Listen Up, Parents!

We’ve learned that things can periodically go awry when working with children. Sometimes this can result in the child or parent being temporarily or even permanently dissatisfied with their treatment. And because parents need to be involved in their child’s therapy from both a clinical standpoint and a financial one, multiple parties need to be satisfied for the therapy to continue.
If you are a parent or if you ever plan to be one there is something important you should know. No matter how well-adjusted you are, no matter how many parenting books you read, independent of how many episodes of Dr. Phil you watch, regardless of how little violence or conflict your child is exposed to on television and in real life, even if there is little to no history of psychological problems in your family, there is a viable chance that your child will need to have mental health treatment at some point. This is not the end of the world. School stress, bullies, biochemistry, peer pressure, anything and everything can cause children to have psychological distress. Feel no shame or embarrassment in getting help for your kid.
If and when the day comes that your child goes to therapy, tattoo this advice into your brain:
Do NOT abruptly pull your child out of therapy without closure.
It sounds simple yet is not always heeded. Consider my work with Luke, a 13 year old adolescent with depressed mood and weekly fistfights at school. Luke was a somewhat “goth” type kid with long, dark hair and black fingernails. Despite being a bit below average height and weight it seemed clear that he was winning virtually all of the fights he was in, given that his knuckles were often red yet the rest of his body was always unscathed. We got along well and he was a great conversationalist (“the red fists are my trophy over the vanquished, Doc Rob”). Over many weeks Luke and I would talk about fighting: what does it mean to him to beat up another kid, what is leading up to the fights, does he feel regret afterwards, is there an alternative to this? At one point he said “I just don’t want to be on Earth anymore.” This scared me a bit and, having had months of unsuccessful attempts to curb the behavior and boost his mood, I advised his mother what had taken place and that a medication evaluation should be considered.


Mom: Medication? But I thought you people didn’t believe in drugs.
Dr. Rob: I suppose some psychologists don’t, but I believe it’s worth considering. Your son is having a very tough time and this has been going on for many weeks now.
Mom: That’s why I brought him to you.
Dr. Rob: I understand that, and I think I can still be of service to him, but he might need something more, even if it’s temporary.
Mom: Is this because of the whole “Satan” thing he has going on?
Dr. Rob: No not at all. It’s about his depressed mood. I’ve been trying to work with his strengths but he seems stuck.
Mom: What do you think his strengths are?
Dr. Rob: Well he’s motivated, articulate, artistic…
Mom: You think he’s autistic. At 13 years old. Like we wouldn’t have known that by now?!
Dr. Rob: No, ‘artistic.’
Mom: Oh. Well I don’t understand why you aren’t doing your job correctly.
Dr. Rob: What I’m doing right now is my job, Mrs. Luke.
Mom: Then I think we’ll follow your advice and take our business elsewhere.
Dr. Rob: I don’t mean that you should…
Mom: We’re going.
This was not good as Luke and I had a good therapeutic connection despite the need for more intensive services. I called Mrs. Luke three days later to see how Luke was feeling and to discuss continuing our work, but to no avail. I did get a message from her a few weeks later stating that Luke was taking medication and was “doing so-so, no thanks to you. He misses you and the medication only helps a bit, but you clearly have no idea what you’re doing. Take some continuing education classes and then we’ll talk.”
While not every client and therapist will “click” most children and adolescents who come to treatment on a regular basis get comfortable with the routine. The structure and stability can help them. At some level of consciousness the child says “At 5:30 every Monday I see Dr. Rob. I see him for 45 minutes. He is pretty predictable: we play games, we draw, he is nice to me, we talk about my feelings. He tries to help me when I have a problem. Sometimes he is successful and sometimes he isn’t. But he is solid because invariably he is THERE for me.”
Could Luke’s abrupt departure from our work directly and profoundly (and negatively) impact his adult relationships? That’s hard to say because so many variables will play a part in his life over the years. But we do know that what happens to us as children plays a role in our futures. We see countless people in their teens, 20’s and 30’s (and beyond) with attachment issues: people who can’t let go of people whom they love but don’t love them back anymore, people who can’t get close to others or have commitment or intimacy issues. Could abrupt parental reactions toward terminating therapy cause attachment issues? That might be a stretch, but don’t think that whisking your child away from a solid relationship definitely won’t have any future impact. That’s just naïve.
I do not spout out these Pearls of Wisdom (POW!) without doing my field research first. Just in case my experience with Luke was an isolated incident, I considered my own past. I was in therapy when I was an adolescent because I didn’t know how to cope with so many hot teenage girls coming on to me all the time. That or I had some social anxiety giving speeches, I can’t remember. Anyway, I called my mother to fill in some blanks.
Robert: I wanted to learn more about my experience in therapy when I was a kid.
Mother: Good God what a waste of time.
Robert: Really? How so?
Mother: After dozens of sessions with the therapist are you comfortable with public speaking now, at age 33?
Robert: I’m 36. And no.
Mother: Sounds like the definition of a waste of time to me.
Robert: Do you remember how the therapy ended?
Mother: Other than me writing a check every week to some woman who blamed me for everything that was wrong with you?
Robert: I mean how did you decide not to send me anymore?
Mother: I wanted you to stop once I saw things weren’t going anywhere. But you said that you liked the woman and wanted to continue to try. I figured it might mess you up even more than you were if I just jerked you out of there. So I kept paying. And paying and paying. I could have bought a Trans Am for that kind of money! Finally you said that you had had enough and wanted to stop. The therapist said that you two should have a few “closure” sessions or something stupid so that you didn’t have even more issues as an adult. I suppose it made some sense so I sent you a few more times and then you stopped and I got to buy nice clothes and the new Kenny Loggins album.
Robert: Wow, that was very insightful of her. And you. I love you Mom.
Mother: Don’t patronize me. You’re 38 and still don’t have children. If I had pulled you out of therapy you might have become a serial killer or something even more neurotic than you are.
Clearly then, taking the stability from a child is not only ignorant, it’s basically cruel and will ensure your child becomes the next Charles Manson.
The reality is that practitioners will not be able to help every kid that comes into the office and sometimes they cannot help some children fast enough for the parents’ or school’s tastes. If this happens and an arrangement cannot be worked out, do not abruptly end the relationship. Let the therapy end with a formal goodbye, even if it means holding off on Kenny Loggins’ comeback album, due out this summer.

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20 Responses to “Listen Up, Parents!”

  1. Drew says:

    “I was in therapy when I was an adolescent because I didn’t know how to cope with so many hot teenage girls coming on to me all the time.”
    Hilarious and awesome, as usual.

  2. Anonymous says:

    Dr. Rob, does this apply to adult therapy too, or just kids?
    Dr. Rob Note: I definitely think this can be applicable to adults as well. That’s a whole other post, b/c kids generally don’t process change and loss the way adults do.

  3. Anonymous says:

    That would be a helpful post! Hint.
    Trans Am and Kenny Loggins… Oh dear!

  4. J says:

    I want to meet these people that don’t have anxiety before giving speeches.
    I was yanked from one therapist to another due to my anxiety issues. My parents spun it as we couldn’t afford the first; I later found out it was because the first could not perscribe the anxiety medication.
    The second therapist and I had to part our ways as he never talked to me, but always greeted me with a handful of pill samples. But I’m not sour over the occurance. Present me still likes samples because I’m a cheapskate. Some things just never change.

  5. Amber says:

    Your mom sounds like quite a character!
    On a side note, in the case of Luke he may really have needed meds to help. Keep in mind though that some people choose to be that way.

  6. Matt says:

    Any story involving your Mom is hilarious.

  7. Mike says:

    Well hopefully Luke is not getting his meds from his GP.
    I remember when my son’s pediatrician stated to us our son needed son intervention help with his development. We were happy for the input. He said some parents flip out seeing it as reflection of them.

  8. kate says:

    “Keep in mind though that some people choose to be that way.”
    eek. amber i cringe a little when i hear stuff like that because the ‘choice’ here isn’t always so clear. people do a lot of screwed up things to themselves in order to elicit certain negative feelings (yay, masochism!), but it’s often not a choice. like dr. rob says, our childhood experiences play a big role in determining our futures and a lot of times we act out certain patterns that have been implanted early on (yay, repetition compulsion!). differentiating those who ‘choose’ to be a certain way and those who are victims of circumstance is too arbitrary of a line to draw.

  9. Wayland says:

    Bro, it’s almost painful when I read what your mom has to say to you. Is the quoted conversation exaggerated or is it truly verbatim?
    Dr. Rob Note: Verbatim? I don’t know anyone with a memory THAT good.

  10. Amber says:

    Kate~ No, the choice isn’t clear. But I was one of those that chose to be unhappy. In my teen years to add to the hormone changes and general teenage drama I dealt with a lot of shit. But so did other friends of mine. Some chose a drug route, some chose to ignore it, I chose to cut and wish death upon myself. I eventually did get some medical help in the form of zoloft and attempted suicide by ODing on those. Obviously it didn’t work.
    All I’m saying is…some people want to wallow. And they wallow as long as they need and grow up into pretty stable adults.

  11. Joy says:

    You are hitting the nail on the head, as usual. Check out childtrama.com and the Child Trauma Academy which uses the Neurosequential Model…Loss (loss of a relationship with a therapist & frequent moving, even) IS TRAUMA to kids, and depending on their age can impact their brain development.
    Good advice to parents, I hope people listen. 🙂

  12. kate says:

    amber, i’m sorry to hear about that. i take a different perspective than you when it comes to masochism (cutting, drug abuse, etc.). i don’t think people choose to wallow–i think they unconsciously provoke emotional pain in order to resolve it. when you say that you chose to be unhappy and wanted to wallow, i worry that you’re ascribing yourself (and those in similar struggles) too much blame. regardless, old patterns are hard to break and i think it’s excellent and commendable that you are free of yours.

  13. :yb detsoP says:

    Everyone is so mean to you. Especially clients. You should get Luke to beat them up, including his stuck up mother.
    Dr. Rob Note: I’ve said more than my fair share of mean things in my personal life. Luke would not be pleased.

  14. Maggy says:

    DocRob no wonder these kids are in therapy. Honestly most of the parents you talk about sound like they need a good therapist as well. Parents tend to blame everyone else except themselves, and being a teacher I see that all the time. Another great post!

  15. Alainne says:

    This brings up another interesting point – that parents are human too, and even when they try their best, they are going to f* up their kids. I think a big part of becoming a healthy adult is forgiving your parents for their human failings.

  16. Tracie says:

    I, too, was pulled out of therapy when a doctor suggested medication. As soon as the “talk” about meds started (the therapist, by the way, was my good friend’s mother, which I’m sure has to violate *some* rule of confidentiality), my mom pulled me out of there the same day.
    The irony was that my symptoms didn’t get better, and I later went to a GP for medication. (My mother felt more comfortable with my getting scripts from her than from someone specifically trained on the pills I was being urged to take.) The GP vastly overprescribed, and I spent the next 2 years in a meds haze. Thanks Mom!

  17. Unfortunately, I am all too familiar with this situation. Unfortunately too many parents think Therapy = $$, and not Therapy = Helping My Child.
    I think most of my parental frustration comes from when a parent has just enough information to be very dangerous. “I heard [crazy fad intervention] works better. Why don’t YOU do that?!”
    The fallacy of a “magic pill” is definitely problematic, even in the face of empirically support data showing Therapy + Meds = Better Outcomes than mono-therapy.
    I can see why some people only see adults, too bad there are so many kids who need help.

  18. Blank says:

    Dear Doctor Rob,
    If you were worried about Luke not handling the therapy well, could you not have offered his mother one free “farewell” session to Luke so you could’ve explained what was going on better? If the cost was really the issue there, I don’t see how she could have refused, and I’m sure you could have avoided at least some regrets by going that little bit further for Luke’s needs. Maybe this is just food for thought that can be used in the future.
    Anyway, could you (sometime in the future) make a post about your observations between parents and their children in therapy? Are any of the parents’ issues projected onto the children? Just curious to see your input on the subject. Thanks.

  19. Jenna says:

    Don’t you want to tell parents like that that they are being bitchy? I always want to tell people when they’re being jackasses. How are you so nice to such jerks?

  20. Andrea says:

    After my parents divorced when I was 12, I was taken to see several therapists as well as a psychiatrist. The therapy sessions were always cut short due to lack of funding or moving to another city except in one memorable instance.
    Dr. Polly worked with me for several weeks until one week she said she had to go to a conference and would have to miss two sessions. She said that if I felt I needed to talk to her after she got back that I could call her and set up another appointment. Of course I did, but Dr. Polly was nowhere to be found. I later found out from my mother that this was her way of “pushing me out of the nest.” I still have abandonment issues.