How to find the right therapy for your child
Mental illnesses are not uncommon in children and adolescents. However, they are often still stigmatised in society and are sometimes not taken seriously enough. «Parents are often afraid that they are to blame for their child's mental health problems,» says Franziska Schlensog-Schuster, Chief Physician and Deputy Director of the University Clinic for Child and Adolescent Psychiatry and Psychotherapy in Bern. «I then say to them: If I have a toothache, I go to the dentist. So I also get help if I have the feeling that my child is not developing well psychologically.»
Mums and dads should not wait too long to get this help (read our article here: Does my child have serious problems or is it just a phase?). If left untreated, mental illnesses can lead to a variety of massive impairments that can have a negative impact on the child's life even decades later.
Parents are often afraid that they are to blame for their child's mental health problems.
Franziska Schlensog-Schuster, child and adolescent psychiatrist
«As a result of an illness, blockages often arise that hinder important developmental steps such as social integration or school and vocational training,» emphasises Andrea Wyssen, head psychologist at the above-mentioned university hospital. «Studies have shown that affected children or adolescents do not always subsequently manage to achieve a level of professional or social functioning that corresponds to that of a healthy person, even if they receive treatment later on. The developmental delay is simply too great.»
The first steps
A good first port of call for schoolchildren with mental health problems is the paediatrician. They have usually known the child and the family for a long time, can make an initial assessment and prescribe psychotherapy if necessary. In urgent cases, parents can also contact the outpatient centre of the nearest child and adolescent psychiatry department directly. The prescription model has been in force in Switzerland since 1 July 2022. This means that psychological psychotherapists working in an independent practice can carry out psychotherapy largely independently following a medical prescription and bill the costs directly to the basic insurance provider.
«The first order includes 15 hours of therapy,» explains head psychologist Wyssen. «After an interim assessment, a second order with a further 15 therapy sessions can follow.» When looking for a suitable specialist to carry out outpatient psychotherapy, Wyssen recommends choosing professionals with sound training wherever possible: «I advise parents to choose a specialist psychologist or a medical specialist with a federally recognised title.»
These are child and adolescent psychotherapists who have studied psychology and also completed a federally recognised psychotherapy course, and child and adolescent psychiatrists who have studied medicine and then completed specialist training in psychiatry.
Unlike psychological psychotherapists, child and adolescent psychiatrists are therefore also authorised to prescribe medication, issue sick notes and write orders for psychotherapy. «Both professional groups can also bill via basic insurance. However, I also recommend specialists in training if they receive good guidance and content-related support from the training institute,» says Andrea Wyssen.
A search that is not always easy
Parents can find help in their search for federally recognised specialists primarily on the relevant portals of the Swiss psychotherapist associations and federations. Special search masks can be used to search directly by postcode, language, therapy method and disorder.
Other professional groups such as psychologists, psychological counsellors and coaches for children and young people also offer their services. You usually have to pay for the services yourself. In some cases, supplementary insurance covers the costs. Psychologists have a degree in psychology, but have not completed any federally recognised psychotherapy training. Coach and psychological counsellor are not protected professional titles.
Find suitable therapists and psychiatrists:
- Therapeuten- und Therapeutinnen-Portal Sanasearch.ch: www.sanasearch.ch
- Föderation der Schweizer Psychologinnen und Psychologen (FSP): www.psychologie.ch
- Assoziation Schweizer Psychotherapeutinnen und Psychotherapeuten (ASP): www.psychotherapie.ch
- Schweizerische Gesellschaft für Kinder- und Jugendpsychiatrie und -psychotherapie (SGKJPP): www.sgkjpp.ch
«It is therefore difficult for parents to find out who is really well trained and suitable,» explains Wyssen. «However, for more preventative interventions or less pronounced problems, such people may also be suitable - especially if they have additional training in psychological counselling recognised by the Federation of Swiss Psychologists (FSP).»
Recommended procedures
There are a variety of different psychotherapy methods for treating mental illnesses in children and adolescents. However, the four main psychotherapeutic methods that are accredited and therefore covered by basic insurance in Switzerland are psychoanalysis, behavioural therapy, systemic therapy and talk therapy. All four methods are well-tested and effective. However, they have different focuses and approaches.
It is important that the child or adolescent has a minimum motivation for therapy.
Franziska Schlensog-Schuster, child and adolescent psychiatrist
Which therapy is most suitable depends on many factors, including the individual disorder, and therefore cannot be generalised. «I recommend that parents seek advice from a specialist. Paediatricians are often very knowledgeable or can at least name someone who can help,» says child and adolescent psychiatrist Schlensog-Schuster.
- Psychoanalysis is the oldest form of psychotherapy and was founded by Sigmund Freud. It is regarded as a revealing process in which the reasons for current symptoms in the past are tracked down, made aware of and dealt with accordingly.
- Talk therapy is characterised by a humanistic view of man and assumes that the solution to every problem lies within the patient. Through special techniques in constructive dialogue and active listening, the therapist helps the patient to speak freely about their thoughts and feelings in order to recognise the solutions themselves.
- Behavioural therapy is a learning theory method. It assumes that dysfunctional behaviour is learned through experiences and so-called reinforcers such as rewards and punishments, but can also be unlearned. Later - in the so-called second wave - the aspect of cognition was added, and the third wave now also incorporates mindfulness, acceptance and emotion-focussed interventions into the therapy in order to help patients to feel their emotions and feelings better and thus be able to regulate them better.
- Systemic therapy looks at the individual and their problems in the context of the systems in which the person lives. This primarily includes the family, but also the school or circle of friends. The focus of systemic therapy is primarily on the relationship processes in the systems, which are considered to be decisive for the development, maintenance and also improvement of psychological problems. This is why parents are particularly involved in this form of therapy.
Prerequisites for successful therapy
In order for psychotherapy to be carried out successfully, certain requirements and framework conditions must be met. «For example, the child should live in a safe environment. In addition, psychological emergencies, such as acute suicidal behaviour that requires inpatient admission, must always be well clarified. It is also important that the child or adolescent has at least a minimal level of motivation for therapy,» says the deputy clinic director.
It is typical for adolescents to show a rather dismissive behaviour towards the therapist at first.
Franziska Schlensog-Schuster, child and adolescent psychiatrist
In addition, parents must also be willing to co-operate in order to support the process. Parents must be able to tolerate the fact that their child sometimes becomes more familiar with another person during therapy than with themselves. «Parents can feel excluded to a certain extent, which is also painful,» says Schlensog-Schuster. «However, our duty of confidentiality is extremely important for the children, as this is the only way to provide them with a safe haven from which nothing can get out.»
Starting therapy - creating an atmosphere of trust
After the initial telephone contact, there is usually a consultation in the practice where the therapist and patient get to know each other personally. «With younger children under the age of twelve, the parents are often present at the beginning. Older adolescents also come alone,» says Schlensog-Schuster. In the first few sessions, the aim is to identify the exact symptoms of the disorder. This involves asking about the specific problems, but also about the family environment, school or possible previous illnesses. Tests are often also carried out to confirm a suspected diagnosis.
Psychotherapy is not intended to fix children and make them fit for their parents or society.
Franziska Schlensog-Schuster, child and adolescent psychiatrist
In addition to anamnesis and diagnostics, the first few hours are primarily about creating an atmosphere of trust for the young patients in which they feel comfortable. It is very important for the success of any psychotherapy that they are able to open up to the therapist - regardless of the form of therapy. «However, it is also typical for adolescent patients in particular, who are just beginning to detach themselves from adults, to exhibit rather dismissive behaviour at first,» mentions Schlensog-Schuster.
«This is healthy to a certain extent and also understandable, because they have often had bad experiences with adults, which they initially transfer to the therapist.» Wyssen, a child and adolescent psychotherapist, therefore considers it premature and wrong to immediately change therapists, as it is rarely a wrong choice. Rather, this behaviour reveals the underlying problem, which can usually be dealt with very well in therapy.
The child takes centre stage
Once the diagnosis has been completed, a goal is usually agreed on what is to be achieved in the therapy and a therapy plan is drawn up. This is implemented and the newly acquired knowledge and behaviours are practised so that they can be applied effectively in everyday life. At the end of the therapy, the extent to which the desired goals have been achieved or whether an extension of the therapy is necessary is finally reviewed.
If one person in the family moves, all the other family members inevitably have to move too.
Franziska Schlensog-Schuster, child and adolescent psychiatrist
The child's well-being always takes centre stage - not the needs of the parents. «Psychotherapy is not there to fix children and make them fit for their parents or for social demands, which are sometimes very strict,» says Schlensog-Schuster. «Instead, people should be able to find ways that are truly beneficial to their health, even in the long term.»
This change usually also has an impact on the child's entire environment. «Because if one person in the family changes, all the other family members inevitably have to change too,» says the child and adolescent psychiatrist. This means that established rituals and structures also have to be scrutinised and sometimes changed. This can be exhausting and uncomfortable at first, but is ultimately also beneficial.
Mobile intervention - a new contact point
Read the short interview with Denise Ernst, social worker and head of the «Mobile Intervention for Youth Crises» here.
Contact and further information: www.zh.ch/intervention-jugendkrisen
