Dear Dr. Wes:
What tips do you have for finding a good therapist, particularly for a child with ADHD?
This is an issue of great interest to many readers, Simon. So, I’m going to answer it more generally and then add in a few specifics about ADHD kids and families. First, consider consulting your child’s pediatrician to see whom he or she recommends. Some physicians have professional experience with certain therapists and can help narrow down the field to a likely match for your child. We receive local and regional referrals from physician’s offices every week because we’re known to offer an integrative approach to therapy and medication management for kids and adults. However, I’ve talked to enough parents since my book came out to know that this is far from a sure-fire solution. Some physician’s offices just keep a list of providers that’s little more than an alphabetical directory of names in the community. When it comes to mental health, you really want more than a list, you want someone you can trust. So, if your pediatrician declines or hands you a list, you better start from scratch.
Talk to friends and family who have gone to therapy, particularly if they have a child with ADHD, oppositional tendencies, or similar social/academic struggles. Other consumers can be your best resource. However, since every office has both raving fans and former clients who were less impressed, try to get more than one opinion. Depending on how large your town is and how many providers there are, you shouldn’t have too much trouble picking out those who’ve been successful.
One thing that works great in picking other businesses and just doesn’t work for therapy, is online reviews. Our profession actually discourages reviews on Yelp or Google because privacy concerns prevent us from responding to them. They also tend to skew negative because really, who is going to go on line and spend time congratulating their therapist? It’s just not that kind of relationship. Moreover, there are hundreds of weird healthcare rating sites that show up, grab a provider’s name and then try to get us to claim the listing and buy worthless advertising. No reputable provider does that, so any rating you see isn’t as meaningful as say, an Amazon rating of a product or an Angie’s list rating of a home contractor. If you don’t know someone personally, I wouldn’t accept their review.
For an ADHD child, you might also look at directories for both the CHADD.org website and ADDitude.com. Both list professionals by state, but both note in big bold letters that they are not endorsing anyone’s services. So, consider this more of a directory, and less of a referral. Speaking of which, the days of the yellow pages are long gone. Almost no one advertises in print any more. Instead, try Therapyfinder, which is a service of Psychology Today. We advertise there, but many providers do not. Sometimes a good Google search will work just as well.
Once you’ve identified several providers, read each one’s webpage for information on how they practice. I may be an overly pro-tech (which is why you’re reading this on our blog now and not a newspaper), but I think any practice that doesn’t put time and energy into a good webpage isn’t sending a very good message about their dedication to practice. Yes, some providers may disagree, but the value of a consumer being able to assess a mental health provider’s information when making a decision about treatment far outweighs the learning curve in creating an informative website. Even therapists who don’t have much online prowess will provide you with a resume upon request. And if they won’t do that, it’s pretty hard to make a decision to see them.
Look for someone who clearly specializes in working with kids the same age as your child. That means both training and experience. The training can be in graduate school or in continuing education. I personally take two or three times the amount of continuing education required for relicensure each year. It’s okay to ask a therapist how they’ve specialized their continuing education, though it may not be super obvious to a layperson. For example, I did a full year of study at the University of Michigan to become a sex therapist and sex educator. On first blush, you might think that’s more relevant to adults than kids, but in fact, my entire point in taking that program was to improve my ability to work with teens and young adults around issues of sexuality because, guess what? That’s what they want to talk about regardless of their diagnosis. That has actually sharpened my skills in working with teens. Frankly, it’s more important that the provider has a coherent plan for continuing education than that they study a particular issue. Too many providers just sign up for anything that comes along close to home.
Regardless of training and experience, some therapists just aren’t suited to work with teens. Others are great with teens and not so great with younger children. Some know these limitations and advertise them. Others believe that as long as they are kind and caring, they’re ready to roll with whomever walks through the door. If you see a therapist who lists just about every specialty imaginable in every age group, you should keep moving. This isn’t evidence of breadth and flexibility. It’s evidence that they’re overselling their skills.
When you decide you like an office, contact them using their preferred method of communication. Some want a phone call. Others prefer electronic contact. We have a form new clients fill out and submit securely and then we follow up on email. We have scores of new clients each month and this helps us keep track of them while helping us gather critical data before we ever meet a new person we’re going to treat. It’s helped us match client and therapist far better than in the past.
Some commentators will advise you to set up an interview session with the provider either by phone or in person to get a feel for how they practice. There’s an old riddle that explains why I don’t think this is a very good idea. Let’s take advantage of its wisdom:
You’ve just arrived in a new town, seeking your fortune, and you need a haircut. In this town, there are two barbers. The first barber has a neat, dapper haircut, and his shop is immaculately clean. The second barber’s haircut is awful. His shop is filthy. Giant tumbleweeds of hair drift across the floor. The scissors are caked in layers of rust. Which barber do you want to cut your hair?
Answer: You cleverly deduce that the first, well-groomed barber couldn’t possibly cut his own hair; therefore, he must get his hair cut by the second barber. You also realize that the second barbershop is filthy because that barber has so many customers he has no time to clean. You go to the messy, unkempt barber.
I’m not suggesting you go to the filthiest therapy office you can find, but I would suggest that providers who have enough time to call you back and talk for half an hour or those who can afford to hand out free get-to-know me sessions are either independently wealthy or struggling to get clients in the door. Moreover, you’re not likely to learn enough in those informal discussions to answer your questions about whether the person is right for your child. Instead, go in, pay for an intake, take your child, and see what you all think. The exception are providers who require a call or meeting as part of their intake process, just as we require our forms to be submitted up front. Such providers are usually so busy that they have to narrow down the field of clients they accept. Because they’re so picky and reject clients they don’t think they can help, they usually have good success rates. If they think your child is a good candidate, this may be a good arrangement. But those providers are rare and if you’re not selected, you’ll be back on the search.
You may be tempted to go in to your chosen therapist and meet with him or her first minus your child. Some parents think this is a good screening tool before entrusting their child to the therapist. Except in rare cases, I strongly advise against this. First, you can’t tell much about a therapist without seeing how they interact with your child. Second, any chance that your child might connect with the therapist is blown sky high when he or she finds out you’ve already flown over that territory and dropped your version of the truth. And before you ask (as many have), “Do we really have to tell our child we came in first?” consider whether you’d trust a therapist who agreed to that kind of secret bargain and whether you could ask your child to trust him or her. Yes, I know therapists who do this sort of thing, but I don’t refer to them. Though things have improved greatly in the last few years, some kids remain leery about therapy. Don’t double down on their suspicions by getting off to a bad start. Once in a while a parent will insist on this. If they can’t give me an unusually good reason, I decline the case.
In meeting with a therapist what should you be looking for? Here are a few things I suggest considering:
- I’m not a fan of gender-matching. The idea that a girl needs a woman therapist is as outdated as any other gender stereotype. The same is a true for guys. Apart from good training and experience, what children need is a therapist who captures their attention, entertains them, and wins their hearts. Some guys do much better with women therapists and I’ve made a career out of seeing teen girls and young women.
- Connection is everything. Therapy has to be influential and without a one-to-one human connection it simply won’t be. As but one example, if your child isn’t talkative, the last thing he needs is a therapist who sits in silence and waits for him to speak. And some do exactly that. A skilled therapist knows how to “feel” his or her way through a session with a quiet kid and knows how to shut down a kid who is talking “all over the place.” ADHD kids come in both of those flavors so a good therapist has to be flexible enough to change up as needed. And remember, your view of a therapist’s connection may differ substantially from your child’s, so try and think about this through his or her eyes, even if your child isn’t yet the most discerning therapy consumer. It’s not always how much your child “likes” the therapist that will indicate a connection. Recently, a middle school girl told her mom, “God, sometimes I just want to kill Crenshaw.” The mother said, “Really? Then are you sure he’s the best therapist for you?” The girls said, “Yeah, I know he is. Because sometimes I want to kill him.”
- Connection is top priority, but that doesn’t make individual-only therapy the best modality. Be sure the therapist knows how to involve you in the process. In most cases, children and teens should not routinely be seen in therapy without some ongoing consultation with parents. Sometimes I see kids with their parents every session. Other times I see the parents only three or four times a year. Also, consultation doesn’t mean the therapist downloads everything the kid says. In fact, that’s a sure-fire way to fail. It means the therapist advises you on how to work better with your child, maintains the child’s privacy, and keeps all consultations above board to avoid garnering suspicion.
- In joining the process, it can be difficult to watch someone else care for your child, especially if they appear to be very good at it. However, if your child broke an arm, you’d go to a specialist because you couldn’t heal the arm yourself. The same is true with therapy. We’re not your child’s parents and we can’t replace you, nor do we want to. But you do have to step back and let the process unfold while also coming in to work as a team with your child whenever asked. Some parents err in one direction and others err in the opposite. Our goal is to strike a good balance.
- Parents and kids should leave therapy with specific strategies. The process will often drift, and in many cases, that’s a great journey of discovery. But it has to be problem solving too. The best therapists tend to be “kindly blunt” in directing you and your child on that journey, not just a caring ear or paid friend. In fact, if you and your child like everything your therapist is saying, you may be with the wrong therapist. If your kid “Wants to kill Crenshaw,” we’re either making progress or I’m in deep trouble. Feel free to ask which.
Finally, make sure that you’re giving any therapist you choose enough time to show results. It’s easy to jump to the conclusions that something doesn’t “work” after a couple of sessions. But therapy takes time and effort, for both the child and the family. Make sure you attend the sessions and follow the therapist’s advice, until you have a clear reason not to.
If you have a question for Dr. Wes or any of the FPS staff, send it to email@example.com.