Tag counseling

Summer: Great Time to Have Your Kid/Teen Get a Mental Health Evaluation

black kid skateboardFor many kids and teens (and by association, parents) the summer represents a reprieve. Of course, there is no school. But, other responsibilities usually lessen as well. For this reason, stress can lighten by a large margin; symptoms that your child may have demonstrated during the school year can either evaporate or lessen to manageable levels. This can cause just about any parent-lunatic to convince himself/herself that all is well now.

Yes, kids can grow out of symptoms with time and maturity. However, unless there has been some dramatic and substantive change (e.g., peace was rendered in a significant relationship that had been troubled, treatment caused a significant breakthrough), it is unlikely that your child or teen has grow out of a problem, or problems, in the matter of a few weeks. It is more likely that the abatement of school-year based stress has caused the problem(s) to go underground and that such are likely to return, in a stronger and more entrenched variation, in the fall. (In my clinical experience this often happens by the first report card and nearly always by the holidays.)

This makes the summer a great time to get an evaluation, and for at least four reasons:

  1. Being under less stress will make it easier for a child psychologist to two boys thumbs upaccess the reasonable side of your child or teen.
  2. If your child or teen demonstrates problems at both school and home, the summer affords the opportunity to focus on home-based challenges exclusively. This portends to leave everyone feeling stronger and better equipped to deal with school-based issues in the fall.
  3. If your child suffers from mood disturbance or anxiety symptoms, it can be much easier to assess and treat such in the summer. Actually, the same thing goes for most kinds of problems (e.g., difficulties with attention, disordered eating).
  4. With the decreased stress, it may be easier for everyone to better appreciate and discuss your child or teen’s strengths.

glasses and bookThe only typical downside to a summer evaluation is that it can be more challenging to get teachers to complete behavior rating scales. However, my experience is that most teachers are generous with their time as long as you approach them in a respectful manner. Here’s a sample ask: “Dear Mr./Ms. X, I’ve arranged for Dr. Y to evaluate Aiden so that I may better understand his opportunities for growth. Dr. Y. has indicated that your opinion is very important in helping him to do a good job. I appreciate that you are off in the summer, so if you don’t have the time to fill these forms out, no worries. But, if you can fill them out I would be most grateful!”

I hope you will consider an evaluation if your child or teen has been demonstrating problems either now or during the last school year. Doing so will leave your child or teen less likely to number among the majority of those youth who need mental health care but do not get it. (For a referral click here.)

 

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What is Cognitive-Behavioral Therapy?

stressed boyCognitive-behavioral therapy (CBT) is often the talking treatment of choice for juvenile anxiety, depression, and various kinds of problems that result from poor stress coping. The word “cognitive” refers to strategies that deal with thoughts and thinking. The word “behavior” refers to strategies that deal with behavioral choices. This blog entry will review some of the major strategies that often comprise CBT.

Externalizing the problem: kids and teens develop a name for their anxiety, depression, or the primary problem area. As Stephen King once wrote: “Monsters are real, and ghosts are real too. They live inside us, and sometimes, they win..” Youth are taught that their symptoms of anxiety and depression no more constitute their personhood than symptoms of diabetes or asthma define the personhood of someone suffering from those conditions. Moreover, youth are taught to recognize how their internal enemy attacks them and what specific and effective countermeasures they can deploy.

Behavioral activation: this strategy involves arranging to do fun things on a regular basis. When youth are depressed or stressed out they often get into a rut where they wait for a good mood to do something fun. This CBT strategy teaches a youth that s/he can manipulate his or her mood by forcing himself or herself to do something that stands to be pleasurable. Youth are also taught that fun activities that are novel, social and involve physical activity tend to be the most effective (e.g., to avoid getting into a rut with fun activities as well).

√ Physiological calming: this is a term for learning how to relax muscles in theboys praying back to back body and to belly breath. Most youth overestimate their ability to relax their bodies. In CBT they learn strategies for becoming super relaxed. Moreover, they learn that a relaxed body and anxiety are like oil and water: they just don’t mix. Some practitioners also employ methods for measuring a youth’s success (e.g., through the use of biofeedback).

√ Coping or happy thoughts: this strategy involves developing a list of true and adaptive thoughts that promote positive feelings. Kids are taught that they can swap out uncomfortable thoughts just like they can swap out uncomfortable jeans.

√ Thought testing: this is a strategy for determining whether a painful thought is true or not. Anxiety and depression attack thinking and cause a youth to believe painful thoughts that are not true. This technique is very helpful for helping youth to determine what painful thoughts are real (and which can be subject to problem solving) and which represent their internal enemy’s lie (and are to be disempowered).

Teen girl√ Problem solving: this strategy is useful when a problem is distressing a kid or teen. When suffering from anxiety or depression problems can become super magnified and overwhelming. This very powerful strategy disempowers over reactions and produces adaptive coping responses.

√ Exposures: this strategy involves having anxious youth deliberately put themselves into developmentally appropriate situations that make them anxious, in a measured and gradual way, so that they can use their CBT tools to accomplish mastery and to dominate their internal enemy.

It’s common for parents to be taught how to coach and reinforce the CBT techniques. Moreover, multiple strategies can be done together as a family (e.g., physiological calming, problem solving). The CBT might also include other techniques for specific problems affiliated with anxiety or depression (e.g., response prevention for OCD). Moreover, sets of related strategies than be imported into the CBT depending on the problem(s) the youth has. For instance, social skills training can be used for youth who struggle making and maintaining friends, behaviorally oriented family therapy can be used for defiant youth who refuse to practice their CBT techniques and strategies from positive psychology can be used to produce experiences of happiness and meaning (e.g., the use of gratitude, personal strengths, acts of kindness).

The research supporting the efficacy of CBT is well developed and suggests that mom and daughterparents would do well to consider making this treatment available for any child or teen who suffers from anxiety,  depression or an assortment of problems involving poor stress coping. To find a qualified provider near you click here.

Elements of Quality Mental Health Treatment for Youth

billboard2 copyI find that many parents have little idea what to expect when taking their child or teen for mental health services. In my last blog, I described elements of a good mental health evaluation for a child or teen. In this entry I will describe elements of quality outpatient mental health treatment. (Please keep in mind that some of these elements may not be present in your child’s or teen’s care but s/he may still be receiving good treatment.)

√ A diagnostic impression is shared. The insurance company is usually getting this information, so you should too. More importantly, having these words allows you the opportunity to educate yourself about the condition(s).

√ The clinician has discussed how he or she arrived at the diagnostic formulation and the the primary scientific findings pertaining to such (e.g., causes, prevalence, outcomes).

√  The clinician shares specific information regarding which treatment(s) is/are   therapy etchingrecommended. This should include giving you the name of what each treatment is called; again, this allows you to educate yourself about the science behind the intervention. The clinician also does well to include, in instances when more than one intervention is recommended, which intervention is treating which problem or diagnosis; a discussion of the prognosis is also usually advisable.

√ The clinician endeavors to answer all of your questions, either at the time that you ask or later, including telling you when the available science does not allow a question to be answered well or thoroughly.

√ The clinician develops measurable treatment goals in collaboration with you and/or your child or teen. These goals need not be (and usually are not) a comprehensive listing of what will be worked on. But, they include signposts that help you to know (1) if the treatment is working and (2) when you are done.

therapy with teen√ The clinician is comfortable with, and even encourages, you and your child or teen to express differences of opinion regarding what s/he is stating or recommending.

√ The clinician follows the agreed upon treatment plan and doesn’t make changes without getting your informed consent.

√ The clinician tracks progress, keeps scheduled appointments, doesn’t take phone calls or check his or her phone during the appointment (unless you’ve agreed to an exception), meets the entire time, remains both pleasant and alert and gives you sufficient notice of any extended vacations or breaks from treatment.

√ You get the sense that the clinician cares about your child or teen and his or her success.

√ You are kept informed about progress. While the clinician may not share information that your child or teen wishes to keep confidential, s/he should keep you informed in general terms. If the treatment is behavioral in focus, it is also commonly recommended to teach you how to coach and reinforce the skills your child or teen is learning.

√ If there are problems at school, the clinician should be available to collaborate with school personnel; sometimes this may warrant attending an in-person meeting at the school.

√ The clinician may recommend things you can do to augment the work (e.g., overwhelmedread a book, attend a support group meeting).

√ The clinician is not shy about bringing up sensitive topics, including if s/he believes that your getting mental health care for yourself could be helpful.

√ Appointments are scheduled at a pace that is consistent with how the treatment is usually prescribed (something you can easily learn yourself with a little leg work).

√ While your insurance company may dictate what is covered and what isn’t, you should never get the sense that the insurance company is dictating what is diagnosed or what treatment(s) is/are being recommended.

Good luck! To find a clinician near you, click here.

What Does a Good Mental Health Evaluation Look Like?

billboard2 copyIn last week’s blog I discussed why the summer can be a great time to get a child or teen a mental health evaluation. This week I will review the elements of a good child or teen mental health evaluation. At the end I will offer a few qualifiers.

(I recently ended a term co-chairing the Pennsylvania Pediatric Mental Health Task Force, a collaboration between the Pennsylvania Psychological Association and the Pennsylvania Chapter of the American Academy of Pediatrics. That task force endorsed the standards I am reviewing here.)

A good mental health evaluation for a child includes the following elements:

• A family interview. “Family” can be legitimately and differently defined across clinicians. For me, it is the youth of concern and his or her parents and stepparents. If the adults cannot be interviewed together (e.g., there is too much resentment) this can be spread across interviews. I find it very difficult to get the relevant information, while building a trusting relationship, in less than 90 minutes. This is an essential part of the evaluation as it is exceedingly difficulty to accurately understand a child’s or teen’s symptoms independent of the context in which that youth resides.

• A youth interview and/or play session. Each child or teen has a great deal of useful line of kidsinformation to share. However, s/he may not be able or willing to do so with his or her parent(s) in the room. This is true even among youth who are not psychologically minded or inclined to cooperate.

• The completion of parent, teacher and child behavior rating scales. These scales allow a clinician to measure whether a youth’s symptoms and strengths are atypical among children or teens of his or her age and sex. The available research also suggests that parents, teachers and kids each possess important, complimentary and unique information about a given youth’s functioning.

• A review of academic records. This includes report cards, state achievement testing and relevant special education or disciplinary records. Sometimes parents believe that the school life is not a problem but records suggest that there are important opportunities for growth there. Moreover, such records can present the clinician with information that allows him or her to develop a more nuanced understanding of a kid (e.g., how often a child is tardy or absent, academic strengths and weaknesses).

defiant boy• A review of any relevant medical, psychological, welfare or forensic records that exist on the youth. I tell families that work with me: “If you’re in doubt regarding whether a document could be important for me to review, include a copy of it.”

• A behavior rating scale that screens for parental wellness. The research and my clinical experience both suggest that the number one complicating factor in mental health treatments for youth is the mental health status of his or her parent(s). (You can find numerous articles on this blog pertaining to the connection between parent and kid wellness.)

I have seven qualifiers for these remarks:

1. Other evaluation tools may also be needed to render a reasonable diagnostic formulation (e.g., psychological testing, medical evaluations, speech and language evaluations).

2. There may be clinical contraindications for doing some of the procedures I have reviewed here. However, if such contraindications exist they warrant discussion.

3. Here’s the elephant in the room: limits on insurance coverage often drive medicalsymbolanddollarsstandards instead of the other way around. Too many times I’ve heard clinicians lament that they do not do what they believe is clinically warranted because an insurance company won’t pay for it. Yes, that can be a harsh reality (actually, a very harsh reality). But, parents (and sometimes the youth too) deserve to hear, from the clinician, what the clinician believes is an advisable evaluation plan. Then the parents can decide, once they are informed regarding the pros and cons of their choices, whether they wish to proceed in a truncated fashion (i.e. what the insurance will cover) or do as the clinician recommends. (For my blog entry on paying for mental health services, click here.)

4. Here’s the elephant’s sidekick: child and teen clinicians are busy people who often have large caseloads (put this statement all in caps for those child clinicians working within agencies). A given child or teen clinician may feel too busy to do an evaluation the like of which I’ve described here. If so, this also deserves a frank discussion so that parents can make their own decision about who to see. I have no problem with a clinician doing a truncated evaluation. I do have a problem with a clinician doing a truncated evaluation without informed consent.

character checking off checkboxes5. A diagnostic formulation can hit the bullseye without all of these elements being included. Heck, if a parent honestly answered my questions for 10-15 minutes, and I were to develop a formulation based only on that interview, I might end up being right a good amount of the time. However, I’d be wrong, or importantly incomplete, in an unacceptable number of instances. This is why due diligence is warranted.

6. The evaluation standards I’ve reviewed here include a cost-benefit analysis. (If that weren’t the case, I’d recommend psychological testing for every child and teen.)

7. A good mental health evaluation on a child or teen will offer a thorough review of his or her strengths. And, this will be a central aspect, not just a preliminary or sidebar feature.

There are numerous other issues I haven’t covered here (e.g., what are the signs that a child might need a mental health evaluation, how can one parent get this done when another is resisting it, what’s a good way to approach a school or teacher about participating). But, you can find these topics addressed either in other blog entries (use the search bar at the top right) or in my parenting book Working Parents, Thriving Families: 10 Strategies that Make a Difference.

Next week I will review methods for active partnering and participation with your child’s or teen’s mental health professional. For now, good luck, and click here for referral information.

What Can I Expect If I Take My Child to See a Psychologist?

upset characterA recent national study indicated that by adulthood about 90% of youth will have qualified for a mental health diagnosis at one point or another. However, only about 20% of these kids get any kind of mental health care. So, if your child is showing some distress s/he is in a huge club. But, if you’re getting him/her help for it, you are in an elite club.

Different mental health professions may go about their work in different ways. This blog entry is meant to characterize how an evidence-based psychologist might proceed. (While there are always exceptions, psychologists are the doctorally trained mental health professionals who most commonly provide talking treatments.)

The first thing the psychologist will do is an evaluation. These are the elements I believe constitute a cost-effective, evidence-based evaluation (each of these elements has been endorsed by the Pennsylvania Pediatric Mental Health Task Force):

• A family interview (who is in this interview can vary but often both birthboy umbrella pointing parents and the child of concern are included)

• An individual interview with the youth of concern

• The completion of behavior rating scales

• A review of relevant records (e.g., school records)

• A feedback session that reviews a diagnostic impression, addresses key issues (e.g., causes, prevalence, prognosis) and recommends a treatment plan

What follows are some common concerns I’ve heard from parents who are considering getting mental health care for their child.

If I take my child to see a child psychologist s/he might suffer self-esteem damage (e.g., mom thinks there is something seriously wrong with me).

boy head on handExperienced psychologists know that this is a concern and have procedures in place for helping (e.g., assessing for your child’s strengths, making the experience enjoyable). Moreover, the symptoms that are troubling your child are far more likely to be causing, or to cause, self-esteem damage than interacting with a highly trained, caring and kind adult.

I’m not comfortable signing up for a long course of treatment.

Most research-supported treatments, for most problems, are designed to be short-term. Sure, there are instances where a longer course of care is indicated. In medical pediatric practice short-term treatments are more common than longer-term treatments; the same thing is true in mental health pediatric practice.

Treatment is too expensive.

I’ve been doing this work for over 20 years. I’ve never seen an instance where aconfused child way wasn’t afforded to those with the will to be persistent. Please see this blog entry for a list of strategies. Moreover, the toll from untreated symptoms can be devastatingly higher.

I don’t want to weaken my child (e.g., encourage senseless whining, create dependency, promote externalizing responsibility).

Evidence-based psychotherapy is designed to make itself obsolete as soon as possible, to promote healing and to instill resilience. Alternatively, psychological symptoms often weaken functioning, dampen the human spirit and lower the ceiling on interpersonal, educational and vocational outcomes.

My kid doesn’t want to come in. There’s no point in doing this if s/he won’t cooperate.

black kid skateboardMost kids and teens are neutral or opposed to the idea of mental health care. Actually, if a kid is interested in counseling it suggests either that he or she is very psychologically minded and/or is in a great deal of pain. I tell parents new to my practice not to worry about this. It’s their job to get their kid to my office. It’s my job to make the time worthwhile.

The final chapter of my book Working Parents, Thriving Families, goes into much more depth on this topic, including describing what the most common evidence-based treatments entail and how to tell if your child is getting quality care. Please also see these related blog entries:

Seven Common Myths About Counseling

Signs that a Kid Needs Mental Health Services

Mental Health Concerns are Nearly Universal by Ag2 21

Ignoring Kids’ Mental Health Needs is Expensive

I’ll close by stating that I travel widely within my profession. My experience suggests that the average child psychologist is an extremely devoted and mission-driven person who really cares about kids and doing right by them. If you’d like to check this assertion out for yourself, click here.

Mental Health Concerns Are Nearly Universal By Age 21

Earlier this year a landmark study on the prevalence of psychological disorders in youth was published in the Journal of the American Academy of Child and Adolescent Psychiatry. Examining youth living in 11 counties in the southeastern US, it is the first to track kids’ mental health status from ages as young as 9 through age 21 (a total sample size of 1,420). The authors–Drs. William Copeland, Lilly Shanahan and E. Jane Costello and Ms. Adrian Angold–note some key findings in their report:

• Assuming that there was no incident of psychiatric disorders among the missing cases (an unlikely event), 70% of the sample met criteria for a mental health disorder, at some point, by age 21. (This is referred to as the unimputed number.)

• If one were to assume that the rates of psychiatric disturbance are the same among the missing cases, the frequency of a mental health disorder by age 21 rose to 82.5%. (This is referred to as the imputed number.)

• Child participants entered the study at one of three different ages: 9, 11 and 13. Among the youngest cohort (i.e., entered the study at age 9), the rates of having a diagnosable mental health problem by age 21 was “higher than 90%.” The authors note “This suggests that the experience of psychiatric illness is not merely common but nearly universal.”

• When examining the imputed analyses, these were the most common disorders: substance abuse–42%, behavioral disorders (e.g., ADHD, Oppositional Defiant Disorder)–23.5%, anxiety disorders–20.9% and mood disorders–14.8%.

While all research studies have their flaws, and this one is no exception (e.g., an under representation of African-American and Hispanic children), this study numbers among those contributing to the notion that mental health disorders and physical disorders, as they manifest in youth, have many similar characteristics:

• The odds of having at least one by adulthood are nearly universal.

• Most are not chronic or severe.

• Most can be cured or effectively managed through evidence-based interventions.

• Most will either worsen, or promote needless suffering, when they go unrecognized or untreated.

However, there is a key way that mental health and physical disorders in youth are substantively different. As the authors indicate: “Only about one in three individuals with a well-specified psychiatric disorder received any treatment at all, and even when treatment was obtained, it rarely conformed to best practice recommendations.” I find myself wondering when we will grow weary and intolerant of this needless suffering that our babies endure.

If you, as parent or caregiver, would like to find an ally in your neighborhood to help you to understand whether a child or teen under your charge could use help along these lines, click here. To read a consumer guide for child mental health services, see Chapter 10 in my book Working Parents, Thriving Families: 10 Strategies That Make a Difference.

You may also find value in reviewing posts I’ve written on related topics:

Affording Mental Health Care

Signs that a Kid Needs Mental Health Services

Seven Common Myths About Counseling

Millions of Teens are Suffering Needlessly

Mom Arrested for Giving Her Daughter Xanax: CBT Can Help to Avoid Such Sad Stories

According to a story this week in the North Platte Telegraph, a mother in Nebraska was arrested for intent to deliver a controlled substance after she gave Xanax to her 15 year-old daughter (the story indicates that daughter later gave it to a friend). I know no more about this story than what is contained in the above link. But I find myself wondering how much each of the following factors contributed to this unfortunate arrest:

√ The pharmaceutical industry markets directly to the public. The marketing budget of this industry far exceeds the public education budget of any mental health association that tries to teach the public about how psychological pain can be understood and relieved.

√ Studies vary but between one in ten and one in four youth suffer from an anxiety disorder (e.g., this graph, from the National Institute of Mental Health, demonstrates the high rates in teenagers).

√ Between 2/3rds and 90% of these kids receive no care. And, even when they do receive care they’ve often been suffering for years first and/or the care is truncated (my blog post discussing some of these issues regarding teens can be found here).

√ Many people, including primary care physicians and teachers, do not know what cognitive behavior therapy (CBT) is or that it is the number one researched talking therapy for relieving anxiety in children and teenagers.

This author knows of not one authoritative association or legitimately published researcher who recommends that anxiety disorders be treated by medication alone, in any human, at least when the afflicted person is able and willing to take part in talking therapy. Moreover, many kids successfully treated with CBT do not need medication to help manage their anxiety-based symptoms.

Cognitive behavioral therapy, which is a time-limited intervention, involves learning a collection of strategies for manipulating emotions and thoughts. Some of these strategies involve recognizing and adjusting thoughts (i.e., the “cognitive” part of the term), while others involve adjusting behaviors (the “behavioral” part of the term). In the case of anxiety treatments there are often two phases. In the first phase the child or teen learns the cognitive and behavioral strategies for defeating anxiety. (In my practice I’ll teach anywhere between five and ten strategies depending on the youth’s problems and situation.) In the second phase the youth then deliberately puts herself or himself into those developmentally appropriate situations that tend to evoke anxiety (e.g., getting on a school bus instead of being transported to school) and uses the techniques to conquer the anxiety. The work is finished once the youth is able to defeat all such fears. Often at termination both the youth and her or his parent(s) cannot believe how far she or he has improved in a relatively short period of time.

These treatments can be delivered to a child by himself or herself (with intermittent parent sessions so that the parent(s) are in a position to coach the strategies once the treatment is over), in groups of youth or together with family members. To identify a mental health professional who might be available to deliver this treatment in your area, click here. Below I have also listed links to three related blog entries.

Affording Mental Health Care

Signs that a Kid Needs Mental Health Services

Seven Common Myths About Counseling

Where Are Your Wells of Wisdom?

I’ve been doing psychotherapy continuously for the past 24 years. In this time I’ve come to think of each person’s psyche as a cottage in a forest. My client–which can be a family or an individual–and I initially collaborate on an assessment of whether the cottage needs repairs or remodeling. If so, we partner, guided by science, and do that. This kind of work on cottages has characterized the lion’s share of my career. However, it has recently dawned on me that most people (and perhaps even all) have wells of wisdom located around their cottages. When they access these wells they can usually figure out how to proceed when life gets complicated, stressed or confusing.

Some clients know where their wells are without my help. I can see the paths they’ve worn from their cottage to their wells. When thirsty, they go to their wells without much thought, just like someone might make a daily commute without much thought; such people make many decisions in a way that promotes love and self-actualization. However, I find that most of my clients do not know about the existence of their wells, never mind how to access them. Therefore, one of my jobs, as their therapist, is to help them both to find their wisdom and to get in the habit of accessing it.

Let me give a few examples, keeping in mind that people differ regarding where their wells are located.

One person I knew could access her wisdom by imagining how she would look upon a given decision from the context of her deathbed. The gift of death to the living is perspective. Realizing this my client would wonder how her deathbed self would wish for her to proceed when she was facing a difficult decision or a complicated situation. This allowed her to be wise, even if her chosen course sometimes brought her into conflict with other here-and-now agenda (e.g., keeping a clean house, defeating someone with whom she was arguing, purchasing a new car).

Another person I knew could access his wisdom by imagining what advice he would give his son if his son, some years later on as an adult, came to face the same dilemma or problem. It was fun watching him go from complete confusion to complete clarity as he traveled from his cottage to this particular well of wisdom.

Another person I knew would imagine what her therapist would say about a particular problem. She had worked with this therapist for about 18 months and found his Buddhist/mindfulness perspective wise and enlightening. As she had internalized his voice, she only had to envision what he would say to find the right course of action when life became difficult.

I now have woven this principle into my practice. Yes, many cottages need repair and remodeling and, as a therapist, I have a valuable role to play in that regard. (I’ve also subjected my own cottage to such work on two occasions.) But, I’ve learned to assume that many people have more wisdom hidden inside themselves than they realize. It only takes finding the well and then remembering to go to it enough so that the journey becomes automatic when thirst arises.

Do you know where your well is? Do you realize how much wisdom you have inside of you? If not, maybe a therapist can help you to discover it. For a referral click here.

Signs that a Kid Needs Mental Health Services.

About 14-22% of children in the United States suffer from a diagnosable psychological disorder. Add 20% to that number if you include youth who suffer at sub clinical levels. However, only about 20% of these children get effective care. And, even when they get it they’ve often had to suffer for years first. This occurs even though the research on the effectiveness of child psychotherapies is very positive. What would we conclude about our culture if this were true of our childrens’ dental health instead of their mental health?

I’m writing this blog entry to try to review key indicators of when a child might benefit from mental health services. There are four primary areas of functioning that one can consider: relationships with adults, relationships with peers, academics and mood.

Relationships with adults: The key issue is whether the youth gets along reasonably well with adults. Of course this includes parents/parent-figures and teachers. But it also includes coaches, extended family, bosses, etc. If the youth is frequently in conflict or frequently avoidant or detached from any significant type of relationship with adults, an evaluation may be warranted.

Relationships with peers: Kids need to be able to form friendships, and get along effectively, with other kids who are doing well. For example, if a teen’s close friendships are primarily with those who often get into trouble, abuse substances, or are significantly symptomatic, a significant problem may be present. Likewise, if a child or teen is avoidant, aggressive, controlling or otherwise routinely rejected or ignored by most other youth, this is of concern.

Academics: This is one of the trickier areas to describe tightly. The central issue here is not grades, though grades consistently falling in the C and lower range would generally indicate that a problem exists (assuming that the teaching and curriculum are appropriate). The central issue here is the youth applying herself or himself when she or he does not feel like it.  Developing this psychological muscle (i.e., task persistence when internal motivation is required) is one of the most important developmental tasks of childhood. So if a child is not applying herself or himself, or experiencing significant turmoil or failure in academic pursuits, an evaluation is likely warranted.

Mood: The key issue is whether or not the youth is content. Happiness is great. Contentment is the bar however. If the child is consistently sad, angry or anxious for a significant portion of his or her waking day, this is signaling a need for professional attention. It is often the case that a parent may be confused regarding what a child or teen is thinking or feeling. Thus, problems with sleep, appetite, concentration, connectedness with the world or physical activity can be signs of a problem. (There may also be absences of experiences of joy, but more for kids with depressive disorders than anxiety disorders. )

As I write this blog, there are 42 ways that youth can be diagnosed with a mental health disorder. So, this is hardly a comprehensive post. However, if a child is getting along well with others, is doing well in school and seems content, that child may be fine. The only significant area I’ve left out is experiencing success in one or more extracurricular pursuits. While a lack of positive experiences in the latter area is not, by itself, necessarily indicative of a problem, a child who lacks for such experiences may be more vulnerable to attacks on self-esteem.

I hope you will share this blog post with those who could use it. If you would like to read about common myths about mental health services, click here. For ideas on how to afford care click here. And, finally, to find a lean-mean-healing machine in your neck of the woods, click here.

Affording Mental Health Care

This entry reviews the cost issues affiliated with mental health care.  While paying a provider for counseling can be expensive, it need not be. Some thoughts to help:

• Many health insurance policies cover some portion of the cost. Often a client is left with only a small copay. Moreover, with the signing into law of the Mental Health Parity and Addiction Equity Act, many policies have expanded their coverage of mental health services.

• Monies spent on counseling are usually considered a medical expense and so may be deductible from your taxes..

• If you have a university in your region with a graduate program in the mental health professions (e.g., clinical psychology, psychiatry, etc.), they may have an outpatient training clinic that offers services at a very low cost. In these clinics those working towards advanced degrees often provide the care under the supervision of experienced faculty. For instance, I direct such a clinic and our most common fee is $10/visit.

• Most people do not live far from a community mental health center. These centers receive public funding to support their charter. Therefore, many of them will offer services on a sliding scale or otherwise arrange for flexible payment plans. If you’re unsure where the one by you is, call up any psychologist in the yellow pages and ask.

• There are a number of charitable organizations that sponsor mental health services on a sliding or a reduced fee scale (e.g., Catholic Charities, Jewish Social Services, etc.). In all of the instances that I know of, one need not belong to the sponsoring religious group in order to get care.

• If you or a loved one suffer from a chronic medical or psychiatric problem you may qualify for support from social security. To find out more be in touch with an attorney that specializes in disability applications, your local community mental health center or your state’s mental health or disability offices.  Other programs may also be available if you cannot afford health insurance.

• Many providers may be willing to reduce their fee if you can show cause. I would not ask for this up front. But, after the evaluation is concluded, and the provider has come to know you and your circumstances, it never hurts to ask. The large majority of the thousands of mental health professionals I’ve met over the years are a mission-driven lot who care deeply about what they do. To find such a person near you, click here.

In factoring cost issues please also consider what it would be worth to be free of the problems that are having you consider getting care. What would it be worth to be free of depression, to have your child stop acting defiantly or be free of anxiety, to have your marriage healed, etc.? Imagine life with troubling mental health burdens either eliminated or controlled; then ask yourself what that would be worth?

For my post about common myths about counseling click here.

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