Getting “more” out of therapy

[Anonymous]

My 13 yr old son (HFA, ADHD, 2e, inattentive, anxiety dx) started therapy 6 months ago when he had sudden signs of depression, obsessive thoughts of things that were scary to him, existential dread. We also started him on 10mg of Prozac. He’s doing much better and no longer has the issues that brought us to therapy. However, he and we would like to continue so nothing sneaks up on us again. However, he says he has nothing to talk to her about anymore so the play various games like chess and a board game. I’m not going to lie, paying $200 a session for him to play chess hurts. She came highly recommended and works with neurodivergent kids frequently. Am I wrong to think she could be working on other things with him? I want a therapist like the ADHD Dude that can also work with him on social skills and executive functioning issues but I guess that’s not normal and I’m dreaming. Any advice?

[Anonymous]

I'd start looking for a therapist who takes insurance.

[Anonymous]

Anonymous wrote:I'd start looking for a therapist who takes insurance.

Impossible, we have Kaiser and they only have enough therapists to schedule meetings every 2-3 months and they never got to know him or his issues. We want a relationship.

[Anonymous]

where are you located?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'd start looking for a therapist who takes insurance.

Impossible, we have Kaiser and they only have enough therapists to schedule meetings every 2-3 months and they never got to know him or his issues. We want a relationship.

It sounds like your son has a relationship with this therapist. I am a bit confused about what you wrote. It sounds like he’s made a lot of progress on his primary concerns. You have other things you’d like the therapist to work on but it doesn’t seem like you’ve communicated that to the therapist. If your son has told the therapist he doesn’t have much to work on and you haven’t raised these things, it doesn’t reflect on her that she hasn’t worked on them.

Also - perhaps there’s more you aren’t hearing about. Kids and teens often report “nothing” when they don’t really want to talk about it. Maybe they are talking about real things and he just isn’t sharing that with tou

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'd start looking for a therapist who takes insurance.

Impossible, we have Kaiser and they only have enough therapists to schedule meetings every 2-3 months and they never got to know him or his issues. We want a relationship.

Can they refer you outside of Kaiser? Can you change insurance? Otherwise, you don't have many options but to pay if you want the therapy to continue, or cut back to every other week.

[Anonymous]

I am a therapist, and if I was seeing a child for depression that was improving, I would not guess out of thin air that mom wants me to now work on executive functioning. You have to communicate your goals if you want your goals addressed.

[Anonymous]

Anonymous wrote:I am a therapist, and if I was seeing a child for depression that was improving, I would not guess out of thin air that mom wants me to now work on executive functioning. You have to communicate your goals if you want your goals addressed.

But would you be okay to charge mom $200 to sit and play chess with the child?

[Anonymous]

I think it makes sense to space out therapy visits (like once a month). A therapist whose orientation is to play games probably is not going to be the type to have effective strategies for executive functioning.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am a therapist, and if I was seeing a child for depression that was improving, I would not guess out of thin air that mom wants me to now work on executive functioning. You have to communicate your goals if you want your goals addressed.

But would you be okay to charge mom $200 to sit and play chess with the child?

I would be if I’m also having meaningful conversations at the same time. Playing games is a great way to build comfort and often facilitates productive conversations. Kids who may be resistant to sitting and talking about their emotions/thoughts often open up when they feel less on the spot, like when playing a game.

All I’m saying is that the parents and therapist should discuss treatment goals now that the depression has stabilized. It might not be a great fit long term, but it seems premature to look for another therapist without actually talking to this therapist about goals and approaches.

[Anonymous]

I agree that the way to “get more” out of therapy is to set treatment goals that everyone is on board with. You could tell the therapist that you’d like them to continue meeting both to monitor his depression as well as build social and executive functioning skills. Ask the therapist what they think of those goals, how they would address them, and to from there.

[Anonymous]

Are you talking regularly with the therapist? I would ask directly about what they are working on together at this point and what the goals are for your child at this point. There is a lot that can be done through games - including executive function and coping with disappointment, raising concerns, etc. The therapist could be using these games strategically to plan out a situation where the therapist wins or maybe inadvertently "cheats" and the child has a chance to call them on it, etc. These can be really beneficial tools.

[Anonymous]

If he’s going weekly maybe cut back to every other week. It stood out to me that he wants to keep going. That’s huge and they have a relationship, which can be hard to find. My kid had a lot of different issues come up when he was 14-16 and it took a long time to find someone he felt comfortable with and where he was willing to attend the sessions. Now at 16, I constantly wonder if I’m wasting money and don’t know most of what they talk about. But he wants to continue so we do. My son sees his therapist every other week now.

[Anonymous]

I don’t mind when therapist does this because in our case it’s keeping my DS willing to go to therapy… if it feels like “work” every second every time he would resist going. I think it depends on the kid whether playing games is a reasonable strategy for maintaining/strengthening the trust and the relationship… or if it’s kind of a waste. But yeah I would also consider cutting back to being an every-other-week client. And it’s totally normal for u to ask if the therapist if he/she thinks the sessions are productive and raise ideas of what to work on.

[Anonymous]

Maybe step back to every OTHER week. My friend had an interesting theory about therapy - you go to iron out issues, and then after that, just go in for routine maintenance every so often.