May 27, 2021
Cindy Lopez:
Welcome to Voices of Compassion, CHC’s podcast series providing courage, connection and compassion, highlighting topics that matter to our community, our parents, families, educators and other professionals. My name is Cindy Lopez, and welcome to our episode today. We’re talking about therapy for your children as a parent of a child with anxiety or any other concerning behavior you’re probably wondering if therapy is appropriate or even would be a good option and what the therapy experience might be like and if it’s really feasible, plus, maybe you’re not even sure that you could get your child to go to therapy. So, what do you do? We discuss these questions and more with Dr. Vidya Krishnan, Head of Adolescent Mental Health services and Child and Adolescent Psychiatrist at CHC. You’ll hear ideas and strategies to think about as you consider therapy for your child. Dr Krishnan is there anything else you’d like to share with our listeners as we get started?
[00:01:10] Dr. Vidya Krishnan:
Yes, thank you, Cindy. I do very strongly believe more than anything else parents are the experts in their children. You know your child more than anybody else in this universe. Sometimes the pieces of the jigsaw puzzle don’t feel like they fit together very well and a job of people like us is to help you put the jigsaw puzzle pieces together in a way that makes sense for you and your family.
[00:01:33] Cindy Lopez:
Yeah, thank you so much. I know that’s really important for parents to hear. So thinking about this topic of supporting your child and wondering if therapy is right for your child, and then thinking about how do I actually get my child to go to therapy. So, how do you know if therapy is the right option for your child or why would I consider that as a parent for my child?
[00:01:55] Dr. Vidya Krishnan:
If there’s any situation where you feel like your child is not able to lead their best life for any number of factors, that is an important reason to consider if therapy among many other things is an option for you to consider. People normally think of therapy as something that comes into the picture because there is a psychiatry diagnosis or some kind of an identified labeled problem. But I think anytime there are struggles with communication, behavior or relationships within the family or outside of the family, those are all good reasons to consider if therapy might be a good option for your child or your family.
[00:02:35] Cindy Lopez:
I was doing a session last night for a school with one of our other clinicians, Dr. Baran. And this question came up: how do I know when to seek help? And one thing that stuck with me that she said is whenever their behavior is kind of keeping them from participating from seeing and interacting with friends or keeping them in the house, like they’re too afraid to go out and I think that’s what you’re alluding to, so if their behavior is cause for concern, and you’re also seeing like they’re not participating really in things that they have liked to do before and seeing friends and some preferred activities, that might be a time to look more closely or to seek additional help. Would you agree with that?
[00:03:22] Dr. Vidya Krishnan:
Yeah, no I definitely would agree with that right, the main cornerstones of a kid’s life are school, friends and family, anything that prevents a child from engaging with those things in a meaningful manner is cause for concern.
[00:03:34] Cindy Lopez:
And so can you talk a little bit about what happens in therapy? What does that look like? Just to give a quick overview.
[00:03:42] Dr. Vidya Krishnan:
Right at the end of the day there are two main tasks in therapy. One of the tasks in therapy is this relative stranger who has a skillset is trying to make a connection and a relationship with your child, mostly because nothing can happen outside of the context of relationship. We have to know the other person to be able to engage in help, that’s the first thing. So relationship building is an important part of what happens in therapy to begin with, and ongoing, but the second part of what happens is that jointly the child, the parent, the family, along with this person that you have engaged with, identify the particular areas of concern or struggle to develop goals. And then depending on the age, stage, ability, engagement of the child, we’ll use those goals to marry them with the skills they bring to the table to then craft a unique, customized plan of how they would go about doing it. For certain children, it will involve play and talking, for some others it will involve doing through various skills development, for some other ones that will be coaching. So how it plays out within the session obviously depends on a number of factors that I laid out, but eventually it is a joint collaborative effort, to work together towards the common purpose.
[00:05:10] Cindy Lopez:
Yeah, that relationship between the child and the therapist is really important, and that has to kind of sync up. And just a word about teletherapy, we do offer teletherapy now. And so that has been a nice option for parents and families, as we’ve all been sheltering in place. And it will continue at CHC, into the year and post COVID because it’s an important, accessible tool for families.
[00:05:39] Dr. Vidya Krishnan:
The interesting thing Cindy is that having done teletherapy for the last year, many times exclusively, even though I was doing teletherapy well before the pandemic, I do have to say that it’s actually very successful to deliver very, very high quality of therapy through this teletherapy mode, particularly for our kids who are very tech savvy, way more tech savvy than I was at that age and stage in life.
[00:06:04] Cindy Lopez:
So Dr. Krishnan, teletherapy, is a great option for families right now. I’m wondering what if a child just feels like I’m not going to get online and talk to a screen, do you have any thoughts about how parents could frame that for kids?
[00:06:21] Dr. Vidya Krishnan:
Yes, I agree with you, Cindy, you know, we all have spent a large amount of time behind the screen this last year, and it’s definitely a challenge. And for some children, there is a great level of screen fatigue to interact with one more person from behind the screen even if that is a helpful voice reaching out to them. So in some of those instances, we do have the parents take the leadership and start the engagement. But the good news is as case rates decrease and as vaccination has become more prevalent CHC is on the road to opening up more in-person services in a safe environment for families and children, where that is the form of engagement that is preferred by the child and the family, which allows for a more personal introduction into therapy in the more traditional sense and many children just as the excitement of going back to in-person school is increasing, the possibility of accessing therapy in an in-person format is open to those who feel safe and comfortable doing so in an environment that is customized for this purpose.
[00:07:28] Cindy Lopez:
Yeah, that’s a good point. So as a parent thinking about therapy, like do I participate in my child’s therapy or what does that look like?
[00:07:39] Dr. Vidya Krishnan:
Oh, absolutely, you would participate in your child’s therapy. We think of the help you’re able to provide the entire family unit, your child being an important part of that family unit and as I first pointed out, you are the expert on your child. And, without you, it is not possible because you are the one sometimes who is on the front lines of implementing some of those things, or the suggestions that we make. Also, you are the person who is able to bring into the session the information about what’s going on in this child’s universe. Me and my office or on my Zoom is not able to know that information and so absolutely.
[00:08:20] Cindy Lopez:
As you noted, parents are really an expert on their child so it’s good to have that perspective too. So let’s fast forward, right, I’m a parent, I’ve decided my child does need therapy. How do I talk to my child about that? And like, what if we do all this and then my child refuses to go to therapy, what then?
[00:08:42] Dr. Vidya Krishnan:
How we talk about therapy definitely is the first question and like everything else about children, so much of it depends on the age and stage of where the child is at. And if you’re thinking of really young children, we’re talking about, say elementary school age children, right. If you’re talking about that or younger, you are framing it as to what therapy is specifically going to be. Not uncommonly I will have parents tell their child, we’re going to go to see a talking doctor who will play and talk with you, that’s a common thing. So they have some context and you would frame what will happen there. As a joint endeavor, saying that the two of us, or the three of us or four of us there’s going to be . Multiple parent caregiver units involved in the treatment. So whoever is going to be the larger unit saying we are all going to go together to learn how we can use our calm voices. We can use our words better, we can keep our hands safe. So using very, very specific, simple language to frame what you’re trying to accomplish in a way that the child can understand, or you may have already talked about is the way to go with someone that young, but being very clear, that it is going to involve talking or playing because most of the other people, if you think about it, when you say doctor or treatment of some kind, they’re used to seeing their pediatrician and dentists, one of whom drills their teeth and the other of whom gives them shots, right. You want to kind of lower that anxiety and as you move into slightly older kids, you’re thinking late elementary school, middle school aged children, we still want to keep that communal us going.
You can have more sophisticated language because kids have a greater understanding of their difficulty. So they’re saying, that this therapist is going to help us with our bodies, is going to help us with our anger, is going to help us with big emotions so you kind of think about those bigger things in a way that the child and the family may have already been, but if you notice the commonality between both this is the fact that you never want to be blaming of the child or framing it where you’re talking about the child as being bad or being the target or the label you want to make it seem like a family project where we all have equal participation.
It shifts a teeny tiny bit when you head over into the, you know, preteen, teen ages. Mostly because at that point, kids actually know more about what therapy really is, which is, really works in your favor. And there you want to highlight some other aspects of therapy where you identify the target, particularly like you started talking about in the beginning, Cindy, about what Dr. Baran said, particularly in terms of functional areas, right. I know how much you’re struggling with school or how much you’re struggling with your friends or how much you’re struggling in your relationship with us or me. And I want you to have a safe space where you have the privacy to talk about your thoughts and your feelings, and have someone help you with them so you feel able to manage these things and I want to make that space available to you, so you can work on it and it is confidential. So if you don’t feel comfortable talking to me, you have this other place that I’m happy to create for you, where you validate their concerns, let them know that you are noticing that they’re struggling and offer them this opportunity.
[00:12:14] Cindy Lopez:
Thank you for tuning in! Just a note, before we continue on with today’s episode, we hope you’re following us on social media, so you don’t need to wait a whole week between episodes to get engaging, inspiring and educational content from CHC. Our social handles are linked on our podcast webpage at podcasts.chconline.org.
It’s important for the child to have skin in the game, so to speak, it’s important for the child to buy in and to take some ownership, like what, is it that they want to get out of it. Dr. Krishnan, what if your child really just puts their foot down and says I’m not going to therapy, just refuses?
[00:12:56] Dr. Vidya Krishnan:
Right, and which is not uncommon. You know, there is a couple of different things, sometimes it’s because there is real fear because it’s a new thing, a new task and new activity, and it’s really hard for children to do that. The second thing is that sometimes it could be that the child doesn’t believe that there’s anything that they need to address. And so each of those would be dealt differently, right. If you think it’s more related to a fear of therapy is showing them that you’re going to be a part of the process, you’re going to be joining them can be particularly useful, but sometimes you can do role modeling, which is our privilege as a parent where you show you know this is the person I’m going to go meet them and you make it known that you’re meeting them and you’re talking to them and it’s safe. And,maybe you can kind of encourage them to maybe start trickling in by joining you sometimes so they can have a safe environment to get to know this provider without the pressure of feeling like they’re on their own trying to do this by themselves, which is incredibly reassuring for many small children.
The other thing that also is important to recognize is that while that is a good entry point many, many therapeutic interventions are just as possible to accomplish, particularly in the younger crew with just the parent participating in therapy to be able to make changes that trickle down into the child and their life. Again, going back to the central point, the parent is the central influencing figure in a child’s life around whom they spend most of their time. So there’s a lot of intervention that can be done outside of that. Even if the child is not willing or able to participate for the second part of it goes back to your skin in the game kind of point Cindy, because one of the things is if your efforts to have the child be able to go into therapy do not succeed, having or facilitating an interaction between the therapist and the child together can sometimes be helpful because the therapist can then see if there’s any way they can help the child to formulate maybe some goals that may not be your goals of working, but something that the kid feels really engaged and interacted with and they may be very different from each other, but it is the cornerstone of getting the relationship going because now that it’s skin in the game and they feel I am going to get something out of this, I’m not just going because mom or dad want me to go.
[00:15:17] Cindy Lopez:
Yeah, that’s really a good point. And I think that if parents are still trying to figure out how to set this up with their child. Another thing they might do is actually contact the therapist that they would like to use for their child and go meet the therapist themselves and have the therapist talk through with them how they can talk with their child so the therapist could kind of customize talk tracks, so to speak.
[00:15:44] Dr. Vidya Krishnan:
Oh, absolutely, absolutely. And the other thing is that, especially when you think of more older kids, the other tool that any parent’s disposal, respecting a young or an older teen’s autonomy is always, you know, incentive and negotiation and bargaining to find a way to get that foot into the door. And then hoping that burgeoning relationship will then take a life of its own and kind of be able to take wings and fly.
[00:16:11] Cindy Lopez:
So, Dr. Krishnan, thank you so much for sharing your insights with us today and your expertise. I’m wondering if there is one thing that you hope our listeners would take away from this episode, what would that be?
[00:16:26] Dr. Vidya Krishnan: I will probably go for three, but I’ll keep it really brief. First one is relationship is everything, the second thing is find a way to have your child have skin in the game. And the third one basically is that even if your child is not able to participate in therapy, you can on their behalf and still make a big difference.
Cindy Lopez:
So that number one, when you said relationship is everything, so is that parent child relationship, is that therapist, child relationship. Is it all of the above?
Dr. Vidya Krishnan: All of the above.
Cindy Lopez:
So, Dr.Krishnan, again, thank you and to our listeners thank you for joining us. We hope you’ll join us again next week for a new episode in our Voices of Compassion podcast series. And just so you know please, check out chconline.org. You can find lots of information there about therapy, evaluations for your kids, assessments. You can arrange for a free 30-minute parent consultation with one of our clinicians and that’s always a good place to start if you’re not quite sure what next steps might be.
So please take advantage, there’s so much on our site that’s great information that’s available and the lot that is free, especially if you go check out our online resource library, there’s a ton of free resources including recordings from past parent education sessions and also all of our podcasts can be accessible there too. So thank you for joining us this morning and we look forward to talking with you again next week.
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