Ending a Relationship with a Therapist
Archived Q&A and Reviews
My six-year-old son has been in play therapy, twice a week, for 2 years. Many of the behaviors for which I brought him there are now resolved (whether because of therapy, maturity, or the many other changes that happen over the course of 2 years, I don't know). Still, he retains serious problems with his behavior, particularly among his peers (on the playground and in school). His therapist has not given him a firm diagnosis.
After 2 years of therapy twice a week (not to mention weekly sessions with a tutor for his dyslexia and dysgraphia), I want to try taking a break from the therapy (and the frantic schedule) and put my son in an aikido class, or maybe a social- skills day camp, or maybe just take him to the park more--just something else, something new. Having no other experience with child therapy, I have no frame of reference as to whether or not this therapist is really helping, and whether or not it would harm him to break from the therapy for a while. My questions are:
- Could it really harm him to take a hiatus?
- How can I answer the therapist's belief that he should stay in therapy with her? To hear a therapist tell you that your child will be harmed by removing him from her care, even temporarily, is a difficult thing to argue with, especially if you have no science to counter with.
- Finally, are there local support groups for socially difficult kids (simply put, he's an antagonist, inordinately afraid of being vulnerable)? Are there local support groups for the PARENTS of kids like mine?
Dear Flummoxed Parent,
You are your son's mother and I would urge you to trust your instincts, which are telling you your son needs a break right now. After 2 years of what is quite a lot of intense therapy, he can definitely benefit from a hiatus. It can be a perfect time to refresh and spend more time with him - as you say, at the park, etc - and try and get a new take on where he is at and what he may need. Sometimes a child needs space to process the growth they have made, and it is in these periods that a child may aquire new insight or take developmental leaps.
Since he has already experienced individual therapy for a period of time, and since it seems his issues are now primarily social ones, I would say that group therapy of some form would be ideal for your son at this point. I'm sure some BPN parents can point you in the direction of some appropriate group leaders, but what springs to mind is Jim Beatty http://www.hahathisaway.com/, though I haven't observed these groups personally.
I would also encourage you to pursue something more physical, such as martial arts (aikido, capoeira, etc), that can help your son ground himself in his body and learn impulse control in a group setting, if that's something your son seems capable of. Speak to the teacher first about any concerns you may have and make sure you feeel it will be a success-oriented experience for him, rather than something that may knock his self esteem and trigger negative behaviours.
And finally, I am a board certified music therapist with extensive experience with children and adolescents. This fall I plan to be running social skills groups for children using the medium of music. Music therapy is a non-threatening and engaging medium that is ideal for addressing social, emotional and behavioural issues. More can be read at www.musictherapy.org. I will post further info on BPN nearer the time but feel free to contact me with any questions. Best of luck, Maya
I am a child therapist with 15 years experience, and I would be very leery of a therapist who wants you to believe that your child will be severely harmed by taking a break from therapy after two years of twice a week seesions. It is not unusual for kids to take a break during the summer, and it's often helpful, since it gives them a chance to try other things and to consolidate their gains. Even for children who really would benefit from staying in therapy, it's rarely terribly harmful to try a break, and it gives families a chance to see how things go, and return in the Fall ready for more work. There are always exceptions, and your situation may be one of those, but if that's the case, then it would be a good thing at least for you to get a better understanding of why it's so important to continue at this time. Ask your child's therapist to explain to you very clearly why she thinks it is so important for him to continue through the summer, and ask about the possibility of scaling back for awhile, maybe down to a couple of times a month for maintenance. Frankly, without clear justification, I would suspect an economic agenda. anon
In broad terms it sounds like we have similar issues. My daughter went to play therapy for over a year. We recently quit, and now I send her to a social skills group at CPMC in the city, as well as to 1:1 OT for handwriting and sensory issues. The benefits and goals of these two interventions are much clearer than play therapy. Therapy was mysterious in that 1) we have no real idea what goes on in there 2) is it intended to help my kid directly, or is it supposed to help me get a better understanding of my kid through what the therapist learned? (that part never happened). It did offer her a safe space, but I sense they were dancing around the issues more than I could accept. Quitting was difficult, as the therapists can always tell you your kid's not ready. Trust your gut -- you can always come back. Her therapist insisted on 3+ sessions to ''say goodbye'' for closure, and I could see the logic of this and did not complain. My daughter seems fine with it. Good luck.
I'm a child therapist, and here's my two cents. In my experience, most children who come into therapy have some resolution of symptoms fairly quickly, and other symptoms that take longer to resolve. Some parents (and children) stick it out with the therapy and some will take a break after the most disruptive issues have gotten better. The most important thing is, if you are going to take a break, to give your child the chance to have a real goodbye with the therapist. I don't mean just a session to say goodbye, but a good month or so to really be able to have a proper leavetaking, including a chance for the child to understand their own progress in therapy: the loss that ending the therapy may represent, and a real sense of their own accomplishments.
What's your relationship like with your son's therapist? Do you have bi-weekly or monthly meetings to talk about how your child is doing (in therapy and in his life at school and at home)? Do you trust your therapist to make recommendations? If your son's therapist says that taking a break from therapy would ''harm'' him, I would inquire about what the therapist means, specifically. Is he saying that a sudden, unprepared for separation from a beloved therapist might be harmful? Or is he trying to say that there are symptoms that your son still has that would benefit from therapy? Whichever he means, he should certainly be prepared to be specific in delineating your child's accomplishments and where he still might need help. He should also be able to point you in the direction of other things you might do (akido, support groups for you etc.) that you might do to help your son
It is reasonable to expect a therapist to be clear with a parents about treatment, and for a treatment plan to be created that all parties are in agreement about.
It is also important to periodically check in directly with the therapist to assess where the treatment is going, and to also check in about what you are seeing at home and school. The therapist should encourage this dialogue. What are the current goals. Is going to therapy 2x a week addressing those goals? Is the therapist also having sessions with the parents to go over what's happening, hear about what's happening at home and create a bridge between the therapy work and the real world? Just meeting with a child so young without connecting directly with parents feels like treating the child in a vaccuum. I don't know if that's what's occurring here...but a child spends much more time in school and at home then with a therapist.
Therapy is a relationship, and the termination of therapy can have an effect on a child. Endings or pauses in therapy can also be done sensitively, with the door left open for future visits.
Your child has been in therapy two times a week, since age 4...without a diagnosis? Has your therapist suggested that a full neuropsychological report might be useful to help find a direction for treatment?
You are your child's primary relationship. I encourage you to feel empowered to get specific with the therapist about their treatment rationale, and to see if there's a compromise position available.
Many kids have a less structured schedule during the summer...for some kids this is wonderful; for those who may need more external structure, summer can be chaotic and confusing. Perhaps with the structure of school ending, making too drastic a change in other activities could be contraindicated. anonymous
I think cold turkey changes can be really hard for kids. Why don't you try a ''weaning'' approach, say cut down to once a week for a month, then every other week for a while. That will give you some time to gauge how he's handling the transition anon
People are often not aware of how much homeopathy can do, but I have seen it work very well in cases similar to what you describe. You could take a break from the therapy or do both together, either is fine. I think you may be able to see significant improvement Anon
Trust your instincts! I have two children who were in play therapy long-term for quite different reasons and with different therapists. Despite some early improvement. both stalled and later worsened. One had no diagnosis and the other had a ''label'' that gave little insight. Deciding to move on from therapy was in both cases a very difficult process, but in the end was the right thing for us.
I now believe (1) that if therapy doesn't seem to be helping, it probably isn't, and (2) if therapy isn't helping, there's a real chance that it's doing harm. It can be harmful if the therapist misunderstands the root causes of the child's behavior or if the child feels blamed for things they can't yet control or don't understand. One of my kids came to believe that therapists don't understand and can't help, and now resists therapy that I believe would help. Spending time in unproductive therapy deprived my kids of the benefit of appropriate treatment at an earlier age, when it would have been more effective. It also left them less time for other activities and social interaction.
I now believe that a framework for understanding the child, such as a meaningful and accurate diagnosis, is the best foundation for therapy. Much has been learned about the brain since the time when many practicing therapists were trained, and there are many new insights as well as help from other disciplines, such as occupational therapy and speech and language. In our case, a thorough neuropsychological evaluation set us on the road to helpful treatment. An eval isn't cheap, but compared to the cost of twice-weekly therapy it's not bad.
Therapists can have a powerful influence, and it can take a lot of courage to trust your instincts against the strong beliefs of a professional. And other professionals, even if they disagreed strongly with the therapist, were reluctant to encourage us to switch. As much as we worried about it, when we discussed discontinuing therapy, it turned out to be what the child wanted -- it obviously was no longer meaningful to the child, and we've never had any reason to regret the decision. I've only regretted not making the change sooner.