Thursday, June 2, 2011

Why I No Longer Work With Children

I used to work with children in mental health clinics in Brooklyn and the Bronx, from 1997 to 2003. I also worked with children as 50 percent of my private practice from 2001 to 2005. I no longer work with children, however. I decided that since most of the problems I was seeing in the children were caused or exacerbated by their parents, it didn't make sense to treat the children. Psychotherapy was not what they needed.

Of course, some children do have real disorders, but those disorders, such as Attention Deficit Hyperactivity Disorder, Childhood Onset Bipolar Disorder and Childhood Onset Schizophrenia, are neurologically based illnesses that often require medication and frequently don't respond to psychotherapy. Children do develop anxiety and depression, but in most cases, anxiety and depression in children is just a response to a negative environment. Some of the most commonly diagnosed childhood "disorders" such as "Oppositional Defiant Disorder" are just terms used to describe what children do when they are angry about they way adults around them are behaving.

Here's a case that illustrates the pitfalls of diagnosing and treating children: In 2002, when I was working at clinic in the Bronx, I was assigned to work with a 12-year-old boy, whom I'll call as "Jose." He presented with many symptoms of depression and ADHD, including anger, agitation, restlessness and verbalized unhappiness. He was unable to sit still and seemed distracted. He had a history of being abused by his mother, and had been removed from her care and placed with another relative. We agreed I would see him weekly and also that he would be further evaluated by the clinic psychiatrist.

Jose's relative didn't bring him regularly for his scheduled sessions, and after he didn't attend his appointment with the psychiatrist, I called in a report to ACS (the Administration for Children's Services, New York City's child welfare agency). The ACS worker arrived at Jose's home to discover that he wasn't there and his caretaker had no idea where he was. After Jose was found, he was placed with a different relative.

The following week Jose was brought to his therapy appointment by his new guardian. All of his symptoms had miraculously disappeared. He was no longer restless, distracted, or agitated, nor did he appear to be sad. The clinic's receptionist asked me "is Jose taking some new medication?" All of Jose's symptoms had been a reaction to his environment. Because his new caretaker was empathic and genuinely interested in him and his welfare, he adapted to this new environment by acting like the normal boy that he was. I continued to work with him, because of his history of abuse, and he seemed well on his way to a complete recovery when unbelievably, his former caretaker went to court to try to regain custody of him. She'd felt insulted that someone had decided she was not a fit parent. Jose was dragged into a legal situation that re-traumatized him. The situation was eventually resolved, but only after Jose was subjected to further damage.

One could argue that if it hadn't been for my intervention, Jose would have continued to have been neglected and his mental health would have been in serious jeopardy. I would agree, but it doesn't change the fact that most of what I did for him was work that I wasn't paid to do. I worked as a "fee-for-service" therapist at the clinic and was paid only for therapy sessions. This model is extremely common in New York. All the work I did advocating for Jose--calling ACS, attending his court case and making follow-up phone calls--was unpaid.

Our mental health system simply isn't designed for children. In later posts, I'll describe more pitfalls of the system. For my personal well-being, I had to remove myself from working with children. Most children's problems need to be addressed by professional child welfare workers and advocates, not by psychotherapists. But because the system continues to describe children's natural reactions to negative environments as disorders, therapists and other mental health workers are often the persons who end up advocating for children's basic needs.

4 comments:

  1. You are a very brave person to have written such an article on this serious matter, I applaud you for this. While it may be true that some children have a certain chemical imbalance within the brain, this is still not a "mental illness" many are diagnosed merely for the sake of there being no other options. I have done extensive research on this and have formulated a theory or two of my own. I have been met with favorable results in that what is currently being diagnosed as "mental illness" can be categorized as common "emotional distress" stemming from a lack of empathy on the part of many adults that are connected with such a child. My theory if I may is titled C=ea2 and suggests humans are neglecting the fact that we are absurd sensation based beings of implied essence and inference, where we are lacking is in our ability to infer. This shows up in the loss of empathy that I have reason to believe is caused by "striving to become logical and intelligent', when in fact we do hold the capacity for a certain intelligence, it is limited or possibly retarded as a result of us not recognizing this other element or facet of human nature.

    I am not a therapist nor do I hold any degree, however I have been assisting many people, children included, with such things as what you are writing about.

    When I can get a person to understand, agree and accept what this work suggests, they instantly show signs of relaxing and this is something to see.

    If you are interested I would love to discuss my work with you and see where it will lead.

    editnse@hotmail.ca

    http://ezinearticles.com/?expert=Richard_Crant

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  2. I do think that people have lost some of the inability to intuit and empathize. We overvalue "science" and "research" which today often consist of projects and experiments funded by pharmaceutical companies. We have lost faith in common sense. Here's an example from a different area: Witness the controversy over hydraulic fracturing; anyone with an IQ over 70 could figure out that if you break up the deep rock with toxic chemicals, some of those chemicals will eventually find their way up through the layers of rock. But "studies" done by oil and gas companies claim otherwise, and underfunded regulatory agencies don't have the resources to prove them wrong. So the public is misled by being told "studies" have found this obviously dangerous activity is "safe."

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  3. I agree that the mental health system is not set up for children, in fact I would argue that it isn't set up for people.

    My 10 year old son suffers from a mood disorder. He's not a case of the neglected child, but rather he's surrounded by the love and support of his family. His symptoms are real and thanks to medication he's doing better. But we will always be fighting with the HMO system.

    I've been documenting symptoms for 3 years now with logs and charts, yet the psychiatrist and therapist never have enough time in their sessions to go through these kinds of notes, let alone the issue at hand. I feel like as his mother, I've had to take on the full time job of researching and pursuing treatment options while fighting a system that doesn't have the ability to treat a child.

    It's very frustrating and scary. My greatest fear with our HMO is hospitalization, can you imagine being 10 years old and being brought to the hospital with strangers while your parents are not allowed to stay with you. I feel like our current system will only create more trauma.

    Our system has failed us more than once, I just hope that it doesn't cost my son his life!

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  4. Actually, although I no longer work directly with children, I do consulting work in state-operated and state-licensed psychiatric hospitals including children's hospitals. When I interview the children there, they generally tell me they like the hospital. Sometimes, they don't want to leave. I wouldn't worry about the HMO sending your child to a hospital, however. The last thing an insurance company wants is a patient in the hospital, because hospitalization costs a lot of money.

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