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Why? Because

mombeach-insideWhen our daughter was two she had a standard answer when confronted with angry parents.

“Why did you throw all the baby wipes into the toilet?” we’d ask.

“Because I do,” she’d answer. “Because I did.”

It never failed. Whatever the disaster – water sloshed all over the kitchen floor, her dresser drawers unpacked and the contents strewn across her room, her brother’s micropet collection hijacked and missing – we would ask why and she would answer, “Because I do, because I did.”

And it seemed like a fair enough answer because when you’re two years old how can you have the words to explain such a complicated situation? To explain the lure of developmentally-appropriate curiosity? The driving need to explore?

“I saw the full container of baby wipes,” she can’t say. “And I opened them just to smell but the smell – it reminded me of you and of daddy and then I wanted to feel the cool of them on my skin and wipe them across my eyes the way I’ve seen mommy do it to get off her mascara before bedtime. I imagined myself like mommy, wiping away the dirt of the day and then when the chill of the wipe went away, I tossed it aside and reached for another one. Before I knew it, they were gone and the toilet was clogged. But I didn’t mean to use them all up and I didn’t mean to break the potty.”

No, she couldn’t say any of that, she said, “Because I do” and “Because I did.”

I think about this not just with my kids but also sometimes when I’m working with a client (child or grown up) in therapy. Sometimes we won’t know why. Sometimes we won’t know why until later. And that’s ok because sometimes we don’t need to know why.

Sometimes all we can do — all that we need to do — is deal with the results. With kids, we can involve them in the clean up. With clients, it’s the same thing. We can deal with the results (the fall out, the grief, the anger) and then eventually if we’re patient with ourselves and each other, we’ll start to make sense of the why.

Meanwhile we can get comfortable with the reality of not knowing. We can work on trusting the process — our child’s growth, our own growth — and operate with the belief that learning is inevitable, if we don’t actively try to stop it, but that we can’t control the time line.

Life is a journey, right? Not a destination!

Teens and Confidentiality in Counseling

Teens and Confidentiality in CounselingParental involvement is a key ingredient in kid client success in therapy. What this looks like will depend on your child and his/her treatment plan, your practical ability to be involved (are you a noncustodial parent? Is your child receiving services at school?) and the therapist. But at the very least, you and your child’s therapist should be communicating regularly.

Depending on the child, the parents and the treatment goals, I include parents in the following ways:

  • Parents attend sessions with their child (this is common with young children and with children who are struggling with attachment);
  • Parents come in for the first or last few minutes of session;
  • Meeting with parents separately before or after the child’s session;
  • Scheduling separate sessions with parents when needed and appropriate;
  • Arranging for phone calls to check in.

I like kid feedback for how parents should be involved, particularly with teenagers who are navigating the developmentally appropriate need to separate along with the necessary support from parents. Sometimes this means helping the teen figure out how they want to talk to parents about something and then inviting parents to session to help mediate a discussion.

I go over confidentiality with parents and teens in session with the understanding that we will all respect the teen’s privacy in the counseling relationship but that the adults will keep her safety paramount in decision-making around what to share. When kids are struggling in a gray area, I always encourage them to invite parents to the discussion but I won’t go over their heads and tell secrets unless I’m concerned for their safety.

Here’s the Ohio ACLU publication about minors and their rights. The part about counseling (this is a PDF file) starts at page 40: Your Health and the Law: A Guide for Teens.

From the file:

A minor who is at least 14 years old can request outpatient care without notifying a parent as long as the treatment does not include medication. However, such care is limited to six sessions or 30 days, whichever comes first. After that, the care must stop or the parents must be informed and must consent in order for treatment to continue. During the first six sessions or 30 days, the parents will not be informed of the treatment unless the teen consents or the care provider feels the minor is likely to harm someone. Still, before the parents can be informed, the care provider must first tell the teen that the parents will be notified.

I have not had a teen call and ask for counseling on her own but I have had other loving adults (relatives or family friends) call me to find out if they can bring the teen to counseling without parental consent. I always explain how the law works and explain that except in cases where parental involvement would be dangerous to the child, it’s really best to have parents be a part of counseling.

There are guidelines around counseling teens and maintaining confidentiality. As a counselor practicing in Ohio, my ethical guidelines come from Ohio’s Counselor, Social Worker, and Marriage and Family Therapist board and my professional organization, the American Counseling Association. Both these entities recognize that teen confidentiality is a gray area. The ACA and their sister organizations for social workers and other therapists regularly publish articles and papers on the topic.
Here’s a handful for you to check out:

As you can see, there are not definitive answers because these topics are complex and so very individual. How I might, for example, handle it if a client tells me s/he is sexually active will depend on many things including but not limited to:

  • Why the teen is in counseling in the first place;
  • With whom they are being sexually active (is it consensual? Is it legal?);
  • How old the teen is (there’s a big difference between a 13 year old and a 17 year old);
  • The family’s values around sexual activity;
  • The circumstances surrounding the sexual activity (are there pressing concerns about safety?).

My first priority is always first and foremost safety but I recognize my ideas about safety may be different than the families. For example, say I learn that a 17-year old after careful consideration and planning decides to access birth control and have sex with her long-term partner. Perhaps she comes from a strict, conservative family whose religious beliefs condemn premarital sex. I am unlikely to break confidentiality under those circumstances.

I say this to encourage parents to talk to their teen’s counselor to make sure that they understand each other. If you want a counselor who would break confidentiality then I’m not the right person to work with your teen. It’s best we all know this ahead of time.

That said, I do not ever encourage teens to lie and I do not side with them against parents.

Finally, when confronted with a sticky situation I seek supervision, meaning I go to my peers and my mentors to get feedback when I’m not sure. While maintaining confidentiality about the individual and the family, I ask for help and document these efforts accordingly. It’s dangerous for any therapist to operate in a vacuum and I am fortunate to have great counselors available to me to answer questions and help me examine ethical practice as it applies to the complicated reality that is counseling kids and teens.

5 tips for talking to your child about counseling

how do i talk to my child about counselingSo you’ve decided your child needs counseling. How do you explain to them what counseling is and why they’re going?

1. Tell them that a counselor is a person who helps people who are feeling stuck.

Many children (and adults) who are in therapy believe that they — their inherent selves — are problematic. Lots of children (and adults) have already been through the wringer by the time they come see me and their self-esteem is suffering for it. They may be feeling like they are root of all of their family’s problems. They may think that the people who love them really hate them. They may believe that they are in someway defective and that’s why they’ve got to come and see me. What I emphasize is that counselors help people who are feeling stuck. If your child is anxious you can say, “A counselor helps kids who are feeling stuck in their worrying.” If your teen is depressed you can say, “We’re seeing a counselor who helps people who are feeling stuck in their depression.” If your middle grade child is raging you can say, “The counselor will be able to help us figure out how to help you get better at managing your anger.” After all, your child is NOT her worrying or her depression or her challenging behavior. Your child is a whole, complicated person who is struggling. Counselors help with the struggle; they help people get unstuck from the struggle.

2. Let them know that the counselor will help everyone in the family do a better job with each other.

If I’m working with a child then I’m also working with her parents. As I said, sometimes the children who see me think they are at the root of all of their family’s problems. Kids are naturally self-centered (it’s a developmentally appropriate part of growing up) and so the divorce, the fighting, the tension — they think it all comes back to them. And if it is their behavior driving the decision to get counseling then they’re partially right. But kids don’t exist in a vacuum and if a child is struggling then the parents surely are, too. Counseling is meant to help everybody, which means helping the child be her best self and helping the parent be his best parenting self, too.

3. Explain that they will get to set the pace.

Kids who come to see me don’t always want to talk to me. That’s fine. Being guarded with a new person — particularly a new person who’s been enlisted to help the child over a sensitive topic — is appropriate. We can play Uno, we can play with the kinetic sand, I can watch the child build block towers or create art or otherwise orient herself to our relationship. I do not make children talk to me and even most reluctant teens will come around if we have time and space to learn how to work together. (Note: Once we’ve established rapport I will push when pushing makes sense but at the beginning we take it slow.)

4. Don’t insinuate that therapy is a punishment.

If children get the idea that seeing a counselor is one step away from being sent to juvenile detention it makes it awfully hard to build rapport. It goes back to #1 up there; if people believe that only screwed up people go to counseling then the threat of counseling might get seen as a weapon. “If you don’t get it together I’m taking you to a therapist to get your head on straight!” Or to other people, “He’s gotten so bad that we’ve had to start seeing a counselor!” Ugh. Not a great message. Even if you’re feeling discouraged and even if you feel like counseling is your last ditch effort, please remember that coming to therapy is a really smart and positive move.

5. It’s OK to acknowledge the problems that got you there.

No, you don’t want to make your child feel like the problem. No, you don’t want to put the whole burden of change on her either. But you can be frank about why you’re going. Sometimes parents will say, “Is it all right to talk about his tantrums here? In front of him?” Yes, it is. After all, he’s the one having them and he knows they’re an issue, trust me. There are some topics that aren’t for tender ears (or at least aren’t until we’ve made them age appropriate) but getting the problem out into the open without judgment and in the spirit of moving forward is a good thing.

If you’re still not quite sure how to talk to your child about it, bring it up with the therapist you’ve chosen to work with your child.

Anxious Kids (and Anxious Parents)

anxious childThis Saturday I’m hosting the free talk on Kids & Anxiety. It looks like there’s going to be a full house (fortunately I have enough chairs now and we’ll just squeeze in if everyone shows). Because of the interest, I’m hoping to schedule another time to offer it early in the new year. I’m also doing out reach to professionals in other areas who are interested in sharing their wisdom with us so to keep up to date on future free events, please subscribe to my newsletter. (You can do this by scrolling down and filling out either the bright yellow box that will magically appear or by filling out the form in the black area at the bottom of the page.)

Because of the interest in the workshop and requests I’ve had from people calling my practice, I’m going to offer a group to help anxious kids in a few weeks. This is an 8-week program using research-informed practice to give kids tools that will help them understand and deal with anxiety. The workshop is called Coping Kids and you can learn more about it here.

I wanted to offer the group for several reasons:

  1. Research shows that group psychotherapy can be as effective as individual psychotherapy (and is also less expensive);
  2. It’s been my experience that many of my anxious kid clients feel isolated by their worry. Meeting other children who are learning to manage their anxiety can be a huge, huge relief;
  3. Creating community is incredibly healing; this goes for kids as well as adults;
  4. Finally, many of us learn best helping each other learn. Groups give us the chance to do that.

I do require a (free) 20-minute meeting beforehand just to make sure that the group is a good fit for that child. If it’s not, I’ll be happy to share other resources or give some direction if the parents are interested. Also I want potential members of the group to have a chance to meet me, see the space and ask questions.

I am going to keep the group small with a maximum of six kids so that everyone has the chance to participate.

Curious to learn more? Let me know.

When you have nothing to say

emforsterI remember when I was in my early 30s and seeing a therapist to process my experience with infertility. At the beginning I had so much to say that I didn’t know how I would make it between sessions. Then after (I thought) I had said it all, I would worry before appointments that she’d be disappointed because I didn’t have an idea about what we should talk about.

I used to plan our topics. All week I would store up events or musings and I’d have them neatly prepared. I would continue to do this even after I realized that during most of our appointments we’d end up talking about something completely different. She’d ask about something we discussed the session before or in our casual opening we’d end up on a subject I hadn’t even considered. But I’d wrench us back around to the topic I had planned even if it fell flat because I thought I was supposed to.

I didn’t know then that it was more than OK to just show up. I didn’t have to have a topic prepared. I didn’t have to know what we were going to talk about. I could let the conversation happen organically and trust her to help me figure out what I wanted to say.

Therapy is a lot like writing. Sometimes you come to the page with a plan and sometimes you don’t. Sometimes you have it all outlined and mapped out and sometimes you’re free writing whatever comes into your head no matter how messy and disorganized and ungrammatical it might be.

You can’t have too much of one or too much of the other. Yes, you do need to have goals and you need to pay attention to your goals but you also need time when you’re sitting in the chair riffing on whatever comes up.

You and your therapist are working in collaboration. You don’t have to come up with every topic and she’s not going to always lead the way. The two of you will discover what it is you’re working on through the course of your conversations. If you do too much editing (especially if you’re not bringing things up because you are afraid she will be upset or bored) then she’ll be working with less material than she needs. If you try to plan your topics because you’re afraid that she will be annoyed if you sit there blankly saying nothing then you may lose the opportunity to see what the silence will bring to you.

(Sitting in silence with a person who is wholly tuned in to you can be very powerful. Try it sometime.)

Therapy is collaborative creation and growth. Trust the process and give yourself permission to allow the session to unfold however it will.

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