Chapter 4: Finding Help
Suppose you have decided to find professional help, or at least some guidance in deciding whether it’s needed. How do you go about finding such assistance? Where do you turn first? How do you know whether an individual or agency is professionally qualified and competent? How much will it cost? How long will it take?
Much depends on where you live. If you are in a city, there probably are many helping persons and agencies. But in a small town or rural area, your efforts to find help may be complicated by long distances to available resources.
Sources of Reliable Information
How do you discover what helping agencies and professionals are available in your community? Talk with someone you trust who knows the community well, or can find out what’s available. A clergyman is often such a person. He probably has referred people to appropriate services frequently. If he’s new in the area, he probably knows how to get reliable information from other professionals and social service directories. He can help you evaluate your need for help, and also suggest which services will meet your need. He’ll probably know how to help you check on the training and credentials of private practitioners.
There are listings of helping agencies in many areas. Larger cities and counties often have directories of social service agencies, including counseling facilities. Some have telephone information and referral services. Usually a call to the nearest office of the United Fund (or Community Chest), department of mental health, mental health association, or county welfare office, will either produce information about available agencies or tell you where to obtain it. Or, a letter to the national office of groups like The Family Service Association of America (44 East 23rd Street, New York, New York 10010), American Association of Marriage and Family Counselors (6211 West Northwest Highway, Dallas, Texas 75219), or The American Association of Pastoral Counselors (201 East 19th Street, New York, New York 10003), will get information regarding the nearest treatment agencies. Information about the training of professionals in private practice who treat children, youth, and families can usually be obtained by writing the national, state or local office of the appropriate professional association of the particular counseling discipline: pastoral counseling, social work, clinical psychology, psychiatry, marriage counseling.
How do you evaluate the professional competence of an agency or private practitioner? There are persons with inadequate training (including a few outright charlatans) in the field of counseling; care on this is important. Here are some of the questions to ask in evaluating a public or private nonprofit agency: Is its reputation good in the community? (No agency or individual enjoys everyone’s approval, but community opinion should be generally positive if they’re doing a competent job.) What do other professionals in the helping field think of it? (Check with your minister or doctor.) Is it funded by the United Fund or the Government or a body which holds member agencies accountable for accepted standards of practice? Is the agency administratively responsible to a board of citizens? Are you treated with respect by the agency personnel?
Evaluating those in private practice is difficult. Reputation is important, but it’s no guarantee that the person is well trained. It is never out of place to ask either the person or the professional body which accredits him, what his training is for the job he’s doing. If a professional person responds defensively, this in itself raises questions about the adequacy of his training. Be especially careful when considering help from a "marriage counselor"; check to make sure he is well trained.
Not all psychologists, social workers, psychiatrists, and clergymen are trained as counselors. Clinical and counseling psychologists are so trained, as are counseling social workers. Psychiatrists who specialize in neurology may not be competent psychotherapists. Most nonpsychiatric physicians and lawyers have had little or no training in counseling on emotional problems, although they may know about reliable referral resources. Clergymen not specializing in counseling often have had sufficient training in counseling to equip them to recognize severe problems, make appropriate referrals, and engage in brief crisis counseling and marriage counseling in less severe problems. Some doctors are aware enough of psychological factors to help parents decide whether counseling is needed. Much depends on the clergyman’s or doctor’s sensitivity and openness to the complex realm of relationships.
It is sometimes helpful to talk with more than one agency or counselor before deciding on which to try. Find a counselor in whom you can develop confidence. If this confidence is not established within a reasonable period of time it is important to discuss your feelings with the counselor; if the block continues it is quite legitimate to end the relationship and try another counselor or agency. However, if you find yourself "shopping around" regularly or often, then you should begin to wonder whether your resistance to change is interfering.
How much will counseling cost? This varies according to the helping person or agency. Private practitioners usually charge considerably more than agencies. Agencies supported by taxes or community funds use sliding fee scales based on the family’s amount of income in relation to the number of people dependent on it. If you’re considering help from a private practitioner, check on going rates in your community for persons of that particular training and experience. Whenever you get help, be sure to have a clear, mutually acceptable understanding of precisely what the fee will be. (As a person who cares about people and your community, you may well decide to join forces with those groups who are attempting to provide more services, especially for troubled children, on an ability-to-pay basis. This is an area in which churches should be involved through their social action committees.)
How long will the counseling be needed? The answer varies with the nature and severity of the problem. Occasionally, one or two sessions can clarify things enough that the family or couple can take it from there. It is wise to commit yourself to at least a half dozen sessions before you decide whether to continue. Many people become discouraged around the third or fourth sessions and drop out before they’ve really discovered if it could help them. Often at least two or three months are required. Some change should be noted by this time if the counseling is effective. Some people continue in therapy for many months. This is sometimes necessary if the problems are severe or if a person or family is living under continual stress. Some of the newer crisis counseling approaches, however, can often shorten the time needed for relatively healthy families to make real progress in mobilizing their latent strengths, improving their communication, and pulling out of the tailspin of their crisis.
After regular sessions are over, many counselors encourage people to check back occasionally or to get in touch whenever they feel the need to talk things over. You should feel free to use this kind of professional help in much the same way that you use dental or medical checkups -- to get help with minor problems and to prevent future trouble.
What to Tell Your Child
How should you explain the need for help to your child once you have decided to seek it? It is always best to tell the truth: "This family has some problems and we are all going to get some help in figuring them out," or "We have all been unhappy lately and we are going to see whether we can get some help to make things better."
"We are worried about the fact that you are having trouble at school (unhappy, having bad dreams, setting fires, using drugs, running away), and we are going to see whether we can get some help with the problem."
It’s well to avoid making the child feel that he is the only problem, even if he is the one with obvious symptoms. He will be more responsive to therapy if he feels his parents or family recognize their own problems and involvement. Thus it would not be wise to say: "You have been misbehaving lately and we are going to take you to a counselor," or "Your teacher says you are not getting along in school and you need some help."
Emphasis on the "we" aspect of the situation takes some of the burden of responsibility for change off the child and spreads it around in the family where it actually belongs.
Don’t offer the child a choice about going to the counselor unless you really mean for it to be his choice. "Would you like for us to go and get some help with this problem ?" often brings a "No!" Then you are faced with talking him into it, or forcing him, if that doesn’t work. It is usually better to make a positive statement that "we are going" with the assumption that he will accept your judgment as he does in most other things.
Of course, the age of the child influences how you present the idea. A small child need only be informed of the plans and helped to deal with his feelings about it. An older child may take some part in the discussion providing the parents retain the final decision. With adolescents, it’s a different story. It’s rarely productive to insist that a young person get help if he resists strongly. The parents can present the problem as a family one; often the adolescent will respond positively enough to give it a try at least.
What if a child or adolescent objects or refuses to come? If it’s a younger child it would be handled in the same way you handle other things he has to do but doesn’t want to: "I know you don’t like the idea but we are going to give it a try and see if it helps us all feel better." Accepting and understanding his fears, while at the same time assuming that it must be done, is usually best. Getting into verbal battles sabotages the experience in advance. The child feels forced to get nothing from counseling, in order to win the battle against his parents. If the child continues resisting once he has begun coming, it is the counselor’s job to help with the feelings and to decide along with the parents whether to continue or to try some other course.
With an adolescent who isn’t interested or strongly resists, it is usually best for the parents to get help themselves in the hope that changing their approach to him will alleviate the problem or that he will decide on his own to get help. Sometimes it is possible to insist on "giving it a try" for one or more sessions with the understanding that he may terminate if he doesn’t like it. A counselor who relates well to adolescents can often "get through to them" when parents can’t, simply because adolescents need to fight their parents as part of the process of becoming free to grow up. Sometimes an adult outside the family -- a teacher, pastor or school counselor -- can motivate a youth to get counseling help when the parents can’t.
It is never a good idea to try to fool children about the reason for getting help. They always know it isn’t just for fun. They are entitled to an explanation appropriate to their age. They may not be ready to accept the explanation, or able to understand it fully, but they need to know what the adults involved have in mind.
What Will It Be Like?
Even when you decide that it’s necessary, it is hard to ask for help. As parents, we feel we should know how to raise our children, make them happy, and avoid problems. When anything goes wrong, we feel we have somehow failed. This book has been emphasizing the importance of remembering that we’re human and therefore we often make mistakes and fail to measure up to our own goals as parents. This does not mean we have failed as persons. As Alfred Adler once said, we need "the courage of our imperfections." Everyone needs help at times; many of us muddle through without it but we’d do a lot better if we had it. Actually it’s a sign of strength to be able to say "Yes, something has gone wrong. We need help." (If you and your spouse can’t agree on the need for help, the one who feels assistance is needed should have a few sessions with a counselor to evaluate the need and decide if he wishes to get help with his side of the relationship.)
A counselor often enlists the parents’ help even before he sees the child. He usually wants to know two kinds of things: factual information about the child, and what the emotional climate of the home is like -- its positive resources and its problems. The first interview with the parents is their opportunity to assess the counselor as well, to talk over their fears and feelings with him and to sense his potential helpfulness. Parents should discuss openly with the counselor any negative feelings they may have in this initial contact. (Some counselors want to see the whole family the first time. They feel that they can assess the situation more fully and be more helpful in their recommendations if they begin this way. Either method can be effective. Which one is used usually depends on the individual counselor’s particular preferences and the nature of the problem.)
Feelings of uneasiness and guilt which often remain after one begins counseling may interfere with the helping relationship. As parents we don’t like the feeling that someone else can succeed where we believe we have failed. When your child begins to change in counseling you may feel it is further evidence that it is "all our fault." Many parents withdraw their children and themselves when the child begins to change.
Actually, when a child improves, it’s usually because the whole family has changed, not because of some magic the counselor has worked. If your child stays improved, it has to be to your credit as well as the therapist’s skill.
Watch for unconscious resistance to change. Whatever took you to counseling was painful enough for you to want help; but you may feel uneasy when things start to become really different. The way things were was at least familiar. Who knows what a different way may be like? Will it be better? Or worse? Will future satisfactions make the present struggles to change family relationships worthwhile? Let’s face it, change is hard work.
In counseling, things often get worse before they get better. Since things were already bad, you probably feel you really can’t stand it if they get worse. It helps to know that this is an expected phase and is temporary. A seriously misbehaving child may become more difficult after several sessions of play therapy. Sometimes it’s because he’s learning new ways to deal with feelings and isn’t very good at it yet. Sometimes it’s his own resistance to change; sometimes he’s testing out his parents to see whether they really mean their new approach. Usually such a regression passes if parents can be patient enough, long enough.
It is easy for parents to feel left out, or angry, or doubtful about the value of it when their child is involved in counseling. This is particularly true if the parents are not themselves involved in counseling or if they are seeing a different counselor. They may have little contact with the child’s counselor. But it also happens when the same person is working with both parents and child. Parents have a right and responsibility to make as sure as they can of the counselor’s competence and the effectiveness of his therapy. If they have reservations they should be certain to bring them into the open where they can be discussed and resolved if possible, before they decide to give up the process. Sometimes such a discussion actually helps the therapy to progress more rapidly.
Parents are often bothered by the confidential nature of what goes on between child and counselor. They feel they have a right to know what happens. Child counselors, however, insist on confidentiality for many reasons. They feel it shows respect for the child and encourages him to trust the therapist with his inmost fears and feelings. This trust cannot develop if the child suspects that his words or actions may be reported to his parents.
It is almost inevitable, and is certainly very human, that parents will be angry at their child’s counselor at times. They have a right to be. But for this reason, it is all the more vital that they be able to trust the counselor both with their child, and with their angry and mixed up feelings about the counseling. The anger will cause trouble only if they are not aware of it or if they do not deal with it directly in conversation with their own or the child’s counselor.
Parents sometimes sabotage the child’s therapy without realizing it if they are unaware of their negative feelings. Bringing a child late to his sessions, canceling them at the drop of a hat, making the child feel guilty about the money being spent, undermining the child’s confidence in the counselor, are all subtle ways of sabotage. When parents are also seeing a counselor regularly they can deal with their feelings openly so that the sabotage is less likely to occur. A good counselor will encourage them to do this.
Usually change does not happen fast enough to suit us when we’re hurting. You may feel that you have improved as parents, but your child is going right on with his perverse ways. Try to bear with it. Patience is a major ingredient of successful therapy. You can’t expect to undo in a few weeks what has been developing over many years. Also, children often wait until they are sure the family situation is different before they show changes that are taking place in themselves.
Between counseling sessions, families should try out their new ways of communication. Often, in the beginning, they don’t work. Or newly discovered feelings stirred up in counseling come popping out at home in hurting ways. These things are discouraging.
It helps for parents to work on increasing the satisfactions in their marriage. This relieves the pressure of impatience for the child to change, and increases the security of the family so that it is safer for everyone to change. Dealing with our own stress, independent of our children, relieves the burden for everyone. Plan and do some things as a couple. Don’t wait till the child improves to have some fun yourselves. He or she will improve faster if you let yourselves enjoy being a man and a woman sharing each other and life.
Sometimes parents feel that they should be able to solve their own and their child’s problems by the use of religious practices such as individual and family prayer, Bible reading, and devotions. They believe that having to ask for the help of a counselor is somehow an admission of failure in their religion. But God is the spirit of life and growth and can work through a skilled counselor (whether or not that person uses "religious" language). He may help free the family to "live its religion" more fully in their relationships. As communication and relationships improve within the family, religious practices may, for some, be meaningful ways of expressing and celebrating new joy, honesty, vitality, and unity within the family.
To continue the growth impetus of counseling, join a growth group for parents. This is a small (twelve or less) group designed to stimulate the rate of normal growth in reasonably healthy people. The gains you’ve made in counseling will be more likely to continue and expand as you want them to, if you don’t try to "go it alone." By meeting regularly with other parents who also want to improve their marriages and families, you can be helpful to each other.
If no group exists, start one! The leader should be trained in facilitating communication in small groups. Your clergyman may have this training or know someone who does. Growth groups (in contrast to most other groups) encourage honest sharing and mutual caring. (You can encourage your church to become a more exciting place by helping to develop a network of growth groups, for persons at all the life stages. Such groups are the ideal method for a church that wants to be true to its mission -- that of becoming a center of healing, and growth and training for helping others.)
The continuing growth of your family can be nourished by participating in the church and community organizations (YMCA, adult education, scouts, service groups) which you find meaningful. Avoid the danger of over-involvement (which can hurt families) but keep connected with those groups which provide enjoyable relationships, broadening of your horizons, and opportunity to make your community a better place for people! Particularly important is the cultivation of a supportive circle of friends and/or relatives, to be your "extended family" -- your support group or spiritual clan. Such a circle is vital to family emotional health, especially during periods of crisis.
If you find a competent counselor and work hard at changing, you’ll learn new skills in relating and communicating. You will need the counselor less and less as you employ these skills in improving your family relationships. (‘improving" means making them more mutually satisfying.) An unhappy relationship isn’t like a broken leg that can be taken for granted once it’s healed. It’s more like a muscle weakened through long disuse; continuing exercise is essential to keeping it healthy. The value of counseling isn’t that of getting a disturbed child or relationship "fixed"; the real value is in the new skills your family acquires to keep everyone in the family "going and growing." It takes continuing effort, but counseling lets you discover both that you can do it and how.
The grooves of old relationship patterns are deep; it’s easy to slip back into them. There is a strange attraction in old, familiar ruts; only the new satisfactions of better, closer relating can keep you from backsliding. When you feel your relationships slipping, use what you have learned in counseling -- talk about it in the family and decide what needs to be done to get off the skids. If this doesn’t help, arrange quickly for a few "retread" counseling sessions to help you get back on the growth track.
Clinebell, H. J., Jr., and Charlotte H., The Intimate Marriage (New York: Harper & Row, 1970).
Halpern, H. M., A Parent’s Guide to Child Psychotherapy (New York: A. S. Barnes and Co., 1963). Discusses the role of parents.
Moustakas, Clark E., Psychotherapy with Children (New York: Harper & Row, 1959). Includes a chapter on parents’ use of play therapy to help children deal with crises.