When Is Therapy Appropriate?
An easy rule of thumb is to consider professional help when general solutions, such as those offered in coparenting classes are not working for your family or are proving difficult to implement. Has it become difficult to establish rules for your children or to establish a shared family definition as to what behaviors constitute safety, respect, or communication? Is a child expressing resentment or rebellion toward a stepparent? Is there conflict between the parent and stepparent over how to enforce rules or whether there is fairness among the children? Has conflict suddenly increased between the “original” or biological parents, or is a child expressing reluctance to be part of both households? Children and adolescents must sometimes learn to accept new realities, which are not of their choosing, and a parent may feel caught between the new relationship and the needs or desires of a child.
New stepparents may need guidance as to how quickly to assert a role in the child’s life. Children may feel caught in the middle of a conflict between the parents, angry about the disruption of the original family, guilty about enjoying a relationship with the new stepparent, or any number of other feelings. Conflict or tension between coparents or among any of the involved adults or children can create or exacerbate any preexisting problems. Conflicted adults may sabotage limits being set for their children in the other household, or convey the subtle message that children can or should cope with problems by avoiding, rather than resolving, them. This may undermine children’s healthy development and make it difficult for them to adjust to the new stepparent or the recombined family. Children who don’t develop healthy coping skills are at serious risk for future psychological problems. A qualified and experienced therapist may be able to help resolve these issues, particularly if the therapy is structured to allow the therapist to assess and intervene with the various factors and people involved.
Involve the Other Parent
When separated parents are in conflict or don’t communicate well, the decision to consult a therapist may be more complex and anxiety provoking. Parents are often concerned that the decision to consult a therapist may be perceived as a weakness in their household or be exploited as such by the other parent in custody litigation. In fact, the opposite may be true, as the decision to consult a therapist is an acknowledgment of the child’s difficulty and a desire to seek help.
Nevertheless, the decision to seek psychotherapy for a child can have implications for the child’s functioning in both households. The existing parenting plan or court order may require that parents confer before beginning any significant medical treatment. Even if there is no order specific to psychotherapy, a unilateral decision to engage the child in treatment may be a breach of trust with the other parent, poisoning opportunities for future cooperation. More important, unilateral action places the child squarely at the center of parental conflict, forcing the child to keep a secret or inform the other parent about the therapy. This places both the child and the therapy at risk.
The reasons for this are complex. Therapy that is kept secret from the other parent places enormous burdens on the child, places the therapist in an ethically untenable position, and may disrupt or doom the process as a result. These risks are sufficiently serious that mental health professionals have been disciplined by professional licensing boards for undertaking treatment of a child based on consent from only one parent. Even when the engaged parent has sole legal custody, failure to consult the other parent raises any number of risks.
Even with minimal information sharing between households, with the assistance of the therapist or other professionals, the adults in both households can support the child’s progress and, potentially, reduce both the cost and the duration of treatment. Although children may behave differently in different households, it is likely that some emotional issues exist for the child in all settings. In fact, one of the healthiest messages parents can convey to the child is that they value the child as an individual who has a special place in each household but is her own person, with her own feelings, that both Mom and Dad understand that feelings occur everywhere, and that both parents want the child to feel better and succeed in all areas of life.
Fortunately, therapists who are well qualified to work with stepfamilies also have many tools and skills for managing information and assisting cooperation between households. Experienced therapists may require that the treatment contract give the therapist discretion to engage members of both family systems and share information in the manner that best benefits the child or children. This may require a careful consent process and the selection of a therapist worthy of this level of trust. Selecting the therapist may be the first step in creating the cooperation necessary for therapy to succeed. When one parent will not agree to the child’s involvement in therapy, or to the selection of the therapist, a court order may be necessary. Various jurisdictions handle this type of conflict differently. Consult your lawyer about the best approach.
Choose the Right Therapist
For most families, the selection of a therapist involves a variety of issues. Cost is an important consideration; however, it also is important to ensure that the therapist is qualified to assist with the specialized issues that often arise in post-separation and blended families. It is common for families who are spending enormous sums on litigation or experts to be reluctant to spend for quality treatment, or to refuse to expand the search beyond therapists who accept reduced rates from insurance panels. Finding a therapist through your health insurance plan may result in lower hourly rates for the sessions but may limit your choice to therapists who are generally qualified but not specialized in treating the problems of blended families. The plan also may not allow the flexibility you may need to tailor services to your particular family.
Many therapists can work with blended families, but the more complex the issues and relationships, the more likely a therapist with specialized skills is needed. Specialized therapists can be expected to be familiar with research on separated families and the particular issues arising in stepfamilies, as well as the legal framework of divorce. The most qualified therapists are able to both provide information and offer specific methods that aid families in addressing and resolving problems. The therapist should have a solid knowledge of child development, the skills that children must master at different ages, and the emotional reactions that often arise for both parents and children. The best qualified therapists also are able to maintain a professionally objective and engaged approach between households, even in the face of intense pressure from one or both parents or the refusal of a parent to cooperate. Obviously, even the most skilled therapist cannot compel a parent to cooperate; however, as consistent with the child’s needs, both parents should be given an opportunity to do so.
If there is an ongoing custody conflict or legal process, it is particularly important to have a therapist who is familiar with the legal context, including the time frames within which families may need to achieve changes. If the therapist is not adequately qualified to assist the family, treatment may ultimately be less effective and more expensive, particularly if conflict escalates.
A qualified therapist must be familiar with practice guidelines and ethical standards governing the profession, as well as the limits of the therapist’s role. In simplest terms, the therapist’s job is to help the family resolve problems. The therapist may offer suggestions for solving problems within each household, and for improving cooperation and support of the child as he/she moves between households. Therapists should not make recommendations about parenting plans or offer opinions about family members whom they have not met. Professional guidelines and standards, such as those produced by the Association of Family and Conciliation Courts and the American Psychological Association, are publicly available, as are models of appropriate family therapy. These publications are useful for knowing what to expect from qualified therapists. Your attorney also may be able to recommend experienced therapists in your area.
Procedures Matter
The therapist you select should engage in a careful consent process, advising you as to what to expect from therapy, clarifying financial arrangements, and explaining the limitations of confidentiality. It may be helpful for the therapist to coordinate treatment with other professionals, such as therapists treating individual family members or a parenting coordinator. In some circumstances, the court may order a therapeutic intervention and provide some mechanism for accountability, such as a provision for the therapist to report progress and parent cooperation to another professional or the court. In most circumstances, however, therapy is most effective when the sole focus is on helping the family, and the therapist has the skills and flexibility to intervene effectively. The therapist may ask for discretion to offer some measure of confidentiality to children and to choose the timing and method that is most effective for sharing information among family members.
Ask the therapist to describe the model and procedures he or she uses. If the therapist is treating the entire family, he or she may meet first with the coparents and then with the “new” couples (parent and stepparent) in each family. Other therapists will begin with the adults from each household. When the child is the identified client, the therapist may initially meet with the child, but should be able to identify procedures for bringing balanced information (i.e., information from each parent and household) into the process. Experienced therapists will want to meet everyone in each household and may meet with various combinations of family members. The therapist should also be able to provide some information about the scientific basis underlying the therapeutic model.
When a family is under stress, it often is tempting to engage a therapist who is willing to “short cut” the consent process or to make decisions that are beyond the therapist’s role. It may be tempting for a parent to find a therapist who will support his or her position and criticize the other household or a particular person within the blended family. It is tempting to “blame” the child who seems angriest or most reluctant to become close to the stepparent. Families often gain the most, however, when a therapist retains a balanced perspective and communicates with both households and all involved family members. The process of therapeutic contracting and consent may seem tedious, but these procedures form the basis of trust between family members and therapist. Skipping these steps places the therapy, and everyone involved in it, at risk.
What to Expect in Family Therapy
Therapy is never an easy process, because change isn’t easy. Families often seek help because they are in conflict, so a therapist will need to understand the conflicting needs and desires of various family members. At the beginning, not everyone will feel equally comfortable speaking with everyone else, so the therapist may want to hold sessions with various combinations of family members and work toward more open sharing of information and difficult feelings. It is common for a therapist to spend some individual time with each child before asking the child to express feelings to a room full of adults. The therapist may request that adults reassure children that they have permission to speak openly, while setting appropriate limits on children’s behavior.
Part of the therapist’s job is to challenge family members to change and to suggest more effective ways of coping with problems. Families may have established patterns that once seemed workable but are no longer effective, healthy, or supportive of a child’s or adolescent’s development. Conflicts about behavioral expectations and discipline are common and frequently comprise the immediate reason for the parents’ decision to engage the therapist. If a child is acting out or engaging in unhealthy behavior, the decision to consult the therapist may have been made by the adults, with or without involving the child. In such circumstances, it is not realistic to expect that the child will immediately like the therapist or want to attend. Developmentally, the child’s greatest need may be for the parents to agree on reasonable rules and enforce them consistently, but a child who has not had consistent limits may vociferously resist that process. Children who don’t trust adults to accept their feelings, or who have learned to avoid them, also may resist therapy initially. Others will be eager for the support.
Therapy should provide children and adolescents with an opportunity to express difficult feelings in a safe environment and with the tools to cope effectively and conform one’s behavior to what is generally expected for the child’s age and developmental level. If a child voices consistent discomfort with a therapist or opposition to the process, it is important to discuss that with the therapist. Particularly in the early stages, however, it may be important for parents to send a consistent message that therapy is not a choice and that both parents want the child to cooperate with the therapist and with plans for change in the family. A skilled therapist can assist parents in helping the child to see what he or she has to gain from cooperating, i.e., less family conflict, respect for the child’s feelings, an appropriate voice in family decisions, and the progress of therapy. But parents should not expect an immediately or consistently easy process. If the problems that the family was struggling with were easy, or easy on children, they wouldn’t need to consult therapists.
Most adults approach therapy with a conceptual understanding that something in the family needs to change, but they may privately harbor the hope that it is other family members who will need to do most of the changing. If the parenting plan is unresolved or there are ongoing legal disputes between the parents, these issues may impact all aspects of the therapy—coloring the information presented to the therapist, the expectations brought to therapy, and the willingness to change or to try different techniques to solve problems.
Parents may come to the second marriage/relationship with a strong investment in parenting skills that have worked with their own children but that are proving ineffective with stepchildren. The repartnering of a parent may rekindle emotional issues from the first parenting relationship or between children and one parent. The parent who has the strongest relationship with a child also may be left with the most difficult work to do, as parents don’t always share equally in the most difficult parenting activities, such as coping with social problems, academic issues, or difficult emotional experiences. Sadly, some nonresident parents who become involved in second relationships do decrease contact with their first children; a new stepparent in the other household may have much to offer the child but may have difficulty allowing adequate time for the relationship to develop. Parents may unconsciously favor their own children over the stepchild or invest so heavily in the new relationship that children’s needs are overlooked.
A skilled therapist must balance educating parents about these common issues with offering suggestions for resolving problems in a different way. Often this is not a question of “right” or “wrong,” but is simply making adjustments or trying a different approach when the family’s current attempts to solve problems aren’t working. A skilled therapist is unlikely to always provide feedback that is comfortable or makes everyone happy but should be able to offer practical suggestions for improving the situation. Although it is important for family members to be open to new ideas, it also is essential to be honest about how well the proposed solutions are working or any impediments that have arisen in the process. Resistance to change is natural, and a skilled and effective therapist will be alert to such difficulties. Likewise, a good therapist is a good listener who understands that families have knowledge about themselves that the therapist cannot possibly know.
In most therapy with separated or blended families, issues will arise that are most effectively resolved when both parents are consulted. Even when a child’s difficulty appears to exist primarily in one household, adults in the other household may send subtle (or direct) messages about how seriously the child needs to take the therapy process or the need to change problem behaviors. This intervention may be difficult for both of the child’s parents and for the stepparents who are establishing their roles in the child’s life. Often, however, it is an important tool for enabling children and adolescents to change. This is another reason that selection of a qualified therapist is important. Children adjusting to blended or recombined families are being asked to accept the intimate involvement of another adult in their lives, often without a choice in the matter. If adults demonstrate that they can ask difficult questions, tolerate uncomfortable feelings, and try new approaches to solving problems, they may be of enormous help to children facing the same difficult requirements.
Make Therapy Work for You
Effective therapy may offer great benefit to families in transition and to the healthy development of children and adolescents. The best therapists attain specialized knowledge and adapt their skills and approaches to the needs of the family. Therapy will not always be easy but should provide tools to parents and children to help master the difficult challenges of “blending” the family, creating the healthiest possible family systems, and promoting a healthy future for the children.
Additional Resources
American Psychological Association, Ethical Principles of Psychologists and Code of Conduct (2017) (including 2010 and 2016 amendments).
American Psychological Association, Guidelines for the Practice of Parenting Coordination. 67 American Psychologist, 63–71 (2012).
Association of Family and Conciliation Courts, Guidelines for Parenting Coordination 44(1) Family Court Review, 164–181 (2006).
Association of Family and Conciliation Courts, Task Force on Court-Involved Therapy: Guidelines for Court-Involved Therapy, 49 Family Court Review, 564–581 (2011).
Jay Lebow, Integrative Family Therapy for High-Conflict Divorce with Disputes over Child Custody and Visitation, 17 Journal of Family Psychology, 181–192 (2007).
Jay Lebow & Danielle Black, Considerations in Court-Involved Therapy with Parents, 9 Journal of Child Custody, 11–38 (2012).
Lyn R. Greenberg, et al., Evidence-informed interventions for court-involved families: Promoting healthy coping and development, Oxford University Press, 2019.
Lyn R. Greenberg, Family Forensic Psychology, in B. H. Fiese, et al., (Eds.), APA Handbook of Contemporary Family Psychology: Applications and Broad Impact of Family Psychology, 687–703 (2019).
Lyn R. Greenberg et al., Playing in Their Sandbox: Professional Obligations of Mental Health Professionals in Custody Cases. 5(3–4) Journal of Child Custody, 192–216 (2008).
Lyn R. Greenberg et al., Effective Intervention with High-Conflict Families: How Judges Can Promote and Recognize Competent Treatment in Family Court, Journal of the Center for Families, Children, and the Courts, 1–18 (2002).
Lyn R. Greenberg et al., Poor Planning Produces (Predictably) Poor Results: Systematic Intervention Planning. Newsletter of the Association of Family and Conciliation Courts California Chapter (May 2013).
Lyn R. Greenberg et al., Keeping the Developmental Frame: Child-Centered Conjoint Therapy, 9 Journal of Child Custody, 1–30 (2012).
Lyn R. Greenberg et al., Catching Them before Too Much Damage Is Done: Early Intervention with Resistance-Refusal Dynamics, 54(4) Family Court Review, 548–563 (2016).
Lyn R. Greenberg, et al., Concluding Thoughts and Future Directions in Lyn R. Greenberg, et al. (Eds.), Evidence Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development, Oxford University Press, 2019.
Lyn R. Greenberg & Jay Lebow, Putting It All Together: Effective Intervention Planning for Children and Families in Leslie Drozd et al., (Eds.), Parenting Plan Evaluations: Applied Research for the Family Court, (2nd ed.), Oxford University Press, 2016.
Lyn R. Greenberg, et al., Early Intervention with Resistance Refusal Dynamics and Hybrid Cases in Lyn R. Greenberg, et al., (Eds.), Evidence-Informed Interventions for Court-Involved Families: Promoting Healthy Coping and Development, Oxford University Press, 2019.
Lyn R. Greenberg & Matthew J. Sullivan, Parenting Coordinator and Therapist Collaboration in High-Conflict Shared Custody Cases, 9(1-2) Journal of Child Custody, 85–107 (2012).