Choosing The Right Therapist

Children and teens are more often becoming anxious and depressed.   

Successfully transitioning into adulthood has become more challenging.

One in ten children and teens in the United States worked with a psychotherapist during the past year.

That translates to over 7,000,000 parents having decided that their child needed the help of a trained therapist.

A parent’s decision to enlist the help of a therapist is not done lightly. Therapy is costly. It requires a significant time commitment, very often is expensive, and involves bringing a stranger into the private life of the family. 

Making things more difficult still, most parents don’t know what to expect when taking their youngster to a psychotherapist. Some parents wonder whether the clinician will have their child lie on a couch and talk about their earliest memories.  (PRO TIP#1: If a therapist does this, you’ve gone to the wrong therapist).

Other parents may have heard that therapy with children involves having them play with small figurines in a sandbox. (PRO TIP#2: Having young children play during therapy is a way to ease the anxiety they feel when meeting with strangers… but, if that is all that the therapist does, you can hire a babysitter for much less money).

This lack of understanding regarding what to expect makes it difficult for parents to know what to look for when selecting a therapist for their young child or teen.

Although I’ve written before about how adults can best approach the task of choosing a therapist for themselves, the task of selecting a therapist to work with a teen or child is somewhat different and, in some ways, more confusing.

Let me help make this process easier for you. Having worked with children, teens, and adults for over 30 years (the majority of those years spent in a university hospital setting where I supervised young clinicians) I’ve come to a few conclusions about how best to select a therapist. These conclusions are based on both my experience and a large body of research.

Seven Factors For Selecting The Best Teen/Child Therapist

ONE: Professional degrees are not hugely important. Research over many years has been consistent and clear: the professional degree a therapist has earned does not, in general, correlate with better therapy outcomes.

Whether you select a Licensed Marriage and Family Counselor (LMFT), a Licensed Clinical Social Worker (LCSW), a psychiatrist (MD) or a psychologist (PhD) is not crucial.

The bottom line, when it comes to selecting a good therapist, don’t put much weight on the specific degree that the therapist has earned.

TWO: A therapist with more years of experience is not necessarily a more skilled therapist. 

As a rule, it is a good idea to find a therapist with several years of experience. But, a therapist with five years versus ten years of experience is not necessarily a less able clinician. Most clinicians reach their professional peak a few years after licensure.

A smaller portion of therapists continue to advance their skills in the years following. These therapists continue to become more effective because they take the time to reflect on their work with patients, carving out time to actively consider how they can improve, and then implementing methods to do so.

This is rare. Consequently, you will do well to simply look for someone with several years of experience working with children and teens. (Some recently completed studies suggest that years of experience may be important in certain situations, but this research requires further elaboration before it can be applied in a practical way to guide the choice of a therapist).

THREE: Theoretical orientation is only moderately important. Cognitive Behavior Therapy (CBT) is the single most popular approach that therapists adopt to help people of any age.

Its popularity arises because there is a wealth of research showing that it is effective. Unfortunately, some distortions about CBT have also taken root. These revolve around the mistaken idea that there are few , if any, other approaches as effective as CBT.

This is simply not true.

There are literally dozens of formalized therapeutic approaches that have been developed over the years. Many of these have solid bodies of research backing up their effectiveness claims.

The field of psychotherapy is not immune from the influence of ‘group think.’ When a large swath of therapists begins to extol the virtues of one particular approach, many other therapists will jump on the band wagon.

This is not a criticism of CBT. For many psychological problems CBT is effective. My point to parents is that CBT is not uniquely effective when compared to other well-established, systematized treatment approaches. This is not an opinion, it is a rather a fact established by years of research.

If you are interested in going a bit ‘into the weeds’ to see what approaches are supported by science the American Psychological Association has a frequently updated list.

The takeaway from all of this is that there are many types of psychotherapy, and a subset of these has very solid evidence supporting its effectiveness.

There is no single approach, however, that is universally more effective than others.

Consequently, the ideal is to find a therapist who is skilled at helping children or teens who struggle with the problems with which your child is wrestling.

If they are skilled, it will not matter much (if at all) what approach they use. In fact, the main consideration related to specific treatment approach is that you and are child are comfortable with it.

How do you determine if the therapist is effective in using whatever approach they embrace?

The best way to determine if a mental health professional is using an effective strategy is to talk with those who have worked with that specific therapist.

If that is not possible, look at reviews, and likewise get referrals from friends, teachers, or pediatricians.

(PRO TIP: When meeting with a therapist for the first time ask what approach he/she uses. Their response should be easy to understand and make sense. This isn’t rocket science, so if their explanation does not make sense to you, it very likely doesn’t make any sense at all… head for the door).

FOUR: Male versus Female is important only if it is important to your child.  Ask your son or daughter if they have a strong preference, then take their answer into consideration when making your selection.

FIVE: Experience with the problems your son or daughter is wrestling with is very important.  Such experience does not guarantee a good outcome, but it does shift the odds in your favor.

If your teen daughter struggles with an eating disorder, for example, you are best off finding a therapist who has experience working with teenage girls who have eating disorders.

SIX: Your child/teen’s initial response to the therapist (including your response) is of utmost importance. If you walk away after the first or second session thinking you’ve found someone who is competent, genuine, and someone you and your son/daughter can work with, you are likely to have a good outcome.

Years of research consistently find that this is the number one predictor of favorable results when selecting a therapist. 

SEVEN: The therapist’s willingness to include parents in the therapy is vitally important. I can’t stress this enough. You should insist on being a part of the therapy.

This need not mean you meet with the therapist at the same time as your son or daughter. It does mean that the therapist speaks with you regularly to get your input and answer your questions.

With children this is a straightforward matter (although some child therapists insist on not involving parents, if that is the case you need to find another therapist right away).

It becomes a little more complicated with teens. Teens (and even older children ages 10 to 12) require a degree of confidentiality regarding their disclosures to their therapist. Without these reassurances of confidentiality, a teen is not likely to trust the therapist, and without trust, there will be no significant sharing of information.

But the confidentiality need not be complete. Parents have a right to set limits on what is kept from them and what should be disclosed. The exact parameters will vary depending upon the parent and teen’s relationship and preferences.

The simplest way to establish what these limits should be is for the therapist, teen and parents to meet together and discuss what limits on confidentiality will be. Sometimes compromises are needed, but nearly always a working solution can be reached.

Conclusion

There you have it, seven things to keep in mind as you search for a therapist to help your son or daughter. Follow this guidance, and you’ll save yourself a great deal of grief and possibly a great deal of money that otherwise might be spent working with a therapist who is a poor fit.

And best of all, you will drastically increase the chances of finding a therapist that helps your son or daughter become a happier, healthier youngster.