Mad Medicine Alert: Why never to send your kid to a shrink

by Janice M. Horowitz

A former Time Magazine health reporter reveals the hidden forces at work every time you go to the doctor — and tells you when to raise the red flag to get the best care possible.

Medicine isn’t pure. Every time you sit in a doctor’s office, there’s something going on behind the scenes that you probably sense, but you can’t quite put your finger on. And you’re too preoccupied with what ails you to give it much thought anyway. I’m not talking about what you suspect: insurance companies or drug makers. This is much more fundamental. With Mad Medicine Alert, I explain what’s really going on when you’re at the doctor so next time you have a medical problem, you’ll know exactly what to look out for. You’re going to become one smart health consumer

Today’s Alert: Therapy for Young Kids

In my last blog, I warned about the hidden forces at work when you step into an urgent care clinic. Today’s alert is about the perils of sending your young child off to a therapist.

When a kid acts up at school, what happens? He gets sent to a shrink. Parents getting a divorce? It’s the children who go to a therapist. And when a child is bullied, off to treatment she goes. With so much stress on kids nowadays — and on their hovering parents — it’s no wonder children get carted off to therapy at any sign of trouble.

But should they? A small but growing group of child psychologists argues, no. Rather than placing young children in a therapist office, it’s the parents, they say, who should go in for therapy so they can learn for themselves how to help their kids.

I know a couple whose third grade boy in private school was so rambunctious and anxious he couldn’t sit still. Sometimes he erupted; once he kicked a classmate. After many meetings with the teacher and finally the administration, the school urged the parents to get their boy to an outside therapist. If not, the kid would be expelled.

Intimated, ashamed and themselves anxious, the parents moved quickly to round up therapist recommendations. They spoke to a few on the phone, and honed in on the nearby one they thought sounded the most like-minded and professional.

And into the system the 8-year-old went. The parents met with the therapist at the beginning and then, week after week, Mom dropped off their child for a 50-minute session. Sounds logical, even critical to get this boy into the hands of a professional. But, as is nearly always the case in medicine, nothing is simple. There’s always something going on behind the scenes.

Carting off a kid to a therapist who doesn’t exhibit “average” behaviors — even if it’s only being shy or easily frustrated — is a particularly American way of handing the vicissitudes of childhood. It all becomes a self-perpetuating, insular little world of people at work: teachers eager to cast off a “demanding” child, administrators willing to outsource any kid resembling a problem, and the guilt-ridden parent, pressured into seeking outside help for their child branded as maladjusted. Lastly there are child psychologists who keep the referral loop in motion — and their thriving practices — by reinforcing the kids’ need to see them. And they are sure to make sure the protocol isn’t disrupted by giving talks at schools that pathologize all sorts of childhood behaviors.

In most countries, families aren’t pressured to give kids special treatment, other than a little bit more parental guidance and patience. In fact, in many European countries, children are not permitted to see a therapist without a parent present until they are at least 9 years old.

Here’s the alert:

Putting a young child in therapy is not a benign act. There are risks. Think about how vulnerable grownups are when they enter therapy. Now imagine a young child. First there’s the sheer unchecked nature of treatment. Therapy is among the only medical fields where the practitioner and patient are alone in a room for an entire visit, and quite a long one at that. In other specialties, there’s nearly always a nurse, technician, mentor or protégée who, if not always present, at least steps in.

In therapy’s uniquely insular medical setting, it’s difficult enough for adults to have an objective grasp on whether their therapist is any good; this is a lot trickier when it comes to kids. How can a parent judge what’s going between the child and therapist other than relying on the misplaced observations of an 8-year-old? There’s little transparency in the confines of the four walls of a therapist’s office and no real clinical measure to go by. If a kid’s behavior seems better, it may be due to therapy or just that a child is growing out of his problems — which kids do.

And here’s the biggest alert: what happens back at home when a kid is seeing someone on the outside? The treatment carries the risk of upending the family dynamic. It’s most pronounced when children come to view the therapist in her calm, rarified world, as the “good parent,” compared with the ones at home, who operate in the down-and-dirty, eat-your-vegetables, brush-your-teeth daily grind of child-raising.

There are other ways therapy can disrupt the complex relationship between children and their parents. A triangulation starts to occur when the child develops an alliance with the therapist at the expense of the parents. It is not unheard of for therapists to disparage parents in an effort to validate a child’s feelings and build trust between the patient and practitioner. And then, the child takes this uneasy sense of cognitive dissonance back home, bringing the therapist back too as an ever-present elephant in the room, handily invoked by the kid when he wants to get his way.

And parents face their own set of risks. They often start to think that the paid professional knows more than they do as they start to hand over more and more of their own expertise to this other person, the one the child begins to view as not merely a kinder parent, but also as the more competent adult.

A few therapists are now willing to throw a wrench into the loop. One, Carol Wachs, co-author of Parent-Focused Child Therapy, says that kids belong on the soccer field or at play dates that are themselves real-life learning laboratories instead of in a stranger’s office. It is in these everyday events where children can experience the normal struggles that help them develop coping mechanisms.

Wachs and other experts say that it is the parents, not the child, who should be working with a therapist. When parents get counseling in the service of their child, they have to think empathically about what a child is experiencing and work out abiding ways to help in a process that should bolster the relationship for years to come.

So here’s the rule: start to question not just the practitioner, but all the parties involved in pushing you into getting psychological treatment for your young child. This is particularly important when it comes to emotional disorders since diagnosis are not all that objective. Unlike physical problems, matters of the mind and behavior are ambiguous, vague and open to interpretation. Sometimes you need resist the consensus and try a different route, one in which you learn on your own how to deal with your children and then, go ahead, and talk to them.