These are answers to Frequently Asked Questions regarding Therapy and Services. For answers to specific Behavior questions see “Behavior Blog” or ask Patience directly through the Behavior Questionnaire/Contact page.
Type of Therapy
Q: What type of therapy do you provide?
A: I provide “behavioral therapy” which is basically training children to behave in a more appropriate way in home and school. It also involves training parents/teachers how to interact in a more efficient way with the child to elicit the desired response from the child. This is effective therapy for children with behavior issues such as ADHD, Oppositional Defiant Disorder, Autism, as well as Anxiety and Depression.
Q: What is Cognitive Behavioral Therapy (CBT)? And what’s the difference between CBT and just “Behavior therapy”?
A: Cognitive Behavioral Therapy (CBT) is basically teaching a child (or adult) to think differently which therefore changes their feelings and ultimately their behavior. For example: Situation: Child is faced with going to school and child doesn’t like school. Child thinks “my day is going to be the worst” then he feels sad/anxious/grumpy, and likely will be frowning/moody/crying/ maybe even school avoidant. However if we change that thought to “I’ll look forward to choir at the end of the day” then we change our feelings to hopeful, maybe even happy or content, then our behavior changes to smiling, looking forward to end of the day, attending school, etc. This is a very basic example. CBT also teaches appropriate coping strategies besides just changing thoughts and feelings but also how to calm down when upset like deep breathing, for example.
Behavior therapy is part of CBT but without as much focus on the thoughts “cognitions” part but more on behavior and consequences. This means basically teaching the child “if you do this behavior- you get this consequence” and “if you do that behavior- you get this reward/consequence”. The difference of which to therapy model to utilize depends on age of child and how much they can process thoughts. Very young children need basic behavior therapy, and older children can often work on changing their thoughts. CBT is also used with adults, and behavior therapy is used with adults in a few cases as well.
Q: Do you provide ABA (Applied Behavior Analysis)?
A: No, I am not a trained ABA therapist; however I have learned some of the general ABA skills and worked with children in some ABA-based classrooms. While ABA is recommended for young children with more severe autism, it is difficult to access because it requires full time therapy- either hiring someone privately in your home for many hours, or a specific ABA classroom. ABA is a part of behavior therapy. I provide more generalized behavior therapy that I tailor to what your child needs. ABA is only one set of standard interventions that is not able to be adapted to a specific child.
Type of Therapist
Q: Are you a Play Therapist?
A: I use play in therapy because I work with children, however I am not a “certified play therapist” as that is a specific certification. Play therapists usually are doing nondirected play therapy for kids with trauma. I do directed play with teaching young autistic children social and play skills. I use therapeutic play with other children such as playing therapy games, reading books that teach skills, etc. [Note- if your doctor/school suggested you need a play therapist, they might actually be referring to a behavioral therapist as many people do not understand the distinction.]
Q: Are you a “CBT” therapist?
A: I do use Cognitive Behavioral Therapy strategies however I am not a certified CBT therapist (that is an extra certification that usually therapists that do specific treatment such as for phobias would need).
Q: Are you a child psychologist?
A: No- I am a social worker. However I do what most people consider a child psychologist to do. The difference is the theoretical background. Social workers focus more on the environment and setting and psychology mostly focuses on the brain (loosely simplified explanation of difference). Social workers do a lot of casework and therapy. Psychologists do a lot of evaluations and research. A specific Child Psychologist would do therapy and intensive testing and evaluations. I do not do intensive testing evals, however I can diagnose and provide a general assessment.
Q: Do you have a BCBA certification? (Board Certified Behavioral Analyst)
A; No, I didn’t pursue that as it requires more training such as working for free as an intern. I do however have a lot of experience in behavior work and have been trained to do FBAs (Functional Behavior Assessment) which is figuring out why a child is doing a specific behavior from gathering data on the child’s problematic behaviors.
Q: What’s your licensure title mean? /What is “LCSW”?
A: LCSW stands for “Licensed Clinical Social Worker” which means I have a clinical license to provide social work services- it’s above an LSW license, and on top of a Masters degree- similar to a doctorate like a nurse practitioner is to a medical doctor. I have a Bachelors Degree in Social Work (BSW), a Masters Degree in Social Work (MSW), and an LCSW (I previously had an LSW until I got my LCSW which is a higher distinction).
Q: What’s the difference between social worker, LPC, psychologist, and psychiatrist?
A: Mostly the difference is the theoretical approach or therapy style; however social workers, Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs) and psychologists sometimes use the same types of therapy models like psychoanalysis, family therapy, cognitive behavioral, dialectical behavior therapy and other types of therapy. A psychiatrist is different as they manage medication. Some psychiatrists provide therapy as well, but most only do medication and refer to therapists to do the therapy part.
Q: I took my child to see a child therapist and they just talked about the problems but didn’t provide any solutions, are you like that too?
A: No. I am very solution focused! If you just want to “vent” about problems but not receive feedback and suggestions see a “supportive” therapy therapist.
Q: Can you provide a diagnosis?
A: Yes, an LCSW can diagnose psychological disorders. If I think the child requires further evaluation or assessment I will refer to a licensed psychologist for further testing either independently or through the school district.
Q: Do you prescribe medication? Or recommend medication?
A: I cannot prescribe medication. Sometimes I do recommend medication, but often behavioral therapy is effective without needing medication. Please see a psychiatrist or pediatrician for medication. I can make some recommendations and explain types of medicine if you just need information about options.
Q: What is the difference between BHRS “wraparound” therapy, office based “outpatient” therapy, and what you provide?
A: Outpatient therapy is traditional therapy in an office where a child/adult comes to see the therapist in the office. BHRS (Behavioral Health and Rehabilitative Services) also known as “wraparound” is for children with more intensive behaviors where there is a therapy team that goes to the child’s home and school, [and community if needed], and works on the child’s behaviors in the moment/in the environment. The team includes a Behavior Specialist Consultant (BSC), Mobile Therapist (MT) and sometimes a TSS- Therapeutic Staff Support (one on one behavior aide for child).
To obtain BHRS children need MA (government medical assistance insurance) which is free and available for children with a diagnosis regardless of income in Pennsylvania. Children also need more severe level of behaviors, sometimes have several diagnoses and in need of more intensive services than outpatient therapy.
My services cover both kids who need outpatient and kids who might need BHRS. I can come to the home to meet with kids who need therapy but can’t come to an office or aren’t comfortable in an office setting. I can work with kids in the school providing therapy and behavior consultation, if the school allows, as well. I can provide more intensive behavioral help at home as well which includes working with the child and teaching parents how to handle child’s behaviors as well. I can help families obtain BHRS if needed and provide therapy until BHRS can be put in place (it often takes a few months to get started due to the process). I can help families stepping down from BHRS who do not want or need outpatient therapy as well. I used to be a BSC and MT and also outpatient therapy so have a lot of experience in both fields.
Q: Why don’t you take insurance?
A: In short because it’s really difficult to bill insurance and make sure they pay! I charge a very reasonable rate that is close to what some people are paying as a co-pay. You can see if your insurance will reimburse for “out of network” therapy and I can provide you with the information they will need (usually my NPI number, licensure, and child’s diagnosis) or they might need me to complete a form. Sometimes you can be reimbursed for some of the therapy camps under group therapy.
Q: How many visits will we need? How long will it take before I see results?
A: It really varies a lot depending on the needs of the child, responsiveness of child and parents following through with the behavior suggestions. Often children make progress in about 4 visits. I recommend 3-4 visits with 1 per week for a month until they are making progress and then decrease to every few weeks as child makes more progress. Some older children/teens may have a lot to work on in therapy and may need more time to talk and work through problems.
Q: Do you just play with the kid or actually teach them skills?
A: I teach them skills through play! I use a lot of “bibliotherapy” which means using books to teach skills. I use games, coloring, worksheets, and activities to teach the skills as well.
Q: Should parents be in the sessions or not?
A: Often children are more responsive and open without parents present. Alternatively it’s often easier to work on behavior and discipline strategies with the parents without the child present. Often I will set up separate appointments/times to meet with parents some of the time alone and with the child some of the time alone. However if the child is really upset/anxious without parents present, or if there are issues between child and parent that need to be mitigated together with a therapist, then family sessions together are appropriate.
Q: What should my child expect? Will they like therapy or hate it?
A: Your child should expect to have fun! Most young children really enjoy therapy because they get one on one attention, do fun activities, and feel heard about their feelings. Some kids don’t like therapy because they don’t like discussing their feelings, would rather be doing video games or other reasons. You can explain therapy to your child by saying a helper is coming to teach you how to feel better or not get into so much trouble, for example.
Q: What ages do you work with? Is my child too young for therapy?
A: No one is too young for therapy! Children as young as 2 and 3 with severe difficulties handling their feelings or behaviors or have autism and need to work on several different skills can really benefit from therapy. In an outpatient office therapy the focus will be more on helping parents learn some strategies for handling the child’s behavior, however in the home the child’s behaviors can be handled in the moment and play skills can be taught as well. Preschoolers and Kindergartners usually really enjoy therapy and respond well.
I also work with teens and parents.
Q: Do I need a diagnosis or referral?
A: No, however I can provide a diagnosis if you would like one and also communicate with your child’s school, pediatrician, or others involved if needed. [Note- If you want to be reimbursed by insurance you usually need a diagnosis, however that diagnosis is confidential and will not be shared outside or what you request.]
Q: If I get therapy does it mean my child is “crazy” or has major psychiatric problems?
A: No! Everyone has something they need to work on, or improve and those in therapy are doing well to seek help to improve themselves! Many children deal with emotional and behavioral problems and its okay. Most people do Not have major psychiatric issues like personality disorders, schizophrenia, etc and those are not diagnosed until adulthood anyway.
Q: Is my child’s behavior “normal”? Am I overreacting?
A: If your child is severely aggressive, makes suicidal/homicidal comments (even if they don’t actually follow through with their threats), that is not normal and you should seek help. Think about this- does your child stand out from other kids in their class, siblings, cousins, peer group for some reason? If their behavior does not seem to be like others in their peer group there might be a concern.
If your child struggles socially- doesn’t have friends or understand social cues, or is anxious often, seems angry, irritable, sad, or upset often it is a good idea to seek therapy to help them feel better. Often children don’t just “grow out of” emotionality, anxiety, and aggression but need to be taught proper coping skills. Some kids do mature through some phases but often these problems come back later in a different way. It is much easier to handle behavior at a young age and teach coping strategies when younger than waiting until child is older, with ingrained behavior traits, and has to learn a new way to handle stressors. Some kids just learn these things naturally and other kids need a lot more help to learn strategies.
Q: My husband, grandmother, friend, etc says my child is fine and there’s “nothing wrong with him”, but I’m still concerned, what should I do?
A: Seek a professional evaluation, or ask your pediatrician. Often family members will come around and be more understanding of the child and situation when a professional has provided a diagnosis and treatment plan. If the professional agrees the child is fine, perhaps the parents could use some therapy to handle their anxieties about the child. Often a therapist can explain the diagnosis and needs to the family members and friends to help others understand and be helpful in providing treatment.
Q: Do you provide therapy to parents too?
A: Yes! In conjunction with child’s therapy, or alone! If parents are struggling with stress of parenting and need someone to talk to with some parenting advice and help as well as handling anxiety and stress it can be so helpful to have a child therapist who understands the complexities of children to help the parents. I can come to the home to work with the parents or make referrals if needed.
Fault/Origin of problems
Q: Is it my (parents) fault my children are misbehaving?
A: Its possible parenting is the problem, however if one child is having more severe behavior problems than their siblings it is likely that there is something wrong- such as a psychological diagnoses or lack of skills. Some children are just naturally more behaved than others. Some children just pick up skills and other kids need to be taught them more specifically- just like if a child is having learning difficulties and needs extra help, a child may need extra help to handle their feelings and behavior.
Q: Why is my child anxious or sad when there is no reason to worry and their life is really great? am I not doing enough for my child?
A: Sometimes people just struggle with these things and it’s no one’s fault. It’s not always situationally based- for example a child who is sad but nothing “sad” or bad happened to them. Sometimes it’s just chemical- which means faulty brain functioning! Learning some strategies to cope and change thoughts is helpful and sometimes medication is also needed. Contact me for more help.
Q: For Christian families: Isn’t my child’s misbehavior just sin?
A: It could be. But it could also be a lack of skills or motivation. There can be other reasons for your child’s problem behavior besides just willful disobedience.
Q: For Christian Families: I tell my child that Christians shouldn’t be depressed or anxious- they just need to trust God and pray to him, but it’s not working.
A: Sometimes prayer and trusting God is sufficient, however if it’s not working your child might have some anxiety or depression and needs more coping strategies. It’s not their fault or just due to lack of trust, kids and adults with anxiety and depression have different brain chemicals that need assistance.
Q: Who designed your amazing website?
A: My brother Zeke. He helps small businesses design their websites and do marketing. Check out his website: Creatively Innovative.