Tell me how to choose a child/family therapist.
November 17, 2009 8:05 AM   Subscribe

Should I go for the in-plan, cheap co-pay therapist or pony up more cash for the therapist who seems a better fit for my family? Would it be bad to switch therapists shortly into the process?

My family needs some help from a therapist. Specifically, my daughter needs some help. She's young (in elementary school), and she was adopted into our family a few years ago. It was a huge trauma for her, and we're all still dealing with the after effects, including huge and frequent tantrums and bedwetting that would be more typical in a child much younger than she is (among other issues). She's still grieving and she's really suffering.

My understanding is that children who were adopted do best when dealing with therapists who understand adoption and how that can hurt a child years after the actual adoption, and so I would like a therapist who has worked with similar issues and similar kids.

I have a pretty good health plan for mental health issues. However, in my area, there are only one or two therapists who are in network, with a reasonable co-pay (around $15), who work with kids and who seem to have knowledge about adoption. I haven't spoken with any of them yet.

There's another practice in my area which specializes in dealing with adoption and dealing with kids who are in foster care or who were adopted. They work with everyone in the adoption triad (ie adoptive parents, kids, birth/first parents). They are out-of-network. My insurance company would cover some of the fees, but we might be looking at $60+ per session.

My inclination is to go right to the therapists who specialize in adoption. But should we give an in-network therapist a try first? Being able to have a low copay would probably mean we could afford much more therapy for much longer.

Will it mess up my daughter if we start with one therapist and switch?

I'd welcome any advice you have on choosing a therapist, especially one who works with kids. Thanks.
posted by anonymous to Society & Culture (11 answers total) 2 users marked this as a favorite
Dumping a new therapist who is not working for you is kind of standard, and actually good practice.
Start with the one you prefer though. If the expense gets to be too much, the more expensive therapist can help you transition, and you daughter will have had the intensive specialized care that she needs.
posted by Sara Anne at 8:11 AM on November 17, 2009 [1 favorite]

Interview both of them, by phone or in person, then make a decision based on your gut, and how they "seem" to you.

In a few years, a happier daughter would far outweigh the financial outlay, if you choose the more expensive therapist who is a better fit. Although it does not have to turn out that way. My advice would be to not let finances dictate this, though.
posted by Danf at 8:17 AM on November 17, 2009

Dumping a new therapist who is not working for you is kind of standard, and actually good practice.

I really agree with this statement, but not in this case.

While you don't provide many details (like age of adoption) about your specific adoption, you're talking about a situation in which some fundamentals have been disrupted for your daughter. One of those fundamentals is the consistency of major care givers. While you should certainly transfer to a new therapist if you are seeing one that is not working for you, in the case you're describing you should seek to minimize any potential disruptions. You will likely want your daughter to be able to rely on whatever therapist you all start out with, and have to help her deal with switching if it's at all possible.

(Note: I'm not your therapist, but I am a therapist, and my wife is a therapist who works with exactly the kinds of kids you're talking about here. You can email me if you would like.)
posted by OmieWise at 8:20 AM on November 17, 2009 [6 favorites]

You need to at least speak to the in-network therapists before you decide this.

One of them might completely wow you, in which case you have an easy decision.

Both of them might wow you, in which case you can pick based on convenience.

Both of them might be unsuitable, in which case you can go to the more expensive therapists.

You don't have to expose your daughter to them, you can simply interact with them, interview them, and see what happens.
posted by kathrineg at 8:51 AM on November 17, 2009 [5 favorites]

Also, you can call the Provider's Line at your insurance company and ask them to contact the Out of Network Therapist to invite him to participate on the Network.
posted by 3dd at 9:08 AM on November 17, 2009 [2 favorites]

Also, you can call the Provider's Line at your insurance company and ask them to contact the Out of Network Therapist to invite him to participate on the Network.


You may even want to write a letter that details how this problem is escalating and could become a significant expense for your insurance company if appropriate treatment is not provided sooner rather than later.

I've had success getting out-of-network providers brought in network when the services provided by in-network providers was no adequate to my needs in a way that would have eventually cost the insurance company.
posted by jefficator at 9:16 AM on November 17, 2009

A therapist who isn't knowledgeable about your situation might take more sessions to get results, or even take things backwards.

Talk to the therapist before you take your daughter and see what their attitudes are.
posted by yohko at 9:19 AM on November 17, 2009

Agree with OmieWise, am also a therapist working with kids (including several who are adopted). Do some extensive talking with each potential choice over the phone, to help you make your decision. It is VERY tough on kids to start with one therapist and begin to develop a trusting relationship, then get pulled out by parents and have to start with someone else--and I'm just talking about kids without the attachment difficulties of adoption. It will be very important that you pick the therapist that you think you'll be able to stick with for your daughter.

I do want to acknowledge, though, that it's entirely possible for your daughter to not feel comfortable/be able to build trust with the therapist you end up choosing (after several meetings, not just initially--it's probably going to be difficult for your daughter initially, but the right therapist will be able to engage her and build that relationship over some time), and in that case, switching is a better idea than staying with the same one.

Ideally, the one you end up choosing will be a great collaborator and will keep you very involved in therapy, so that things like that can be very openly discussed among all of you. I feel like that's the most important aspect of my work with kids/teens--always making sure the parents are appropriately involved at the level of being able to collaborate with me and give me information, and also for me to be able to give parents some support and tools.

Also consider talking to the out-of-network therapists about sliding scale availability.
posted by so_gracefully at 9:30 AM on November 17, 2009

Really and truly, what katherineg said.
posted by katemcd at 10:29 AM on November 17, 2009

You should interview potential therapists before introducing your daughter to them. Also, can you call the adoption-focused practice group and ask them for their opinion about your daughter's needs and about the other therapists you're considering? Doctors have always seemed to me to be less territorial than many other service providers, and they understand insurance concerns, so many of them may be willing to have a conversation about their peers. Additionally, you should ask the specialists whether they have a sliding scale.
posted by decathecting at 10:35 AM on November 17, 2009

I think your instincts are right - head in the direction of a therapist who works with the whole family. Cross off anyone who suggests they can treat your daughter without working with mom, dad, brothers and sisters. This isn't to say that you're doing anything wrong or that it's your fault your daughter is struggling. It is to say that she's part of a system and the entire dynamic of that system is going to have to shift if your family is going to thrive. So yeah, stay with impulse. It will serve you well.

You said that the in-network therapists work with kids. Does that mean they specialize in children/families and have extensive training and experience with kids? Ask them how many education hours they've logged, the number of hours spent working under the supervision of a specialist, and the number of years spent practicing with children/families as their primary client population. Also ask them to give you a list of their professional affiliations. And of course, ask for references.

Don't assume that "works with kids" = "qualified to work with kids." States vary widely on the latter. You may not need an adoption specialist, but you do need a child/family specialist. Obviously, credentials alone do not a good therapist make, but training/education/experience are good places to start winnowing the candidates.

Think of it this way. You're the boss. You're hiring someone to for a very special, very important job. You want a seasoned, serious pro. Some due diligence now should help you narrow the field enough so that you can focus on the more subjective elements of choosing a therapist - their warmth, good chemistry, good repoire, and a good fit.
posted by space_cookie at 12:42 PM on November 17, 2009

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