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HOW DO WE GET FROM HERE TO THERE?
Choosing a Therapist for your Child

By Nancy Ng

Most of us adoptive parents wish, if not believe, at some level that we could just fir in with the rest of the parenting community. We read adoption books hoping they are not referencing our kids. Even if we know better we sometimes feel that our families aren’t so different, that good basic parenting is all that is needed.

Many of us are tainted by the societal myth that you must be crazy if you need therapy or you must have failed as a parent if your child needs professional help.

Many of us have seen or read too many dramatic accounts of attachment-disordered murderers who did not grow up in families of origin. Most of us live in adopting-ignorant communities where adoptive families may be vilified or sanctified; where we are buffeted by “to bad you couldn’t have one of your own” attitudes.

Most of us have endured lengthy, intrusive home studies which might sensitize us to perceived criticism, and increase our longing to shut the door and go it alone.

So, when we do make the decision to seek therapy, we enter the search with heightened concern.

Choosing a therapist is a consumer decision. If we were buying a car we would certainly do a little research first.

We might:
1. Determine just what was available
2. Decide what we need from a new vehicle
3. Outline what specific features we need
4. List who would be driving and how often it would be used
5. Ask about the consumer rating on the particular model
6. Figure out financing and
7. Last but not least, pay attention to how we feel about our choice.
Who would sign on for a sports car when s/he only feels safe in a SUV?

The questions aren’t so different when one is choosing to invest in therapy.

1. Availability: Therapists come in a variety of models. The Adoption Information Clearing House lists:
Pediatrician or Family Practice Physician - Medical doctor (M.D.) who specializes in childhood or adolescent care and who typically treats routine medical conditions; a primary care physician who refers a child for additional lab studies or diagnostic procedures and who coordinates referrals to other specialists. Physicians can and do prescribe medication for a variety of behavioral and emotional symptoms.

Psychiatrist – Medical doctor (M.D.) who specializes in the evaluation of major mental or emotional disorders which may require medication. Psychiatrists complete medical school and follow with post-graduate training in psychiatric disorders and perhaps subspecialties in child and adolescent psychiatry. Psychiatry’s primary focus is on medication consultation and management.

Clinical Psychologist – A clinical psychologist has completed a doctoral degree (Ph.D. or Psy.D.) in psychology and usually has completed advanced courses in general development, psychological testing and evaluation, as well as psychotherapy techniques and counseling. Many clinical psychologists develop a subspecialty in child and adolescent development, psychological testing, and family therapy.

Clinical Neuropsychologist – Clinical neuropsychologists hold a Ph.D. They complete undergraduate and graduate training in biological and medical theories pertaining to human behavior and doctoral studies in clinical neuropsychology, followed by post-graduate specialty training in the assessment and treatment of neurodevelopmental disorders, neurological and medical conditions, traumatic brain injury, learning and memory disorders and the differential diagnosis of organic versus psychiatric or psychological disorders.

Clinical Social Worker – A clinical social worker (LCSW or MSW) has completed a master’s degree in social work with emphasis on family structure and children’s interactional strengths and weaknesses. Social workers typically focus on social, educational and family adjustment issues, but usually do not have professional training in psychological testing. Many complete advanced training and licensure in order to be qualified under state licensure requirements to offer counseling to individuals and families.

Marriage and Family Therapist – Marriage and family therapists (MFT) have a master’s degree in counseling techniques that mainly focus on family relationships, children and couples. Family therapists focus on communication building and on family structure and boundaries within the family. MFTs are licensed by the state.

Pastoral Counselor – A pastoral counselor has a minimum of a master’s degree (many have completed doctoral training) and focuses on supportive interventions for individuals or families, using spirituality as an additional source of support for those in treatment.

2. Need: What do you want to get for your child? Evaluation? Medication? Help with behavioral issues? Attachment work? It is helpful to talk with other parents and with others who know your child. Sometimes a good evaluation is absolutely necessary. Some kids, particularly those who have moved through the foster care system have been over-evaluated and underserved. It is important to consider just what specific questions need to be answered and why. Medication has been demonstrated to be of great help to many children, but that does not mean that there is a magic pill for your child. Schools often request behavioral therapy to lessen acting out in the classroom. Often that too can be helpful as a quick fix but does nothing to resolve underlying concerns. Attachment is always a concern when children have been moved from their first parents but that does not mean that all adopted persons are at risk for Reactive Attachment Disorder or need intensive attachment therapy.

The questions within the questions tend to make parents “leave it to experts”. Remember that the parent is the real expert on his/her child. Part of the parental responsibility is to share his expertise with those who have particular clinical knowledge while still keeping the driver’s prerogative.

It is wise to remember that all human beings have biases: experts in Attention Deficit Disorder tend to see ADHD; newly trained attachment therapists may over-diagnose Attachment Disorder etc. Be particularly wary of those who have a too quick or too simple diagnosis for a complex little human being.

3. Specificity: Does the clinician have particular training and experience in working with adopted children? If so, what, where and for how long? Has s/he worked with a variety of types of adoption-intercountry, transracial, special needs, open? Is s/he a member of the adoption triad? This may or may not be a plus depending on whether or not s/he has broadened her education and understanding beyond personal experience. How culturally competent is the therapist? If s/he is racially similar to the child in a transracial placement, how do her personal beliefs on transracial adoption affect her therapy? How are the parents and other family members involved in therapy? How does s/he view confidentiality – as between the therapist and the child, or more logically as involving the parents, child and therapist?

How does s/he view the different needs of adopted children and those born into their families? Does the therapist give assignments to parents and children to work on at home or do they believe change occurs in the 50 minute hours?

Is the therapist available in emergencies? Does s/he make home visits? How does s/he interact with schools, pediatricians and day care providers?

Does s/he use a variety of therapy modalities (play, EMDR, art, sand tray)? Why or why not?

4. Duration and control: How will you know of treatment is working and how will you know that it is no longer needed? It is important to agree on these points up front and to have specified review times. Flexibility is key. Many families benefit from what Joyce Pavao calls “intermittent, intensive, long term” work. Ideally families could obtain service “as needed” – that is, intensive therapy during the predictable and sometimes unpredictable developmental crisis, plus regular check-ins with a therapist who knows the family. Parents and children have a right to expect that visible progress will be made on the specific reason that prompted therapy even while working on larger issues.

5. Consumer rating: Even if Consumer Reports rated therapists, they might miss the particular needs of adoptive families. Check with adoption support groups and agency workers about a particular therapist. Ask specific questions about what training and reading the therapist has done and what s/he is willing to do. Don’t hesitate to ask a therapist about their on-going clinical supervision or consultation.

6. Fees: Does the therapist take Medicaid (MediCal)? Does s/he accept Victim’s Witness payments? What is the hourly rate? Is s/he willing to apply for payment under your insurance plan? Does s/he charge for phone calls? Has s/he worked with adoption assistance? While it is not necessarily true that you get what you pay for, neither is it true that the least expensive or most “covered” service is best. Money is a factor; at the very last families should expect the therapist to understand that every expensive minute counts.

7. Trust your instincts: It won’t matter much if you don’t like the slick whit-shod car salesman, but it is absolutely essential that parents have an open, trusting relationship with their child’s therapist. At least initially it is probably more important that you like the therapist than whether or not your child does. “Right”, “fun”, “easy” and “helpful” are not synonymous. The goal is not that the child bond with the therapist but that they can work together with you to create positive change. Therapy is not a “one size fits all” endeavor. Shop around, choose well, “trade in” if things are not working. Speak up and expect reasonable results. You, your child and your family deserve the best.

Nancy Ng, editor of News from FAIR, is a parent by birth and adoption. She has trained parents and professionals in adoptive parenting and clinical interventions. Nancy Ng holds a degree in Marriage and Family Counseling and is part of Mickey’s Place, a therapeutic, educational and support service for adoptive and foster families.

FAIR, the newsletter, News from FAIR and our website,www.fairfamilies.org--good luck--see you in Vancouver?
Nancy Ng