Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: February 2013

Frequently Asked Questions: 
How Can Psychotherapy Help to Improve Difficult Parent-Child Relationships?

 

Alexander Lupis, M.A.
 

How can psychotherapy help children and their parents?

 

Psychotherapy is an opportunity for a trusted outsider—a professionally trained psychotherapist—to work with a family to try to resolve problematic behavior or feelings in the child—aggression, impulsive, hyperactivity, sadness, self-harm—which is complicating the parent-child relationship.  

 

How does psychotherapy with children start?

 

Typically, the therapist conducts an assessment over two to three meetings, learning about the child’s developmental and family history, observing and playing with the child, and consulting with the child’s teacher.  The goal is to understand how internal factors in the child interact with family dynamic processes to create and sustain the disruptive behavior. The therapist will give parents some feedback at the end of the assessment to let them know what they have learned and how the therapy with the child will initially proceed.

 

What happens after the assessment is over?

 

The therapy starts off with a tentative idea or ideas of what issues may be causing the difficulties, and as time goes and on the therapist gets to know the child and family better, the therapist is gradually able to clarify how these issues can most effectively be resolved. For example, the child may have a temperament that is difficult to sooth or a temperament that is not a good match with the parent’s approach.  Children are also sensitive to the emotions around them and may be reacting to stress or marital conflict at home. Children may have multiple caregivers who give them mixed messages about rules. Children may be struggling to adjust to social demands and academic expectations in school. Sometimes biological, genetic or neurological factors can also play a role and interact with these issues.    

 

How do psychotherapists work with parents?

 

The psychotherapist will often want to have regular monthly meetings with the parents to provide updates on how the child is doing in therapy and to get feedback on how the child is doing at home. Therapists help parents to explore aspects of parenting that they feel unsure or uncomfortable with. The stress, guilt and frustration of having a difficult child or strained parent-child relationship can also be explored. They also look for family events that may have triggered the child’s behavior—a recent death, illness, separation, job loss or increased conflict in the family? This gradually helps to make parent-child relationship more understandable and enjoyable.

 

What do psychotherapists do in their sessions with children?

 

Since children more easily express their concerns through play, the therapist will choose age-appropriate for use in the sessions, The child may recreate with the therapist the difficult interactions they experience at home. These communications and reenactments help the therapist understand what’s disturbing the child and what may be disrupting the parent-child relationship. The therapist will use this knowledge to give parenting advice and help the child practice things which are difficult for them to understand or tolerate.

 

What are the different kinds of family issues which can come up in child therapy?

 

Sometimes children are over-stimulated by too much play or television, or under-stimulated by parents who are overworked or depressed. Parents may expect too much or too little from their children, making it hard for a child to learn at their own pace.  Children may get caught up in parent’s arguments or competition for their loyalty, which is confusing and teaches children to express excessive anger. Children who are overly indulged with or deprived of food, gifts and affection may struggle with their feelings of vulnerability and dependence, as well as disrupted impulse control.

 

What kind of specific questions or advice can therapists have for parents? 

 

Therapists may want to explore how a difficult issue in the parent-child relationship was handled in the parent’s childhood, to see if there are some unresolved feelings or experiences that are currently getting in the way of parenting. Therapists may have suggestions for parents on how to adjust the way they set limits and reward good behavior for their child. The therapist will monitor and explore with the parent how these changes influence the parent-child relationship. The therapist may also suggest that parents consult a couple’s therapist if there is significant marital conflict, or that a parent see an adult therapist if they are overwhelmed with sadness, anxiety or anger.

 

How is confidentiality handled in child therapy?

 

The parent as the legal guardian for the child has a right to know what is going on in the therapy sessions.  For therapy to work—for children to express themselves freely and behave in an uninhibited way—children must also feel that their parents won’t know all of the details of what they do in sessions. State law also requires therapists to report credible evidence of child abuse or neglect to child protection officials.

 

How soon can we expect to see results?

 

Because most parents often bring their children to therapy after difficulties have been building up for months or over a year, therapy usually takes time to show signs of progress. Sometimes, problematic behaviors may even get more difficult at the beginning of therapy, when so much attention is focused on the issues.     

 

What if I have done research on the internet and found a diagnosis that fits my child?

 

Parents should be cautious about relying on technical or medical jargon that may reflect the difficulties their child is having. Most diagnostic categories are broad and children can develop the characteristic behaviors in diverse ways, which would warrant different kinds of therapy.  Also, many problems of childhood are transient, so the diagnostic labels may give a misleading impression of permanence.   

 

For more information about parenting, visit the American Psychological Association web site: 

http://www.apa.org/topics/parenting/index.aspx

http://www.apa.org/topics/children/index.aspx

http://www.apa.org/topics/teens/index.aspx

http://www.apa.org/topics/divorce/index.aspx

 

Some helpful books on children and parenting: 

The Magic Years: Understanding and Handling Problems in Early Childhood, by Selma Fraiberg

The Emotional Life of the Toddler, by Alicia Lieberman

Parenting from the Inside Out, by Daniel Seigal & Mary Hartzell