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Three Key Considerations in Selecting Your Child’s Therapist

The new science of treating a child’s challenges.

Malik Bhai/
Source: Malik Bhai/

Having a child who you believe has a learning, behavioral, or developmental difference can be one of parenting’s most difficult challenges. The array of possible treatments is, more often than not, vast and confusing. How do you know if you are making the right choices? Most importantly, how do you know if a therapist’s thinking is right for your child?

In this guest post, clinical psychologist Mona Delahooke explains why and how she has integrated the science of relationships and treatment for children to offer parents and their children more effective approaches to issues they may be facing. Her relationship-based approach unravels the latest neuroscience to make her work invaluable to service providers who work with young children.

Dr. Delahooke explains:

Seeking mental health support for a child can fill parents with both hope and fear. You might feel relief that you are taking positive action to help your child. But that often comes with stress over finding the right provider. Therapists have a wide variety of approaches to similar challenges. How to choose?

Not long ago, I met parents facing just that question. Their six-year-old son Henry would become so upset at kindergarten recess that he frequently started physical tussles with classmates. After a behavior therapist failed to remediate the situation, his private school was on the verge of asking Henry to leave.

By the time his parents contacted me for a psychological evaluation, they were quite confused about what would be best help Henry. It’s no wonder. The variety of approaches can be downright dizzying.

When I was training as a child psychologist several decades ago, I learned many different paradigms, including behavioral, cognitive-behavioral, psychodynamic, psychoanalytic, humanistic, and play-based. Our professors taught us to rely on the “DSM,” the Diagnostic and Statistical Manual of Mental Disorders, for everything from making a diagnosis to formulating a treatment plan.

As I began to practice, I found that things were not as neat and simple as I had learned. In real life, working with children and families was more art than science. More than I relied on research, techniques, or ideology, I used my intuition—my sense as a human being about what each child needed. Over time, the establishment came to validate that approach.

In 2013, the National Institutes of Mental Health (NIMH)—the world’s largest funder of mental health research—stopped funding research that was based solely on the DSM manual. An explosion of neuroscience research in the 1990s had revealed how intertwined the body and mind are. This meant rethinking not only research, but also treatment strategies as well.

Now the NIMH requires that research look at something much bigger: the underlying processes that support mental health. These processes encompass a wide range of biological, environmental and psychological pathways that contribute to mental health challenges.

One critical process is a regulatory system that includes “emotional regulation,” the ability to calm oneself in mind and body. When a child’s emotional regulatory system is compromised, it hinders the child’s ability to feel calm, recover from disappointments, make transitions, and manage the stress of daily life. These challenges often result in tantrums, oppositional defiance, and acting-out behaviors.

The Link Between Emotions and Relationships

Courtesy of the Publisher
Source: Courtesy of the Publisher

There is a good reason that the NIMH’s new paradigm supports focusing on emotional regulation. It is grounded in the foundation that all human beings need a sense of safety in relationships for psychological wellbeing.

Relationships build brain architecture and provide a foundation for a child’s developing capacities. When we consider this critical link between emotions and relationships, it becomes clear that relationships are the foundation upon which all mental health treatments should be built.

That kind of relationship-based approach proved critical for Henry, the boy who had so struggled on the kindergarten playground. The solution: We devised a plan that included a steady dose of focused relational attention—including listening and warmly engaging with him—throughout each school day. Now Henry felt safe and had adults around him to offer support, so he felt calmer and his challenging behaviors lessened. He played and laughed more, and his peers no longer feared his outbursts.

Each child is unique, and each requires a unique roadmap for support. When therapists provide these supports in the context of healing relationships, the benefits can be profound.

3 Important Insights for Selecting a Therapist

Here are points to consider when looking for a child therapist:

1. Seek out therapists who prioritize your child’s emotions (and yours) through a supportive and engaging relationship. Why? Emotions help humans survive by helping us detect threats and respond to danger. Emotions, from the Latin root movere, “to move,” are what stir us into action. Guided by our emotions, human beings search for social engagement. When we feel safe in body and mind, we can explore, take risks, learn, and grow. When we don’t, we direct excessive energy toward basic survival. Most children with mental health challenges have difficulty regulating their emotions.

2. Look for therapists who recognize that it’s more important to make a child feel safe than to manage the child’s behavior. When we focus on behaviors to the exclusion of emotional safety, we do more harm than good. According to neuroscientist Dr. Stephen Porges, nurturing the child’s feelings of safety should always precede simple behavior management. Otherwise, a child may appear to be thriving, but on a deeper level, he or she is suffering. We build true psychological resilience from the “bottom up,” through loving and supportive relationships.

3. Find therapists who use a relationship-based developmental roadmap. These therapists may describe their philosophy as informed by interpersonal neurobiology, neuro-relational frameworks, or DIR (Developmental, Individualized, Relationship-based), among others. They understand that “talk therapy” is often applied too soon with children. Therapists with a relationship-based practice will start by building a solid relationship with the parent, and use nurturing relationships to understand what individual differences are contributing to a child’s unique challenges.

Want to learn more? I explain how all childhood professionals can integrate the new science of relationships and emotions into everyday practice in my new book, Social and Emotional Development in Early Intervention.

Related: 13 Concerning Signs of Mental Illness in a Child

Avoiding ADHD’s Wide Net: One Parent, One Child at a Time

Copyright @2016 by Susan Newman

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· See my book, Little Things Long Remembered: Making Your Children Feel Special Every Day


Damasio, A. R. (1999). The feeling of what happens: Body and emotion in the making of consciousness. New York: Harcourt Brace.

Delahooke, Mona (2017) Social and Emotional Development in Early Intervention: A skills guide for working with children. Eau Claire, WI: PESI Media & Publishing.

LeDoux, J. (2015). Anxious: Using the brain to understand and treat fear and anxiety. New York, NY: Random House.

Siegel, D., & Bryson, T. (2011). The whole brain child. New York, NY: Random House.

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