Forward 66 6. Types and Forms of Child Psychotherapy 81 7. Child Diagnosis 99 8. Engagement: The Framing of Child Psychotherapy 121 9. Treatment Planning 135 10. The Parallel Process of Child Psychotherapy 152 11. Contributing to Your Child’s Psychotherapy 162 12. The Work of Child Psychotherapy 181 13. Hurdles, Obstacles, and Snags 197 14. Supplementing Your Child’s Psychotherapy 207 15. Higher Levels of Care: When You and Your Child Need More 225 16. Separation and Consolidation: Saying Goodbye to Your Child’s Psychotherapist 236 Appendix A: Case Studies 255 Appendix B: Recommended Readings 259 Appendix C: Child Mental Health Services Contact Information by State 260 Glossary 269 Bibliography 277 Index 283 [ viii ] Contents HOW TO USE THIS BOOK It is the intention of this book to be a supportive document used in the fashion that you feel would be most helpful. This is not a textbook. We include theory as a way to demonstrate where our ideas come from. We have included the name of the theorist in paren- theses. The bibliography can provide you with ways to learn more about that particular theorist. Where we do use a professional term, we offer an expla- nation. To that end, we have included a glossary of terms at the end of the book. You may read this book by picking and choosing those chapters that address your current concerns and questions, by reading it cover to cover, or by brows- ing the chapter summaries as a way of getting a brief overview. You can always return to this book to read or re-read a chapter that addresses issues that have become more meaningful to you as your child’s situation changes. There is merit in all of these options and, of course, how you use the book may change over time. However you choose to make your way through this book, we recommend that you read the Introduction. It is an account of what you may be experi- encing and was written to help you organize your thoughts as you begin this journey. We seek to provide you with a very complete understanding of the way child psychotherapy works as well as your valuable contributions to the therapeutic process. Introduction A Framework and Rationale for This Book his book is for all parents—mothers, fathers, LGBT, single, separated or Tdivorced, widowed, adoptive, relatives, foster, medically ill, and of any cultural and ethnic background. Loving and caring for a child connects all of us to each other. If you find yourself reading this book, then you are a parent who is already considering the possibility that your child may need psychotherapy. You may have started psychotherapy with your child and now may be unsure how to proceed. Perhaps you are thinking about psychotherapy and are not sure where to begin. The thoughts, issues, and difficulties that bring you and your child to this moment may already be creating increased feelings of stress or confusion. These feelings may be contributing to a reduced sense of control and more anxiety for you, your child, and your family. Wherever you are at this moment, let us, for the sake of all being on the same page, start at the beginning. If you have not participated in psychotherapy before, you may be uncertain about what kind of help this is and how it helps children. You may have heard things from your friends or family, or you may have seen things on television or in movies that have created some ideas about what psychotherapy is all about. You may have many kinds of images and stereotypes of what a therapist looks like and acts like—the couch, the soft speech, and the calm. These images come in many forms. If you have participated in your own psychotherapy or if your child has seen a therapist, knowing about therapeutic processes through your own expe- riences will shape how you understand your child’s needs in psychotherapy and how to address those needs. Unlike the parent who has never engaged in psychotherapy before (their own or their child’s), you may have specific ideas about types of psychotherapy, how to interact with a therapist, the language used, the duration of treatment, the focus, and so on. If the experience was a positive one, helpful and enlightening, you may see engagement in psychother- apy as straightforward and easy. If the experience was not a positive one, you may be skeptical about psychotherapy and about how a therapist could help the situation with your child. For both groups, it is the goal of this book to create a deeper understanding of the process. We would like you to think about typical types of choices we make in life and how we prepare for these. Let us use the idea of engaging in an activity that is unfamiliar to people when first attempted. You can choose one—picking out where you want to live, considering taking a pregnancy test, deciding on what car to buy, determining if you want to change jobs, or selecting which school you want your child to attend. These are activities that you can have much more control over by getting information about them ahead of time. Learning as much as you can about these activities helps you to know your options and to make good choices for yourself. If you do not feel prepared, these types of processes and the decisions you will have to make to accomplish them can very easily feel overwhelming. Whatever you are thinking about psychotherapy, the following discussion will focus your thoughts in such a way as to make psycho- therapy with your child more manageable. There are different models of understanding difficulties and problems in a child. Typically, health professionals use the medical model owing to our country’s historic esteem for physicians and the ever-present focus on (and advertising of) medications as remedies. The medical model almost exclu- sively looks at symptoms, diagnosis, and treatment concepts as a way of addressing problems. This book offers an alternative viewpoint—an exten- sion of the humanistic model, or the person-in-environment model. The humanistic model is based on an understanding of a person’s strengths, her psychological makeup, the positives and negatives of her social supports, the environment in which she lives, and her cultural background. The humanis- tic model values the role of diagnosis and the possible use of medication but sees this as a part of a holistic perspective of understanding and helping an individual. [ 2 ] You and Your Child’s Psychotherapy Adding to this idea of different stances in treatment is an examination of perception. Perception is the act of using one’s senses to know something. Logically, there are many ways to perceive something. Each person, based on his or her own unique qualities, experiences, and ideas, perceives things differ- ently. Applied to your child and her or his difficulties, this idea of differences in perception becomes important. What you sense is a problem, others may not. You may have, with no input from others, decided to pursue psychother- apy for your child because of something you have noticed that concerns you.