Dear Dr. Batya,

- L.C., Haifa

I sense your ambivalence about having your son seen professionally and wonder if you feel there is a stigma attached to psychotherapy or you're afraid that he may be labeled inappropriately. How do you personally feel about him being evaluated? Do you think it is good to be getting him the help he may need or do you see it as a sign of parental failure?

Most children want to work on their problems and are happy for a little help from someone who can "make things better." These are generally nice, emotionally healthy children who are neither "sick," "bad" or "crazy." When their issue is resolved, they go off happily.

You seem unsure as to whether there really is a problem, and that is where a trained professional can help. Children are evaluated for many reasons. They may have behavioral issues, attention problems, depression, low self esteem, difficulties in adjusting to anything from aliya to a new sibling, fears, difficulty coping with traumatic events, loss, school or developmental issues, family problems, peer or social concerns and many other issues that they are dealing with. Anxiety may be a symptom of any of these or may be seen on its own. Checking this out may give everyone peace of mind.

Your best bet may be to first meet with a psychologist and see if she feels it would make sense to see your son. I, for example, always meet with parents of a pre-adolescent first to get a detailed history of the problem and other relevant details that are best not discussed in front of the child. After this visit, it can then be decided if it makes sense to meet with you or your son alone or together. Not all problems that seem related to a child require the child to be seen. Sometimes, parenting or family issues are best resolved without the child being seen at all. If the psychologist does meet with your son, she may do a baseline assessment of his everyday functioning and then sit back and see how things change over time.

Children are typically less concerned about seeing a psychologist than adults. I love how open and honest kids are. They may express themselves in words or through play. Your son probably has a lot of insight into his anxiety. Preparing a child in advance of his appointment reduces anxiety and enables him to know what to expect.

I often explain that I tell "younger" children that I am a "feelings doctor." I talk about feeling angry, sad, happy or mad but I don't give any needles. While I usually prefer to see a child alone initially (as he'll be more open and often he doesn't mind), if he is at all uncomfortable, I never have a problem with a parent coming into the room. I think it is important to have your child lead the way and with time, most children look forward to coming to sessions.

I also talk to both parents and children about issues of confidentiality. It is important for children to know that what they tell me will remain in the room, but everyone needs to know that if I feel the child is at risk for hurting himself or others, all bets are off in terms of confidentiality. What your son chooses to tell you is up to him, and I certainly would encourage him to talk about his sessions if he wants.

Now, you've mentioned that your child is anxious but haven't given me many details. Anxiety is common in this age group as there are many changes as children hit puberty. Children also may have peer issues and worries with respect to both school and family. Again, it is hard to say just what is going on without a detailed evaluation. One wants to know for sure whether your child has always been anxious or if this is a new problem. The answer to this will likely determine how to proceed in terms of treatment.

Now, how do you find a therapist? Speak with your doctor, rabbi, school, a friend or family member, or check out sources such as ESRA, AACI and Telfed. If you go to see someone, it is very important for both you and your son to feel comfortable with that person. Trust your gut instinct. It is your right to be able to ask questions and you both need to feel heard and respected. Make sure the therapist is licensed in his profession, qualified in terms of seeing children and experienced in treating your child's specific problem. Once you have done all of this, relax and leave it in the hands of the professional.

The writer is a licensed clinical psychologist in private practice in Ra'anana.

ludman@netvision.net.il