What are your credentials and background?

There are many types of licensed mental health professionals, including psychiatrists, psychologists, clinical social workers, professional counselors and marital and family therapists. There are different types of schooling involved. A psychiatrist must have a medical degree and can prescribe medication. A psychologist has a doctorate degree in psychology and can provide in depth testing. Clinical social workers, professional counselors and family and marital therapists generally have master’s degrees in their applicable field. They do minimal testing and focus mostly on providing therapy. All must do supervised hours for 2-3 years to become licensed. Ask if the therapist has areas of special expertise such as working with kids with OCD or with children who have experienced trauma.

How long will therapy take?

That completely depends on the child and what they need. I’ve seen clients from a few months to a couple of years. Some clients have chronic concerns and will be in therapy for much of their lives. It depends on the nature of the concern, how long that has been a problem. Generally, the therapist will review this with you throughout treatment, so it is not a surprise when treatment is completed. Ideally, this is determined together between the therapist, child and guardian.

What will you tell me as the guardian?

Confidentiality is tricky when it comes to minors. I tell guardians and youth that I am required to report to the parent and possibly authorities in the case of harm to self or others. Examples include suicidal or homicidal ideations, life threatening self-harm, child abuse or if the child or another child is in danger. The child will know if I do have to disclose something to the parent and we often tell the parent together. Furthermore, the guardian is part of the intake process and will be aware of what is written in the child’s treatment plan. As for specifics that also depends upon the age of the child. A guardian is going to be more involved with a six-year-old than a sixteen-year-old. I encourage guardians to let me know if anything significant has happened during the week preferably in an email prior to the appointment, but at least before I see the kid. That way I can address the concern with the child during the session. I ask that the guardian let the child know they have emailed me or spoken with me about the concern. I worked with a young lady who had various problems at home and school. Her mom would email me the morning before the session to give me an update. Then, the youth and I would discuss her mom’s concerns in therapy. Sometimes the youth agreed and sometimes she did not. However, she was thankful there was open communication and her mom and I were not communicating behind her back. Things I do not disclose are concerns with the youth’s sexuality, feelings they have about a guardian, and issues at school.

What happens in a therapy session?

This depends on the therapist, the techniques the therapist uses, the presenting problem and the age of the child. A play therapist will use various play techniques to help the child process their feelings. A therapist using Cognitive Behavioral Therapy will teach a child techniques to help manage their thoughts, feelings and behaviors. They will learn coping skills such as deep breathing, imagery, and mindfulness techniques. A child in therapy for Obsessive Compulsive Disorder (OCD)  would do a lot of exposures to help them overcome their obsessions and compulsions. If a child has anxiety, the therapist might use exposure therapy by gently exposing them to feared situations. Many therapists use a balance of talk therapy and play therapy with children. Although I’m not a registered play therapist, I do use some play in my sessions. This might be using a dollhouse, puppets, sand tray, playing a therapy game or even playing a game such as Candy Land or Uno. I find it is helpful to play games with teens to help facilitate discussion. Many teens feel awkward sitting across the room talking but may feel more comfortable talking while playing Uno. Ask the therapist about their approach.

What is the cost per session, and do you accept insurance? 

This completely depends on the therapist, their experience, and where you live. Some therapists accept insurance and some do not. You will want to talk with your insurance provider to see if that therapist is in network. Many therapists do not take insurance at all. It takes a great deal of time to work with insurance companies. Many therapists would rather spend that time working with clients. Plus, there is more freedom in private pay. Insurance companies generally require a diagnosis within the first couple of sessions. They also may want to see treatment plans and only approve a certain number of sessions. There are many times when a client does not really qualify for an official diagnosis in the DSM5-TR; however, there are areas of their lives where they want to see improvement. Not taking insurance allows the client and therapist to work together to determine the number of sessions needed. An insurance company may limit the amount and the client may not be ready to terminate when the insurance company stops paying. Therapists who do not accept insurance may provide you with a “superbill.” This is a form that you can submit to insurance on your own to apply to “out of network” benefits. Some therapists will offer a “sliding scale” based on the client’s income if the client cannot afford the full amount.

How long is a therapy session?

Therapy sessions are generally 45-60 minutes. 45 is the most common as that allows the therapist to finish up with paperwork before seeing the next client. Trauma and OCD treatment usually take 60 minutes as they are more in depth.

How often will we meet?

Therapy sessions typically occur once a week for most clients, providing a consistent and structured approach to treatment. However, for specialized treatments such as trauma therapy and OCD therapy, we understand the importance of offering options tailored to individual needs. At Aspire Counseling, we provide the flexibility to choose between traditional once-a-week therapy sessions or more intensive twice-a-week therapy for those wanting faster relief. As treatment progresses and symptoms improve, the frequency of sessions may be adjusted accordingly. This could involve reducing sessions to every other week or even once a month. Any changes in frequency are always discussed collaboratively with both the guardian and the child beforehand, ensuring that the treatment plan remains aligned with the client’s progress and needs.

Do you specialize in a specific method?

Some therapists use techniques from various types of therapy modalities. Others specifically use evidence-based treatments. These include Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, Trauma-Focused Cognitive Behavioral Therapy, Exposure and Response Prevention Therapy just to name a few. The benefit of evidence-based practices is that there is evidence that shows the treatment strategies actually work. There have been many studies that show the positive effects of this strategy with this specific population. Some therapists are trained in more than one EBT and will use the one most applicable for your child. For example, I use Trauma Focused Cognitive Behavioral Therapy for kids who have been through trauma and Exposure and Response Prevention Therapy for kids (and adults) who struggle with OCD. Therapists at Aspire Counseling are trained in at least once evidence-based practice.

I encourage you to ask the therapist questions. I do not get a lot of questions, but I appreciate it when I do. This helps me to determine if I am a good fit to work with the young person. There are times that I do not do a specific method of treatment the child may need. I would see if someone else in our office could see them or I would refer them to another practice in town who may be able to better meet their needs. We want kids to get better and it is important to find a therapist who is able to meet their needs. 

About the Author

Kristi Sveum (LCSW), is a therapist at Aspire Counseling. Kristi specializes in working with children, teens, and young adults experiencing trauma, anxiety, grief, stress, OCD and much more. When Kristi isn’t working at Aspire Counseling you can see her at the University of Missouri- Columbia (Mizzou) basketball games cheering the tigers on!