Dear Therapist:

I appreciate the tremendous service you provide to our community both in your practice and by clarifying and explaining so many mental health issues through this column. My daughter (age 13) was recently referred to therapy by her school principal due to concerns about her behavior. She insists my daughter must go in order to remain in school. My daughter is refusing to go. I am wondering if I can ask a therapist to meet my daughter in an informal setting, like going out for pizza. I think it's less intimidating than sitting in an office with a stranger.  I know this type of activity is done in "Big Brother/Big Sister" Programs. Is this something that is done for real therapy? What are your thoughts?

Response:

There are a few aspects to your question. The first relates to your daughter’s refusal to see a therapist. I wonder if this is due to general defiance, fear or anxiety, lack of understanding of the process, or a denial of the fact that there is a problem. Are you, as a parent, unwilling to make it clear that she needs to seek a therapist in order to remain in school—or are you afraid that she would be fine with the alternative? Or do you feel that forcing her to see a therapist might in other ways be counterproductive?

While these are all concerns that should be considered, your direct question is specifically about whether a therapist would be willing to see your daughter in an informal setting. There may be some concerns about doing so. There is a privacy issue. Also, clinical therapy is by definition done in an office setting. This is partly to allow the therapeutic alliance—and subsequent procedures—to develop in a closed environment, separate from “real life.” This can be important in order to help the client view the relationship and process from a perspective unencumbered and untainted by the very life issues that cause (or at least reinforce) negative reactions.

However, although there may be issues with more informal therapy, you should view the situation from a pragmatic perspective. Firstly, should you try and gain a better understanding of your daughter’s refusal to attend therapy sessions—and is there something in your approach that should change? Next, the advantages and disadvantages of an informal therapeutic style should be weighed in order to determine what would likely produce the best outcome. To flesh this out, you might want to consult with a child and adolescent therapist, who could help you to make this determination.

Therapists, as a rule, practice in their offices. However, a good therapist will be careful not to shoehorn all clients into their perspective and their particular brand of therapy. Rather they are able to change their strategies to conform to the needs of their clients. I’m sure that there are therapists who are flexible enough to recognize the fact that not all clients are best served within their office setting.

Therapists who deal with children and adolescents especially will understand that not all kids respond to one particular style of therapy. Additionally, in this post-COVID world, we have learned to be more flexible in general with regard to the definition of the clinical setting. If your clear, objective, professionally endorsed decision is that an informal setting would best meet your daughter’s needs, you will likely be able to find a therapist who would be willing to work with you.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 516-218-4200

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