Environment


This category includes family structure, socioeconomic conditions, cultural milieu and education. For instance, are there marital, financial, alcohol or other problems that have influenced the child's development? Is the family able to tolerate the transient turbulence their child might experience as he or she works through issues in psychotherapy? Is the family healthy enough to welcome and help sustain the changes the child makes? Does the child have to contend with instability and violence in the neighborhood or school?

Therapeutic Options


The most appropriate psychiatric intervention depends not simply on the diagnostic label, but also on a variety of factors pertaining to the child and parents. For example, is the child able to introspect, communicate verbally and through play, and relate to a psychotherapist in a way that fosters understanding, growth and development? Is the particular disorder responsive to medication or to a cognitive behavioral approach exclusive of psychotherapy? In any event, the child and parents must be allied with the therapist in the treatment process. Only by knowing the child and the parents can the clinician effectively predict whether they will cooperate with the chosen modality.

The decision to recommend psychiatric treatment is a difficult one. It is quite typical for a child to become symptomatic while accomplishing a developmental step. And some children, as they continue to grow, play and relate to family and peers, get better on their own. But some do not. After completing my evaluation, I arrange a summation meeting with the parents to convey a sense of the child's strengths, weaknesses and symptom complex, and to make recommendations for intervention when needed.

I recommend psychiatric treatment if:

  • The child is arrested in development.
     
  • The child's concerns inhibit the capacity to learn or sustain relationships.
     
  • The parents are unable to sufficiently help the child because of their own developmental status, because it stirs up painful feelings or because their issues are part of the problem.
     
  • The child has lost the capacity to use play to master problems.
     
  • There is a biologic disorder that will not get better without medication and/or psychotherapy.



If the parents reject the recommendation for therapy, I add a final child meeting to the consultation so that the child and I can talk over my ideas and say good-bye.

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