First, I evaluate if the observed emotional distress is disrupting daily functioning, threatens to overwhelm the child or interferes with the achievement of age-appropriate developmental milestones. For example, parental divorce is an emotionally upsetting experience that children react to in a variety of ways. If a child's reaction includes uncharacteristic school failure, fear of sleeping alone or heightened anxiety when separating from a parent, it indicates that normal functioning has become disrupted, and referral for psychological treatment is indicated.

Similarly, psychological treatment may be warranted when a child's difficulties interfere with normal family functioning, even though the child is not upset by this circumstance. I see this situation frequently with children who have unrealistic or exaggerated fears about going to school. These children become frantic when faced with separation from the parents. The child may be content to remain at home but the parents are often very distressed and inconvenienced by their child's unreasonable refusal to go to school. The child's inability or unwillingness to separate from the parents may make them late for work or miss work altogether, and they may feel frustrated and helpless to effectively deal with the situation.

Children may also benefit from psychological treatment when the problems they face are complicated and beyond the range of normal daily experience. For example, children who suffer from serious or life-threatening medical problems often derive benefit from the assistance provided by a knowledgeable therapist. The therapist focuses on helping these children develop coping skills to deal with their unique situation and advises parents regarding how best to support their child.

The least common but most serious indication that psychological treatment is needed is when a child's symptoms are severe or the behavior is extreme and potentially life threatening. This would include situations in which a child is experiencing false auditory or visual sensations, setting fires, assaulting others, or is severely depressed and making remarks about committing suicide.

Parents react in varied ways when faced with the idea that their child needs psychological treatment. Some parents tend to feel guilty and blame themselves for their child's problem. Other concerned parents may experience confusion or uncertainty regarding their child's need for treatment. A teacher, for instance, may describe the child as evidencing emotional or behavior problems in the classroom, while the child appears to behave normally at home. Parents who receive this type of feedback often have difficulty reconciling their own perception of their child with those of the teacher.

Most parents can and should attempt to help their child cope with problems before consulting a therapist. However, as with all areas of life, there are some situations where outside help is warranted. The average parent is not reluctant to consult a physician for their child's medical needs. In fact, parents who do not obtain appropriate medical care for their children are considered negligent. I believe the informed parent also recognizes when their child may need or benefit from psychological treatment and understands that such intervention is not in any way a sign of parental failure.

Child psychotherapists possess specialized knowledge and skills that enable them to identify problem behaviors and formulate appropriate interventions. A therapist trained to work with children and families can develop individualized treatment plans appropriate to each child's specific needs.

I consider parental involvement to be a crucial component of every child's treatment. From the first session, parents are relied upon for information concerning their child's development, behavior, relationships, and habits and they are closely consulted regarding the goals of treatment. I view parents as partners in the treatment process and rely upon them to provide critical feedback regarding the effectiveness of interventions as they are developed and implemented.

Children's reactions to stressful life circumstances range from mild and short-lived to severe and long lasting. When a child's problems do not resolve within a reasonable time-frame psychological intervention is recommended. Therapy offers children the opportunity to identify, discuss and understand problems and to develop necessary coping skills. Therapy also provides the opportunity to address parental concerns, educate parents regarding their child's unique needs, and assist them in meeting these needs in an appropriate, effective fashion. Finally, it is important to recognize that without appropriate and timely treatment a child's problems may become severe and lead to more serious, long-lasting difficulties.

References
(To view, roll mouse over the "References" heading; to hide, click on the heading)