If your preschooler sees a pyschologist...

[Anonymous]

what are your child's issues and what does a session with the psychologist look like (for your child or you as the parent)?

My 4-year old DS has always been incredibly intense, emotional, hyperactive, and defiant in most every situation (home, public, extracurricular activities), except at school/daycare (he goes to a very structured preschool and his teacher has very specific expectations). He is also in private OT and shows a lot of his behavioral issues there. We saw a developmental pediatrician at KKI in the fall, and she indicated that we should work with a psychologist who has experience with young children to focus on compliance issues before worrying about other diagnoses due to his age. She noted that we may be headed for an ADHD with anxiety diagnosis in the future. We found a local psychologist that we have been seeing for almost 3 months. We alternate weeks, where DH and I go by ourselves to discuss issues we're having with DS and then DS goes the next week. From what I can tell, he and the psychologist just play, doing whatever he chooses to do with little direction. He thinks it's great, but, as a result, she sees none of the behavioral issues that we're facing, and there is no discussion of them with him.

I'm relieved that DS is able to hold it together in school, but he is incredibly difficult to manage at home and out in public. We didn't expect working with the psychologist to bring a quick fix, and we realize that we need to do a lot of the work ourselves, but we're just not sure what we're getting out of it for $165 a session. Is he just too young to really work with directly, even through play therapy, with these types of behavioral issues? We're wondering if we need to seek out a different psychologist. We're going to get back in touch with the dev ped and try to get a better idea of what she thinks the psychologist should be doing with DS and us. I thought that by 3 months in, DH and I would have some more tools to deal with him aside from "focus on giving choices and providing immediate consequences," and I thought there would be more role playing between him and the psychologist in terms of dealing with frustration, anxiety, etc.

Has anyone dealt with similar issues with a very young child and found working with a psychologist to be helpful?

[Anonymous]

Your son sounds like mine, although mine had behavioral problems at school too. We have been seeing a licensed counselor, not a psychologist, and he loves the sessions and is mostly well behaved in them because he gets to play. But, our counselor will from time to time do things such as interrupt him or have him move to a new task (things that tend to get him upset), so that he shows his defiance and she can get him to talk about what he's feeling/thinking/should do instead. They also use the time when they are just playing to discuss emotions, she he's better able to understand what he's feeling. I have no idea if this is the best approach, or how much it is helping, but with these sessions and other things we do he is better able to manage his emotions and behavior. She also makes suggestions to us for things to try at home that might keep him from overreacting to everything.

[Anonymous]

I think you'd find behavioral therapy useful. KKI has a clinic in Columbia, MD but there are other participators closer in to DC. I've found the feedback and ways in which I can approach situations helpful. You may also want to look into the Kazdin Method book and/or provider.

Yes, it takes a few sessions to get to know the parent and the child and establish goals, but it doesn't sound like your current therapist has a plan of action. Play-based therapy has a purpose, but it doesn't sound like it is the right match. I'd address your concerns with the therapist and if he/she can't meet them it would be time to move on.

[Anonymous]

I am facing similar issues with my Kindergartener who is doing play therapy. I just don't know what he is getting out of it. Except ours is different because we do not have sessions with the therapist. But yes no behavior issues in therapy so how can it help?

[Anonymous]

Thanks, PPs. The lack of a plan of action really resonated with me. I feel like that's what we're missing. The dev ped noted the KKI center in Columbia, but encouraged us to try to find someone closer to us (we're in Alexandria). Seems like it's worth a call to see if they have anyone to recommend a little closer to us.

[Anonymous]

We had some success documenting tantrums, etc. and their antecedents, and ended up discovering that our son's anger issues related mostly to hunger, food sensitivities, and tiredness. He has other problems, but defiance has been solved. Maybe you should try documenting?

[Anonymous]

I understand your frustration. Our DS was older when he started seeing a psychologist because we needed assistance in helping him learn to manage his emotions. Like your psychologist, he pretty much just played, saw none of DS's anxiety/negative behaviors and because DS was having a good time, he wasn't able to access memories of when he was out of control - and thereby unable to discuss situations. What a waste of money. We quit. However, like a PP, we did work with a service provider who would play with him and then get him into situations where these negative emotions would rear their ugly head (frustration at not being able to figure something out, losing when he expected to win, etc.). In those sessions she was able to get him just to the point he was spiraling out of control and then talk him through techniques to bring himself back down. It was far more helpful than the psychologist.