The first time I sought a mental health professional for my daughter (and I’m running out of fingers to count them on), it felt like I was launching a rickety rowboat into the ocean in hopes of finding a habitable island – one that was accepting new clients. And that was before I had to convince a child who was terrified of the bath to jump in for the ride.
Before COVID-19, the Centers for Disease Control estimated up to one in five children in the U.S. will experience a mental disorder in any given year; 4.4 million kids ages 3–17 had diagnosed anxiety. A year of pandemic stress, closed schools and distance from peers and family has contributed to a spike in young people struggling with their mental health.
Psychiatrist Tom Tarshis founded Bay Area Clinical Associates (BACA) in part to help address the shortage of psychiatrists, psychologists and therapists available to help kids in the Bay Area. In the second half of 2020, BACA – which has 37 clinicians and is growing – saw a 78 percent increase in families seeking help.
Therapy can be a huge help. But even if you think your child might benefit from talking to someone, you might not know when – or how – to bring it up with your kid, what to look for in a therapist, or what exactly you’re signing up for.
Here’s what I’ve learned as a parent and what Tarshis wishes families knew going into therapy.
Approaching your child about seeking help may not be as difficult as you think. Younger children often haven’t yet internalized any social stigma about therapy. And older kids? Tarshis says it’s often teens themselves who ask their parents to find them a therapist. At least in the Bay Area, “the great news is that our youth are empowered with respect to mental health,” Tarshis says.
I can corroborate this. My East Bay teen recently educated me: “Oh Mom, everybody has a therapist.”
Still, if you are the one to bring up the idea of therapy, keep the focus of the “problem” outside of your child. You can share that you know she’s going through a difficult time, and that you’d like to find someone who can help both of you learn some new skills to make things a little better.
Look for the Right Match
Therapists (sometimes also called counselors) include individuals with varying credentials and degrees of authority. (Also, let’s be frank, a range of price points).
A licensed clinical social worker (LCSW) has a master’s level degree and can assess mental health conditions and provide psychotherapy (talk therapy). They or other master’s-level therapists are generally the most budget-friendly option. Psychologists and psychiatrists have doctorate-level degrees and higher rates. Both can diagnose mental health conditions and treat them, including with psychotherapy. However, only a psychiatrist – who is a medical doctor – can prescribe medications.
Who your child needs depends on many factors, and you might start by asking your pediatrician to share a recommendation. Once you’ve got some names, there are a couple of key things you should look for in a therapist. One is a good fit. Though this may seem like a luxury if you’re having difficulty finding any care, Tarshis says that an important predictor of success in therapy is having a good connection between child and therapist. By the fourth session, even a skeptical teen should be enjoying their sessions to some degree.
Second: Ask what tools the therapist uses. Psychotherapy encompasses many therapy types, so it’s important to know that cognitive behavioral therapy (CBT) is widely considered to be the most effective treatment for anxiety.
Check In With Yourself
Anxiety is heavily influenced by genetics. You may not have a diagnosable condition, but particularly during pandemic times, you and your child’s other caregivers can help your child by prioritizing your own mental health. I feel guilty every time I exercise instead of giving my teenager attention after a long day. But I also know if I don’t spend 30 minutes burning off frustration/anxiety/stress/cabin fever, I’m going to be a much worse parent for the rest of the evening.
In his practice, Tarshis recommends parents pick an evening and write down every positive thing and every negative thing they said to their child that day. As parents, we often default to negative reinforcement techniques, such as yelling at a child who is afraid of the dentist to get in the car because you’re running late for his appointment. Tarshis says “positive parenting” – making three positive statements for every one correction – is the top treatment for correcting behavioral conflict. It’s also extremely powerful in helping kids who are anxious or depressed.
Positive statements can be as simple as thanking a child for a hug or for putting a cup in the dishwasher the first time you asked. “If you as a caregiver create a positive, caring, open-communication environment,” says Tarshis, “you’re giving very strong protective effects for your child.”
Tarshis adds that parents have a big role to play in therapy. No matter the age of your child, the therapist should be checking in periodically to discuss how the family can contribute to treatment. “If you’re bringing in a child aged 10 or younger for treatment and your treatment provider is not meeting with you on a monthly basis,” says Tarshis, “that’s not gold standard care.”
Set the Scene
In an early therapy session years ago, my daughter couldn’t keep her nervous eyes off of the therapist’s hand as he scribbled notes. I realized I hadn’t explained that writing things down – what a kid likes to do, or how they handle anxiety – helps the therapist remember the special things about a particular kid, and that he would keep those notes private.
Unlike visiting the pediatrician, therapy is more like a class, one in which your child gets to be the only student. He’ll have a session on a regular basis (perhaps weekly) and in the case of anxiety, will likely go for 12–20 sessions.
The therapist’s office might look similar to the doctor’s offices your child is familiar with. However, it is often a space shared with other mental health clinicians and has a slightly different feel. There may be a button to press to let the therapist know you’ve arrived. There may be white noise machines to help keep conversations private. The therapist may have a couch, comfy decor, or toys for younger children.
And these days, therapy might be on your iPad. Tarshis and his team are researching outcomes of in-person and remote therapy. He says that the general consensus right now is that video sessions can be as effective as office sessions, with the added benefit of making therapy logistically easier for families.
Hold Insurance to Account
Many clinicians run cash practices, leaving you to deal with the technicalities of insurance reimbursement. According to the American Medical Association, patients are self-paying for more than 26 percent of psychiatrist appointments each year. That is far more than in most other medical specialties. Insurance is obligated to cover mental and behavioral health; the 2020 California Mental Health Parity Act requires insurance to cover out-of-network costs in some cases. If your insurance provider isn’t responsive, you can contact the California Department of Insurance.
Deciding to work on managing anxiety takes guts! Your child is about to tackle worries and fears that feel very distressing. Tell her how proud you are that she’s taking on this challenge. And pat yourself on the back for supporting her.
Books for Kids
What to Do When You Worry Too Much, by Dawn Huebner (Magination Press 2005)
What to Do When You're Scared and Worried, by James Crist (Free Spirit Publishing 2004)
Outsmarting Worry, by Dawn Huebner (Jessica Kingsley Publishers 2017)
Books for Parents
Helping Your Anxious Child, by Ronald M. Rapee (New Harbinger Publications 2008)
SOS: Help for Parents, by Lynn Clark (SOS Programs & Parents Press 2005)
Anxiety Relief for Kids: On-the-Spot Strategies to Help Your Child Overcome Worry, Panic, and Avoidance, by Bridget Flynn Walker. (New Harbinger Publications 2017)
Little Panic: Dispatches from an Anxious Life, by Amanda Stern (Grand Central Publishing 2018)
Ask Lisa: The Psychology of Parenting (Started during the pandemic, so lots of current info here)
Your Anxious Child: 5-minute Solutions with Edward Plimpton
(for book suggestions, including middle-grade books that tackle mental health)
— Tom Tarshis and Summer Batte