How do you find the right therapist?

[klmno]

Long sorry-

Brief history: difficult child was fairly normal kid until he learned his dad had chosen not to ever see him or be in his life- this happened when difficult child was almost 11yo, in fall of 2005. I didn't tell him this outright, but he had questions that I answered honestly and he put 2 and 2 together. Then there was a cancer scare with me and a family friend died of cancer all in the same time period and difficult child was worried about what was going to happen with him. He started acting out at school and a couple of teachers and principal said things to him about being headed to juvy (his acting out at that point was not illegal activity so I felt that was uncalled for). Anyway, he was saying things like he must be bad and that's why his dad didn't want him and I tried over and over to help him see this was a reflection on his dad, not him, and that he wasn't "bad". Also, he was overly emotional over everything. So, I took him to a family therapist. It turned out he was a Christian focused counselor, not that there's anything wrong with this, but we weren't exactly looking for a spiritual healing at that point and I felt he should have told me up-front that this is what he does. He told me just get married and go to church and the problem would be solved. When I asked him to try to address what we were there for, he looked at difficult child and said "ok, so how does it feel to know your dad rejected you". I guess the therapist noticed my jaw on the floor and difficult child about to fall apart so he suggested going to a psychiatrist, that maybe he wasn't the right person.

We started with a psychiatrist and therapist in his office. difficult child's behavior got worse in the meantime and along with that, he gave away gifts/toys from Christmas and birthday, and started behaving very erratic and doing things that he could have died or been seriously injured by. (I call this indirect suicide.) neuropsychologist had been scheduled, that therapist was trying to address the "bad behavior" because he said it was more critical, psychiatrist hadn't prescribed any medications yet because he wanted to wait for testing and opinions on whether problem was more conduct related, depression, etc. One therapist we tried said (after 2 to 3 mos) he didn't know what to do about the erratic behavior. Erratic and dangerous behavior got so extreme that I took difficult child to psychiatric hospital who diagnosis'd him with Depression, rule-out bipolar and conduct disorder. They put him on prozac and after 6 weeks, difficult child was a different kid again, back to his old self and maybe a little better. A different therapist kept treating him like a conduct issue, and difficult child hated him, so we stopped that. neuropsychologist testing revealed scores all over the board, mainly problems related to memory and verbal things but above average in some things like problem-solving.

Things were going well until winter 2006-2007 when school notified me of escalating behavior issues. Nothing big in itself, but being disruptive often. I started noticing things at home- being overly emotional, etc., so I talk to psychiatrist who decides prozac dosage should be increased. 2 to 3 weeks later, after sd "rejects" difficult child (the way he interprets a long-term suspension), he goes on a 2 hour crime spree and racks up 7 charges. psychiatrist thinks it's prozac induced mania. difficult child was off all medications for 6-8 weeks this summer while psychiatrist evaluates base-line. Now, trying mood stabilizers. He starts seeing a different therapist who is more like a mentor and difficult child really likes him but this one never appears to address anything other than chat about whatever difficult child wants to chat about that day. They play computer games sometimes. I will say difficult child is showing more mature decisions regarding social interactions (friendships, avoiding issues with other kids, etc) and staying out of trouble more.

This past fall, he was evaluated by a psychiatrist/Educational Sp/therapist team at teaching hospital. Now, this team had been given all previous records and spoke to current psychiatrist, then interviewed us and gave difficult child a different test (?), so they were well-informed about all history. Someday, I might actually get the written report. Anyway, this psychiatrist said this is not that difficult. She says it was the "dad" issue that caused a serious depression to start out with. He needs a therapist to deal with this first (Adjustment disorder and depression). Second, he is cycling now so keep on mood stabilizer for time being. He needs therapist to work with him about the "I must be bad, therefore, I act bad" and a therapist to work with me/or us about how I can help him and parent him better to stay on track. Because Mainly, she believes it's treating difficult child's bad behavior like he's a major conduct problem that triggers the mania, yet, obviously, it has to be dealt with somehow while trying to get him out of a negative cycle. She believes this is so textbook, one therapist should be able to cover it all. Then, she herself says, who would be the right therapist for that?? She said if we can get a therapist to cover these issues, the cycling might stop and she thinks there is a good chance difficult child could learn to manage/prevent these tendencies in himself and MIGHT be able to try coming off all medications at some point down the road.

So, parents, this is my question, who would be the right therapist? And, how do you find them. Calling up asking has only gotten me "of course, we can handle that" then it's that difficult child would have to give up this therapist/mentor he has, which doesn't sound like a good or agreeable idea. And, I'm afraid we're going to end up with another bad experience- someone who really doesn't know how to address these things appropriately and none of them tell you that until they've made things worse. Is it just the area I live in - many of you here seem to have found excellent tdocs. Tdocs here really don't seem to know any more than common sense.

 

[smallworld]

First, do you "buy" the theory that the new psychiatrist set forth? In other words, does it make sense and ring true in your difficult child's case?

Second, how stable is he on his current medications?

Third, what are the current therapist's qualifications?

Fourth, when do you think you will have a copy of the report? I'm not sure I'd recommend making any moves until that report is in your hands.

Personally, I don't believe any case is "textbook," including your difficult child's. If you live in the Difficult Child metro area, PM me. I might be able to give you specific suggestions.

 

[klmno]

Yes, psychiatrist's words seem to make everything fall into place- so much so that I felt a weight being lifted off my back.- In a way- of course, there's still the issue of treatment. Whether or not bipolar issues (cycling) is going to be a MAJOR issue for the rest of his life or a "tendency" that he can primarily maintain himself remains to be seen. I can't expect more than that. I was very impressed with psychiatrist- she didn't seem to waste time on completely unrelated things but seemed thorough in eliminating some comorbid diagnosis's- like Obsessive Compulsive Disorder (OCD), for example. She seemed EXTREMELY educated about mood disorders, yet could still speak/explain things to me and difficult child in a down-to-earth way.

He's stable in the sense that I don't think he's a danger to self or others, not something I would have said in Feb of 2006. . I don't think medications are quite right yet. psychiatrist on evaluation team asked an interesting question to both difficult child and me. She asked as compared to how he was at the worst, and that being a zero, on a scale of 0 to 100%, how much of an improvement do I see right now. I put it at 60%, however fall of 2006, I would have said 90%. difficult child said he thought he was at 70 to 80% right now. Something doesn't seem quite right to me and difficult child has said similar things- like "these don't seem like right medicines for me". Now, he clearly had several bipolar signs when he was not on any medications, but again, I don't think we have them right yet.

Current therapist, along with the others he's had, is Licensed Clinical Social Worker (LCSW). He's great as a mentor, I think, although I still have some reservations. Then, there's the fact he hasn't returned either call I ever made to him (2 or 3 in a six mo. period) and then I had asked him to recommend an advocate for IEP issues and he assured me he could do this, then charges me $100 to go to the meeting and had absolutely nothing to offer except telling school members that he'd work on behavioral issues with difficult child and handing out business cards. I had asked the intake person at this grouup about a therapist for me/difficult child issues but she said since difficult child was seeing this therapist, I had to go thru him. I was uneasy about that because I just can't view him as anything other than a mentor- he's never addressed any real issues. I actually wonder sometimes if he's even "kosher" with too much "play time" and "not telling too much". I'm overly paranoid about things like this sometimes though, so it could just be me. difficult child likes him and given the issues difficult child has, I hate to remove his mentor from his life.

I need to write a letter (the 3rd) to this place about getting a report. I've been getting the run-around by the people answering the phone. The psychiatrist apparently has her report finished but the Ed Spec might not and they want to wait for both to be complete. But, twice they told me they did mail a copy to me, however, I never rec'd anything. I've told them I'll come pick it up in person, they tell me they'll call right back, then never call.

I'm in central Va.

 

[klmno]

Another thing I shoulod mention, psychiatrist on evaluation team implied that if we'd had a therapist on board at the very beginning who addressed the first issues, and things hadn't gotten to the prozac script, it appears a lot of things could have been prevented and might never had developed.

 

[BusynMember]

Hi, hon. I saw you wanted my input. Wish I could help you, but I haven't had really good luck with therapists. Self-help groups helped me the most. As far as therapy, one type of therapy did help me, but it's Cognitive Behavioral Therapy. And as a kid, well, back then I was "bad" and there were no therapists. Not really. I'm so sorry I couldn't help more. I hope others can.

 

[flutterbee]

I found our therapist by word of mouth. She was recommended by our guidance counselor who knew of another student seeing her and had seen good results.

Before I took difficult child to see her, I spoke with her at length on the phone and met with her individually. (Although I was 99% sure when I talked to her on the phone that she was going to work out. She just seemed to really get it. I didn't have to break everything down, Know what I mean??) By the time we got to her, we were several years into this with no luck. One therapist was too easily manipulated by difficult child, another was too intimidating to difficult child...you get the idea.

She is an MSW (Social Worker - Master's Degree) and she was the first person to pick up on the Executive Function and possible NonVerbal Learning Disorder (NVLD) issues. She was the first person to recommend a neuropsychologist. She was the first person to really 'get' difficult child, and she also understood that her relationship with difficult child (as with any therapist with difficult child) was volatile and proceeded carefully. In fact, she refused to see us as a family for fear of alienating difficult child. She wanted us to see someone else for family therapy...someone she would, of course, be willing to share information with.

Find out what therapeutic interventions the therapist employs. CBT is very common and is the gold standard with which to treat depression, among other things. But, there are others out there like EMDR, sand therapy, etc. Sometimes a combination of treatments are helpful, especially if they seem to hit a wall that they can't get past. Get a feel for how s/he would relate to difficult child. They need to build a bond with the child so the child feels comfortable opening up and really working with the therapist. Would your son be more comfortable with a man or a woman? Those kinds of things.

Good luck.

 

[flutterbee]

Oh...I forgot to mention building resources. difficult child's therapist talks about this a lot. With anyone - child or adult - who is emotionally fragile, somewhat unstable, whatever you want to call it...before you can really work on the hard stuff, the therapist should first work with the patient to build resources to be able to cope with the stuff they work on down the line.

If they start pushing too fast, too soon they're going to push difficult child right out the door. We had that happen with a therapist (psychologist - doctorate). He didn't realize just how volatile difficult child was - she can compensate very well - and he pushed too hard. We weren't even out the door when difficult child started full blown meltdown. We got home, I sent her upstairs to her room to let her get her meltdown out and called therapist from the kitchen phone to find out what in the hell just happened. I got his voicemail. He could hear difficult child screaming on the voicemail and she was upstairs on the other side of the house with the door closed. He called me the next day and was just dumbfounded. I was kinda like, 'Now do you believe me?!' He actually was a very good therapist. He just didn't pick up on how volatile difficult child was. But, that cinched it. He could get nowhere with her after that.

 

[Martie]

Hello,

Finding the right therapist can be difficult for a male child with issues such as yours. My ex-difficult child only related well to one therapist out of many and one psychiatrist. That said, he did get better over the years. Some people are good for one thing (like mentoring) and others are good with medications and sorting out diagnoses. I REALLY don't like that current therapist charged you for contributing nothing to an IEP meeting and handed out business cards. Ditto that you can't get the new evaluation report in writing. I agree with smallworld and I would not make changes without the report.

There is no magic formula for finding the good therapists and avoiding the rip-offs artists but word of mouth is a good resource, and I have always used my professional contacts with therapists who only see adults as informational resources because they tend to know who the good child therapists are. Specifically, even though your child is not adopted, a therapist who has experiences with loss and feelings of rejection turned inward (and outward) might be something you would want to ask about in seeking a therapist. One of the best family therapists I ever had contact with specialized in attachment issues and even though that was not ex-difficult child's issue, the therapists' vast experience with adopted children was a big plus.

I wish there were an easy answer.

Martie

 

[klmno]

Thanks, Ladies! I'll start by faxing a letter to evaluation team about report and maybe go ahead and make an appointment with a therapist just for me to see if they can recommend someone for this situation.

 

[DammitJanet]

If they think that one therapist might be able to do it then I think that you making an appointment and getting a feel for the therapist might be a good way of feeling things out.

I have had many bad experiences with therapists in my time but I allowed myself one more chance with this last woman I see now. I am so glad I did. It was a leap of faith. She is wonderful! I wish I could clone her.

She is empathetic and kind. She just gets it.