Question 1

How do I know if my child has an anxiety disorder and warrants treatment?

Accepted Answer

Psychiatric diagnoses are provided based on the frequency, duration and severity of symptoms as well as the impact on overall functioning (including social, familial and academic). Whether or not your child meets criteria for an anxiety disorder, if they are struggling to manage anxiety, specialized treatments can be helpful to teach adaptive coping skills, build resilience and reduce the impact of symptoms.

Question 2

What is OCD? How is it treated?

Accepted Answer

Obsessive compulsive disorder (OCD) is a psychiatric condition that involves the presence of obsessions (unwanted intrusive thoughts, images or urges that cause distress) and compulsions (behaviors engaged in to eliminate the obsession and/or decrease distress). Common obsessions relate to contamination, losing control, harm, perfectionism, unwanted sexual thoughts and religion. Common compulsions include washing and cleaning, checking, repeating and engaging in mental compulsions. The evidence-based recommended therapeutic treatment for OCD is cognitive behavioral therapy (CBT), specifically exposure and response prevention (ERP). ERP involves systematically exposing oneself to the thoughts, images and situations that lead to anxiety and/or start obsessions while refraining from engaging in compulsions. Through careful repeated exposure, anxiety levels decrease, and habituation occurs.

Question 3

My child experienced the death of a loved one. Is therapy needed?

Accepted Answer

Not everyone who experiences a loss needs therapy. However, many benefit greatly from the opportunity to work toward accepting the reality of the loss, learning safe and healthy ways to externalize emotion, adjusting to a world in which the deceased is missing and identifying ways to establish continuing bonds. Grief therapy is often particularly helpful for those who have experienced traumatic loss such as death of a loved one by suicide or overdose or whose symptoms of grief are debilitating and/or impair functioning. In children who are grieving, significant and persistent changes in academic functioning, social interaction, sleep, appetite or mood are signs that therapeutic intervention may be warranted.

Question 4

What can I expect during the first session?

Accepted Answer

The first two appointments are typically used as diagnostic evaluation sessions. For minor clients, the first appointment is for parents/guardians only. This provides the opportunity for caregivers to share openly and candidly about family history and presenting concerns. Initial treatment goals will be identified, and discussions will be had regarding the caregivers’ roles in treatment and ways progress will be measured. The second appointment is the minor client’s portion of the diagnostic evaluation. Time is spent introducing the child to the therapeutic environment, establishing rapport, discussing presenting concerns and beginning to provide psychoeducation.

Question 5

What is Cognitive Behavioral Therapy (CBT)?

Accepted Answer

Cognitive behavioral therapy is the evidence-based recommended therapeutic treatment for anxiety, OCD, depression and a number of other emotional challenges and mental health disorders. CBT is an active, skills-based treatment approach that focuses on the interplay of one’s thoughts, feelings and behaviors. Cognitive behavioral therapy differs from many other forms of psychological treatment in that there is substantial scientific evidence that confirms the methods produce change. Common CBT techniques include relaxation training, cognitive restructuring and exposure therapies.

Question 6

What if my child needs medication? Do you prescribe?

Accepted Answer

I do not prescribe medications. If a medication consult is needed, I am available to provide you with referrals for skilled providers who are authorized to prescribe.

Question 7

How often will I/my child attend sessions?

Accepted Answer

Weekly sessions are typically recommended until progress is noted toward treatment goals. Once progress is made, a decrease in session frequency to every two weeks is often warranted. Once all treatment goals have been met, a further decrease to monthly maintenance sessions is recommended to ensure progress is maintained. Oftentimes, after several months of monthly maintenance sessions, clients are either discharged or continue with quarterly mental wellness or ‘booster’ sessions. Just as children have wellness visits with their pediatricians, many families choose to continue with quarterly mental wellness sessions to maintain and monitor progress, continue to learn adaptive coping skills, and preserve the therapeutic relationship. This is especially helpful should problems arise later in development as the client already has therapeutic support in place.

Question 8

Are there things I/my child can do in between sessions to maximize treatment?

Accepted Answer

Absolutely! Homework is often provided in between sessions. Whether it be skills to practice, data to be collected or exposures in which to engage, compliance with homework is an important part of the cognitive behavioral treatment process.

Question 9

How long is the treatment process?

Accepted Answer

Everyone progresses at a different rate. When consistent weekly treatment sessions are had and clients (and parents/guardians) are compliant with the homework that is often prescribed in between sessions, treatment is most effective and efficient. The length of active treatment depends on the number of treatment goals, severity of symptoms, response to interventions and a number of other factors. While progress is often noted continually, many meet treatment goals after approximately 24 sessions.

Question 10

How do you keep children engaged during video appointments?

Accepted Answer

I add structure to sessions with young children by using a visual schedule. While building rapport, children are invited to share drawings or items from home on camera. I keep young clients engaged by switching activities frequently, using screen sharing and an interactive whiteboard and incorporating movement into sessions.

Question 11

How can I pursue insurance reimbursement using my out-of-network benefits?

Accepted Answer

Contact your insurance company directly to inquire about your out-of-network benefits. Many are eligible to receive a percentage of amounts paid in reimbursement. My clients are provided with monthly superbill receipts that include all of the information that is typically needed for those seeking insurance reimbursement.

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