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Don’t assume behaviors are a phase, says psychologist Jacqueline Sperling

Jacqueline Sperling, a clinical psychologist in Cambridge, Mass. treats children and adolescents ages six to 19. She is the director of training and research at the McLean Anxiety Mastery Program at McLean Hospital. PHOTO: JOSH ANDRUS FOR THE WALL STREET JOURNAL

By Elizabeth Bernstein
March 27, 2017 12:08 p.m. ET

Many parents have wondered, looking at a nail-biting child or taciturn teen, if their parenting is adequate or if their child would benefit from professional help.

Jacqueline Sperling, a clinical psychologist in Cambridge, Mass., is the director of training and research at the McLean Anxiety Mastery Program, an intensive group-based outpatient program for children and adolescents ages six to 19 at McLean Hospital. She also has a private practice and is an instructor in psychology at Harvard Medical School.

Dr. Sperling practices Cognitive Behavioral Therapy (CBT), which helps a person identify inaccurate or negative thinking in order to respond to a situation more effectively. She treats children with anxiety disorders and Obsessive-Compulsive Disorder (OCD) and offers guidance to parents on how to manage children who are struggling with their feelings and often with behavior problems, as well.

When should parents bring a child to a therapist?

I recommend sooner rather than later. It is best to seek help when you start to see signs that behaviors are getting in the way of a child’s social, academic or home environments: If a child starts turning down playdates or has trouble making friends, if grades start to decline or the child becomes distressed about schoolwork to the point of shutting down. Bring them to therapy if a child has trouble following rules, frequently argues, repeatedly seeks reassurance, withdraws from family members or becomes increasingly dependent on caregivers at home.

A feelings identification toy Dr. Sperling uses with patients. If someone throws the ball to you, you catch it, and if your right thumb lands on ‘worried,’ for example, then you share an instance of when you were worried. PHOTO:JOSH ANDRUS FOR THE WALL STREET JOURNAL

I don’t advise parents to assume behaviors are a phase. Therapy can teach skills that are helpful for everyone, so there is no harm in getting extra support.

What can a parent do if a child resists therapy?

Sometimes treatment-resistant children will say they want their parents “off their backs.” One way to engage such children is to help them see that coming to treatment to work on goals can be a way to help understandably concerned caregivers give them some space.

What issues do you see in children now?

I see children with anxiety disorders and OCD. These issues often hang together with others, such as depression, attention difficulties and tics.

Children with anxiety disorders often acknowledge they’ve always had a tendency to be anxious but that certain stressors at a particular age caused the anxiety to worsen.

Is anxiety about school on the rise?

School houses almost everything a child may fear, and the increasing demands placed by overscheduled days and interactions online may be contributing factors to the rise in anxiety about school. An important part of the evaluation is to determine what it is about school that is contributing to such distress.

Are parents present in a typical session?

For CBT sessions, after an initial evaluation with the family, I start with just the child in the room. Parents are invited to contact me beforehand to share updates and relevant information.

For at least the last 20% of the session, parents are invited in so the child can teach them the skills that were learned, review what else was covered, and discuss the homework plan for the subsequent session. Parents are taught to be coaches and cheerleaders to support the treatment.

What’s the average length of time that a child might be in therapy?

CBT is a collaborative short-term treatment that aims to teach children the tools they need to be their own coaches in the future. An average duration of weekly treatment may be around 12 to 16 weeks.
Intensive treatments for particular issues, such as anxiety, offer treatment multiple hours per day and per week. The aim is to help children get concentrated doses of treatment so that they can return to their daily lives and routines more quickly.

How do you discuss a child’s session with parents?

I talk with children about how what they share remains private between the two of us; however, there are exceptions. Any evidence of child abuse has to be reported to authorities, as well as any threats to hurt a particular person or population. I also explain that I keep what the child says private from the parents except for any threats to the child’s safety or health.

I ask the child toward the end of each session what other, non-safety information he or she feels comfortable sharing. I want children to experience a sense of control and understand the limits ahead of time.

How do you handle it when children say damning things about their parents?

I address the feelings driving those statements. A child most likely is really angry with or hurt by parents, and I want to validate these feelings as well as teach children more effective ways of communicating their emotions to get their needs met.

When is medication appropriate for a child?

I always am happy to refer children to psychopharmacology providers for a consultation if the family were interested. Medication can supplement the effectiveness of CBT, which can be needed if a child is struggling to function.

What are the more subtle signs that a child or teen may be suicidal?

Symptoms of depression, such as loss of interest in hobbies, sadness or irritability and hopelessness, as well as social withdrawal and gestures of giving away belongings can be signs that one is considering killing oneself. Major losses, such as deaths or breakups, and threats to one’s self-esteem, such as not achieving one’s goals that happen ahead of some of the above behaviors can serve as red flags. This by no means is an exhaustive list.

You aren't going to plant the idea of killing oneself if you bring the topic up. You will show that you care and aren't afraid to talk about suicide. If you are concerned, ask.

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