Your seven-year-old son, Shaya, is so embarrassing. He approaches adults and asks personal questions that seem inappropriate. He seems to have no sense of shame, and little interest in conforming to social norms. You cringe at the thought of taking him to family affairs and public events, where you never know what kind of catastrophe might transpire. And when you broach the topic, he easily dismisses it and hardly makes eye contact. You have already heard dubious murmurs as to your parenting capabilities on several occasions, causing you to feel completely misunderstood. And that is despite all the parenting lectures you invested in.

Chanan, who has just turned six, has been turning your life upside down for as long as you can remember.   His explosive outbursts are both unpredictable and utterly irrational. You were convinced that his rigid inflexibility was just an extension of his “terrible twos”, but he has since doubled in age and his explosions have only increased in duration and frequency.

Everyone seems to adore Moshe, a lovely, compliant eleven-year-old. But Moshe’s parents are worried that he seems to have little drive and never takes the initiative. He gives up easily and just doesn’t seem to have many interests. When he does get excited and begin a project he rarely completes it.

And Yakov, who is seven, is so active and aggressive that you are scared to leave him in the playground without constant supervision. And even that doesn’t seem to stop neighbors from complaining about him. Although Yakov’s teachers and the principal are polite at PTA, the looks on their faces imply what the future will look like as Yakov journeys through his school years.

Shaya, Chanan, Moshe and Yakov’s parents are worried about their children. Are these normal behaviors? Will they “outgrow” them, or should the parents take action?

Most of you reading these short vignettes can probably identify a child you know as closely meeting one of these descriptions. Do these children need to see a therapist? How would therapy benefit these children?

Let us first identify the purpose of psychotherapy.

To Love and To Work

When I began my social work career, many people commented to me that they believe that most people could benefit from psychotherapy. Yet what percent of people who assert that they would benefit actually step up to the plate and attend weekly sessions? In a groundbreaking 2004 survey, a Harris poll showed that 27% of people in the U.S. received psychotherapy during that era. That survey also concluded that only one in three people who needed psychological treatment was receiving it. So, you may ask, where is the other 54%?

Sigmund Freud, the father of modern psychology, defined mental health as the ability “to love and to work.” In simple terms, a person’s mental health is limited when it gets in the way of his regular ability to function and to have relationships with others. The purpose of psychotherapy is to help the consumer attain those two objectives. This can be accomplished through many forms of therapy, with each therapist offering his own style and each consumer responding in his own way.

That said, in determining whether to take your child for an assessment, the parents should initially look at three factors. They are: 1) the parent(s) 2) the child and 3) the parent-child.

1)      The parent: Is the parent the type to become easily alarmed or overly reactive? Be mindful that you are not reacting simply because your child is not perfect. Sometimes, children evoke feelings in a parent that might be a result of the parent’s own unresolved issues. In that case, it is really the parent who needs therapy.

2)      The child:   The next step is to evaluate whether the child’s issue is significant enough to require psychotherapeutic services. It is strictly this category that would deem the child fit for psychotherapy. Here is a partial list of issues that might be resolved by a mental health professional:

• learning or attention problems (such as ADHD)
• behavioral problems (such as excessive anger, acting out, bedwetting or eating disorders)
• a significant drop in grades, particularly if your child normally maintains high grades
• episodes of sadness, tearfulness, or depression
• social withdrawal or isolation
• being the victim of bullying or bullying other children
• decreased interest in previously enjoyed activities
• overly aggressive behavior
• sudden changes in appetite
• insomnia or increased sleepiness
• mood swings (e.g., happy one minute, upset the next)
• development of or an increase in physical complaints (such as headache, stomachache, or not feeling well) despite a normal physical exam by your doctor
• management of a serious, acute, or chronic illness
• problems in transitions (following separation, divorce, or relocation)
• bereavement issues
• therapy following physical, or emotional abuse or other traumatic events

3)      The parent-child: Whether the child’s issue stems from a poor attachment or not, it can often be dealt with through an enhanced parent-child relationship. This approach offers the parents tools to regularly help their child develop his lagging skills in his natural environment. This can be done in individual or family counseling.

Moshe Norman, MSW LSW is a child and family therapist in Lakewood, NJ. He can be reached at through his website www.moshenorman.com