Purpose Statement – 

Counseling Professionals, PLLC encourages parental/guardian engagement in mental health counseling for minors. Participation can vary greatly based on the age and need of the minor. Below is a breakdown of different levels of engagement based on the minors age, along with some considerations and suggestions for guardians/parents:

Parent Engagement and Options by Age & Issue – 

Age 6 and Under:

For children 6 years old and under, high levels of parent/guardian engagement are generally recommended. These young children are closely connected to their parents, who are often their primary source of security and support.

In-Room Participation:

• In this age group, therapists often request or require a parent or guardian to be present during sessions. This not only helps the child feel safe and comfortable, but also allows the therapist to observe interactions between child and parent, which can inform treatment.

• The therapist can model behaviors and reinforce skills and strategies being taught during therapy.

Age 6 to 11:

As children grow, there is often more flexibility in the parent’s role in counseling.

1. In-Room Participation:

Some therapists may still prefer parents to be in the room, especially for younger children in this age range or for specific interventions.

2. Weekly to Monthly Guardian-Shared Time Sessions:

These sessions involve both the child and the parent and can focus on communication skills, relationship building, and collaborative problem-solving.

3. Monthly Guardian-Only Sessions:

These sessions allow parents to discuss their concerns, gain support, and learn strategies to help their child without the child present.

4. Monthly Guardian Email Sharing:

This can be a less time consuming way for parents to stay involved and informed. Parents can share observations and concerns, and therapists can provide general updates and strategies.

5. As-Needed Meetings:

This more hands-off approach involves meetings with the provider only as specific issues or concerns arise.

Age 11 to 17:

As children enter adolescence, their need for autonomy and privacy often increases, which may affect the parent’s role in therapy.

• Discussion with the Provider:

o It is advisable for parents to have a conversation with the provider about how they would like to be involved in their teenager’s treatment. Some teens may be more open and honest in therapy when they have more privacy.

o Regardless of participation level, the child’s confidentiality needs to be respected and parents need to support their child/be involved in someway. 

o The most effective treatment often involves a team approach, where the therapist, parents, and child are working together towards common goals.

• Confidentiality:

o At this age, respecting the minor’s privacy becomes increasingly important to build a therapeutic alliance. Therapists typically maintain confidentiality unless there is a risk of harm to self or others.

o Parents, adolescents, and the therapist are all aware of goals, and therapists can share these with parents in separate sessions or communications, helping parents support the goals of therapy without violating the teen’s privacy.

• Collaboration and Teamwork:

o Communication: 

To maintain trust, it is vital for parents to maintain open communication with the provider about their preferences and concerns. This collaboration helps in forming a treatment plan that respects the family’s values and the child’s needs.

o Parent Education and Support: 

Therapists often provide parents with education about their child’s mental health issues and effective parenting strategies. This can empower parents to support their child’s treatment outside of therapy sessions.

o Respect for the Child’s Autonomy: 

As children grow, it’s important for parents and therapists to respect and encourage their increasing autonomy, while also ensuring their safety.

o Consistency: 

Parents are encouraged to consistently reinforce what is being taught in therapy at home. This can involve using similar language, rewards, and consequences as the therapist.

Accurate Expectations of Duration, Treatment Engagement, & Session Frequency – 

Duration: 

It is important for parents of minors in mental health counseling to be aware that children and adolescents may not perceive issues in the same way that adults do, nor might they share the same motivation for change. As a result, the counseling process with minors can sometimes progress more slowly than it does with adults. It is crucial for parents to have discussions with the provider about their expectations for the therapy process, in order to avoid disappointment or the setting of unrealistic goals. 

Treatment Engagement:

The therapist works diligently with the minor to help them recognize the issue, cultivate a desire for change, develop the motivation to maintain that change, and then establish new, healthier habits—all after building a strong rapport. Additionally, counseling represents only a small part of the broader influence in a minor's life. Often, the most effective counseling outcomes for minors are achieved when there is conscious change and active involvement from the greater family unit, as well as key stakeholders such as schools or community resources. Therapists are deeply committed to aiding their clients, but their role is ultimately one of influence rather than miraculous transformation. A therapist’s work is most effective when it is part of a collaborative, holistic approach involving multiple supportive figures in the child's life. 

Session Frequency:

For children and adolescents experiencing issues such as anxiety, depression, bullying, and trauma, it is generally recommended that they engage in therapy sessions either weekly or twice a week initially. This frequent and consistent contact with a therapist can be essential for establishing rapport, closely monitoring symptoms, and providing timely and intensive support during a critical period. As progress is made, and as the minor client demonstrates increased stability and continued improvement, the frequency of sessions can be gradually reduced—transitioning from weekly to biweekly, then once every four weeks, and eventually to as needed. This tapered approach helps to ensure that gains are maintained while also allowing the client to increasingly manage their mental health independently as symptoms abate. For issues related to study skills, career counseling, or ADHD, weekly sessions are still often recommended initially to establish structure and momentum. Biweekly sessions may be acceptable in these cases, but parents should be prepared for potentially longer treatment durations to achieve the stated goals, given the reduced frequency of therapeutic contact.

Use of Toys, Games, Puzzles, Videos, and Video Games in Counseling – 

Play therapy is a well-established approach in counseling with minors, which involves the use of play—a natural language for children—to communicate with and help them. A common saying among child therapists is: play is children’s language, and toys are their words. 

• Through play, children can confront their issues and explore their emotions within a safe, nurturing environment. The therapist can use play to observe how a child approaches problems, interprets social situations, and manages emotions. These insights are shared with parents to help inform parental involvement and therapy goals. 

• Toys, games, puzzles, videos, and video games can all be integral tools in this form of therapy, as they enable the child to express their feelings, thoughts, and experiences in a more comfortable and understandable way. 

Here are the top five reasons why therapists may use these tools in play therapy, and how they contribute to effective counseling:

• Increasing Trust:

o The use of familiar and enjoyable activities such as play helps to create a relaxed and non-threatening environment. This makes it easier for children to build a trusting relationship with the therapist, which is foundational for effective therapy.

• Enhancing Engagement:

o Play therapy tools are designed to be engaging and appealing for children. They are much more likely to be attentive and actively participate in sessions when these tools are employed, as opposed to traditional talk therapy methods which may not be as engaging for minors.

• Facilitating Comprehension:

o Children’s cognitive and language abilities are still developing, and they might not be able to articulate their thoughts and feelings verbally. Toys, games, and other play therapy tools can help children to understand and express complex emotions and concepts in a more age-appropriate and accessible manner.

• Encouraging Commitment to Therapy:

o When children find therapy to be a positive and enjoyable experience, they are more likely to be invested in the process and committed to attending sessions regularly. This commitment is crucial for the therapy to be effective over time.

• Broadening Perspectives:

o Play therapy allows children to experiment with different roles and scenarios, helping them to see situations from various angles. This can promote empathy, problem-solving skills, and flexibility in thinking, which are key for emotional and social development.

Communicating Preferences:

If a guardian has reservations about the use of any of these tools—such as toys, games, or digital media—they should share their preferences and concerns with the provider before counseling begins. It is important for the treatment plan to align with the family's values and expectations, and open communication is key for this. Despite their proven effectiveness in treatment, these tools are just that—tools—and skilled therapists can adapt their approach based on each child’s unique needs and circumstances, as well as the family’s preferences.

Academic Performance Expectations and Reinforcement Outside of Therapy –

Academic Performance Expectations and Reinforcement Outside of Therapy are essential components to consider when a minor is receiving counseling services. It is important for parents and guardians to understand that counseling does not “force” minors to engage in healthy study or academic habits; rather, it aims to facilitate the development of skills and behaviors that can support overall well-being, which may indirectly lead to improved academic performance.

Here are important considerations for parents and guardians:

• Role of Counseling:

o Counseling focuses on mental and emotional well-being and the development of healthy behaviors for long-term success. While counseling can equip minors with tools such as stress management, focus, and emotional regulation—which can indirectly lead to better academic performance—it is not a substitute for tutoring or direct academic intervention.

• Reinforcement at Home:

o Given that counseling typically takes place for only an hour every week or two, the reinforcement of skills and behaviors outside of therapy is vital. Parents and guardians play a critical role in this, as they can establish and maintain a structured, supportive environment at home. This might involve setting clear boundaries, facilitating effective communication, and providing consistent positive reinforcement for effort and progress.

o It is recommended that parents/guardians meet with the therapist if they are unsure or need support in developing a better system of support at home or in utilizing resources for academic success.

• Collaboration with Educational Institutions:

o If specific academic progress, such as improved grades, is a goal, it is beneficial for parents to work in conjunction with the child’s school and utilize the resources it offers. This may include engaging with teachers, school counselors, and exploring options for a 504 Plan (which provides accommodations for students with disabilities) or Individualized Education Plan (IEP). The therapist can collaborate with parents and administration to help advocate for student/client success.

• Additional Resources:

o For academic support in a specific subject, parents are encouraged to seek tutoring services and educational resources outside of the therapy context. Schools often have recommendations for effective local or online tutoring services.

o Therapists are often engaged when the damage academically is done and cannot reverse bad grades. Tutoring can help fill in those gaps.

o Summer support in counseling sometimes can be retroactively helpful for academic support as an agreed upon summer study program between parents/guardians and the student that may result in progress that gets the client back on track academically before the start of the next year.

• Pressure on Therapists for Academic Results:

o Placing pressure on a to directly produce specific academic results—such as improved grades—can undermine the therapeutic relationship and may not align with the primary goals of counseling. Such pressure can also create stress for the child, which is counterproductive to both their mental health and academic performance. In extreme cases, if the expectations for therapy are not aligned with the services a therapist can provide, it may result in termination of services.

Communication:

It is important for parents and guardians to have open and honest discussions with both the therapist and the academic institution about their goals and expectations. Clear communication allows all parties involved to work towards a shared understanding and collaborate effectively for academic goals.

While counseling can support a child’s overall well-being and indirectly contribute to improved academic performance, it is not a direct intervention for academic issues. For specific academic progress, parents and guardians are encouraged to utilize a multi-faceted approach that involves the home environment, school resources, and possibly outside tutoring, in addition to counseling services. It is also crucial for parents and guardians to manage their expectations of what counseling can achieve alone.

Requesting Medical Records - 

The purpose of medical records in the context of mental health counseling is to facilitate the development of comprehensive and effective treatment plans tailored to the individual needs of each client. These records contain essential information about a client's medical and mental health history, previous treatment plans, progress notes, assessments, and other relevant data. This information enables therapists to make informed decisions regarding the most appropriate therapeutic approaches and interventions for the client. While parents and guardians of minors in treatment have the right to request access to these medical records, such requests may be denied by the therapist if there is a belief that the information could be misused or would not be in the best interest of the minor. Typically, medical records are intended to be shared between medical professionals to aid in treatment continuity and coordination of care. Medical professionals are trained to understand the treatment approaches and are not meant to educate others or explain approach justification. If a provider agrees to release notes to parents/guardians, a time should be set up to review those notes at that time to provide education and details. Parents and guardians can request that certain treatment modalities be used if recommended by other professionals, or for records to be shared between professionals, but without direct communication, the modalities employed will be determined at the discretion of the therapist. This decision is based on the therapist's training, the minor's specific situation, engagement level, and treatment goals.

Referring to Another Therapist Based on Child’s Needs and Therapist Expertise - 

If a situation arises where specific modalities or resources are needed that fall outside of the scope of the therapist’s abilities or expertise, the therapist may work collaboratively with the parents or guardians to provide resources and referrals to other professionals who are better suited to meet those specific treatment goals. This ensures that the child’s mental health needs are addressed in the most effective and appropriate manner.

Transitioning a Child out of Therapy  – 

It is imperative that caretakers and the therapist carefully plan for transitioning a child out of therapy. Adolescents and teenagers are also encouraged to participate in this conversation. Once goals are completed, it is recommended the child partake in at least one “termination session” to process their experience in therapy. While significant progress in therapy needs to be celebrated, it is also recommended the parents and therapist discuss the process of the child returning to therapy in the future if needed: symptoms that may reoccur, therapist possible lack of availability, etc. 

Legal Situation Notice – 

Counseling Professionals PLLC is committed to the mental and emotional well-being of its clients and maintains a steadfast focus on this therapeutic goal. For this reason, counselors associated with Counseling Professionals PLLC will not engage in custody cases or become a tool to be used in parental or guardian disputes. This is rooted in the principle that therapy is designed to be a safe and nurturing environment for personal growth and healing, not a battleground for legal or familial disputes. If counselors are compelled to testify in any way without directly offering and agreeing to a rate to attend court, the cost will be 600 dollars an hour, rounded up to the nearest hour, with a 200 dollar an hour court preparation fee. This fee will be the responsibility of the party compelling the forced services, as it compensates for lost wages and disruption of services for other clients. It is essential to understand that outpatient therapy is not an investigative field of mental health; therapists from Counseling Professionals PLLC can only operate based on what is shared in therapy sessions. Their role, if compelled to be in court, would be akin to that of reporting hearsay or serving as a general character witness. Therapists are engaged in the service of progress for their clients, focusing on the therapeutic goals and needs of the minor, rather than serving as tools in disputes between parents or guardians. For those seeking a mental health professional to engage in court situations, the appropriate professional is typically a Forensic Psychologist, who is specifically trained to provide psychological information to legal entities, but it is worth noting that these services can be quite costly.

Questions – 

Thank you for your collaboration and awareness of what therapy for minors is for and the aims of counseling with minors. Please let CJ know if you have any questions at CJLeach@CounselingProfessionalsPLLC.com. 

Further Reading – 

Meta-analyses of Play Therapy

Bratton, S., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Professional Psychology: Research and Practice, 36(4), 367-390. doi:10.1037/0735-7028.36.4.376

Dowell, K. A., & Ogles, B. M. (2010). The effects of parent participation on child psychotherapy outcome: A meta-analytic review. Journal of Clinical Child and Adolescent Psychology, 39(2), 151–162. doi:10.1080/15374410903532585

Haine-Schlagel, R., & Walsh, N. E. (2015). A review of parent participation engagement in child and family mental health treatment. Clinical Child and Family Psychology Review, 18(2), 133–150. doi: 10.1007/s10567-015-0182-x

Jeon, M.-H., & Myers, C. E. (2023). Successful strategies for parent engagement in play therapy: Voices through humanistic approaches. International Journal of Play Therapy, 32(3), 156–167. Doi:10.1037/pla0000199

LeBlanc, M., & Ritchie, M. (2001). A meta-analysis of play therapy outcomes. Counseling Psychology Quarterly, 14, 149-163. doi:10.1080/09515070110059142

Wymer, B., Swartz, M. R., Boyd, L., Zankman, M., & Swisher, S. (2022). A content analysis of empirical parent engagement literature. Journal of Child and Adolescent Counseling, 8(1), 16–30. doi:10.1080/23727810.2022.2037987