Does your child need therapy? Thoughts on parental fears and why we need you involved

Historically, psychiatry has not been kind to mothers. Early (and mostly wrong) ideas about what ‘caused’ emotional/behavioral difficulties and psychiatric disorders made it easy for clinicians to blame parents for all childhood conditions. Autism is a classic example. In the 1940s Leo Kanner, one of the most influential child psychiatrists of the time, stated that children with autism were kept in “refrigerators that did not defrost.” By refrigerators, he was referring to mothers, who he believed were emotionally and interpersonally distant. As most of you likely know by now, Kanner was wrong.


Since then, the attack on parents appears to be relentless. Our media outlets are filled with misinterpretations (and sometimes accurate interpretations) of research findings and statements by clinicians that directly or indirectly blame parental behaviors for their kids’ problems.

• You cuddle your kids too much
• You don’t love them enough
• You are too strict
• You are too permissive
• You are too emotional
• You are not emotional enough
• You give too much freedom
• You hover over them
• You don’t praise them enough
• You praise them too much

The list is endless.

The consequences of this parental blaming are devastating: parents full of either guilt and shame or anger and defensiveness, and worse, children who don’t get the treatment they actually need.

So I often find myself doing damage control with parents and explaining their new role in helping their kids improve. So today I wanted to share with you what I often tell parents who are either reluctant about therapy or are struggling with making decisions regarding their kids treatment.

• Does your child need help? Examine your childs academic, social, family, and emotional functioning to decide whether he needs help. If your kid’s behavioral or emotional difficulties are such that his functioning at home, school, or with peers is impaired, he may need help. You may ask, what is impaired functioning? There is no standard definition, but we usually become concerned when a child is unable to fulfill many of the basic tasks of being a kid: going to school, getting at least Cs in his courses, developing and maintaining friends, regulating his emotions, keeping himself out of trouble with the law, understanding and following basic rules, etc.

• Getting help does not necessarily mean medication or years of therapy! Getting help may simply involve an evaluation to determine what intervention, if any, may be beneficial to your child. So it is often less scary if parents think that the first step is simply to seek an evaluation or consultation, without any commitment to go beyond this initial consult. The process should not be any different than when taking your child to the pediatrician for an evaluation if your child is having some physical symptoms. If your child needs help, most of our current interventions are relatively short (20-30 sessions) and the times of keeping kids in never-ending years of therapy are gone (at least mostly).

• If you are concerned about your child’s functioning don’t accept a “he is just fine” answer from your pediatrician, especially if the pediatrician only asked you a couple of questions. I am always reluctant to say anything negative about other professionals, but the reality is that many pediatricians have little training in child psychology and psychiatry and especially in the proper evaluation of child psychological conditions. This is not just my perception. A comprehensive national survey of pediatricians revealed that about 70% of pediatricians feel that they lack appropriate training in diagnosing and treating mental health conditions and over 60% felt that they were not competent in proper diagnostic practices . So if you dont agree with your pediatricians opinion that your child is just fine, request a referral for a consultation with a child mental health provider, such as a psychologist, psychiatrist, or clinical social worker.

• In many, many, many, cases, what “caused” your child’s condition does not really matter. This is likely a controversial statement, especially with some traditional therapists, but I say it because parents are frequently overly concerned about finding out what “caused” their kids OCD or ADHD. Often parents feel guilty and want to know if they caused the problem somehow or they are seeking answers that help them understand and accept why things turned out this way. The reality is that in most cases the “cause” will never be known. Although good clinicians will have a deep understanding of the historical and current context (family dynamics, peer group, thinking style, etc.) that may contribute to some of the difficulties, what matters right now is what we do from this day forward to help your child improve. Remember, we can’t change the past but we can improve your child’s future.

• We can’t help your child without your help. There is very little we can do in one hour of weekly therapy without getting parents, and often teachers, involved in the treatment process. This is because the most effective interventions usually require that we make changes at home and in some cases at school. On that note:

• When we suggest a different parenting or discipline strategy we are not saying that what you were doing was wrong or that you caused the problem. There are many, many parenting styles that are effective for most kids. In fact, some researchers even use the term “good enough parenting” to refer to the phenomenon that most kids will be fine regardless of what you do as a parent. But we also have extensive research suggesting that in some cases, such as when a child has a specific disorder, some parenting behaviors are more helpful than others. In addition, the most effective treatments for some conditions require that parents implement specific discipline plans that may be very different from what comes naturally to some parents. So we may ask you to change how things work at home, but not because we are judging your practices or skills, but because we need you to help us implement a treatment that may involve doing things differently. It is really not any different than if your child had a food allergy and the pediatrician recommended that you change your cooking. You were not doing it wrong. You did not cause the problem. But you can help your child by making the changes that need to be made.

In sum, I want parents to know that clinicians want first and foremost to help your child, not to find someone to blame for your child’s problems. We ask you to be involved because that is the most effective way to help your child improve. We need you to be our allies because without your help and support there is often little we can do.

Nestor L. Lopez-Duran Ph.D