"What is therapy (or assessment) for?"
It can be helpful to explain to your family member why they are coming to the appointment. Therapy is the way that we learn new ways to cope with stress, so that you are feeling, sleeping, and functioning better. Testing is a way to know more about an individual’s learning style, stress, emotions, thoughts, and behaviors, so that we can help school, work, and life to be more rewarding and successful. It also helps us to learn about what might be causing distress, so that we can make a plan to help. You can reassure your family member that any “tests” will be about asking questions, or perhaps looking at pictures, working with blocks, or pencil-and-paper tasks. Before we talk about any sensitive information, we will review privacy and confidentiality issues. If your family member is still resistant, read on.
"I don't want to go."
Some clients really really want to come to therapy or assessment, and feel it's a relief to talk about what's going on and how to make it better. But some kids and teens -- and adults too -- don't want to come see a counselor or have testing done. They think it will be a waste of time, boring, or stupid. They may think counseling will actually make things worse. Here's what you can say. But first, you have to listen.
First step: Listen.
This is the most important step, and it's often skipped, shortened, or maybe just barely tolerated with folded arms and eye rolls. I'm talking about the adults here. Admit it - we've all been there. I'm a parent too, so I get it. By the time a counselor is considered, oftentimes the behaviors have become difficult to bear for everyone in the house. When the behaviors or symptoms first started, maybe you were a model of compassion and grace, listening with empathy and offering helpful ideas. But for many families, by the umpteenth time that the issue arises, patience has worn thin.
Or maybe it is so distressing for you as a parent to hear that your child is struggling again, that you shut down a little too. As parents we worry about our kids, and it can be really hard to hear about our child's difficulties. We can feel helpless or even hopeless. We can become stressed, anxious, depressed, and lose sleep.
The key to listening -- really listening -- is to suspend the belief that you have to fix it. At least for now. Fixing it comes later. Spoiler alert: fixing things may not even require you, depending on what's going on. But back to listening.
Do a Sound Check
In order to listen effectively, you will first need to do a sound check. If you were ever in band, choir, or theater, you will know how the sound is checked prior to a performance. The tech and director listen to make sure that the sound is coming across the way it is intended. Is the sound too soft, too loud? Is it annoying, or melodic? Is it powerful or weak? Does the sound undermine the message?
Your voice quality will speak volumes to your child -- and even more so to your teen. Keep your voice neutral. This cannot be emphasized enough. Do not inject judgment, criticism, skepticism, contempt, or ridicule in to your tone of voice - not even a little bit. Adopt the stance of a scientist or investigator -- "Just the facts, Ma'am." Practice with someone if it will be an especially touchy conversation.
Use Reflective Listening: "I get it."
This shows you are listening, that you understand, that you get it. You are repeating back what your child, teen or family member has said, in order to make sure you heard it. In any conversation, this is a powerful tool. We often think that what people want is to have things fixed or changed. But I can tell you from 20+ years of working in the mental health field, that the #1 thing that people want from others is to be heard and understood.
Let's say that your teen says, "Counseling is stupid! I don't want to miss soccer practice, and anyway, none of my friends go to counseling. People are going to think there's something wrong with me!" You might be tempted to counter those beliefs with your well thought-out talking points on the benefits of counseling, how research shows it is in fact not stupid, how his coach will understand, and how truly good friends won't think there's something wrong with him. Wrong move.
Your only job (at this point) is to hear and understand what your son is saying. Try saying this instead: "I agree. I sure wouldn't want to go to counseling either, if it turns out to be stupid. And I can understand you don't want to miss soccer practice. You also said you're concerned that people might think there's something wrong with you. I can see that would be a problem, if your friends thought differently about you."
Now your job is to ask questions. Do not sound skeptical or critical. Keep your tone of voice neutral, but interested in what they have to say. Avoid brushing aside or minimizing fears. Just listen. And ask questions. Lots of questions. Do not jump to suggesting solutions until you both have a solid understanding of what is needed.
In the example above, " I can understand you don't want to miss soccer practice. What are you working on in soccer now?" Try to get him talking about what missing soccer practice means for him. This will not only tell your son you hear him, but it will give you data that can help solve the problem. Maybe you can change the counseling day or time, or maybe counseling can start in two weeks, after the tournament.
"You also said you're concerned that people might think there's something wrong with you. I can see that would be a problem, if your friends thought differently about you. Has that happened before to someone at school? They started going to counseling and it didn't turn out so well?" It can be easier to talk about other people, so asking about people at school or work colleagues can be helpful. This may open up a conversation about friendships, whether they are healthy and supportive, and again, it offers you data so you can potentially solve the problem (after you have heard him out).
"But I've asked questions, and he won't answer me!" or "She ignores me when I ask questions."
Ok, I believe you. But try it anyway. When someone really really doesn't want to do something, they will have an opinion about it. So if your child, teen or family member is saying they don't want to come to counseling, give them a chance to tell you about it. If your family member is used to hearing others minimize their concerns, or if your questions are interpreted as judgmental, then it will take more work on your part to set the stage for better communication. If your family member is shut down, try it again another time.
Don't Force It.
The therapy sessions that have not gone well often started out like this: "You HAVE to talk to Dr. Ferguson. She's going to help you!" Well meaning parents who want their child or teen to get the help they need can feel that they have no choice but to issue directives and even ultimatums. If therapy is truly required, there are ways to discuss that with your family member, which is detailed below.
Most of the time, it is helpful to leave it up to the child, teen or family member to decide when and if they will talk in therapy. I also allow the client to decide if they wish to talk to me alone. There may be times when it will be important for me to speak to the client alone, but I do let the client make the final call. Sometimes it takes one or two sessions before the client is ready to talk to me (either with family members present, or alone), or sometimes longer. Many clients come in to therapy feeling that some aspect of life is out of their control, which can lead to stress, anxiety, depression or other symptoms. By giving the client control when appropriate, we actually achieve more. Everyone likes choices.
There are Choices
Even when therapy is required, there are still choices: What are the client's goals for therapy (not just parents' or a family member's goals)? What day and time works best so they don't miss important activities? (Sports, extracurricular activities, seeing friends, and down time are also "therapy.") Would the client prefer to "just talk" or try art therapy? Does a young child gravitate toward playing with puppets, role plays, or board games? Every activity is built around established, empirically based interventions, so what seems like playing to a child is actually based in cognitive behavioral therapy (CBT), for example.
Shop Around For A Therapist
There is also the choice of therapists. I tell everyone that therapy is just like any other relationship: You will click with some people and you won't with others. So shop around. Find a therapist who understands you, your goals, and your needs. Research has found that the therapeutic relationship itself is a powerful tool in getting better.
When Therapy Is Required
There are times when it is actually necessary to require therapy, such as when someone has been suicidal or engaged in unsafe behaviors that need to be addressed pronto. Sometimes marriages or relationships are at a breaking point, and one or both partners is feeling that counseling is the last hope. This can be explained, while being compassionate and understanding that the client really does not want to be there: "I know that this was not what you had planned for your Thursday afternoons. Right now though, this is what we need to do to keep you safe," or "The judge believes this is going to be helpful," or "Without counseling, I feel that our marriage will fail." Let your family member know that you want to hear what they think as therapy progresses.
Reach Your Potential
Sometimes clients feel that therapy or testing is a punishment, or that it is only for people with "big problems." Counseling has been misunderstood for a long time. Therapy is a time to take care of oneself and one's relationships. It is prioritizing health and stress relief. Everyone deserves to have healthy friendships, function well at school or work, and get a good night's sleep. Appointments can be a time when family members can really hear each other. If we were able to provide testing to every student, we would see the diversity of learning styles that exist in every classroom. I wish that everyone had a counselor to talk to when times were rough, and also to talk about successes. I see therapy as a valuable tool that helps us to focus on what works and address what doesn't, so that we can reach our potential.