Wondering if psychoanalytic psychotherapy is right for your child? It can be nerve-wracking to bring your child to a therapist, let alone a psychoanalytic psychotherapist. To help you make an informed decision about what kind of therapy you need for your kid and to give you a taste of what you will be getting yourself into if you choose psychoanalytic psychotherapy, let me share my process when I first meet a family, who needs my help.

Step 1: The diagnostic assessment: This typically takes between 4 to 5 sessions and allows me to assess the history of the presenting problem, the psycho-social and developmental history of the child/adolescent and their current academic, social and family functioning.

• Meeting with the parents: Usually, I request to meet with the parents first so that I can hear their concerns and begin gathering psycho-social and developmental history of the child. If the child is an adolescent, this may happen over the phone but I do request to meet with parents personally so that we can work together to best help their kid. In addition, I often meet with each parent individually as well to discuss their perspective of the child's struggles and assess the family environment.
  

Acting out can look differently depending on your child’s development, their temperament and coping mechanisms. Some children shut down and refuse to speak, which can happen as early as preschool despite normal language development beforehand. Others act out physically - they may yell, hit, kick or punch when overwhelmed and may show limited ability to tolerate frustration.

Adolescents, in their own right, may engage in risky behaviors such as

• experimenting with drugs and alcohol,
• exhibiting physical or verbal aggression towards peers and adults,
• self injuring  
• acting out sexually. 

Simply, acting out is your child's way of trying to communicate or express something through action that is impossible to communicate through words; their unique way of trying to cope with thoughts, feelings or experiences that are overwhelming to them. 

For example, a teenage boy, whose father is being physically or emotionally abusive towards him at home, may be acting aggressively at school towards his peers. Or a girl, whose parents are in the process of divorce and are struggling to communicate respectfully, may have difficulty focusing on schoolwork and refusing to follow teacher’s direction. 

Unfortunately, it is not as simple as it may sound. There are varying degrees of acting out from truancy, self-injurious behaviors and angry outbursts, to suicidal attempts and violence, all of which can be scary and even paralyzing. When faced with such challenges, parents often experience an array of emotions, including doubt, guilt, shame, fear and anxiety. It is completely normal to feel this way!  

Trying to make sense of your child’s acting out behaviors, especially if they are adolescents, can be overwhelming and emotionally challenging for even the most stable of families. We look for answers at the psychiatrist’s or doctor’s office but often we find none, except for an even more puzzling diagnostic label - “Your child is Bipolar” or “S/he has a Mood Disorder.” 

As comforting as a diagnosis could be, I prefer to treat my clients as individuals, not diagnoses. Yes, conducting a diagnostic assessment and arriving at a definition of the problem is a necessary step in the treatment but it is only the necessary first step. The diagnosis helps us understand and describe the sets of symptoms a child is struggling with, for example, difficulties with affect regulation, inability to focus, irritability, decreased or increased appetite, mood fluctuations, etc., but it tells us little about the kid’s individual psychology. 

What is this young man or woman trying to communicate about their feelings? What is their individual experience? What are they trying to process or work through? How do their actions make other people respond? Are there other ways, healthier ways they can use to express themselves? What else could be going on?

These are some of the questions we try to answer in therapy. We try to find words for thoughts, feelings and experiences that have not been expressed before and that leads to different, healthier actions in the long run. We create a space for the unspoken, for that which tries to find expression through action. 

It is not simple; it takes time and commitment both on the part of the child and on the part of the parents. Sometimes medication is necessary, other times it isn’t. Either way, it is up to you to take the first step and then keep going. 

Do you have a child or adolescent, who is acting out at home or at school? Share your experience in the comment section below or email me your question at [email protected].