A number of friends (some of whom are medical professionals themselves) have asked me for references on our experience with therapy for our children which has helped me realize that there is a need in our community for confidence and direction accessing mental health resources, especially for our little ones.
This blog is going to be a series of anecdotes about our experiences with reference links to the resources we utilized with hopes of educating and inspiring you about accessing mental health therapies here in Central PA.
If you're reading this and hoping for direction - get ready to work. Therapy is work. If you're still in the "this isn't how I dreamed it would be" stage, then this information might be depressing or overwhelming for you. But if you're in the "taking the reigns of your own life," "something's gotta change" stage, then this might be the thing for you. But it's going to take work. Time, money and loads of emotional energy, in the form of getting real with yourself about your behaviors, choices, triggers and your own trauma history. Even if the therapy you're seeking is for your kid, you're still going to have to jump in with both feet and wade into these waters.
With therapy, our family has been able to go from surviving to thriving and yours can too.
So here are our stories about the riding the waves of mental health, seeking to thrive:
I was the first person to seek psychological support in the form of therapy in our family, and this was during our miscarriages, approximately ten years ago now. There's no doubt in my mind, looking back, that my first venture to therapy should have been when I was 22, a second year medical student when I was victim of a serious trauma. Instead of seeking professional help though, I drew inward, and one crisis became two and three, and I went through a self-destructive period of my life which had impacts for several years to come.
During the miscarriages, as you may recall if you've been following me for some time, I began to develop phantom kicks (hence the name of this blog) which I describe as a mild form of panic attacks, and this is the reason I sought professional help. The therapist I saw then, someone different than I see now, used cognitive behavioral therapy with me just like my current therapist is. She also encouraged me to restart my journaling, which has been a lifelong and vital habit for me and also resulted in this blog. She taught me mindfulness and gave me a rock to carry around in my pocket 24/7, that I could grab in an instant and rub whenever someone said something stupid about when were we going to have number 2. By grounding myself in reality, "there's a bumpy rock in my pocket and it feels smooth," I could break the cycle of panic that had been coming upon me so often. It was a useful tool and while I don't carry a rock or shell 24/7 anymore, I do sometimes, and it ALWAYS calms me down when I rub one.
For our next experience with therapy, it was with our kids. Two of our children have had at least one form of therapy (play) since they were four years old. I used to say that one of our children began the "terrible two's" when he was 9 months old. He began throwing temper tantrums young! He was very physically agile, crawling, walking, climbing and throwing all before one year of age, so it wasn't out of frustration of inability to get what he wanted. He talked on time, so it wasn't really about not being able to say what he wanted to say. But, he has always had a low frustration tolerance and feelings that seem more intense than everyone else's in our family.
In the meantime, we began reading books and articles on challenging children. Our favorite and the most useful, The Whole Brain Child. We've utilized "name it to tame it" ever since!
When he was 4, he began to get more aggressive physically and verbally when he was frustrated and this set off some alarm bells. The traditional forms of discipline which had worked pretty well with our first child weren't working with this one and were leaving us all feeling frustrated. So we saw the pediatrician again, not really sure what we thought was "wrong," but recognizing that we needed some help. Whatever it was, it was affecting him and our entire family everyday in big and little ways. He experienced troubles at bedtime and during the day, in routines and on special occasions; he couldn't even enjoy his own birthday party without disruption.
Our Pediatrician gave us a seven page listing of all the local therapists and the one closest to our house was Sand Castle Counseling. Boy did we hit the jackpot there! They specialize in play therapy which is one of the best approaches in kids as young as four, because they don't need to want or be able to talk about their feelings or problems for it to work. It's important to know that we do not go into sessions with our children in their play therapy. The relationship is between the therapist and child and the parents don't participate in individual sessions. Our therapists do separate parent sessions for us, in which the describe and explain what they're seeing in play (i.e.: power dynamics, chaos, organized or disorganized thought... etc.). We tell stories about what we're seeing at home, they suggest why that might be occurring and we work together to identify strategies to mitigate the undesired behaviors and dysregulation.
When you see a therapist, they might see signs and symptoms of a diagnosis and if you’re interested they can talk to you about those, but they don’t officially diagnose, and there is no risk of a lifelong “label,” if that’s something that worries you.
Over time, with our sons therapists help, we were able to have her confirm that our son displayed symptoms of sensory processing disorder, attention deficit hyperactivity disorder and anxiety.
Our son is a sensory seeker. Symptoms we had seen included nail biting, eating with his hands (even applesauce), wearing clothes backwards all the time, giving high fives that left your hand tingling, screeching randomly, walking barefoot all the time, and many more (all of which persist to this day). Shortly thereafter, we were referred to Shreiber for occupational therapy for sensory processing needs, and he was seen there for about 6 months, and we learned some OT techniques to help meet his sensory needs, some of which we continue to use to this day. We learned the Zones of Regulation which weren’t terribly useful for us. But My personal favorite thing we learned there is giving him a heavy chore when he's dysregulated (like carrying something heavy in off the porch or vacuuming) which really does help him (and me) calm down. In general, I see sensory processing issues as one small piece of the puzzle that agitates him, but I saw it as a kind of low hanging fruit that could be tackled pretty easily. Most importantly, you don't want to force them to stop doing the coping mechanisms (like wearing their clothes backwards) if you haven't learned any substitute behaviors. Assessing and addressing sensory needs can be useful to identify and eradicate that from the list of things agitating him.
It is important to note that some symptoms, like nail biting for example, can be symptoms of many different diagnoses (sensory processing, ADHD, anxiety, among others), and having one symptom doesn't mean you or your child have that disorder. No one can tell us for sure why our kid bites his nails everyday; perhaps it soothes him on multiple levels which might be why we haven't been able to eradicate it yet? I don't think we'll ever know for sure.
All along, we suspected he had ADHD, and both teachers and pediatricians recommended we work on the gold-standard, Vanderbilt, which is a parent and teacher survey of ADHD symptoms. We've taken the parent side of this survey for our kids and found it useful for understanding their executive functions and how much inattention is generally considered within normal limits. It might sound simple, but understanding that just like a person with clinical depression can’t simply cheer up because you tell them to, kids with ADHD can’t think before they act (stop their impulsive behaviors) just because you holler at them.
Maybe you are reluctant to have your child labeled with ADHD, as I was initially. What I’ve found, however, is that understanding the diagnosis and the extent of its effects on your child’s executive function, behaviors and abilities can be key to compassion and patience. You can redirect your frustrations at their medical diagnosis, rather than your child, or their choices.
This helps you importantly get rid of the idea that he or she is just willfully disobedient. Based on my own biases and abilities (i.e.: no one in my family growing up, including me, seemed to struggle at all to sit while eating dinner, use their utensils and not sing or talk the entire meal), I believe raising a child with ADHD is going to be a continuous battle with my engrained responses and beliefs. Parenting a child with any of these special needs requires significant changes in your expectations for your child’s behavior, and in my experience, this does not come naturally; it takes constant work (on yourself — not just them) and education.
On the topic of ADHD, hands down the most useful resource we've found has been www.additudemag.com, which I subscribe to, follow on socials, and read articles from almost everyday. I read them almost everyday because they serve as a gentle encouragement that I am not alone in parenting an ADHD child, that these kids have great gifts with so much to offer the world, and they provide regular tips and tricks which I like to try.
My child with ADHD is extremely creative, he's a gifted artist and when he's in the mood, he can produce dozens of pieces of art, working for an hour or more at a time... sitting STILL! In case you didn't know, this is called hyperfocus, and is one of the many ways in which we've learned to see ADHD through a strengths-based lens, through the help of our therapist and online community of additudemag.
Additudemag.com also has suggestions for 504 and IEP's and countless valuable references on the site. One frequently cited author is Dr. Ross Greene, author of The Explosive Child (I read the abridged version on Audible and found it worthwhile), who also offers virtual courses which I’ve taken and found valuable. Dr. Greene teaches us that our kids, regardless of their diagnosis, would meet our expectations if they could, and he offers new ways to address our unsolved problems. Like the mantra "he's not giving me a hard time, he's having a hard time," this critical reframing increases the empathy in my parenting, and I don't know about you, but I need daily (or sometimes hourly) reminders on this!
Our next experience with therapy came through the son whom we adopted through foster care. His play therapist was very quickly able to observe the symptoms of Reactive Attachment disorder through an analysis of his history, our stories and her observations of his play. For his day to day management, she recommended we utilize Time-ins. These were very hard to execute initially, but over time have proven to be an important connection-building and trust-building technique that is counter to traditional forms of discipline.
You may find it useful to know that since this child is from the foster system, he's on Medicaid for all his childhood. This is often a hurdle or barrier to treatment when you search for a therapist. Sand Castle, like many great practitioner groups, doesn't take Medicaid. Ultimately, we wanted to stay with them enough and have the financial resources to allow for it, so we negotiated a cash rate ($100/1 hour session) and have utilized that payment model since. I'm sorry I can't offer much personal experience or advice on finding good Medicaid accepting therapists.
About six months after he came into our house, things started getting really chaotic. At this point, our play therapist suggested something significant needed to change, and that's when I resigned from my job. But the other really big step we took was to engage in Family based therapy. We used Jewish Family Services because they were the next available with our then foster-son's Perform Care (PA Medicaid) provider and over time we found them to be wonderful counselors and advocates.
Many people have asked us what Family therapy is. So here's how I understand it:
Practically, family therapy means two therapists come into your home and help the whole family cope with the issues going on. What's good about this, is that the therapists get to witness you in your environment, where my kids are most likely to display their undesirable behavior's, while you're doing your best to correct and parent. What's bad about this is that the therapists get to witness you in your environment! In other words, be ready to be humbled. For me, someone who really cares what other grown women think of me, this can trigger shame/embarrassment. The kids get comfortable with the therapists real quick, forget that they're there sometimes, or at other times "show off" for the therapists. This can create chaos which is hard for us to manage. But, again, the good thing is that there's someone else there witnessing it. An unbiased professional. And the next day, during the parent only sessions, you get to talk to them about what they observed both from the kids, and how you handled it. Everyone in the family has goals for development; kids and adults alike.... which my partner and I really liked. For example, they observed with us that we had different parenting styles. We surmised that this was because we most often parent independently (one parent - 4 kids) because of work schedules. The family therapists rightly suggested that we needed a co-parenting style. This is something we worked on during our 9-month tenure in the program and continue to struggle with to this day. But, we're aware of it and come back to the lessons we learned with some frequency.
Other similar middle leveled interventions like Family based therapy include Mobile therapy and BHRS, where a Therapeutic Support Specialist can work with your child in the field, I’ve seen this most often for little kids on the autism spectrum. In these modalities of therapy, the therapist follows the kids to school and or extra curriculars where they struggle with certain behaviors and teach them and you how to adapt their behaviors to those environments.
Somewhere in the middle of the pyramid is Psychiatry. The main point of having a psychiatrist is to have medications prescribed. The therapy they provide is often less in-depth and less strategy-based than a therapist or psychologist. The psychiatrist focuses on pharmaceutical treatment of mental health conditions, and not everyone reaches this level. In my opinion, this would almost never be the starting place for mental health treatment. In addition, medication treatment for mental health conditions should not stand alone, it should only and always be used in conjunction with therapy and behavioral / emotional support.
When some serious abandonment ruminations became an issue, we knew it was time to take that next step, however, and began again with our Pediatrician for a referral to Psychiatry. But, perhaps many of you have also experienced this, there is a real shortage of Child Psychiatrists out there and waiting lists can be very long. Ultimately, we got lucky and found a new program within WellSpan Psychiatry, which we quickly signed up for. The care has been helpful, the medications have had significant impact, and we continue to seem them bimonthly via telehealth.
More recently, one of our children has also enrolled in Music therapy at Breakthrough. Music therapy can also have very long wait times unless you’re willing to go during the school day, which we do. In my opinion, this work is at least as important as kindergarten art or social studies. They have more boundaries and different goals than play therapy, but we’ve found it to be useful and is helping him grow. Of note, Breakthrough does take Medicaid and since his play therapy isn't getting paid for by them, they've approved his biweekly sessions music therapy for the year and pay for them in full.
I also know many people who've had success with Equine therapy and know there are several solid local venues for this.
In addition, I also restarted therapy of my own about a year ago at PHA of Hershey. I was struggling with some worries, that in my own estimation seemed rational but more pervasive than they should be, about my kids’ futures. Since the very first visit, I’ve found her input, challenging questions and observations shockingly useful and transformative. All my sessions have been video visits and I haven't felt like this detracted from the experience in any way. I have loved every session. It’s promoted quite a bit of self growth, which by now you know I love. I appreciate, so much, how her insights help me see my unproductive and unkind thoughts for what they are. I’ve been able to understand their origins and honestly I’ve been able to eliminate the ones we’ve identified almost completely. I’m proud of myself and thankful for her helping me do the work!
Unpopular opinion: When seeking out a therapist you need not search for Christian therapists or counselors. A good therapist is going to teach you tried and true, researched and proven techniques for overcoming your anxieties, panic, grief, bad habits, deep ruminations and more. A good therapist doesn't need to be a Christian, or profess their own faith on their website. The power of prayer is synergistic with these techniques but it does not need to be used by the therapist for his or her techniques to work.
In my limited experience (7 total therapists that I've encountered for myself or my kids over the past 10 years), I have not deliberately sought out a Christian counselor even once. Every psychological and psychiatric group we've used has been "secular" from the outside, although some of the individual therapists did mention their faith in their bios. However, all the therapists we have used have been respectful of our faith. They understand it's a big part of our lives, a daily component, they put it on our support maps and refer to it positively in their counseling. No therapist we've met has ever put down, discounted or insulted our faith in any way.
In therapy, from the way I see it, one of the therapists main goals is to help the client see themselves as competent. This has to be internal confidence, not relying on external validation, for it to be seen as true and strong enough to withstand the inevitable trials of our world. Knowing your value and seeing yourself as a gift and uniquely talented creates a wellspring of resilience for tragedy or when unfortunate circumstances or events effect our lives. As a general rule, faith deepens that wellspring. In most cases, real faith, believing a loving Creator gave you those talents, loves you unconditionally, and is the source of your irrevocable value and worth helps people have stronger mental health.
For me, with my current therapist and the cognitive behavioral therapy she has used with me, we worked together to identify grounding statements that help pull me out of unproductive thinking that creates worry and discontent in my life. One of those grounding statements is, this is my mission. This statement brings me back to the greater purpose, the very high call, that my challenging children are in my life. Remembering that God gave them to me so we could flourish together, because He's uniquely gifted me to be their parent - that inspires me to better when it feels impossible or too lonely, or when I'm beating myself up for falling short.
I find further support to continue my mission and feel empowered and directed in this mission through my small group at church and through the faith-based adoption camp we attend every year at Camp Hebron. These are other adjuncts, that have synergistically positive effects on my mental health, along with the therapy and my faith.
Furthermore, during that medical school time when I was 22 and my life was in crisis for at least a year, my faith was very strong. At the time, I was a practicing Catholic and in my desperation, I began going to daily Mass. I also furiously journaled every night, tearing through entire notebooks in a few months. I read the bible cover to cover that year, twice! All this did envelope me in grace, I believe. I was fortunate to have these coping skills thanks to my healthy and wholesome childhood. But, I wonder how much quicker I might have recovered if I'd also sought professional help during that time? I believe strongly that if I would have seen a psychologist immediately after the first traumatic event, that he or she could have identified the self-destructive behaviors I was engaging in post-trauma, labeled them appropriately and helped me stop the course of cyclical crisis I unfortunately found myself in over the coming months. My faith during that time was absolutely vital, but in the absence of professional resources and strong community supports, I truly believe I suffered quite a bit more than I would have otherwise.
I believe the key to mental health recovery from trauma and serious challenge is both and, not either or; both faith and professional resources.
Faith is known in the psychological world, to be a protective factor for mental health and even against suicidality in almost all scenarios (the notable exception being adolescents who are questioning their sexual orientation or gender identity, in that case it increases the risk of death by suicide).
With that in mind, most good therapists, regardless of their own faith background, think of faith as a positive influence on their clients lives (in most circumstances).
And another thing: Church people who tell you that if your faith were stronger, deeper or more true then you wouldn't have anxiety or depression are incorrect. God can, but doesn't always, cure cancer, diabetes, addiction, depression or anxiety when we ask. Our list of medical problems doesn't AT ALL reflect God's love for us, his dedication to us OR our dedication to him.
Our medical problems and whether we succumb to them are not at all a reflection of God's power or our power, God's love for us, or our love for Him, but a universal condition of humanity, part of the fall, and a great mystery that we cannot fully understand (this side of heaven) or control.
Mental health problems are like diabetes. Some people are born with it or genetically predisposed (like a type-1 diabetic) and there's almost no way for them to live a healthy life without regular doctor visits and medication. Others are faced with too much hardship (or in the diabetics case, too much sugar) over their lifetime and their resilience (pancreas) wears out, at which point they need regular doctor visits and medication to maintain a healthy life (like a type-2 diabetic). Some of us (like me most likely) are a combination of the two. There's no shame in admitting you're a diabetic, and there's no shame in admitting you need help with your mental health either.
Prayer alone is unlikely to reverse type 1 or type 2 diabetes. Prayer can definitely help you deal with the stigmata of your disease and cope with the regimens required to keep you healthy. Perhaps most importantly, prayer and a faith community can inspire/empower/embolden you to be disciplined and follow your doctor/therapists recommendations, so you stay on track for a healthy life. But you can get your cognitive behavioral therapy techniques from one person, your medications at the pharmacy, and your support in church or small groups. All your support doesn't have to come from just the one source or one type of person.
In conclusion, psychotherapy has played an invaluable role in my family's overall health and function. I cannot recommend it more highly or the providers we've utilized and I've linked here. If you are on your own journey with this and struggling, uncertain or lost, please do not hesitate to reach out to your primary care physician for insight and advice. Also, do not hesitate to reach out to me, I'd be more than happy to help you navigate or answer any follow up questions that you might have, relative to our experience.
Finally, I encourage you to share your experiences in the ways you feel comfortable. Don’t post it all on social media, but talk to someone. Silence keeps us alone. Drawing inward and putting on your tough guy armor perpetuates the lie that you’re alone, that you can do it on your own or you’re weak if you can’t. Drop that! Our creator created us for communion, community with one another. Confiding in one another creates opportunities for belonging, and true belonging helps us all find meaning, reminds us of our value and allows healing. We all need to get past the stigma of needing help and having mental health problems, and the only way to break that is by vulnerably sharing our experiences in "conversations" like this.
I trust you'll do your best to treat my kids and I with the same dignity and respect you always have. I’m expecting you to refrain from judging me and my children even though I've shared some of our darkest stuff here. Please don't pity us, or admire us. All this proves is that we've got courage.
I promise that I'm a safe space too, to share your struggles.
At the top of this blog, since the day it went live, is this quote:
"...suffering is one of the universal conditions of being alive. We all suffer. We have become terribly vulnerable, not because we suffer, but because we have separated ourselves from each other." -- Rachel Naoimi Remen
So let's stop that cycle, lets come together rather than separate ourselves. Come together stronger!
Post script: My therapist is a PsyD Most of the kids therapists are Masters level, and or MSW (Masters of Social work), the psychiatrist is an MD. Here's a handy resource on the differences: https://www.verywellmind.com/therapy-degrees-2795674
