Tier 4 Child Psychology
Should My Child See a Therapist Alone or Should We Do Family Therapy?
TL
Too Long; Didn't Read
Individual therapy for children is often a 'parentectomy'—artificially treating kids as if they exist independently of their families. For most childhood issues, family therapy is more effective because children are like gas: they take the shape of their container.
The Great Child Therapy Debate
Most parents think child therapy means sending their kid to a therapist who will "fix" them through play therapy and individual sessions. This approach often fails because it ignores a fundamental truth: children don't exist in isolation.
The Individual Therapy Approach
How It Usually Works:
•Child sees therapist alone for 45-50 minutes
•Therapist forms relationship with child (takes 6-8 sessions)
•Uses play, art, or talk to help child "gain insight"
•Parents get brief updates occasionally
•Process takes months or years
•Focus is on child's "internal world"
The Problems with This Approach:
•Ignores the family system
•Creates artificial relationship outside family
•Takes forever to see results
•Doesn't change child's daily environment
•Often enables parents to avoid their role
•Treats symptoms, not causes
The Family Therapy Alternative
How It Actually Works:
•Whole family participates in therapy
•Focus on changing interactions that don't work
•Parents become agents of change
•Immediate environmental changes
•Faster results because you're changing the system
•Child's behavior improves as family dynamics improve
Why It's More Effective:
•Children spend 167 hours per week with family, 1 hour with therapist
•All behavior must be understood in context
•Family is child's most important environment
•Parents are child's best chance for lasting change
When Individual Therapy Makes Sense
For Children:
•Trauma that parents weren't involved in
•Sexual abuse (initially)
•Severe anxiety with specific triggers
•When family therapy is also happening
•Grief and loss counseling
•Building specific coping skills
For Orphans or Foster Children:
•When there's no stable family system
•Multiple placement disruptions
•Attachment disorder issues
•When family therapy isn't possible
The Family Therapy Advantage
For Common Problems:
School Avoidance:
•Family therapy gets child back to school immediately
•Addresses family patterns supporting avoidance
•Parents become united front
•No endless exploration of "why": cure is school attendance
Behavioral Problems:
•Changes family responses to behavior
•Eliminates patterns that reinforce problems
•Teaches parents effective strategies
•Creates consistent expectations
Anxiety in Children:
•Addresses anxious parent patterns
•Changes family's relationship to anxiety
•Builds family confidence and coping
•Models healthy anxiety management
Depression in Children:
•Engages child in activities that don't serve depression
•Changes family patterns that support withdrawal
•Builds excitement about new activities
•Addresses family factors contributing to depression
The Container Principle
Children Are Like Gas:
•No definite volume or shape
•Take both volume and shape of container
•Family is the container
•Change container, change child's behavior
This Means:
•Anxious families create anxious children
•Chaotic families create chaotic children
•Structured families create structured children
•Healthy families create healthy children
Common Childhood Issues That Respond to Family Therapy
Attention and Focus Problems:
•Often family attention patterns, not medical issues
•Inconsistent parenting creates scattered children
•Family therapy changes attention dynamics
•Medication often unnecessary with system changes
Social Difficulties:
•Family teaches social skills better than individual therapy
•Parents arrange social opportunities
•Family models healthy relationships
•Natural social exposure works better than office play
Anger and Aggression:
•Usually family pattern of handling emotions
•Parents learn to manage their own reactions
•Family creates structure for emotional expression
•Individual therapy just lets child vent without change
When to Consider Combined Approach
Individual Plus Family When:
•Child has specific trauma to process
•Severe mental health issues require individual attention
•Child needs specific skill building
•Family therapy is already addressing system issues
The Balance:
•Individual therapy supports family therapy goals
•Family therapy remains primary intervention
•Coordination between therapists essential
•Clear plan for phasing out individual work
Red Flags of Poor Child Therapy
Warning Signs:
•Therapist rarely meets with parents
•Focuses only on child's internal world
•No clear timeline or goals
•Parents feel excluded from process
•Child's behavior at home doesn't improve
•Therapist can't explain their approach clearly
What You Should Hear:
•"Let's work together to help your child"
•"Parents are child's best resource"
•"We need to change what's happening at home"
•"This shouldn't take years to see improvement"
Questions to Ask Potential Therapists
About Their Approach:
•Do you do family therapy or individual child therapy?
•How do you involve parents in treatment?
•What's your typical timeline for seeing improvement?
•How do you measure progress?
About Your Role:
•What will be expected of us as parents?
•How often will we be involved in sessions?
•Will you teach us strategies to use at home?
•How will you help us become more effective parents?
The Collaborative Family Approach
What Effective Family Therapy Looks Like:
•All family members attend initial session
•Sometimes individual meetings within family sessions
•Focus on changing family interactions
•Parents receive specific strategies and tools
•Regular homework and practice between sessions
•Clear goals and timeline for improvement
Your Role as Parents:
•Active participants, not passive observers
•Learn new skills and strategies
•Practice changes between sessions
•Become your child's primary therapists
•Take responsibility for family changes
The Bottom Line
Your child's problems didn't develop in isolation, and they won't be solved in isolation. The most effective approach changes the family system that the child lives in 24/7, not just talks to the child for one hour per week.
Remember:
•You are the most important agent of change for your child
•One hour per week can't compete with 167 hours of unchanged family patterns
•Family therapy works faster and creates lasting change
•Your child's best chance for improvement is you becoming more effective parents
Think of it this way: if your house plants are dying, you don't send the plants to plant therapy. You change the soil, water, and light conditions. Children thrive when their family environment becomes healthier.
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Dr. Gore's Take
Professional insight on this topic
"I believe that children can be compared to gas: A gas has no definite volume or definite shape. A gas always takes both the volume and the shape of any container into which it is placed. You are the container."
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