Dr. Daniel B. Nicholas
November 7, 2012

Many parents bring their child or teenager to counseling because they are experiencing frequent depressed, anxious, and/or angry and irritable moods. Concentration problems, variable school performance or academic underachievement, can be other signs that something is wrong. The following types of problems are a much more extensive list of concerns affecting many of our child and teenage patients:

  • Family, step-family and blended family issues.
  • Divorce or frequent and severe marital conflicts.
  • Anxiety in many forms like social and generalized anxiety disorders, obsessive-compulsive disorderseparation anxiety disorderpost-traumatic stress disorder and specific phobias or fears.
  • Depression– severe, moderate and milder forms of this disorder.
  • Angry, irritable and fluctuating moods. These mood issues can often cause disruptive behaviors that are very upsetting and disruptive to family members. Significant family issues can result, triggering prolonged conflicts and guilt. School and social problems can result. Sometimes, irritable and angry mood can be signs of an underlying depression, anxiety disorder, or a stress reaction to a situation.
  • Academic underachievement (many things can contribute and need to be assessed such as attention problems, sleep issues, motivational issues, depression, anxiety and specific learning disabilities.
  • ADD & ADHD. These disorders can involve a number of symptoms that can include but are not limited to the following: poor or fluctuating academic achievement, difficulty staying focused, a low frustration tolerance, distractibility especially when bored, and sometimes hyperactivity and impulsive judgment. The effects of this disorder can also be very damaging. It can limit your teen’s vocational potential, reduce self-esteem, and can cause relationship, family and legal issues. Depressive and anxiety disorders are also more likely.
  • Health concerns and related psychological reactions.
  • School refusal and avoidance.
  • Social skills difficulties. Can lead to social and emotional problems.
  • Relationship issues. Frequent conflicts and relationship “breaks” can cause major problems.
  • Peer rejection and/or bullying. This can cause severe emotional consequences.
  • Drug and alcohol issues. (at epidemic levels in Chicago land suburbs NOW!) Can be deadly!
  • Eating disorders and distorted body image. Can be both physically and emotionally damaging.
  • Self-injury. Needs to be immediately interrupted. Can become a habit and physically dangerous.
  • Sexual issues and concerns. These issues may be seem hard to talk about but don’t minimize, especially if abuse is a possibility.
  • Videogame addiction. A new and increasing preoccupation that often comes at the expense of school grades and family participation. Meltdowns can occur when trying to separate your child from the game.


These issues and problems require a thorough initial evaluation. Information will be gathered from both the parent(s) and child or teen. It is essential that the therapist understand both the parents and child/teens perspective on the many issues, not just the problematic ones. You may be interviewed both together and/or separately. Sometimes, it is important to get more information from psychological testing. Testing can aid in differential diagnosis for a variety of disorders. An accurate diagnosis will lead to the best treatment plan for your child or teen.

For example, specific rating scales, psychological, and/or neuropsychological tests should be administered prior to the onset of any medication for ADD.These tests are needed to provide more evidence for the diagnosis of ADD, while ruling out and identifying other clinical conditions.

Your therapist will use research supported, therapy techniques, to help you get the best therapy outcomes. The treatment plan will be implemented by some form of individual (egcognitive-behavioral therapy) and/or family therapy. As mentioned, in some cases, a medication evaluation and trial from the primary care physician or child/adolescent psychiatrist may be necessary for best outcomes. Sometimes a combination of treatments is better than either alone. Careful monitoring of medication is a must.

Once the the main issues have been identified, psychotherapy can give your child or teenager new and effective skills to better manage their emotionsFamily therapy can provide better communication and conflict resolution skills to family members. A combination of individual and family counseling may be the right treatment for your particular situation. Your child or teen can get practical strategies to them with their issues, while you refine your parenting approach. The longer a family waits to get help, the worse the problems can become.

An additional complexity that can get in the way and strategies to best manage it follow.


Although many kids will welcome the opportunity to get help, some children and adolescents will be resistant to the idea. This most usually occurs with teenagers, as they may feel that you, not them, are the problem. If intense resistance occurs, it is then important to make the family, or your relationship with your son or daughter, the focus of treatment. Usually, a “deal” can be made to attend at least one session. A good relationship with the therapist can begin at the first session, even if your teen has a negative attitude towards therapy.

If your child or teen continues to refuse to come to therapy, the parents should still come to at least one session. Parent(s) can learn new perspectives and develop the most effective strategies to best manage very difficult family situations. Parenting skill training can help you and your spouse be united and consistent in your approach to your kids. This approach can still often help with communication and to better resolve conflicts, even if your teen continues to refuse to come.


The skills that you and your child will learn with not only help to alleviate or significantly reduce the initial presenting problem(s), but also will help to improve your child or teen’s resilience when they experience tough times in the future.