When Should a Child See a Therapist?

Would a shrink do more harm than good?

by Susan Stiffelman

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My 6-year-old granddaughter has become very anxious lately. Her pediatrician believes her eczema is aggravated by stress. She was due for two shots at her last doctor's visit and fought so hard that it took two nurses and her mother — my daughter — to subdue her so she could get the shots. Could seeing a therapist help her?

Absolutely. A good therapist could help your granddaughter get out from under the grip of her fears and anxiety. Just as important, a skilled family counselor can teach her parents how they can help their daughter when she is feeling stressed.

Most adults try to lessen children's anxiety by attempting to persuade them that their fears are irrational. But if they sense that adults are not taking their concerns seriously, most will children resist the assurances that well-meaning adults offer.

To avoid having your granddaughter keep her worries to herself, (where they can become magnified and create ongoing stress), it's important that the adults close to her allow her to express what she's feeling openly.

A therapist who specializes in treating children is trained to help kids come to terms with their fears and develop strategies for dealing with them effectively. Through conversation and play therapy, the right therapist could help your granddaughter become more empowered to handle the worries that limit her enjoyment of life.

Your granddaughter's parents can also help their daughter with her anxiety. By giving her what I call an Act I, where she can express her worries without them telling her all the reasons why she shouldn't be afraid, she'll become more receptive to their support.

The theme song of Act I is, "What is it like to be you?"

"Oh sweetheart, it looks like you're getting pretty scared of that shot."

OR

"Honey, are you starting to think that shot might hurt a lot?"

If your granddaughter says, "Yes! I know that shot is going to hurt REALLY BAD," you might say, "I'm guessing you wish that the nurse would change her mind and decide you don't need it...."

After she's expressed her worries and feels heard and understood, ask if she'd be willing to hear another point of view. I call this Act II. It's here that you can offer information that might lessen her anxiety.

"A shot can sting. But do you remember when you stepped on a bee and got stung? You handled that even though it hurt so badly. That was much worse than a shot...."

Most parents skip Act I and quickly move to Act II, hurrying to explain to children why they needn't be afraid or upset. But without an Act I, children tend to be unable to hear anything useful.

This is especially true if a child is in the midst of a meltdown, as your granddaughter was when she fought off the nurses at the doctor's office. If a child is already in the middle of an anxiety attack, she is incapable of processing whatever rational advice you might offer to convince her to stop being afraid. What she needs when she's out of control is a calm captain of the ship. When you help a child feel that you understand what she's experiencing without judgment or criticism, it helps her relax and come out of her tailspin.

There are many other ways of handling a child's fears, both chronic and acute. An experienced and caring child therapist can help your granddaughter with her anxiety, and can help her parents learn more effective approaches to manage her fears.

As far as finding a good therapist, the best approach is to ask those you trust. You may also visit aamft.org or psychologytoday.org for referrals. Both your daughter and granddaughter should feel comfortable with the therapist they choose; there's no harm in "shopping around." Even a most well-respected therapist cannot help someone unless there's a natural sense of ease and connection.

Got a dilemma? Find the answer and more of Susan's great advice in our Ask The Therapist section.