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Sunday, August 7, 2011

DIVORCE: How Will I Know if My Child Needs Therapy?

The first concern of parents who are considering divorce is, how till it impact the kids?Most parents worry that divorce will have some sort of negative impact on their children, and so they seek out counseling sometimes immediately after telling the kids about the divorce. Divorce is full of changes and children have trouble coping with stress. For example, children who move neighborhoods, for any reason, between the ages of 6 and 16 have higher rates of drop-out, unemployment in their 20′s, and teen pregnancy. A lot of changes are wrapped in the divorce.

Nearly all children of divorce will have
strong feelings of sadness, anger, frustration, and
anxiety, but can cope better than others, some
receive more support than others.

There are quite a few scientific studies that have tried to answer the question of “how will divorce affect children.” However, this is a very difficult question for science to answer. In the book, The Unexpected Legacy of Divorce: The 25 Year Landmark Study, Judith Wallerstein looks at data from a longitudinal study of the impact of divorce on children into their adult years. It’s definitely worth reading. But, like other studies, it cannot provide readers with the ability to make a clear prediction of how their children will be impacted by divorce.
 
There is no way to predict how children will be impacted by divorce 
in the short-term or the long-term, but counseling is one viable intervention 
to help lessen the negative impacts of divorce on children.

Since I’ve been in private practice, I have had many parents call to make an appointment for their child or a sibling group. The most common presenting problem has been, “We’re going through a bad divorce and I want the kids to have someone to talk to.” I usually ask quite a few questions at this point, and in the end, most children do not seem in need of counseling or psychotherapy at the time of the phone call. I actually end up meeting with the parent or parents to discuss some of the issues in this post as well as give parenting advice to cope with various other problems.
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If you’re going through divorce, it’s probably not a good idea to start the kids in counseling without having some concrete behavior problem that you have observed and can describe to the therapist. Counselor’s need a concrete presenting problem on which to base their initial assessment and to focus on during therapy. And, if you plan on using insurance, the therapy will not be covered unless your child has a mental health diagnosis, such as depression, anxiety, or adjustment disorder. 

Starting therapy before your child needs it or is ready for it can backfire. 
It’s also something to discuss with the other parent – 
hopefully they’ll take a supportive or neutral stance 
and not undermine therapy.

I find that divorcing parents often project their fears, sadness, or anger onto their children. For example, a parent who is distressed about the divorce may feel as though the children feel equally as distressed when in fact they are not. It’s very important for parents to be honest with themselves about their own level of distress. It is not a sign of weakness to feel sad, fearful, or inadequate during a divorce – it’s expected - and having someone to talk to about these bad feelings will keep you healthy.

With regards to children, in general, I recommend that they be screened or evaluated by a licensed mental health practitioner if they have any of the following symptoms:


1) Changes in their mood, either more irritable than usual for longer periods of time, or flat mood or “affect” for any period of time;

2) Changes in their behavior, such as becoming hyperactive, or inactive;

3) Changes in sleep or diet, either eating significantly more or less, gaining or losing a noticeable amount of weight, or having significant difficulty falling asleep, staying asleep or waking up much earlier than usual.

4) Some children might start behaving compulsively, such as organizing things, touching things a certain way or a certain number of times, or developing new fears or old fears becoming worse (dark, burglars, storms, etc..).

5) If you child’s functioning becomes consistently worse, such as social withdrawal or acting out, or their academic performance declines, or their self care diminishes, then an evaluation is needed.

6) Watch for signs of substance use or abuse in teens, such as moodiness, monetary habits, missing items, locking themselves in their bedroom or bathroom, going for long walks, or changing their friends.

Childhood “depression” is actually a controversial issue in mental health. Children may not experience depression in the face of divorce, but teens surely can. Children may instead react with increased anxiety or tension or with behavior problems; they are more likely to act out their emotional problems. We can label these behaviors as “depression” but in the end what matters is that children who are exhibiting significant changes in their mood, behavior, sociability, academics, or diet and sleep need an evaluation.

Divorce is a risk factor for suicide for children and teens. Although suicide is rare for children, it is more common for teens. Fortunately, most teens who attempt suicide do not succeed. The ratio is somewhere around 4:1, suicide attempts to suicides.  

Threats of suicide, either direct and clear or passive 
(“I wish I were never born… I wish I would die”) should be taken very seriously 
and require immediate evaluation in most cases by a licensed mental health practitioner.

This post was not meant to provide all the information needed for making a decision about admitting your child for therapy. If you have questions or concerns, use this as a guide, but contact a local licensed mental health practitioner who works with children and divorce and ask them questions, too. I recommend the following types of mental health practitioners: Social Workers, Licensed Professional Counselors, and Licensed Psychologists. The fees might be different, but they use the same types of therapy techniques, they take insurance, and they will do a thorough evaluation of your situation. You can consult with your pediatrician or your General Practitioner, but keep in mind that they are not mental health practitioners and they will likely have no experience treating children or parents going through divorce; however, they may refer you to a mental health practitioner that they trust.

There are some good self-help books out there, like Sandcastles. There are books geared towards different ages and cultures. So, consider this type of intervention as well; it’s something that you can read with your children, and during divorce children might need more one-on-one time with their parents than usual.


Mental Health Advice Disclaimer: The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

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