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March 21, 2023

Ask Lisa Podcast - Episode 111

What Kind of Therapy is Right for My Kid?

Episode 111

Parents seeking professional support for their kids often run into a confusing array of therapies to choose from. In this episode, Dr. Lisa provides a neutral guide on the various options – DBT, CBT, talk therapy, somatic therapy, play therapy, and family therapy – and describes which options are the best fit for which concerns. From Freudian therapy to body-based treatments, Dr. Lisa and Reena give listeners an accessible guide to therapeutic interventions.

March 21, 2023 | 32 min

Transcript | What Kind of Therapy is Right for My Kid?

Ask Lisa Podcast, Ep. 111: What Kind of Therapy is Right for My Kid?

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being, consult a physician or mental health professional.

The following transcript has been automatically generated by an AI system and should be used for informational purposes only. We cannot guarantee the accuracy, completeness, or timeliness of the information provided.

——

Reena Ninan
So I don’t know if people caught it. But there was a number change at the top of our podcast. And it goes something like this three time New York Times bestselling author, Lisa, The Emotional Lives of Teens hit the New York Times bestseller list, you are now a three-time New York Times bestseller.

Lisa Damour
Thank you Reena, I am really happy about it. I’ll confess and thank you for your support. I mean, it made such a huge difference in this and then our listeners have been incredible. And so I’m just glad that the book is getting out there. And I just really hope it’s useful to families.

Reena Ninan
Oh, it is absolutely useful. I mean, you’re hearing it on the book tour we’re hearing in our inbox, and everywhere I go, people want to talk about it. But I just think it’s so remarkable, because you’re so humble about your success. It’s one of the things I’ve loved about you. And there is nobody better at their job than you.

Lisa Damour
That’s really kind that’s really kind I just feel lucky to get to do what I get to do.

Reena Ninan
And it’s got a great title, “The Emotional Lives of Teenagers.” You gotta get that book. Speaking of someone good at their job, I want to ask you, you were so passionate about this episode we’re doing today talking about what kind of help you should get your child when they’re in need. Why did you feel so passionately that we should do this episode?

Lisa Damour
You know, I think we have gone through a time when so many families are worried about their kids are seeking help for their kids. And it is amazing to me how hard it is, as a consumer to know what all of the options are and what they mean. And also who to trust in those moments. Right. And of course, by the time you’re seeking help for your kid, you are really looking, you’re pretty vulnerable, and you need to know what you’re doing. So I wanted to really make it so that parents had a you know, our listeners had a kind of a neutral, a neutral exposition of what all the different therapies are and what they mean.

Reena Ninan
I love that because I have a feeling I’m gonna learn so much on this episode, I want to read you the letter that we got. It says Dear Dr. Lisa, I’ve been looking into child therapist, psychologist and it is so overwhelming. DBT CBT talk therapy, somatic therapy, play therapy. What does all this mean? And how do I know what’s right for my kid?

Lisa Damour
For me, this is like there’s so much inside baseball in psychology. And yet parents have to make decisions and then they’re trying to trust you know, what they can find online to tell them or they’re trying to trust a practitioner who? How do they even know they can trust that person? Or is that person trying to you know, bring their work that their way? I mean, I I this I love this letter. I absolutely love this letter, because I think a lot of families struggle with this question of like, what is all this? And which one should I look for for my kid?

Reena Ninan
So I guess it’s hard to kind of talk about this when you know, the specific aid was that HD ADHD or whatever the issue might be? So how, how do you even approach this, Lisa?

Lisa Damour
Well, it’s interesting, because the kinds of therapies that are asked about in this letter, we use them for different things. And so some will be making more sense for different kinds of concerns than others. So the first one, was it DBT?

Reena Ninan
It was DBT. And then CBT, which I’ve never heard of any of these.

Lisa Damour
Okay, so I’m just going to do a lesson on what these are because it’s really important for families to know. So to take them in order. DBT stands for Dialectical Behavioral Therapy. And this one, it’s interesting. There’s sort of a historical order in which these emerged. This is a relatively recent but I mean, like literally the last 25 years. So you know, it’s not brand new. And DBT began as a form of treatment. Initially for people who were suffering from borderline personality disorder, which is a disorder we diagnose only in adults. And it has a lot of features. But the overwhelming feature of borderline personality disorder is incredible difficulty managing upset feelings, and tending to manage upset feelings through self destructive actions like cutting or threatening suicide or eating disorder behavior, or clinging to people in a way that actually ends up being off putting. So it’s its own constellation of diagnostic symptomatology. But the insight and it was actually one person, it was a woman named Marsha Linehan, who said, what people who are suffering from borderline personality disorder do not need traditional psychotherapy, where we stir up feelings, right, like the the goal, like often of like talk therapies, and we’ll come to those is like, you know, you talk about what you what you’ve been through, it’s often kind of distressing. And Marsha Linehan view was like, That’s fine for people who are able to manage distress, but the nature of borderline pathology is that you cannot manage distress. And I remember when I was being trained on this, this beautiful analogy was, you know, that with talk therapy, for someone with Borderline pathology is like taking someone who doesn’t know how to swim, throwing them overboard, and then standing in the boat going, I’m with you, I’m gonna do so DBT is swimming, like, how do you manage distress. Now, interestingly, in the intervening 20 plus years, since it was developed for Borderline Personality Disorder, there has been a very helpful expansion of its application to other concerns, where feelings are not managed well. So we now recommend DBT. Often for kids who are struggling with eating concerns, for kids who are struggling with self harming separate from a broader borderline, you know, constellation, anytime we come across a person, and it’s this is we’re talking adults, and then adolescence, we don’t really do DBT. With little kids, we do, you know, helping them manage basic emotional regulation with little kids. But DBT is more sophisticated version of it. Anytime we are looking at symptoms, where the nature of the symptom is the person gets upset, and they do something that is bad for them. DBT can be really helpful. So that’s how I would want parents to size this up is if your kid is cutting or threatening to code or threatening suicide every time they’re upset. And we’ll come back to it, you know, obviously, if there’s threatening suicide, you get them safe first, like no question about that. But if there’s a really sort of a self destructive bent, or a difficulty caring for oneself in the face of painful emotions, DBT can be a wonderful option.

Reena Ninan
Now, how is DBT I know you’ve walked us through a little bit different than, hey, just go see a psychologist, they’ll walk you through it, you can talk through your emotions.

Lisa Damour
So it’s interesting, because there are psychologists who specialize in DBT. They’re psychologists who specialize in CBT. They’re psychologists who specialize in talk therapy, there’s almost no way for the consumer to know what they’re getting. And so what and part of what’s problematic is, these are very specialized trainings like DBT training is something that is unique to itself, I do not have DBT training, I’m a solidly trained psychologist, and a lot of things, I do not have DBT training, I would refer out for that. So part of why it’s really I’m really glad we’re doing this episode is the consumer needs to know because as all clinicians are inclined to do, so we tend to recommend what we know how to do. And so if you have a kid, we’re really DBT would be really probably the better option, and you go to someone who specializes in talk therapy, they may get talk therapy, when that’s not really the best choice for them. So what I would say is, if you have a kid who is really having a hard time managing any painful emotions, and is engaging in self destructive behavior, when they become upset, or outwardly destructive behavior, I would get an evaluation from somebody who has an awareness of DBT and may themselves practice it or no be able to recommend somebody who’s really good who does.

Reena Ninan
And so there was something called CBT. What is that? And what Who could that help them boast?

Lisa Damour
Okay, so CBT stands for cognitive behavioral therapy. And it’s one of our main treatment forms, and it’s enormously mainstream. And I will tell you, DBT has become mainstream do DBT didn’t start there, but it has become that. But CBT has been around since the 70s, at least. And what it is, is very much included in the in the title, it’s cognitive. It’s how we think behavioral, it’s how we act therapy and Deep CBT grew up in reaction actually to the earliest talk therapies. So the earliest talk therapies really come out of a Freudian tradition. Right. So the beginning of psychotherapy, as we know, it was really Sigmund Freud’s work, and the people all around him, who discovered that when you get people talking about closely held events and emotions, they tend to experience relief, you know, or they can experience relief, like this was a totally novel idea. 100 plus years ago, like it was not even on the table. It’s kind of like, I’m in a very young field in many ways. And so the earliest therapies were all this kind of, excavating, curious trying to understand, you know, unconscious motivations, where things are coming from access things that may be outside of people’s awareness that may be informing their behavior. And there’s real value in that, and we’ll come back to it. But then somewhere, I think it was the 60s or 70s, I should know exactly, but somewhere in there, somebody was like, or maybe you don’t have to dredge it all up, maybe you can just help people feel better, by changing how they think and how they act. And you don’t always have to get up questions of unconscious motivation, or, you know, deep past issues. And that’s what CBT is. So when you seek out a CBT therapist, and the kinds of things for which it is fantastic, it is great for anxiety, it can be great for depression, you know, it can be great for compulsive behaviors like that. There are things that CBT is enormous ly strong. So we can start to categorize these, like DBT is when you cannot regulate emotions. CBT can be enormously helpful anxiety can really, I mean, I use this kind of like cautiously to cure anxiety disorders, really. Yeah, it can go a really long way in helping people manage depression. Those are the two big categories of things that people struggle with. And so if you go to see a CBT, practitioner, what they’re going to do is they’re going to have you lay out how you’re thinking about whatever it is you’re struggling with. So say it’s anxiety, where you say I’m so anxious, I cannot go to school, school is terrifying. They will have you in detailed ways, articulate what is scary about school, what you think is scary about school, they will then have you examine those thoughts. Look for distortions and exaggerations. Look for ways to actually challenge your own thinking to have it be much more in line with reality, and then use that to change the behavioral choices that are made. Okay, I’m not doing it full justice. But that’s sort of the high level description of it. And it can be really, really effective. It’s one of the most sort of empirically validated therapies we have is we know from research that CBT can be highly, highly effective for people. So that’s what that means. And there’s a lot of CBT practitioners around that. If you are seeking someone, there’s a good chance to their training is at this point. CBT.

Reena Ninan
Okay, what about talk therapy? I mean, when I hear talk therapy, I just think of Oh, it’s just you showing up to a psychologists office and talking is that what it is?

Lisa Damour
Well, it can be it can be so talk therapy is kind of like this big generic term that we use. When when clinicians use it, were you meaning not CBT probably more, what we will call psychodynamic. And so psychodynamic is the term that we use, that basically Freud plus, so when psychologists are saying the term psychoanalytic, they tend to mean Freud and his contemporaries, like the people who really on laid out psychoanalytic theories, psychoanalytic theory has developed tremendously in the intervening century, has lots of branches and has become very modernized in many ways. And so when we say psychodynamic, what we mean is Freud and then everything that came after Freud. But in that vein, the key principles in this of psychodynamic psychotherapy is this belief. And this is important, right, and this is actually how I was trained, I was trained very much as a psychodynamic clinician, is a belief that a lot goes on outside of our awareness that we don’t know ourselves as well as we might want to. And that if you create an open environment for psychotherapy, where you can just explore and see what thoughts come up, one right after the other, where the clinician can be a really attentive observer and noticing, you know, you talked about this and then I saw you take a hard left under this like a wondering what that might be about. That in that process, you can access unconscious forces that may be making your life harder than they need to be. So talk therapy is vastly more unstructured say than CBT and DBT. But it can really have a place where there may be one of the ways we talk about it sometimes is like ghosts in the nursery, you know, things lingering from the past. that are governing the moment that we’re in in ways that we don’t mean for them to. And a good psychodynamic clinician can help bring that to light. And once that is brought to light, give the client more choices.

Reena Ninan
This letter writer mentions called somatic therapy and play therapy. Can you walk us through what those are?

Lisa Damour
I can. Okay, so somatic therapy is newer to the table, right? I mean, we think I just because of my training, I can think about these things in terms of when do they come on the scene? Yeah. So somatic therapy, it rests on the premise that the mind and body are very powerfully connected, which we now we’re all in agreement about. Now, I will tell you Reena, I got my PhD 25 years ago, and I’m not proud of this, but this is the reality. 25 years ago, mainstream psychology was a little bit like, oh, yeah, that mind body stuff that’s kind of woowoo you know, not not really like conventional wisdom. And we’ve realized the you know, the error of our ways. So somatic therapies are really, really helpful for people who have a psychological challenge with a very powerful physiological component. And mostly what I’m talking about here are people who have experienced a trauma. It’s really interesting work. So when people go through a trauma, whether it’s like, you know, attack of some kind, or an accident of some kind, the nature of trauma is that it overwhelms us overwhelms our coping. That’s what makes something a trauma. And it causes basically, a full flooded, overwhelmed response. And then what happens is that when people think about it, or when they’re trying not to think about it, it will sometimes come back to them. And what comes back to them also is a full physiological overwhelming, like they’re having a panic response where they feel nauseous, or they feel frightened and shaky. That it the market leaves, goes beyond just thoughts and feelings. The market leaves goes into the body and can be carried in the body intention or ongoing, like activation of our reactivity systems in a way that makes daily life really, really hard.

Reena Ninan
Can I give you an example of one thing I think you might be talking about? Tell me if I’m right, it was a black gentleman who had been the victim of police brutality, it ended up being proven in court. And one of the things he told me the interview that he struggles with is every time he sees the police officers, he’s driving by he urinates on himself, and he can’t control that. And he was saying, as a dad, it’s really hard when your five year old boy has control of their bladder and you can’t, but is that an example of a trauma that happened? And there’s a reaction of something? It’s just like…

Lisa Damour
Absolutely, it’s so basic, and then like, am I basic, I think what you mean it’s like core right? And kind of almost like, you know, archaic in its way. So, no, that’s an exact example. So this guy was traumatized. Right when he was beat up by the police or whatever. Yeah, the assault was his coping systems were overwhelmed. He may or may not in that moment, have urinated himself at the time of the trauma Right? Like you lose control of your functioning right which is so so upsetting, right? I mean of setting doesn’t even get it right. And then what happens is, he is now suffering now based on what you’re telling me I’m going to make a best guess from posting Not like stress disorder, which you don’t always suffer from PTSD in the wake of a trauma. But if you have that re experiencing and intrusive symptomatology that he does, we would call that usually PTSD. So he sees a police officer, we would call that a trigger. And that brings him back to the moment of the trauma. And his body recreates what happened in that moment, wow. And so this poor guy, right, and that’s what I mean, like it really gets in the way of daily functioning, if encoded into the body is a traumatic response. So what we do in somatic therapies for people who specialize in it, is to really, really be attentive to the signals from the body tune into the body and help people feel back in charge of their own physiological reactivity. Right. So it may be you know, that someone who cares for a guy like that, you know, thinks about has him think about a situation of seeing a police officers or not actually doing it, but think about it, noticing the shifts in his body using breathing or muscle relaxation to try to counter those shifts. So it’s not so much the talking, right, it’s very much tuning into how the body reacts. And then using various strategies that we know work like breathing and muscle relaxation. To counter that out of control, physiological experience.

Reena Ninan
Good to know. Someone ask you about play therapy, I just assume it’s just kids playing with toys?

Lisa Damour
Uh… for which we charge you a lot of money. So play therapy is like psychodynamic psychotherapy for kids. So we talked about like unconscious processes, and you know, those coming up in the therapy situation. So we don’t expect that younger kids are going to come in and be like, so I had this dream last night. And here’s what happened in the dream. I mean, like, we don’t expect that. So play therapy is one of kids going through something really hard, and finding a way to talk about it may be very, very effective. And you have someone I then this was some of the training I have, who’s very comfortable doing that in a place setting, because that’s how kids communicate. So all of us who are trained in that we have doll houses, in our offices, we have entire families in our offices of like, you know, toy families. I also when I was taking care of my kids, I had tons and tons of animals, like tons and tons of little plastic animals. And what you do is you get a conversation going where you play with it, and then the clinician can introduce like, you know, this is sort of a grumpy lion Daddy, you know, and here’s sort of a sad, you know, tiger, Mommy, you know, and like, what are they thinking and feeling. So, it’s a way where you get at what may be under the surface, and you use play both because that’s appropriate to kids. And also, so it’s not so like, on the nose for them. It’s overwhelming for a nine year old to be like, so it sounds like your parents are really struggling. Right? Like, I mean, that’s not gonna happen, right. But you could have that conversation with racecars, or drawing or other ways that allow for what we call this placement in terms of having those conversations.

Reena Ninan
I know when I covered wars, that often they would have the children color and write, you know, draw things? And then they would the psychologist working with them would explain to me what they were seeing through their drawings.

Lisa Damour
Exactly. So it’s, it’s it’s getting at this idea that there’s a lot going on, but kids need to communicate it in a very particular way.

Reena Ninan
I want to ask you about family therapy, what is that?

Lisa Damour
So family therapy is when everyone’s in the room at the same time. And it can be very, very effective, where the conflicts is largely between people, right? I think often, as a psycho dynamically trained clinician, I think about conflict is either within a person or between people, right. So people can be at odds with themselves, and they can be at odds with others. And so it can be wonderful. And there’s not as many people who practice this as much like therapy sort of have their like moments in time. Family Therapy is not as widely trained or used as it was in the 70s and 80s. But there are still very good practitioners around and new clinicians who are good at this. But if a family is at odds with each other, getting someone in who can serve as a neutral party, that’s really the role of the clinician in that moment, serve as a neutral party to observe the dynamics inform the dynamics, maybe give people different patterns or ways to try to sort through, you know, whatever is coming up in family life.

Reena Ninan
So Lisa, we’ve gone through so many different therapy options that I didn’t even know was available. Why did you think this episode was so important? And I also want to ask you how you can determine what’s best for your child or your family.

Lisa Damour
Yeah, I mean, I think it’s so hard for me as a psychologist to know how opaque what we do is to the consumers who need us. Right? I think that that’s what’s so hard is it by the time you need someone like me, you’re already in a jam. You were already having a very, very bad day. And there’s a part for me I was so glad to get this letter and I thank you for like being agreeable around like talking it through. Where I just wanted to like have someone have a way to give upon information about this from someone who has no skin in the game about the particular situation they’re in, right, because that’s always the worry is the consumer is like, I’m in a vulnerable moment, I’m making this call, I don’t know if the person on the other end of the line is as informed as they need to be going to give me the right guidance or advice. And so I just, I love that we can create a space just to sort of walk these through and give people the information that will help them in what are invariably very, very hard times in their lives.

Reena Ninan
They are very hard times and I think, also, I wasn’t aware of a lot of these DBT CBT. I didn’t know these were options. And sometimes it might give people an opportunity to explore an avenue that might be better for their family.

Lisa Damour
Yeah, I mean, because you want the treatment to work. I mean, that’s the thing that’s so frustrating is when people seek care, get connected to care, or spending time and money on that care. If it’s not the right care, they’re losing time and losing ground. And that also just, I just makes me really, I just hate that,

Reena Ninan
You are always so vested in the lives of people you don’t even know because you have experienced so much in your practice. So Lisa, what do you have for us for parenting to go?

Lisa Damour
Okay, so this is a really interesting thing. We have studied treatment efficacy, right. So one of the questions that people may be thinking is like, Okay, well, which ones are the most effective? And so we’ve asked that question of like, what makes for an effective psychotherapy? And the answer that comes back is not this kind or that kind, or this level of training? The answer that comes back is a good working relationship with the clinician. So that is, in addition to trying to find the right kind of therapy for your need. The thing that you really want to keep an eye on is, do you as the parent may be seeking help, or does your kid as the kid seeking help feel like you and the clinician are working well together on the same team are in a good partnership. And we have found through like massive empirical studies, that that’s what actually drives treatment outcomes, more than anything else, like you could have somebody who’s like 40 years into it, you know, their career, if you’ve got a lousy relationship with them, you’re getting nothing, you could have a newbie, who, you know, is still pretty green as a clinician, but if you’ve got a good working relationship, you’re gonna get a good result from that. So what I would say for people who are looking for clinicians, for their selves themselves with their kids is like, these are the two things you want to wait, what type of treatment is going to make sense? And did you find somebody can you find somebody where it really feels like a good fit?

Reena Ninan
And I think that’s what’s so painful is first getting in anywhere is hard these days. But then, once you get it, and you feel like you should be so grateful, but you don’t gel or your child, you can tell just it’s not working, but you continue doing it spending tons of money, because this is your only option.

Lisa Damour
Yeah. So I know it feels like a very hard but high bar to set at any point. And I certainly know when clinicians remain very stretched then. But for families who can find an exercise options, this is the information they’re going to want to have.

Reena Ninan
Well, thank you for this for laying this all out. And I didn’t realize how many other options there are. So we’re so grateful, Lisa, that you’ve you’ve gone through explain this and maybe open the door for other parents to think of other options. And next week, we’re going to talk about gaming. How do you know when gaming it’s too much for your child? I’ll see you next week.

Lisa Damour
I’ll see you next week.

The advice provided by Dr. Damour here will not and does not constitute - or serve as a substitute for - professional psychological treatment, therapy, or other types of professional advice or intervention. If you have concerns about your child’s well-being, consult a physician or mental health professional.

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