“Where Have All the Child Therapists Gone?”
“Why is it so hard to find a therapist for my child?” It’s a question that’s come up with increasing frequency over the past few years, and I’d like to offer some answers as a private practice therapist who worked exclusively with children and teens for a decade, but has shifted to accepting only adult clients over the past year. Here are five reasons why it’s difficult to find a child therapist:
1. It’s difficult to engage consistent collaborators.
When you work with children and teens, you see them for one hour a week, while their remaining 167 hours is spent outside of sessions with parents, siblings, friends, teachers, tutors, occupational therapists, psychiatrists, babysitters, speech therapists, school counselors, pediatricians, neighbors, grandparents . . . you get the picture. None of these people can support a child in isolation because it requires cooperation to provide the consistent messages that promote genuine, lasting change. However, trying to create a team that communicates with one another regularly, agrees upon the best approach, and understands the crucial nature of this type of collaboration is incredibly difficult. I can’t tell you how many (technically unpaid) hours I spent making calls, leaving voicemails, and sending emails to other significant adults in my young client’s lives only to be met with crickets. It was often the best I could hope for to get one or two brief phone calls with another person who had influence over my client’s daily life in order to better understand their behaviors and needs, and those contacts were usually only at the beginning of treatment, rarely lasting long-term. While it’s easy to understand how hard it is for people to find the time for this type of collaboration, it’s also frustrating to feel like all of the compassion, time, and effort you put into working with a client evaporates the moment they walk out of your office because of influences outside of their control.
2. It’s incredibly time-consuming.
When I work with an adult client, I see them for a 50-minute session and take 10-15 minutes to type their casenote outside of a session. Occasionally, I might consult with a spouse or prescriber if necessary, or email the client some resources we’ve discussed. In general, adults have much more autonomy and influence over their own lives and relationships, so they are able to take what is learned in sessions out into the world with minimal reinforcement from me.
Compare that to doing play therapy. I spent 50 minutes in a session, 10-15 minutes cleaning up and sanitizing items played with during the session, 10-15 minutes writing a casenote, 10-15 minutes emailing caregivers a session summary, and then of course spent time on all of the consults (and consult attempts) I mentioned above in point #1 . . . AND, this doesn’t even take into account those who accept insurance, because as a private pay practitioner, I literally saved myself from a dozen frustrating hours on the phone each week dealing with that system. Those extra minutes began to add up quickly, meaning that I didn’t have the capacity to see as many clients each week, and my waitlist was always growing. Which leads me to my next point. . . .
3. Scheduling is difficult.
When you work with kids and teens, after-school and weekend appointment times are obviously in high demand, but only a limited number are available. For those incredible therapists willing to work late into the evening and during weekends, be indescribably thankful, because for most of us, this isn’t a career-long option.
Before my child was old enough to be in school, I’d stay with him during the morning, get paperwork and calls taken care of in the early afternoon, and then work during after-school hours, usually seeing clients from 3-7PM. However, once my kiddo was school-age, my schedule steadily became a source of resentment for me – dropping him off for school at 8AM and then not seeing him again until he was about to go to bed felt awful, and I could feel myself starting to grieve missing that time with my child. I slowly started cutting back to seeing clients 4 days a week until 6PM, then 5PM every other day, trying to juggle their schedules with the needs of my family.
This becomes even more complicated when you factor in all of the other appointments and extracurriculars that are jam-packed into kids’ and teens’ schedules nowadays, to the point where some clients were requesting one specific hour during the week, and that hour changed depending on the season. As much as I wanted to be a consistent figure for my young clients, I felt held hostage by their ever-changing schedules, and not seeing themat all felt healthier than the guilt and anxiety I felt over not being able to see them consistently – while (most) caregivers understand the logistical obstacles with scheduling, younger brains don’t have that capacity yet – all they know is that they feel abandoned by their therapist, which can create resistance to building future therapeutic relationships.
(Sidenote: This doesn’t even begin to take into account how many therapists were holding sessions from home while trying to support their kids with remote learning over the past couple of COVID-filled years…our bandwidths were drained immeasurably.)
4. It costs more.
I’m not talking about the cost of therapy for clients – I’m talking about the cost for therapists who are maintaining a caseload of kids. Adult clients may need a steady stream of tissues and water or tea, but keeping a play therapy practice relevant requires a great deal more – upkeep and replacement of toys and games, batteries, drawing supplies, art supplies, bubbles, snacks, cleaning supplies…the list is endless and expensive. For therapists who accept insurance, there is the added risk of claims being denied or delayed, or even having insurance companies later claw back the money they’ve paid out because of a retroactive denial. The wear and tear on a therapist’s body is also an expense – crawling around on the floor all day, letting kids tie you up, having sword fights…many of us end up needing medical appointments like acupuncture, massage, and chiropractic care to continue the work without significant pain or discomfort. Combine that with the fact that we can see less clients each week because of point #2 above, and you can begin to understand why the burnout factor is so high among child therapists.
5. Caregivers are reluctant to do their own therapeutic work.
I know, I know – it’s cliche to blame the parents in therapy, but hear me out. We all enter into parenting with our own baggage – attachment styles, communication blocks, trauma reactions, and patterns of coping. If we’re not willing to do our own therapeutic work to address these areas, it is certainly going to affect our children. Think of it this way: Children are like clay – malleable, changeable, and molded to fit the space surrounding them, while caregivers can either be a bowl or a sieve. A bowl is able to hold the clay in place, no matter how much pressure is placed upon it, in order to offer a safe, strong, and predictable framework – this is a parent who has addressed their own needs in therapy. A sieve, on the other hand – a parent who has not addressed their own history and struggles, and has gaps in their ability to co-regulate or communicate with their child – will inadvertently allow bits of clay to seep through the holes any time pressure is applied. While it may appear that the child is “the problem” because we see their behaviors seeping out, they are actually only responding to the environment and relationships in which they are being molded. Once again, children cannot be supported in a vacuum, and if parents are not addressing their own unresolved issues, it limits their ability to fully engage in their child’s therapeutic experience, causing immovable obstacles for the child’s therapist.
So…what can we do to increase the number of child therapists?
The list above is by no means exhaustive and every child-turned-adult therapist has their own reasons for transitioning out of the work, but I hope this gives you a sense of why it can be so difficult to find a child therapist in a way that allows space for both your frustration AND your empathy. While it is never your job to take care of your therapist, and we are more than willing to be present for you with deep emotions and struggles, there are a few small but crucial things you can do to ensure that you are not contributing to our burnout unnecessarily.
- Complete your paperwork quickly. Whether we send out paperwork through an online portal or give you hard copies to complete, there is nothing more annoying than having to continually badger clients to get their paperwork turned in. Trust me, we hate sending it out as much as you hate having to fill it out, but if we want to keep our licenses, it’s a requirement. Be respectful of our professional mandates, and turn it in the first time we ask.
- Pay for your sessions on time. Okay, I stand corrected – having to make multiple requests to get paid for your work is more annoying than nagging clients for paperwork. Pay on time, keep us updated if your credit card changes, and don’t give us a hard time for charging for missed sessions when you’ve already signed our documents agreeing to our payment policies.
- Attend your sessions as scheduled. Constantly canceling on us, needing to reschedule frequently, or regularly showing up late is disrespectful of our time and the dozens of other clients who would love to have your appointment time. If you are going to show up late or miss an appointment, notify us as soon as possible – we might be able to give that spot to another client, or use that extra few minutes to finish up our last casenote, take a much-needed bathroom break, or scarf down a snack.
- Keep us in the loop. If something major is going on in your child’s life, let us know. We can’t do our jobs well if we don’t know the context of what’s happening outside of sessions, and if we are spending our time trying to be detectives, we have less time to spend on supporting emotional wellbeing and the development of coping skills.
- Trust us and the process. Therapy is not a magical fix that occurs in one session, or even in 10 sessions. Building rapport with your child takes time – we have to prove we are safe and trustworthy, just like any other adult in their lives. Relationship-building IS an important part of therapy, and even though it may not look like progress in your child’s immediate behaviors, it ensures future progress has the opportunity to occur.
Finally…if you are fortunate enough to find a therapist for your child or teen who you think is doing a great job, be sure to let them know. This is often a challenging and thankless job, despite its many rewards, and acknowledgment and encouragement is definitely appreciated.