Dear Therapist:

Thank you for this forum and for your time and advice. Our son's school recommended that our 7-year-old be evaluated for behavioral issues at the end of last school year and that he may benefit from some extra help during summer vacation. We had him evaluated privately and paid privately for the sessions that he is receiving and b”H have seen improvement in his overall behavior and his ability to follow instructions. He wasn’t diagnosed with any behavioral anxieties or disorders and doesn’t require any medications.

Our question is how do we know when he has benefited enough from the sessions and that we can stop them? Aside from the cost of the sessions, there is also missed time from school and other difficulties including taking him to and from the sessions in middle of the day…Of course we are willing to do whatever is best for our child but perhaps he has gained enough and can stay in school at this point and doesn’t need the extra help, even though the therapist still wants him to come. 

Response:

I’m glad to hear that your son’s behavior has been improving. Since therapy was initially recommended for behavioral issues, it makes sense that your evaluation of progress is based on current behavior as compared with past behavior. However, there are a few questions that should be addressed before making a decision about discontinuation of therapy.

From whose perspective has your son’s behavior improved? From your wording, it sounds like you may be largely focused on your own observations. If this is the case, there are a few factors to consider. Has his behavior improved in school as well? If so, is this based on feedback from all teachers and faculty? To what degree has his behavior improved (both at home and in school)?

Have you had a discussion with your son’s therapist about the reason they believe that therapy should continue? Did you discuss what it is they still hope to achieve? Have you been a part of the therapy process? Has the therapist kept you apprised of goals and progress?

Your focus appears to be on your son’s behavior. Although this is naturally important, this can be viewed as a “surface” issue. Sometimes behavioral problems do develop due to simplex (surface) factors, like too permissive or too restrictive discipline at home or in school. In these instances, the importance of including parents and school faculty in the therapy process seems obvious.

However, there are often emotions that underlie problematic behavior. Feelings of fear, anxiety, sadness, of being different, and many others can lead to behavioral problems. When this is the case, it is the therapist’s job to identify these feelings and to help the client (along with the parents when appropriate) to work these through. This is significantly more important than simply reducing or eliminating the troublesome behavior. Even if the behavior never resumes, other problematic behaviors can arise. If this does not occur, the underlying issue tends to intensify, often leading to much bigger problems later on.

There are other possible reasons that your son’s therapist recommends that therapy continue. It doesn’t seem that you have very much information about the therapy process, so the sole determinant at this time appears to be your assessment of your son’s behavior. I would recommend that you contact his teachers and other faculty to obtain a more universal understanding of his behavior—as well as their observations with regard to his general mood and emotional disposition.

It is important to get a full understanding of your son’s therapeutic progress and goals. It is also important to have a clear understanding of the issues that have been identified and addressed in therapy. In order to do this, it is imperative that you schedule a session with the therapist to discuss these matters.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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