How do I know if I should I get psychological services for my child?

There may be many reasons that a child or adolescent may benefit from psychological support. At times, genetic vulnerability to emotional distress may play a role, life circumstances such as the loss of a loved one, family violence and conflict, sports injury,illness, and the experience of stress in any form may impair a child’s ability to function to his or her fullest potential. While the reasons for therapy may at times be clear and at other times may be confusing, we know that nowadays children are faced with significantly more stressors in contrast to past generations. The mental health and wellness communities have learned that children who are experiencing emotional and behavioral challenges tend to do better when they have someone outside of their families with whom they can feel comfortable and can trust to share their experiences. Parents can provide their children with the gift of a safe and caring therapeutic relationship that can foster healing, teach skills, and increase resiliency to bolster children's ability to cope with life's challenges. 

How does this work?

 

If you decide that you want to make an initial appointment after your phone consult, you can schedule an appointment directly with Dr.Cristina Scatigno at either her Boulder or Denver locations. This initial appointment also known as an intake is a 50 minute meeting with Dr. Scatigno and the parents. Both parents are strongly encouraged to attend if possible. At this time, we will discuss the reason(s) you are seeking help including what specific behaviors are being observed and/ or reported at home and at school and what environmental changes may have triggered symptom onset. Dr. Scatigno will also ask about your child’s developmental history, your parenting strategies to understand what works and what is not working, and family medical and psychiatric history.

 

If you want to proceed with an evaluation, testing sessions lasting anywhere between 90 minutes to three hours are scheduled, based on the client's age and ability to focus. It is imperative that your child is well rested, has a good night sleep, and eats a good meal prior to attending testing sessions, so that your child can perform at his or her best.

 

If the parents want to begin individual and/or family therapy these appointments can also be scheduled. It is recommended that the same day and time be utilized on a weekly basis so that this appointment becomes an integrated part of your child’s routine. Parents are strongly encouraged to provide Dr. Scatigno with needed updates in the form of email or voicemail messages prior to sessions. Parents are encouraged to participate in sessions. The frequency of this parent participation can be determined on a case by case basis and is typically useful when a child may deny, minimize, or avoid an issue or when the parent and child and working on improving communication skills and trust. Individual parent sessions can also be scheduled in conjunction with the child’s treatment so that the parents remain informed of treatment progress and so that parents can provide Dr. Scatigno with information regarding important changes in living or school situations and to provide observations of the child’s mood and behaviors.

 

Your child’s progress will be monitored and when your child is deemed ready to terminate or “graduate” from treatment it is recommended that this process be planned and celebrated.

 

If parents are seeking a short term consultation, this may occur over two or three sessions and then recommendations will be provided.

 

Will my child be put on medications?

 

A referral to a child and adolescent psychiatrist may be made in cases of more serious symptoms that are evident by impairments in functioning. For example, if you child cannot focus attention in school and is frequently getting in trouble, if your child is so depressed he or she is fantasizing about death or suicide, if your child is so impaired by anxiety that he or she is avoiding significant events, or if your child is experiencing any perceptual disturbances such as hallucinations.

 

This referral will be discussed with the parents and Dr. Scatigno will be in collaboration with the treating psychiatrist to that both doctors can carefully monitor side effects vs. benefits.

 

What if my child is so unsafe that he or she is out of control, suicidal, or homicidal?

 

You may reach Dr. Scatigno in the event of an emergency; however, it is suggested that you immediately go to your nearest emergency room for a psychiatric crisis evaluation if you are concerned for your child’s safety or the safety of others.

 

Will Dr. Scatigno talk to the school?

 

All you need to do is sign a release of information and Dr. Scatigno will be pleased to contact school teachers, school psychologists, social workers, and anyone else involved in your child’s care.

 

What is the difference between a psychologist and a psychiatrist?

 

A psychologist gets his or her education from a graduate school and has a PhD (Doctor of Philosophy) or PsyD (Doctor of Psychology) degree. Psychologists are trained in diagnosis, theories, research, testing, and a wide range of therapeutic interventions including but not limited to adult and child psychotherapy, psychoanalysis, cognitive behavioral therapy, family therapy, and client centered therapy. Additionally, psychologists adminster and interpret psychological tests that include: IQ, learning, emotional, behavioral, and personality tests. Psychiatrists attend medical school, have a MD (Medical Doctor) or DO (Doctor of Osteopathic Medicine) degree, are trained in diagnosis with a focus on the multiple complex biological processes involved in emotions and behaviors as well as the mechanisms involved with medication interventions. Psychiatrists order medical/ lab tests. This is usually bloodwork that measures hormone and medication levels. Usually, psychologists do psychological testing and therapy and psychiatrists do medication management. However, there are some exceptions to this rule. Some psychiatrists receive advanced training in therapy and provide this service. A few states (not Colorado) have passed laws granting prescription priviledges to psychologists who obtain additional training in psychopharmacology. Overall, it works best when psychologists and psychiatrists have a collaborative relationship.

 

What is cognitive behavioral therapy (CBT) vs. dialectical behavioral therapy (DBT)?

 

Cognitive behavioral therapy is based on an integration of cognitive (initially developed by Aaron Beck) and behavioral theories. This theory explains a person’s experiences as occurring in a tri-directional dimension of thoughts, feelings, and behaviors (picture a triangle). It is theorized that a person’s core beliefs of him/herself, others, the world, and the future is based on early life experiences. In an optimal environment, a person learns that he/she is competent and lovable, that others are dependable, the world is safe, and the future is bright. Unfortunatetly, this is not always the case and unhealthy schemas can develop.  Stressful life events can trigger negative “schemas” also known as core beliefs. CBT can help a person understand the ways they process information and learn skills to adjust their thoughts, feeling, and behaviors, to help them function better. Exposure/ response prevention is part of CBT in which clients create a hierarchy of feared stimuli and learn how to master feelings of fear and anxiety. People learn how to face and overcome their fears and worries and learn to tolerate uncertainty. CBT has been extensively researched and found to be effective for adult and child depression, anxiety, attention deficit, personality, and substance abuse disorders.

 

DBT came from CBT and is basically an extension of CBT that incorporates additional skill building. DBT includes the eastern practice of mindfulness, which is learning to be present in the moment, without judgment and with acceptance by utilizing your senses and increasing your awareness. DBT teaches emotion regulation skills, distress tolerance skills, radical acceptance, and interpersonal effectiveness/ communication training. DBT (developed by Marsha Linehan) was initially developed to treat suicidal behaviors and Borderline Personality Disorder and has more recently been modified to treat Bipolar, Depression, and Anxiety disorders. 

 

Mindfulness teaches you how to have a different relationship with your thoughts and how to observe and notice your thoughts, rather than react to them. 

 

Do CBT and DBT work for kids?

 

Yes, CBT including relaxation training has been adapted to treat children as young as preschool ages and DBT has been adapted for adolescents. These both incorporate the use of workbooks, games, and activities to make the skill building and therapy enjoyable and age-appropriate.

 

What is play therapy?

 

Play therapy is typically child directed and follows the belief that “the child knows the way.” Using this approach the child may lead the sessions, choosing what toys/ symbols he or she relates to and connects with. Children will communicate their experiences, beliefs, thoughts and feelings through play. Through the process of play therapy children can work though conflicts and distress using toys as tools to express themselves. Play therapy toys usually include animal and people figures, houses, doctor kits, army men, legos, clay, stories, and art supplies. By creating a safe and secure space in the therapy room, the therapist may guide the child in identifying protective figures, for example, and can help the child explore solutions to the problems in his/her outside lives through the chosen symbols and play themes the child creates.

 

What is relaxation training?

 

This has shown to be an integral part of treating and alleviating the stress caused by anxiety disorders (as well as anger, depression, and mania). As we know, we carry tension in our bodies and our nervous systems may be wired so that we are more vulnerable to experience intense symptoms of anxiety and physical tension. Diaphragmatic or deep breathing and progressive muscle relaxation are proven methods in stress reduction.

 

Are there limits to confidentiality?

 

Trust in your therapist is a fundamental aspect of your therapeutic relationship as it is in any close relationship. While privacy in a therapeutic relationship is key to developing a strong foundation, state laws and ethical guidelines are in place to ensure clients' safety. A therapist is a mandated reporter if there is a suspicion of child abuse and neglect including physical and sexual abuse, child witness to domestic violence, unsafe living conditions, and/or elder abuse. Additionally, if a client expresses intent to self harm, intent to harm others, and/or is gravely disabled due to mental illness Dr. Scatigno will discuss an appropriate plan of action with you, including notifying legally mandated parties to ensure the safety and well being of those involved. Should any of these issues arise, Dr. Scatigno will help you manage this in a thoughtful, respectful, and collaborative manner.