"My kid needs a shrink? Bah, humbug!" Parents who become concerned about a child's feelings, behavior or relationships typically go through a progression of steps before reaching out to a mental health professional. These include:

 Denial:

"Problem? What problem?"
or
"It only happened once, what's the big deal?"

  Normalization:

"Boys will be boys"

  Asking for help from familiar helpers:

"Let's talk to his teacher"
or
"Maybe the school counselor could have a look at him."

Asking for help from familiar professionals:

"I guess I could talk to his pediatrician...."

  Asking for help from unfamiliar professionals referred by trusted friends and family:

"Aunt Betty said he helped her son a lot...."

  Asking for help from unfamiliar professionals:
"I found his name in the phone book...." or "The insurance company told me that I had to call him."

This escalation of concerns and the associated search for resources is normal and healthy. Many concerns about children's thinking, feelings and behavior should be passed off as a blip on the screen or age- or stage-appropriate or be handled by familiar and trusted others. This is good. But when these responses aren't enough, when parents (sometimes urged by teachers or pediatricians) decide they must turn to a mental health professional for advice, everyone gets nervous.

Parents referring their child for psychological assessment or psychotherapy are nervous.  Perhaps you feel some of all of these:

"I'm over-reacting. He doesn't need to see a shrink!
I was just like him and I turned out okay!"

"Can I trust this guy?
 (After all, look at the news! If you can't even trust a priest...!)"

"He's going to talk to me and talk to my kids and tell me its all my fault!"

"My son will never talk to him. He barely talks to me!"

It is Dr. Garber's practice to make every effort to see that each of these concerns is addressed to your satisfaction before your child even walks in the door. Here's how:

1. Are you over-reacting? Probably not. Calling to speak to a mental health professional is not usually an easy step to take, but just in case: Dr. Garber will spend time on the phone with you when you first call to screen your concerns and then will interview you and your co-parents in depth during the initial history and background meeting before your son or daughter is even invited to the office.

  If your description suggests that a preliminary meeting is unnecessary or somehow inappropriate, then he'll refer you to speak with teachers, school personnel, the pediatrician  or other professionals better suited to your concerns.
 
  If your description suggests the presence of a difficulty outside of Dr. Garber's areas of expertise then he'll refer you to other mental health professionals better qualified to help.

2. Trust. Psychotherapy is built on trust. Dr. Garber welcomes your questions and expressed concerns at all times. No matter who refers you to the office and no matter what experience others have had in his care over more than fifteen years in the greater Nashua area, its your confidence that Dr. Garber will answer your questions, will take the time to talk and will treat you and your child and your family with competence and respect that will make this a growing experience.

3. Is it your fault? Probably not, but as loving caregivers you consider that all of the time. Part of Dr. Garber's role in helping your child is to help all of his or her caregivers -parents, teachers and others- to better meet his or her needs. This may mean tuning up your parenting, trying new approaches and growing with your child.

4. Children usually open up. Its not magic and its not a certainty, but the process of psychotherapy and the setting in Dr. Garber's office usually helps kids open up.

  Part of the answer is how you set the stage: Don't introduce the idea of psychotherapy or Dr. Garber as a punishment or as a cure. Make certain that there's no misunderstanding that coming to see a doctor means getting a shot. Its usually enough to acknowledge that the child knows he or she has been having a hard time (making frinds, staying out of trouble, getting homework done, getting along at home) and that you've asked for some help for all of you. For the whole family.

  Part of the answer (especially with teens) is about privacy or confidentiality. Its important to make it clear from the start that (1) What is said in this office is private. No one will tell frinds at school or elsewhere, (2) Dr. Garber respects the child's privacy and won't tell the details even to parents, but (3) as parents you're concerned and Dr. Garber does have a responsibility to report how the child is doing in general terms.

  Another part of the answer is minimizing the pressure: Don't tell your son or daughter that he or she MUST talk . Trust that it will happen. It may be sufficient to simply require that the child arrive for the appointment and leave the rest between the child and Dr. Garber.

One model of out-patient psychological evaluation

Every child is different. Every reason for reaching out to a mental health professional is unique to the child, the family and the situation. For this reason, Dr. Garber will make specific recommendations to you, as his knowledge of your child's needs grows.

Because parents often ask, following is one sample of how an out-patient psychological evaluation is often conducted in this office:

1. Your original call: Between 10 and 15minutes may be necessary to collect basic information, to orient you and to make plans for the initial history and background meeting.

2. History and background meeting: Typically a 90 minute interview with all co-parents present. Children under (approximately) 16 years old are not invited. Bring intial forms The purpose of this meeting will be to learn as much as possible about you, your co-parents, your background and family, the child, his or her siblings, home, school, play ... as possible. The goal is to leave this initial meeting with a concrete plan about how to proceed. This may include the following:

3. School observation: When behavior outside of the home is at issue and particularly when issues concerning attention, concentration, impulse control and/or socialization arise, innocuous observation of the child at school can be very important. It is important that this occur before Dr. Garber meets the child so as to avoid alerting the child that he or she is being observed.

4. Child interviews. Two individual one-hour meetings with the child in Dr. Garber's office to talk and draw and play together. A combination of structured, semi-structured and free play observations are important diagnostic tools.

5. Family observation. Although the most valid observation would be to invite Dr. Garber to move in with the family for six months, this is rarely time- and cost-efficient. Instead, the family is invited to participate in structured tasks set out in the office for an hour.

6. Homework. A variety of take-home questionnaires and self-report instruments may be requested from the child, the parents and/or teachers.

7. Feedback. Dr. Garber sits down with parents (and, on rare occasion, the child as well) to pull together all of these observations for the purpose of diagnostic impressions and treatment planning.