5 Suggestions When Beginning
Mental Health Treatment for Your Child
by Dr. Michael Gombatz
In my practice, when a single parent brings a child for mental health treatment, it is common to hear a parent say, “He is angry because when he goes over his father’s, his father is always yelling and cussing, so now he does it, too.” Or, “I need to help my son not be so angry.” Or, another parent has said, “His mother doen’t pay much attention to him and always seems to have a new boyfriend. She expects my daughter to like him, too.” When the children are teenagers, a parent may say, “My son drinks because his father is a drunk. He wants to be just like his father.”
The examples go on and on. One does not need to be a psychologist to figure out the relationship with the other parent has become distant, strained and or even hostile. If the relationship was amicable, more than likely parents would have stayed together. Much of the time, single parents don’t even like the other parent. They find their son or daughter is anxious, worried, sad, or aggressive… and more.
Because of their distaste, dislike or even “hatred” of the other parent, and even the belief that the other parent may be causing the problem, one parent does not want the other parent involved with the therapy. They want little or nothing to do with the other parent. This urge must be resisted, for the sake of the child because, if not, the risk for emotional harm for the child increases.
Why is involving both parents important? One parent may have emotional fears of losing their child’s love which creates loyalty conflicts in their son or daughter. Excluding the other parent could make the loyalty conflict even worse and foster a child to move emotionally or physically distant from the parent that is not involved in the treatment.
Robust research of mental health treatment for children or adolescents is clear. Treatment is most effective when both parents, regardless of their relationship with each other, are involved in the evaluation and treatment process. Every effort must be made to include both parents. Without doing so, diagnostic errors of anxiety, depression, oppositional behavior, conduct problems, as well as ADHD, can be made if the child’s symptoms are impacted by the unresolved parental conflict and tension.
A parent may even attempt to convince a mental health professional to exclude the parent by asserting the other parent is causing the problem.
Accepting a child patient in this manner by a well meaning therapist can cause more mental health problems than it solves as the child may develop a delusional (false belief) that the other parent is the cause of the problems and estrangement with the other parent. More on this in the soon
5 Suggestions When Beginning Mental Health Treatment for Your Child
Parents divorced, separated, not married and or not together.
Sole Legal Custody
When a single/divorced parent without the other biological parents brings a minor child for treatment, my office manager, Susan Bowen, inquires if there is a custody arrangement and if they have sole legal custody. If the single parent has sole legal custody, we can schedule at the time of the call. We ask for a copy of the legal documentation. We also usually inquire if the parent that does not have legal custody, involves themselves with the chid/ren. If they do have contact, we request the parent with legal custody to contact the non custody parents and inform them of the appointment or if they prefer not to, we ask permission to contact the non custodial parent. Most of the time permission is granted. If not, I am required to honor the wishes of the parent with sole legal custody. If after seeing the child, if I determine that the symptomology present, may have something to do with the non custody parent I inform the custodial parent. Most of the time consent is granted and if refused, I comment that the refusal may compromise successfully working with the child.
In cases of joint legal custody, not the physical shared custody arrangement, I am required to at minimal to request permission from the other parent to see the minor child. The most efficient way is to ask the parent bringing the child to send an email to the child’s parent with a copy of the email to me and ask for a response. If an email is sent, and the other parent does not respond, the good faith request justifies seeing the minor child. Should there be some question about sending an email, I ask for a phone number and we call the other parent.
No Legal Arrangement
If the parent that requests an appointment for the child and there is no legal papers, a request is made to contact the biological parent made by the parent who has custody of the child with a copy to Dr. Gombatz notifying the non custodial parent that the child is seeing a psychologist for mental health evaluation and or treatment. Then an appointment is made inviting the other parent to provide information if he or she chooses.
If a Biological Parent Objects
Appointments are made with the parent having sole custody and if no legal arrangements exists. In cases of joint legal custody, if one parent who has joint custody objects, I make an effort to address the objection and meet with the parent if they choose, to address the objection. This is rare, as most parents will consent, if the other parent is involved in the appointment process. If they are excluded and an appointment is made, most often there is an objection after the fact.
If the evaluation and treatment is for an ADHD evaluation and treatment and medication based upon the evaluation is warranted, and the joint legal custody parent objects, meeting with the parent to explain the evaluation and recommendation usually resolves the objection. They are also referred to the pediatrician caring for the child for discussion and resolution. If the joint custody parent still objects and there is no court order specifying who has tie breaking decision making in medical matters, I generally refer the parent seeking services for a child to their attorney to address it with the Court. This is extremely rare, but often occurs in congested custody cases.
The Mental Injury or Physical abuse Exception
If a child is referred because one parent brings a child suspecting mental injury or emotional abuse by the other parent and desires an evaluation, the child can be seen for an evaluation only and if there is any indication of abuse, the Department of Social Services is notified. The child is not seen further until the Department of Social evaluation is completed and a recommendation for treatment is made by the Department of Social Service. This is also rare and exceptional as often if the medical provider suspects any mistreatment, DSS is notified. If the Department of Social Services makes the referral, the fee is usually paid for by the Department.