Therapy – Some Thought from a Consumer

by Lansing Wood

It’s almost an inside joke among parents with adopted kids, particularly those whose kids joined the family past infancy. "Have you found a therapist yet?" Or, "how’s therapy going?" Implied are the qualifiers: a therapist with whom your family is comfortable, one that understands adoption issues, one you feel makes any difference. In my role as facilitator of FAIR’s PS (Parent Support) group and through my involvement with adoptive families in general, I am aware of the constant and sometimes desperate search of many parents for informed mental health services. Some find the help they seek. Many are disappointed.

Is the problem one of unrealistic expectations? I think not. Shouldn’t a family expect a change for the better, a feeling of relief or hope as a direct result of those visits to the therapist? Even if the child has a history of multiple separations and losses, neglect and physical or sexual abuse shouldn’t parents expect something positive to happen as a result of the services they have sought? It is common for an agency to place children with a requirement that the adoptive family provide psycho-therapy for the child. FAIR, in fact, receives calls from social workers asking if we can recommend a therapist experienced in adoption of older kids. Sometimes we can help. More often we can only commiserate about the need for more specialists in the Bay area who are open to and experienced in working with these challenging children and their families.

I would like to share some personal views which have grown out of my own family’s experience with at least seven therapists, employed by us since we adopted first a six year old and then a seven year old. These therapy experiences have included long-term individual psychotherapy, brief counseling with individuals or sub groups, evaluation sessions (some of which resulted in a decision not to continue on a longer term basis), family therapy, and crisis intervention.

I am convinced that it is the parents’ obligation to see ourselves as consumers of a service. If I take my car to be serviced and I am treated with condescention, vagueness, or inefficiency I have no trouble looking elsewhere. With therapy, it’s immeasurably harder. Am I resisting, denying, being competitive with the therapist, feeling unable to do some painful emotional work or just copping out if I say, "sorry, this just doesn’t make sense, feel right, or seem to be helping?" Do I need to pay the therapist for more sessions to work these things out? In order to be a responsible consumer of this service called therapy, I must ask questions like, "what are the (our) goals for the next six sessions and how can we tell if we’re moving toward them?" I have a right to insist that the therapist explain what my child’s play therapy is all about and how it will help him, in words that I can understand. I have a right to ask whether the therapist thinks change is possible and how he/she plans to help us achieve it. I also have a right to know how long this might take and to be given regular updates on progress from the therapist’s point of view. I have a right to think of and use the therapist as a consultant and to expect specific, clear, wise advice when I ask for it.

I don’t think anything I have said is unreasonable or revolutionary. Yet helping agencies, especially those which accept Medi-Cal or offer a sliding scale for services are often set up in a way that makes client choice of therapist impossible, both initially and as a therapy progresses, regardless of the desires of the client. I feel that it is the responsibility of the therapist to set the tone for a trusting, open relationship with the family, including the parents, even when the main client is a child. The child, in fact, may be unable to enter into a trusting relationship at all. Unless this trust or working alliance is achieved quite quickly between therapist and parents, I believe there is no point in initiating or continuing the therapy. With children who have major problems with the mother-child or parent-child relationship in the first place it makes no sense to strive toward therapist-child bonding at the expense of the crucial family attachment. A therapist who does not work to support and deepen this parent-child attachment is at best irrelevant and at worst destructive.

As an all too experienced consumer of mental health services I am the first to admit that asking hard questions, insisting on relevant, quality service, and continuously re-evaluating goals is time-consuming and emotionally draining, not to mention expensive. How often I have heard families say, "I’m not so sure we’re getting much out of this (therapy) but at least we have someone," or I just can’t face going through the who story again," or "it isn’t fair to Billy to terminate with this therapist, or try again with another, when he has already had so many losses." School district IEP (special education) teams often feel better if there is a therapist involved with a challenging child’s family, regardless of the outcome of the therapy.

Difficult as it may be, we parents must take the ultimate responsibility for these decisions about therapy (Shall we? When? Who? How long? What kind?) and we must trust our own instincts. If we begin to think help is needed – for the marital relationship, perhaps strained by the addition of a difficult child, for the health of other siblings in the family who may need extra support and coping skills, for the severely acting-out or depressed child – we are probably right and we must act quickly to find professional help, not giving up until some relief is felt. Parents can use school, agency or other parents for referral sources but we must be our own judge of the service we are buying, whether or not the funds for therapy come from Medi-Cal, AAP, private insurance, or our own pocket-books.

As for my own family’s experience, several therapists have been helpful in different ways at different times. Sometimes it has been hard to determine progress or to attribute change to therapy. Sometimes we parents have felt detached from a child’s weekly visits or unsure of the necessity for the length of the therapy (3 years, twice a week, with the same therapist, in one case!) A few experiences have been horrendous. However, we are still believers. We continue to try to follow the guidelines suggested here.

In working with one therapist we have seen and felt dramatic change, significant relief, and real security in the kind of relationship our family has with him. I will admit that his most effective work has been with members of the family who have not experienced multiple losses and inadequate parenting early in life. Yet his interventions have helped the family grow and survive some serious challenges, thus benefiting all seven of us.

This therapist at the top of our family’s helpful list was an unlikely candidate in some ways – not a specialist in adoption issues (but quick to learn more about them), family systems oriented (but not locked into any one interpretation of family dynamics or intervention techniques), single (but very good at connecting with young people and secure in his trust, and a willingness to work together in a variety of ways. We are, indeed, fortunate. Another family, however, might not respond in the same way to this or any particular therapist. The relationship is and must be at once professional and highly personal. I want to emphasize that it is the difficult, yet essential responsibility of the parents to trust and act on our feelings, being as honest and informed as possible, as we make decisions about therapy for our own family’s needs. Good luck!

  therapy and support : choosing a therapist
  therapy and support : what to expect