Over the years that I’ve been working with children, I’ve found that every family approaches parent participation in a child’s therapy session differently. And while the parent is often the determining factor, the child sometimes makes the choice as well. Even when parents encourage their child to meet one on one with the therapist, the child doesn’t always feel immediately safe with a stranger. In those situations, parents participate for the first few sessions and slowly work themselves out of the session.
There are many therapeutic models that incorporate different levels of parent participation. Some methods rely on parent participation. Others are geared more towards the child working 1:1 with the therapist. Some therapists are more comfortable with a particular style. It’s important to ask a potential therapist about their approach.
Individual Therapy vs. Family Therapy
When the clinician meets with the child alone, this is considered an individual therapy session. Sessions focus on helping the individual person and the therapeutic alliance is between the child and clinician. The parent is still part of the team, and an important part of the process, but the child should feel like their therapist is their ally.
When the parent participates in the session, this is considered family therapy. Family sessions involve helping to change the family system and the therapist attempts to balance allying with each family member equally.
It gets tricky when a parent attends the session when they are not part of the process. For example, if the parent only wants to observe the session, it is often better for the parent to step out.
Here are my concerns with parent attendance without full participation/family therapy:
- Parent observation can impact if the child will open up to the therapist.
- Therapy is intended to offer a place to discuss issues without judgement. Parents may make comments or facial expressions that impact what a child will share.
- Therapy is intended to be a place where kids (and adults) can learn to draw their own conclusions and gain insight for themselves. While therapists may offer an occasional comment or piece of insight, we try not to offer so much that it’s an overwhelming flow of suggestions and WOW moments. Less is more. When parents attend, sometimes they get excited with all of the OPPORTUNITIES for insight. But two grownups offering suggestions/insight disrupts the opportunity for the child to come to those conclusions themselves. This isn’t as empowering of a dynamic.
- Children may feel like two adults are ganging up on them if their behavior is the topic of discussion.
- Therapy sessions are generally scheduled with a week gap so clients have time to mull over what happened at the previous session. I like to think of this as the mental homework of therapy. When parents observe, they may try addressing what happened in session over the course of the week.
If the parent wants to be part of the process, family therapy is a fantastic option. Once family therapy is established, however, the parent should participate in every session with their child. In a couples or family therapy session, the therapist builds a therapeutic alliance with all of the people attending session- not just the individual. This may make individual therapy appointments with the family therapist less effective. This is why, when attending couples therapy or family therapy, it’s helpful for the family members to have their own separate individual therapist.
Another consideration is the therapist’s preference and/or skills. Some therapists are better at splitting their attention to offer family or couples therapy. Some find they’re more effective working 1:1.
Personally, if I work with a family or group, I prefer to work with a co-therapist. This is because it’s more difficult to focus on both the animals and the humans to make sure everyone is doing okay. Focusing on both is an important part of animal-assisted therapy.
If you want your child to receive individual therapy, but you still want to be informed about the process, my preferred method is to meet individually with the parent once a month, or once every two months, to check in about therapy goal progress and any questions or concerns. At this time, parents can learn tips and tricks for more effectively supporting their child.
In my practice, this means that the parent needs to meet with me while the child is at home with another caregiver or at school. This is due to the setup as there isn’t a formal office for the child to wait, and where it’s a farm there are safety concerns to leaving a child unsupervised.
Therapeutic Alliance and Confidentiality
One of the benefits of the therapist working 1:1 with your child is that it offers the child confidentiality, and the therapeutic alliance is stronger. The child can feel like the therapist is “on their side” versus thinking that the therapist will ally with their parent.
Being a kid is HARD. You don’t have a lot of power, and you often don’t have the words to express what is bothering you. Having a healthy relationship with an adult who understands that and isn’t part of the home dynamic can be helpful.
On that note- It’s Okay if Your Child Wants to Talk about You!
One of the main reasons that I want my kids to see a therapist is so that they have a safe place to talk about the impact of my parenting. The reality is that I’m not perfect- neither are they and that’s okay. Sometimes I’ll make them angry because I set limits that they don’t like or understand. Sometimes I yell because I’m frustrated. I feel better knowing they have another safe adult to talk to. And after they’ve processed a bit with their therapist, I like to think they’ll be able to come to me to discuss it all. That’s the goal.
But having a child talk about you in therapy isn’t a bad thing. Living with other people is hard. If you never have an issue with another human in your household, you’re destined for sainthood. Therapy offers a place to delve into those relationships and the parts we play in them. It allows us to think about how we can do better or be assertive to ask for what we need in the relationship. And those skills are invaluable as kids grow into adults. What may be perceived as a child not being respectful or not complying with authority serves them well when peers encourage them to do things that are unhealthy for them.
Also- Your Child Wants to Talk about that Bad Thing They Did
When children (people) sense that they may get in trouble for something, they don’t want to process this with an adult who might punish them. Therapy offers a place for them to talk about it with a modicum of confidentiality and support.
More frequently than not, we hear about more minor activities- the “I snuck a cookie from the cookie jar” conversations.
When kids start seeing a therapist as a teenager (particularly if they have been suffering from long term mental health problems), the conversation sometimes turns to more difficult discussions such as navigating relationships, skipping class, and underage drinking.
In some circumstances, offering confidentiality and a safe space opens the door for the child to talk about icky grown-ups or icky peers- icky people who need to immediately be cut out of our children’s lives.
The open door to those hard conversations is that conversation they had about how they snuck extra screentime behind your back.
The open door is that the therapist was able to have that discussion without telling their grownups.
If you are there, it is likely that your child WILL NOT talk about these things. It doesn’t matter how amazing you are as a parent- you aren’t a neutral party. The main thing to remember is that your presence in therapy doesn’t mean your child isn’t involved in risk taking behaviors. It just means that they likely don’t have a safe adult to process it with.
With any therapy, there are limits to confidentiality. When there is a big issue that needs to be addressed, such as icky adults or substance abuse, the therapist ideally lets the child know that this needs to be something we all discuss as a team. The therapist and child will process how to have that discussion with their grownups, and bring the grownups into session to talk about it after. This creates a sense of safety around the discussion and gives them a sense of power over what happens.
The reality is that it is SO scary to have these discussions. A supportive therapist can make the process easier. That conversation can model for the child what healthy relationships look like, how to negotiate hard conversations, and help them understand that their grown ups are there to support them.
The Best Way to Proceed with Your Child
The only person who knows your child better than you is your child. In my opinion, it’s important for the parent and child to make this decision together. Regardless of the benefits of your child attending session 1:1 with a therapist, I find it important for the child to feel safe. Likewise, I want the child’s grownups to feel safe letting me meet with their child 1:1. I’m a parent and I know how scary it can be to let an adult that you don’t know meet with your child alone.
Often, children will start therapy with me with their grown-up present. For children with separation anxiety, they may meet for short portions of the session 1:1, but have the parent attend the rest. The grown up can read a book in the barn aisle or watch from the sidelines.
One benefit to animal assisted therapy and working outdoors is that I can take a walk with your child to give them some sense of confidentiality- without ever leaving your sight.
And then there’s the Drop and Run!
In many cases, kids are not anxious about you leaving- they just aren’t sure what is supposed to happen in therapy. They often get excited about the animals or the play therapy toys.
It’s acceptable to say, “I’ll be in the car reading, let me know if you need me” or “I’m going to sit by the garden.”
For tweens and teens, they will generally happily leave you. As a parent, this can be HARD to see your child walk off like this without a glance back. It is one of those developmental milestones that makes your heart ache a little bit.
So sit down with your child and have this discussion: “Would you feel more comfortable with me attending session with you or would you prefer to attend on your own?” This is an excellent conversation to have AFTER the intake session as it is usually best to have everyone present at the intake appointment.
Whatever the choice- Still Let the Therapist Know What’s Going On
Kids forget what is going on. At a Friday appointment, they may not remember the fight they had with their sibling on Monday.
Or they may be ashamed to discuss it.
Bringing it up in a nonchalant way is good- as you pass them off to me, you can say, “Oooo remember that fight you got into with your sibling this week? You may want to talk about that.”
If you have something to tell me 1:1, give me a call or send me a portal message.
When to Schedule Family Therapy Sessions Instead of Individual
I think it’s beneficial to have a different person as the family therapist so I encourage families to decide how they’d like to meet before getting started. The family therapist role is a tricky one where they have to balance their alliance with each family member. Once that individual relationship has been established, it’s tough to pull in the whole family for talk therapy family sessions.
Just to put it into perspective, if you’ve ever seen a couples therapist, you’ll hopefully remember that they tried to ally with both you and your partner. That wouldn’t be possible if you’d been in therapy with that same therapist for a year before pulling your partner into session for a couples session.
That said, equine assisted family therapy sessions with the individual therapist may be beneficial and make sense. As the model doesn’t rely on the alliance with the family members, and the activities are experiential, the therapeutic alliance isn’t the main priority. There is minimal talking in these sessions. Instead, the sessions focus on working together as a team, communicating better, and gaining insight about family roles.
You are an IMPORTANT Part of Your Child’s Success
Even when you don’t attend therapy with your child, you are an IMPORTANT part of your child’s success in therapy. There will be times when you come into session to see something that your child did or the art that they made. Cheering them on is important. There will be times that the child’s therapist can help you figure out how to parent your child more effectively, or help you understand the child’s diagnosis. It’s important for you to acknowledge and celebrate treatment goals being met- even if only partially.
And while it’s hard to see the small victories when your child’s behavior may be difficult or worrying to you, if you are able to notice small successes and let them know they’re doing great, it can encourage them to keep working hard.
And always, always remember to “put your own oxygen mask on first” (metaphorically). You need support too. It’s important for a child’s grownups to seek therapy. It’s important to model that adults seek help when they need it. It’s important to model self improvement. And it’s very hard to be a good parent when you’re under a lot of stress from work, home, and outside relationships.