413. Q&A: How do I tell my child he’s going to start therapy?

Dr. Sarah Bren (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.

(00:41):

Hello. Welcome back to the Beyond the Session segment of the Securely Attached podcast. We have Dr. Emily Upshur here and we are going to answer a listener question. Hi Em.

Dr. Emily Upshur (00:52):

Hi. Good to be here. I’m so excited. I like this one.

Dr. Sarah Bren (00:57):

I know. This is a good question. We get it a lot. So this parent writes in, “Hello, doctors. Do you have any tips on how to tell my seven year old that he is going to start therapy appointments?”

Dr. Emily Upshur (01:11):

Good one. Super common.

Dr. Sarah Bren (01:13):

Yes. So this parent has a seven year old, so we could talk a little bit about that age range, but I kind of feel like since … I mean, I literally feel this question almost every time I have a new family starting with me and it’s more or less the same answer, but the language can shift a little bit depending on age. So we could talk even about younger kids and older kids too, I feel like.

Dr. Emily Upshur (01:36):

I mean, I love that you said that. I will say I do have people who don’t tell their kids, so I think it’s nice to … This listener is obviously really attuned to like, I can’t just drop my kid into therapy and not contextualize it for them. So I love that we’re trying to create language around how to introduce this.

Dr. Sarah Bren (01:55):

Yeah. And it’s funny because I think a lot of people don’t tell their kids because one of two reasons, they don’t know how they’re not exactly sure what and so they kind of avoid it until it’s happening or they actually feel like their kid will have a really strong or negative reaction so they don’t want to tell them and so they just kind of keep it really vague.

Dr. Emily Upshur (02:20):

I mean, one thing I tend to do, just in terms of order of operations, like as psychologists and clinicians, one thing I like to do is meet with the parents first before I give them any advice. If they call me and I haven’t met them yet and I don’t know what’s going on, I’m usually like, “Let’s talk and then we can talk about how to introduce it to your child.”

(02:39):

One thing I love to ask parents or caregivers, whoever is bringing the child is, what do you think your child’s understanding is of the things that you’re struggling with, right? Like of the X, the yelling, the not listening, the worries, the checking behavior. What do you think they understand about it? Because I think the biggest mistake that we make is talking way above kids. We’re talking about something in a way that’s a little bit too intellectualized for kids to understand sometimes and keeping it really in their words close to their experience is important. So I think getting a sense from the parents of what’s going on, what they might think, I love parents or the experts of their kids, what they might think their kid is thinking or feeling or wondering about just the dynamic that they’re concerned about that they’re bringing to the table is a really good place to start. They have the answers.

Dr. Sarah Bren (03:36):

And to that end, I will usually ask parents, like let’s say for example, I don’t know what this mom’s seven year old is going to therapy for, but let’s just say for example, it’s for anxiety and they’re having a lot of, like you described, like checking behaviors or reassurance seeking behaviors, they’re worried, they’re avoiding things. A lot of kids have their own language and parents and parents and kids share their own language for these types of worries. So some kids know the word anxiety and some kids know the word worry and some kids know maybe like fear, but I think you have to ask the family, I like to ask like, so what is the name or the language your kid uses to describe the feeling that’s driving these questions or this checking behavior or the avoidance? And so use the kids language to your point.

(04:30):

If they don’t have language, maybe give it to them in developmentally appropriate kind of words. I don’t usually start with anxiety with a kid that doesn’t know that word, but worry that lands. I’m like, “Oh, this feels like it’s making you worry a lot.” Or these things that we’ve been doing to try to help you feel less worried, they actually haven’t been helping you feel less worried. You’re still feeling kind of like you don’t know if you can do this or you’re not sure if you can handle this.

(05:01):

And so we’re going to go work with a therapist and we could talk about like what you call a therapist. I’ve heard sometimes people will refer to us as feelings doctors, which I like. I think it also depends on what the kid’s coming in with.

Dr. Emily Upshur (05:17):

Yeah. I mean, I guess what I really feel is, again, back to the context of the child. So if I have a child that’s having a lot of behavioral problems and that’s why they’re coming, right? I’m not going to call it a feelings doctor. I might call it a big feelings doctor. I might call it, “Oh, you remember this is a doctor that works on all these big arguments we’re having at home.” I think it’s really about the context. So it’s so hard. I don’t think there’s like one canned way we can talk about it.

Dr. Sarah Bren (05:51):

I think when you’re talking about that, it reminds me like, okay, our kids know they go to doctors all the time, right? They go to pediatricians, they know that context also. So remembering what your kid has basically it’s like what’s their … I’ll sometimes describe it as like a bookcase like we have all these books, these pieces of information, but what’s the organizing space upon which all the books sit, right? For kids, they have a bookcase for doctors and so referencing that like, “Hey, we go to the doctor, we go to your pediatrician to talk about how when you’re feeling sick to feel better, we go to them for checkups to make sure that things are going well even when we’re not sick and they focus on your health and your growth and your body. A psychologist or therapist does the same thing, but for your feelings and your relationships and how you feel about yourself, how we get along as a family.

(06:52):

A lot of times I’m working with families kind of parent child work or parenting and the kids still coming in for a little bit of that, even though I might be working mostly with the parents and I want to give the kid some context so they will say like, this is a doctor who specializes in helping families get along and how it helps us to make up after we have fights or fight less or get what we want from each other a little bit more easily so we can understand and talk with each other better. So I like the point of like you kind of have to know what your focus is to help orient the child to like what that person specializes in and how they help us using the words of the kid and also that first person experience of the kid. So what does the kid feel is the struggle That’s what this person helps us work on because some things are harder than other things, right? We are really good at some things and some things we need help with and that’s normal.

Dr. Emily Upshur (08:00):

Yeah. I mean, as you were saying this, I’m thinking, like I am having these strong feelings of I think one of the most important things is that the adult, the grownup, the caretaker, the parent sort of reduces their own stigma around therapy first, right? Because I think what you’re saying is what I hear you saying and what my experience with kids is they’re like, if the parent is very open to therapy, fluid with therapy, it’s a part of the family culture, it’s talking about feelings and hardship and stuff like that as a part of the family culture, the kids are like, ” Okay, and that’s it. “And they move on. And I think that speaks to sort of, you know, it is a little different because there is still some residual stigma to sharing your problems with people outside of your home or that type of thing.

(08:52):

I think really helping the parents to normalize like we go to exactly what you were saying. We go to coaches, we go to tutors, we might have a reading specialist, we might have a personal trainer, there’s a lot of normalization of it, but I do think we should validate like this might feel a little different than those things, those areas and that’s okay, but maybe we challenge it a little like why everybody has something to work on and this is just another part of our system, one of the systems that we have to work on. The more settled you can be in that as a parent, even myself, I have two kids in therapy, the more I can be like, ” Yeah, it’s just one of the things we do. It’s one of our activities to help broaden your life and make you a well rounded person. “The more I think they’re fluid with that too and it feels a little bumpy.

Dr. Sarah Bren (09:46):

And I think normalizing it is also, there’s an art to normalizing it because one, it is really normal. A lot of kids go to therapy. That’s also helpful to explain too is like, this is pretty common and actually on, I go to therapy or lots of people we know go to therapy. I mean, if you do go, I think it’s helpful to share that with them, but I also think…

Dr. Emily Upshur (10:09):

That’s a big one though. I think a lot of parents wonder if they should share that. That’s a great point.

Dr. Sarah Bren (10:15):

I mean, my opinion is yes, because I think the question should I share this with my kid is rooted in either stigma, but probably more likely rooted in anxiety, like worry that like if like this inherent story we might be telling ourself is there’s something wrong with me. Like if I’m going to therapy, my kid might think there’s something wrong with me. That might be the worry, right? And that might be this internalized narrative that we still carry around therapy, that we go to therapy when something’s wrong with us and I have to like bust that myth because one, I think we go to therapy to work on things and we all have things to work on and so I think you can paint for yourself and also for your kid a very honest picture of the fact that this is how we model bettering ourselves and getting help when things are tricky and that I’m not perfect, you’re not perfect, nobody is, and we all have something we could work on and that really helps pull that sort of that anxiety off of it, I think that the implication is if we do therapy, there might be something wrong with us.

(11:40):

I’ve definitely even had parents explain to kids like, “Oh, we’re going to be working on this thing. We’re going to go to therapy.” Or even not even mental health therapy, but like maybe it’s occupational therapy or whatever. And like a kid might say like, “Oh, is there something wrong with me that I have to do this thing?” And to that I’m always, I think the pull for parents, anytime our kid asks us a question like that, like, “Is there something wrong with me that’s super black and white thinking of if there’s a problem then there’s something wrong with me and that elicits in us a strong desire to reassure them and go in the equal opposite direction like, no, there’s nothing wrong with you. Absolutely not. You’re fine. Everything’s great.” And I mean, I totally relate to that desire to appease that misbelief about oneself, but ironically, counterintuitively, going all the way to that other like extreme of, “No, everything’s fine.” It can lead to like some incongruence for the child because there is something that’s hard and so we’re going to this place to work on skills to make that hard thing a little easier.

(12:58):

And instead of saying, “No, there’s nothing wrong.” I think we get pulled into this binary, right? Wrong and not wrong or okay and not okay, safe, dangerous, good, bad. I like to name that and say, “Oh, your mind just went to this place of like, if we do this, that must mean something’s wrong with you. ” And this isn’t really about right or wrong or good or bad. This is just about like you’re actually naming the polarity and then coming up above it and saying, “This isn’t really about that actually. This is just about getting better at stuff that’s tricky.” And that I think is more helpful when our kid does go to an extreme or we want to go to an extreme, even if it’s a positive extreme I think that’s all part of this problematic internalized narrative around therapy being for when something’s wrong with us and naming that and just saying, “Oh, that’s not actually what this is about.

Dr. Emily Upshur (13:57):

” Well, and I think the other point that’s like you and I talk about a lot and it’s really part of our ethos is it’s really only never one person, right? We view the kid who’s showing up in therapy as part of the family system, right? We are really not saying you’re the problem mom or you’re the problem child, right? We’re saying like, “Oh, something is bumpy in this whole system.” So I think that helps also de- stigmatize and sort of like normalize and talk about it as something a little less like something’s wrong with me, but more like, “Hey, our messages are crossing. We need to be a litle bit more fluid as a family. We’re trying to sort of have a little bit more ease in our interactions.” And I think that orientation, which I know is very much our orientation also helps because we do want everybody participating.

(14:51):

We don’t want there to be sort of just a soul, what we call identified patient. We’re really going to work. It’s not going to feel like just you and the kid, as a therapist and the child and we’re going to put them in a room and no one else is going to be interacting with it. So I think that really helps sort of ease a little bit of the feeling of that too.

Dr. Sarah Bren (15:11):

Right. And naming that, especially if like, so at our practice, what Emily is describing is like at our practice, even if your child’s coming to therapy at the practice, the parents are really involved, right? They might be coming into sessions depending on what we’re working on or we might be meeting with the parents outside of the sessions, but either way, I think that’s helpful if you are going to a therapy practice where your child is going to therapy but you’re participating either in some ways directly in the sessions with the kid or peripherally by having some parent sessions with the therapist so you’re in the loop about what’s going on I would name that also for the kid like, “Hey, so it also can help a kid feel like we’re all doing this together so it’s not just you are going to therapy. It’s we’re going to be working all of us as a family, we’re going to be working with Dr. Upshur or Sarah or whomever and her job is really to help us kind of understand each other a little bit better, get along a little bit better and so we can also, so me and dad, we can help meet your needs a little bit better or we can help you with your worries so that you feel less worried and feel more comfortable and that really believe you can handle some of these situations because I know it’s not fun when you want to go to a birthday party but you feel like you just can’t and you want to stay home instead because it feels too scary. I would anchor some of this stuff in real life examples for them, but also talk about how you guys are going to be doing this together in some way, right? It doesn’t mean you’re all going to be going into the session the whole time together.

Dr. Emily Upshur (17:01):

No, it just shows that like everybody has something to work on.

Dr. Sarah Bren (17:04):

Exactly.

Dr. Emily Upshur (17:05):

And I love that for a lot of these various issues that may come up in families, right all the way from anxiety to maybe some behavior stuff, everybody has a role and that sort of helps I think.

Dr. Sarah Bren (17:18):

Yeah. And one thing, especially with older kids and especially with kids who kind of understand why they’re going to therapy, why they might be, like why that would be on the horizon, right? I like, because I do this whenever I meet a kid too, even if the parents have an idea of what the kid is coming to therapy to work on, and even if I totally agree with those ideas and those become very much informing the treatment plan, I’m always going to ask a kid, “What do you want to get out of this time together?” Like what feels important to you? What feels tricky for you? What would you like to feel easier? Sometimes I’ll ask a kid, if you had a magic wand and you could wave it and something that’s hard right now would be easier tomorrow, what would you change? Or if you had three wishes, what would you want to see different?

(18:13):

And so that’s a great way to ask a young kid how to identify some of the things that don’t feel easy for them. If that’s a hard and too big of a question, you can anchor it in like a smaller context like in your classroom if you could wave a wand and change one thing, what would you change to make it feel easier or at home with your brother or when you’re playing with your friends at the playground. You can get even more specific to the sort of setting in which the challenges might occur because I think that also helps give kids some, it makes the question smaller and easier to answer. Absolutely. But knowing what a kid and for older kids obviously you can still ask that same kind of question, but I really want to get their authentic buy-in and what’s in it for them and what do you want?

(19:04):

This is 45 minutes a week of your time, your time, right? So what would you want to use this time for? And I always want that to be part of the treatment plan because it’s got to be their idea. I’m not saying that going to therapy has to be their idea. I’m saying for them to show up and feel like they’re going to have a useful and beneficial experience and like feel engaged and want to come back, they kind of have to understand that they have some skin in the game, that there’s something in it for them. And so I do think it’s important to kind of one, be curious about what they might want to get out of it and then frame therapy as something that can help them get that even if for like I’m thinking for like older kids, even if what they want is something that is an antithetical to what you want, like let’s say there’s a lot of conflict at home because you’re really trying to get your kid to participate more in family life and they’re avoiding, they’re isolating, they’re irritable, you’re fighting a lot and so we’re going to therapy to kind of work on emotion regulation and cooperation and participation and all that stuff.

(20:22):

The kid might say, “My goal is to get my parents off my back, get them to leave me alone. I want to play my video games. That’s what I want. ” And I think the instinct at that moment would be to be like, “Well, that is not what we’re going to therapy for. ” But I would really encourage parent to be kind of like, “Hmm, I wonder if that might be something you can work on with your therapist to give you some tools for asking for what you want, getting for what you want. ” Because I really do think that’s what I end up doing with kids is helping them find the reason why behind the things they’re getting stuck kind of entrenched in and get those needs met in a different way, a more effective way, a more collaborative way, but it starts by identifying, yeah, it makes sense you want that.

(21:08):

Let’s figure out why that’s so important to you. How do we find a way to get your parents to help you have more of that in a way that works within the family system better? And so I think with younger kids, that’s less of an issue usually, but I do think there is still a need to figure out how to invite a child of any age to identify something they want, whether it’s something they want to have more of or something they want less of or something to feel easier about. Then it’s a lot easier to talk about therapy from their language and their orientation, like their goals.

Dr. Emily Upshur (21:53):

Yeah, that definitely. Because on the flip side, I do also get a fair amount of people that are like, “My child is requesting therapy and I don’t even know if they know what it is. ” And I think that’s also a nice thing to think about talking to the parents too about like, “Well, this is what your child is requesting therapy. I wonder what you think about that. I wonder what you think the reasons are behind that and sort of help them come along on that path too.” It’s really helpful.

Dr. Sarah Bren (22:21):

Yeah. Well, we covered a lot of ground here. I hope that this was helpful and if any of you have questions about this, this is something we love to talk about and love to help families kind of navigate. So please feel free to write us an email, drop your questions, drsarabren.com/question, or you can find us on Instagram @drsarahbren and DM us and we’ll see you again soon. Bye Em.

Dr. Emily Upshur (22:46):

Bye.

Dr. Sarah Bren (22:46):

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.