Why Isn’t My Son Getting Better? part III of III

In part I, I addressed how an inadequate psychological/psychiatric evaluation often results in boys not benefitting from mental health treatment. In part II, I addressed how other mental health provider (“MHP”) factors can contribute to treatment failures. In this last segment, common parental mistakes, leading to complications in treatment, are addressed. Typically, at the root of these mistakes, is a lack of information about the mental health field and the treatment process.

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For example:

Over the years, I have encountered many parents who mistakenly believed that all MHP’s were created equal and that any MHP could treat their son. Wrong! Child and adolescent MHP’s are highly educated as well as extensively trained in treating these specific populations. So, choose very carefully who treats your son.

Whereas, other parents believed that briefly consulting a MHP whenever a crisis arose was sufficient. The inherent problem with this “crisis oriented approach” is that the symptom may temporarily improve but the underlying cause was not addressed, never mind resolved. Consequently, additional crises continue to occur until you do so.

Along, those same lines, I have encountered other parents who believed that boys could be treated in 6 appointments or less. Although insurance companies may perpetuate this myth, this really isn’t possible because of what’s involved in establishing rapport, getting the lay of the land, and then facilitating change.

In my 25+ years of experience, the greater the emotional distress of the boy, the more serious the problem(s), and/or the longer duration of the problem(s), the longer it will take for that boy to make significant as well as lasting changes. Typical duration of treatment for boys under my care ranges from 6 months to 2 years. So, sticking with treatment, getting to the root of the problem, and then resolving it is definitely in the best interest of your son as well as family.

Yet, other parents I have interacted with initially didn’t understand how frequently changing MHP’s was actually counterproductive. Obviously, the inherent problem with this approach is that you’re starting all over again every time you consult a new MHP.

However, because children and teens develop a close relationship with MHP’s who help them solve problems, these kids and teens often have difficulty transitioning to a new MHP. Consequently, if you change MHP’s too many times, your son will quickly learn not to invest in future MHP’s as well as in the treatment process.

So, be proactive. Research whom you consult and how they conduct business, as well as examine the treatment decisions you make as a parent so that your son’s struggles are short-lived and his future is bright!

Originally published on The Healthy Planet, December 31st, 2014

Why Isn’t My Son Getting Better? Part II of III

Previously (in part I), I addressed how an inadequate psychological evaluation typically results in a treatment failure. Lack of rapport, lack of experience, lack of intensity, and poor boundaries are additional reasons why boys do not benefit from mental heath treatment.

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Let me explain:

First, no boy is going to trust or open up to a mental health practitioner (i.e., “MHP”) where ample rapport or a good connection is lacking. For this reason, from the get-go, a MHP should be devoting his or her attention to establishing rapport with both parents as well as their son, and before embarking upon treatment.

Second, attempting to make a boy “fit” the treatment approach a MHP was trained in often results in a poor fit as well a treatment failure, too. A MHP must meet a boy where he is; and, this requires extensive knowledge of and skills in many different treatment approaches. Not surprisingly, a recent study found psychologists 5-10 years post-graduation tend to be eclectic and use techniques from multiple treatment approaches. Suffice to say, choose a MHP based upon education and training as well as experience.

Third, lack of intensity or appointments occurring on an infrequent basis (e.g., at 2-3 weeks) isn’t going to result in much treatment progress, either. Appointments occurring here and there, at best, are about re-connecting and catching up versus conducting treatment. Depending upon the severity of a boy’s presenting problems, appointments need to occur at least on a weekly basis and, sometimes, even at a higher frequency.

Fourth, poor-boundaries are yet another reason for treatment failures. Although many MHPs believe that they can concurrently treat boys and their parents; many boys would disagree!

Typically, this takes the form of a MHP either splitting sessions by first seeing the boy and then his parents, or alternating sessions between the boy and his parents. Not surprisingly, many boys don’t trust MHPs who play on both sides of the fence because they (i.e., boys) believe that whatever they disclose to these MHPs will be directly relayed to their parents. Sadly, this is often the case. If more than one modality of treatment is indicated (e.g., individual psychotherapy, parent training, family therapy, &/or marital therapy), different MHPs need to render these modalities of treatment.

So, if your son is not progressing in mental health treatment and some of the above issues are present, it’s definitely time for a second opinion.

Originally published on The Healthy Planet, November 30th, 2014

Why Isn’t My Son Getting Better? Part I of III

More and more boys are being referred to me because they have not benefited from prior mental health treatment. Are these boys really untreatable or is something else amiss?

In my experience, many so called “treatment failures” can be traced back to an inadequate evaluation. Because most parents don’t know what constitutes an inadequate evaluation, a few examples will suffice.

Solely using a rating scale, completed by parents and teachers, to generate a diagnosis (e.g. ADHD) and then writing a prescription(s) or rendering another modality of treatment (e.g. social skills group), is an example of an inadequate evaluation and one that often results in a poor treatment outcome.

Rating scales may be objective instruments but those individuals filling them out are not. In fact, even when psychologists are extensively trained in how to rate a certain behavior (e.g. hyperactivity), correlation rates (i.e. agreement) among them rarely exceed 80 %. This is why the results from rating scales must be interpreted cautiously, and why they are merely one of many components of an evaluation.

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Another example of an inadequate evaluation is jumping to conclusions after only one 45-minute contact with a boy and his parents. Contextual variables greatly influence what is observed in a first interview. For example, meeting a new doctor for the first time often creates anxiety and restlessness in many boys leading some to erroneously believe that the boy is suffering from ADHD or an anxiety disorder, when he isn’t. The purpose of a first contact should be to establish rapport, gather history, and formulate hypotheses, and nothing more.

In contrast, a comprehensive evaluation is a time intensive process that requires many face-to-face contacts with parents and their son as well as with their son individually in addition to consulting with teachers, coaches, and prior mental health providers.

The prime objective of a comprehensive evaluation is to gather extensive information about a boy’s behavior or functioning across many settings. The second objective is to integrate all of this information and clarify how this boy is struggling, where he is struggling, and why. The third and last objective is to formulate an accurate assessment (i.e. diagnosis) as well as recommend appropriate modalities of treatment. Successful treatment outcomes are much more likely to occur under such circumstances.

So, if your son has been in psychological and/or psychiatric treatment for more than 3-6 months and he has made minimal or no progress; and/or you have consulted more than 2 mental health practitioners with essentially the same outcome, then, it’s clearly time for a comprehensive re-evaluation or 2nd opinion.

Originally published on The Healthy Planet, November 2nd, 2014