Family Issues 1:  Tough Love
Family Issues 2:  The difficult letter
Family Issues 3:  Worried about my son and his treatment

Family Issues 1:  Tough Love
“Dear Dr-Rick,
This is for a friend of mine whose son has ADD (age 19 ) and refuses to take medication, doesn’t want to work, or go to school.  He blames his mother for everything going wrong in his life, and his mother doesn’t know what to do to help him.”
Tough love

Well, there is help available, but none for those not yet interested in help. His best shot is if his mother takes care of herself in the situation.

A message from her might go like this:
‘I am here for you to help you in any way that is, in fact, helpful. So, if you are succeeding in school, you will have a home to work from. If you get a job and are willing to save money for your future, I’m happy to help you do that. Even if you want to seek treatment for your ADD problems, that would  give me some hope that I’m really helping you. But, if you are going to hang out here and not experience fully the way that your life is stuck, well that’s not helping you. I cannot be part of that.  So, let me know what you want to do?’

Then, if he does not decide, it would be like him saying no, so that the last option comes into play.

I know this may sound tough, but that is why it’s called “tough love.” If she can’t do this, a few more years of his living there like this will unfortunately get her ready, but the hard way.

Wish your friend my best and good luck with the outcome of her efforts,

Dr. Rick Blum

Family Issues 2:  The difficult letter
“Hi Dr. Blum,
I just again attempted to write a letter to get something off my chest to my brother & found myself very quickly stuck. He wrote me over a month ago & every time I try to formulate a response, I feel like it would do more harm than good. I find myself unable to avoid getting very specific about my complaints.

All of this may just stir up resentments & exacerbate the conflict between us. I know that whenever I try to write him, I begin to get angry.”

If you cannot write one, write two

A lot of people find an important letter blocked by a rush of emotions that cloud ones thinking.  A technique that is often helpful is to write two letters.   The first is unsent, and it blasts away with all the pent up feelings.  It should be harsh.  Anything that you’d really send is too inhibited.   Then, you write the clear one, perhaps with some points from the first, but edited.  See what this gives you, and we can go from there.

Good luck,
Dr. Rick Blum

Family Issues 3:  Worried about my son and his treatment

My son is 10 years old and an only child. He has been depressed and angry because he has been bullied by 3 boys in his class. We have discussed this with his school and are working with them on this situation.

We were referred to a counselor in our area. He talked to me and my husband for a couple of times and then told us to bring my son to see him once a week. His basic approach is “play therapy”. He wants us to bring my son into the office and takes him into the room and after an hour brings him back. I don’t want to ask my son what they talk about (he tells me what games they play). But at the same time I feel very uneasy for not knowing what is happening in therapy. When I told his counselor he told me he has to respect my son’s privacy and will only tell us if he is a danger to himself or others. Well I am not sure about this approach. I think he is too young to have complete privacy and we should know what is going on during therapy. Also I do not want my son to get the idea of having “secrets” from us and to think it is ok to keep his worries and his thoughts from us.

I have stopped his visits for now. Are we “overprotective and are having seperation anxiety” as the conular put it or do we have a right to be more involved in these sessions?”

Please find responses in three sections on this page.

Dealing with Bullying
How to assess the psychotherapy your son is already getting
Choosing a Therapist

Dealing with Bullying

You’ve raised several important issues, and I would like to address them in three separate sections.  They are important enough for you and for other visitors to my site that I will probably post the responses.  You can look for them under “worried about my son and his treatment.”

The issue of bullying of children by others is as old as there have been children.  What is new is that today there are guns, and today there is a media that informs the nation instantly.  So, when several children across the nation retaliated with deadly violence, we all learned about it.  As a result, the school is very likely to help you with the bullying of your ten-year-old son.  If they hesitate at all, tell them that you have a “zero tolerance for violence against my son,” since that is likely to get their attention.

On the other hand, this won’t stop other kids from labeling your son as an outcaste and subjecting him to more subtle, verbal assaults.  So, he has some work to do also.   I have worked with bullied children for many years, well before the schools were  any allies for parents, and these children have  taught me what works to end bullying.  Here is what I would tell your son:

“Kids who get bullied usually get quieter because of it, and the more quiet they get, the more they get bullied.  There is a small group of boys who get picked on who actually provoke the other kids, and they would need counseling to learn why they are doing that and how to stop.  Most of the time, bullied kids are just quiet because they are being threatened and feel threatened.  Unfortunately, the more quiet you get, the more of a target you become.   This happens because no one can read your mind, and so dumber kids will think things like “he thinks he’s too good for everybody” or “he is so weird that everyone hates him, not just me.”

Bottom line, you need to get some contacts.  Here’s how.  Of all the kids in each setting, pick the one who is the least mean to you, and get to know him better.  How do you do this?  Start when he is the most alone you find him and start up a conversation with him about his favorite topic.   Do you know what that is?  I do.  Everyone’s favorite subject is himself!   So, don’t worry about being interesting to others, just be interested in others.   Ask him questions about his interests.  If you don’t know what these are, then ask him a question like, “so what do you do for fun when you get out of school?”   Show interest in him and gradually others and you won’t be isolated anymore.

Once you are less isolated, the picture of you will change among the kids in general.  If the particulat bullies still pick on you, go through four stages (if you haven’t already).   First, try ignoring them, making sure they are not just “getting a rise” out of you.    Next, ask them to stop harassing you.   Say, “please stop doing that.  I don’t like it.”  I know this seldom works, but teachers usually want to know that you tried it.   Next, go to the person in charge of that setting and tell them what you’ve done.  Finally, go to a higher authority, assuming the problem is still happening, and tell them all you have done and that it is still happening.   What they should do is a combination of bad consequences for the mean kids, combined with getting them together with you in a supervised setting to work out their treatment of you.  By the way, all the good  stuff you do with the other kids will, not only make school more fun, but help the school authorities realize that you are doing your part.  I have never worked with a young person who could not improve his situation following steps like these.  Good luck!   ”

So, these are the suggestions I have for your son.  I would print them out for him.  Let me know how things go.

Best wishes,
Dr. Rick Blum
PART TWO: How to assess the psychotherapy your son is already getting:

I have two concerns about what you are describing in your son’s counseling treatment.  Before I describe them, I should tell you that play therapy has research behind it showing some results.  I have also had a colleague who did it and personally described positive results.

Having said that, most sources agree that it is a rather long type of treatment.  I recommend it  only for children who are not particularly verbal.  In other words, when people call me for treatment of their children, I ask if their children are likely to talk to me.  If the child is verbal, I prefer to speak with them about issues, including a teaching component, which is called “psycho-education,” short for “psychotherapeutic education.”  Only if the child is too young or too shy to talk will I recommend play therapy.   If the parent is not sure, I will see the child once and let them know.

This gets us to the second area.   I am not an attorney, but part of becoming licensed as a psychologist is learning about the laws that affect my practice.  One of the laws I learned  was that children do not themselves hold “the privilege of confidentiality.”   In other words, you are in charge of privacy of your child’s treatment, not the child and not the therapist.  For example, if you want the counselor to report on your child, who signs for it?   You child?  The counselor?  No, you do.  So, I am troubled that the counselor has not informed you of this, actually implying the opposite.

So, how do I handle the child’s privacy?  Before the first session,, I’ll usually talk to the parents about it, as well as the child.  I’ll explain to the parents that, just as adults, children have to feel free to voice some half-baked thoughts in sessions, statements that they are not sure they mean.  If they think that I am going to repeat their words before they are certain that they are the right words, they will not freely speak.  Instead, I will recommend that the parent or guardian extend privacy rights for the child, and that at the end of the session, the child and I will prepare what I am going to be communicating with the parents.  I explain to the child, much as I explained to the parents.   “You know, your parents are going to want to know a little about what we’re doing to see if it’s helpful.  So, what I usually do is check with you first to see what you want me to mention and if you agree with everything I would say.”

For example, at the end of the session, I might say, “I was thinking of letting your parents know that we worked on how to improve your confidence and that I gave you some things to work on.  Oh, and also I could tell them that you are glad that they are helping you with that problem with your younger brother.   How’s that sound?”  Usually, the child responds, “Sure, that would be fine.”  Sometimes, they might say, “I’d rather not bring up the part about my younger brother yet.   I don’t want to get into that.”  Then, the child is happy, I am happy, and the parents are happy and also know what they need to know about their concerns for their child.

See whether your next therapist will agree to operating this way.

Best of luck,
Dr. Rick Blum

PART THREE: Choosing a Therapist

Since you have already stopped the treatment, and since I have discussed the privacy issues in a separate part of this page, I will focus here on how I think you should choose the next therapist.

There is nothing wrong with getting referrals, but keep in mind that unless the person who is recommending a therapist has actually used that therapist, they have no personal experience with what it is like to receive treatment from them.   So, whether you use the yellow pages, your PPO’s list, or another person’s suggestions, you still have to ask some  questions.

First point:  does the counselor call you back personally?  If the answer is no, you are done with that one.  If they do, then now you can find out about the rest.

Notice how the therapist treats you on the phone.  Are you being talked down to, patronized, or does the person instead seem “down to earth”?  In other words, do you feel comfortable with that person.   And, don’t blame yourself if you don’t.  By the way, you can expect people to act pretty much the same in their offices as they treat you on the phone.

Assuming that the therapist seems nice, next ask some question about strategy.   It’s one thing to understand and quite another to know how to help.  You could phrase this by asking if they take a practical approach or if they help direct you to your goals, or if they are strategic.  Now, when you are listening to their answer, there are a couple of extremes to avoid.

Some people, although this is relatively rare, sound like they want to run your life.   Better you should run for the hills.  The more frequent problem is that the therapist will say something like that they will facilitate you or ask the right questions or guide you in coming up with your own answers.  These are all passive approaches, with the result that they will not speak much.

Preferable, from my point of view, is someone who says that they can guide you, but that you’ll be in charge of the directions.  In other words, they find out where you want to go, and are quite active in coaching you on how to get there. This is a more active approach, but still allows you to set your own goals (unless part of what you want is help in learning how to set goals).

These standards apply as much when choosing treatment for your child as they do when  seeking your own therapy.   It will weed out a lot of bad situations, but this is about as much as you can find out on the phone.  Then it takes a visit, but only one, to see whether they can deliver what they promised.

Best wishes on your search,
Dr. Rick Blum