Why Isn’t My Son Getting Better? Part II of III

By Dr. James Feinberg
Child Clinical Psychologist

Previously (in part I), I addressed how an inadequate psychological evaluation typically results in a treatment failure. Lack of rapport, lack of experience, lack of intensity, and poor boundaries are additional reasons why boys do not benefit from mental heath treatment. Let me explain:

First, no boy is going to trust or open up to a mental health practitioner (i.e., “MHP”) where ample rapport or a good connection is lacking. For this reason, from the get-go, a MHP should be devoting his or her attention to establishing rapport with both parents as well as their son, and before embarking upon treatment.

Second, attempting to make a boy “fit” the treatment approach a MHP was trained in often results in a poor fit as well a treatment failure, too. A MHP must meet a boy where he is; and, this requires extensive knowledge of and skills in many different treatment approaches. Not surprisingly, a recent study found psychologists 5-10 years post-graduation tend to be eclectic and use techniques from multiple treatment approaches. Suffice to say, choose a MHP based upon education and training as well as experience.

Third, lack of intensity or appointments occurring on an infrequent basis (e.g., @2-3 weeks) isn’t going to result in much treatment progress, either. Appointments occurring here and there, at best, are about re-connecting and catching up versus conducting treatment. Depending upon the severity of a boy’s presenting problems, appointments need to occur at least on a weekly basis and, sometimes, even at a higher frequency.

Fourth, poor-boundaries are yet another reason for treatment failures. Although many MHPs believe that they can concurrently treat boys and their parents; many boys would disagree!

Typically, this takes the form of a MHP either splitting sessions by first seeing the boy and then his parents, or alternating sessions between the boy and his parents. Not surprisingly, many boys don’t trust MHPs who play on both sides of the fence because they (i.e., boys) believe that whatever they disclose to these MHPs will be directly relayed to their parents. Sadly, this is often the case. If more than one modality of treatment is indicated (e.g., individual psychotherapy, parent training, family therapy, &/or marital therapy), different MHPs need to render these modalities of treatment.

So, if your son is not progressing in mental health treatment and some of the above issues are present, it’s definitely time for a second opinion.

To contact, Dr. James Feinberg, child clinical psychologist, and his therapy dog extraordinaire, Grace, please call his office at 314-966-0880 or consult his website: www.stlouischildpsychologist.com.