How do I figure out therapy?

One of the scariest parts about having a child struggle with suicide is the feeling of helplessness, the not knowing what to do.  It always hurts us when our children hurt: breakups, lost games, mean comments.  But the steaks are high when we think their life is at risk.  We want to take action: primarily to keep them safe and secondarily to feel some sense of control.

Many people, appropriately, turn to therapy for answers.  Therapy, medicine, or a combination of both are all worth investigating.  And that brings me to the point of this guide.  It is an investigation.  There are different disciplines of therapy and many (although maybe not enough) different therapists.  Real progress comes from finding the right fit.  That takes time and trial and error.  And when your kid’s life is on the line, who has time for that?

As a reminder, I am not a professional and I am not offering an opinion or suggestion about the efficacy of any type of therapy.  But there are some things I have learned about the search.

Patience is important.  There is a feeling that “my kid might die, someone needs to do something!!”  But as with most things, no one is coming to save you.  You will have to find your solution.  There are many great programs and tons of caring people in this field.  But it will be up to you to find them.  You may be in totally unchartered waters but you are still the captain of this ship.  Take a breath and start educating yourself.

The questions you will want to answer are what type of therapy is best for my child and which therapists practice it and then balance that with, what do I have access to?  So, where should you begin?

Let me digress a moment and say that trying to force your kid into therapy when they don’t want it will be frustrating, expensive and probably not very effective.  Think about it from your point of view, if someone who loved you said you had to start therapy when you didn’t want to and didn’t think you needed it, how effective do you think it would be?  We can talk about how to try to get your kid to buy in in another guide.  For this conversation, we will assume that your kid is at least partially a willing participant.

In my experience, the process is one of trial and error.  So expect to try something (maybe anything) in the beginning, just to have some support and begin to get your kid the help they need.  My first suggestion is to reach out to your pediatrician.  They likely have some resources and that is a good place to start. They may require an appointment to assess your child. That’s ok.  Sometimes it can be easier to get an appointment with any doctor if you have been recommended by another doctor.  Ask if your pediatrician can assist in booking the therapist appointment, but they may not be able to.

I mentioned before that you are the captain of this ship, but it is your child’s voyage and they have to feel that they have agency over it.  The appointments you get are their appointments.  Before you meet with the pediatrician, ask if your kind wants you in the room.  If they don’t, respect that.  If the doctor asks you to step out, do so gracefully. If you feel like your kid is embarrassed, offer to step out.  None of this will work if your kid feels that they can’t be honest.  You likely don’t want to share all of your secrets with your child and they don’t want you to know everything either.  That is appropriate.  You will not be able to force your kid to stop feeling like they want to die, even if you want to.

So, now you have the names of some therapists and you make some phone calls and likely, you leave a lot of messages and no one calls back.  And you wonder how can professionals in a field that is supposed to help people, ignore your calls for help?  The answer is simple, there are many more people that need help then there are people available to help.  Be persistent, be polite, advocate for your child.

While you are waiting to hear back, while you are on waiting lists, is the time to educate yourself.  Start reading about different types of therapy.  There are so many initials and so many confusing words. CDB, DBT, psychotherapy, family therapy, EMDR, the list goes on and on.  Make a list of the ones you’ve heard of, the words you’ve never heard of, anything that sounds interesting.  Then do a quick Google search for each one and use sources that are commonly known: Psychology Today, NAMI (National Alliance on Mental Illness), WebMD. Now is not the time for experimental treatments.  If that becomes relevant, you will look into it later down the road.  

The different types of therapies have different approaches and different stated outcomes.  I would start with the outcomes.  What is your child’s temperament and what might suit the way they approach the world?  We started with CBT because it is concrete and deals with things the way they are right now.  It is not intended to last forever.  Some people may need talk therapy and a place to discuss how they came to where they are.  Take a (short) amount of time to discuss what you have learned with your kid and see which they want to try.

You are probably still waiting to hear back from the suggestions your pediatrician gave.  If you have insurance or are on a government program, looking at their list of participating providers is a good place to start.  One of the frustrations you will probably experience is that many providers don’t accept insurance and the cost of visits out of pocket is expensive at best and out of reach at worst.  So start with the coverage you have.  If you don’t have coverage, call your state or county for resources.  They should be able to put you in touch with entities that can give you organizations that can point you in the right direction.  It can be a lot of calls.

More often than not, the process begins with whatever first appointment you are able to get.  And that’s ok.  You don't yet know what will work for your kid and your family. So get started.  The providers have their own process, so once you get an appointment, they will tell you how it will work and what the timing and costs are.  Often, there is an intake visit that is longer than a regular visit, maybe an hour and a half to two hours, with both you and your child.  It may be broken up into segments that are just you and the therapist and just your child and the therapist.  Here I would just follow the lead of the provider.  They know what they are looking for and what is effective for them.

That experience will dictate next steps.  Encourage your kid not to make snap judgements.  But also take their point of view into account.  There is no sense spending time and money on a therapist your kid has determined they don’t trust.  Give it a chance.  It takes time to build trust and even more time to start to see progress.  But also be ready to pivot.  Stay on the waiting lists for the providers you liked but couldn’t get into.  Call them from time to time so they know you are still interested. 

By now, time has passed from your initial crisis.  Maybe things have steadied a bit.  Maybe things have been unbearable.  But you are learning more and more what works and what doesn’t, what obstacles have to be overcome and how to do that.  You are the advocate for your child.  You are the captain of this ship that is their voyage.  Travel on and I wish you smooth seas.