Q&A: Should my Child be in Individual or Family Therapy? {EP 124}

So I'll give a quick little spoiler, and that the bottom line is, is that there isn't a hard and fast rule about this. It isn't accurate to say that if a child has a history of attachment trauma, or attachment disorder, or adoption, that they should always be in only family therapy, right? That the therapy should always include their caregivers. That's a assertion I read a lot in online forums. And as a therapist, who does mostly family work, but not exclusively family work, I will just say that the overall answer here is it is never that simple. It's never that cut and dry. So I'm gonna attempt to talk about this in a little bit more of a nuanced way. While also you and I need to have an agreement here that I could not talk about this topic in its totality at all. Like this topic-  this episode I'm recording isn't intended to answer definitively, you know, if your child should be an individual or family therapy, but to give you some things to consider. 

Now, again, I hear a lot that kids with attachment trauma should only ever be doing therapy with the caregiver and a worry about this and a worry about individual therapy is that, one, there is just a really high risk of triangulation. You know, that we get the kids with histories of attachment trauma, there's a lot of risk of the relationships getting really tricky and triangulated. And then there's another concern that the child could attach to the therapist instead of the caregiver. Another question that comes up a lot is how can attachment be worked on between the child and the caregiver, if the caregiver isn't in the room? And indeed, a lot of therapists who are trained in a more attachment based modality would say something like it's the relationship that's the client, not the individual child or the individual person. And I think that that makes a lot of sense. But I think we have to make sure that we never turn anything into these like black and white rules. 

Okay, so let's look at a couple different things. One, that kids with attachment trauma in their history, or who present with symptoms of attachment disorder, meet criteria for what Dr. Bessel van der Kolk describes as complex or developmental trauma. And Dr. van der Kolk has identified these quote unquote, seven domains of impairment in complex trauma. Attachment is just one of them. So, when kids with a history of complex trauma, attachment trauma or attachment disorder, come to therapy, attachment certainly might feel like the totality of the problem or the biggest problem, but it's- it's one of many things that are involved in complex or developmental trauma. So treating the attachment piece, the attachment relationship between the child and the caregiver, typically isn't the only piece that needs to be treated. And even if it's determined that treating the attachment experience, as opposed to doing trauma work first or working on regulation first, even if it's determined that attachment is the priority or the focus of the thing to be addressed, either first or at this time, sometimes a child needs the safety and their attachment system really titrated. 

So what does that mean? Attachment to a caregiver is extremely intimate. And for many kids and adults with histories of being hurt inside an attachment relationship, the intimacy now of attachment instantly brings up feelings of fear or danger. So what needs to happen is that, in the neurobiology, is a uncoupling of the felt sense of safety and connection from the danger danger circuits. So the connection circuitry and the danger danger circuitry, in a sense have gotten woven together for kids with histories of complex trauma or attachment trauma, or kids who meet criteria for attachment disorder. These two pieces are- that don't necessarily go together have been woven together. The attachment circuitry and the danger danger circuitry. So neurobiologically speaking, what we would like to allow the opportunity to happen is for those two things to uncouple from each other. 

Now, experiencing safe connection with a therapist could be the level of connection that the child's nervous system can safely tolerate. So in a way, by creating and allowing safety and connection to unfold in between the relationship between the child and their therapist, they are titrating the experience of safe connection. For some folks who have experienced significant attachment trauma, the intimacy of attachment between the child and the caregiver is so much, it's such an intimate experience, that it instantly triggers the danger danger reflex. I'm talking in metaphors here, there's no danger danger reflex, but like the fight/flight circuitry, right? The- is getting triggered almost instantly upon any felt sense of connection to the caregiver, because it's such an intimate relationship. It's supposed to be intimate. The- how quickly that connection also triggers danger danger means that the uncoupling can't happen. It is simply happening too quickly and too intensely, how connection and danger danger are getting triggered at the same time. Okay? 

So it can be very helpful for clients, and here we're really talking about children but this is true about adults too, for clients to in a way like dip their toe into the felt sense of safety and connection, titrate the intimacy of safety in connection with a therapist. That because the intimacy between the child and a therapist is so wildly different than between a child and a parent will ever be, that that creates a level of safety that allows the child's nervous system to be just a little bit more willing or a little bit more brave to consider experiencing connection. And because the intimacy is so much lower, it has the potential to allow for that uncoupling. The uncoupling of safety and conjecture from danger danger. And then as this uncoupling unfolds slowly over time in the relationship between the child and the therapist, it may indeed begin to be more appropriate to start to bring the child's caregivers into the therapy experience. And then start to work on the child experiencing the connection with their caregiver in a way that could also feel safe. 

Now, while it is possible that there may look like there's a time period where the child is kind of quote, unquote, attaching to the therapist. A really well trained therapist will see this as part of the process. It's not the end. It's like passing through Dallas on the way to Austin, right? If you've started in Oklahoma. It's just a place you pass through this kind of stage where it looks like the child is attaching to the therapist more than the parents. There is some risk with a therapist who isn't as well trained in the nuances of trauma therapy and attachment, that this stage could definitely get a little bit messy. So it's important to screen your therapist really well. A child developing a safe, positive, connected relationship with a therapist really shouldn't become a threat to the parent child attachment. Not the least of which is because therapists aren't responsible for all the basic, like, day in and day out survival care of this child. And those pieces of care are really integral in the creation of attachment. 

Now, the other thing that we can talk about here is that there are some aspects of therapy with kids, even kids with attachment trauma, where those kids need and deserve some confidentiality. It absolutely could be hard for kids to fully engage in, for example, like intense trauma processing with their caregiver present. Other kids might absolutely need and want their caregiver present while they're doing some trauma processing. And it's easy to make judgments like I've heard people say like, well, if their attachment to their caregiver was solid, then their caregiver would serve as a good, secure base for the child to do trauma processing. And I really my experience is that it is not that cut and dry. I have known many kids who have good, secure attachment to their parents that still need confidentiality and privacy to fully explore and process the depths of their trauma. So we really want to be careful about making big blanket statements here. 

Now, I do think we need to talk super briefly about the reality that not all parents are emotionally safe enough for their kids to be present in therapy. Some parents have really vulnerable nervous systems themselves. Some parents have significant histories of insecure and disorganized attachment. And some parents are experiencing what Dan Hughes calls blocked care. Now, these aren't bad parents, not at all. What they are, are parents who need their own support, and that should happen separate from their child's therapy. This child deserves a therapeutic space where a therapist can stay primarily focused on and co-regulating them, not their parent. Which again, is not criticism of their parents. But when parents need their own support and can't be present in the therapeutic space in a way that is bringing safety and connection to their kids, then it makes sense to do therapy individually or separately with kids and with parents. And then again, maybe later we bring them back together. 

What you're hearing me say is that there is no hard and fast rule. The treatment planning decisions are related to a wide variety of things, the goals, the stage of treatment, the child's age, and how slow the child needs to have safety and connection titrated. A very good therapist can create confidentiality, and safety, and, yes, even intimacy that's an important part of the therapeutic experience, with a child client without compromising the attachment relationship between the child and the parent. And yes, many times it is very appropriate and working towards the therapeutic goals for the therapist to be doing family therapy- family therapy with the child and the parent together. It's just that there's no hard or fast rules. And these are a part of therapeutic decisions and treatment planning that the therapist and you can be making together. 

So this, of course, brings a new question up, which is how do we screen for a therapist? How do we- how do you as a parent know that you are trusting your child with a therapist who is well trained in trauma and attachment? That's a totally different episode, we'll tackle that later. For now, what I want you to do is have a conversation with your child's therapist about their treatment plan. Like why are they choosing individual therapy? Or why are they choosing therapy with the parents present and involved? They should have an idea about why. When I was doing therapy, sometimes, after my initial assessment of the family, I started off with parents only. And sometimes after my initial assessment, I started off with kids only. And sometimes I started off with families together. And then I would transition later to doing work with the child only. Sometimes I started with a child only, and then later transitioned to working with the family. Sometimes I started off working with a family and always worked with the family. It really, really depends. And there is a lot of information that should be going into that therapeutic decision. 

So what I want you to take away from this episode is exactly that. It really depends. There's no hard and fast rule. And as a parent, I want to encourage you to have this conversation with the therapist about their treatment planning decision, and about why. And then you as the parent absolutely should feel empowered to ask as many questions as you need to ask until that decision makes sense. 

Okay, so I know this is a big, complicated topic and I addressed it in less than 20 minutes. Of course, I'm not addressed- like I said, I'm not addressed all of the complex nuances here. But I hope this gives you just a little bit more information about how to connect with your child's therapist about this question: individual therapy versus family therapy. Alright, y'all hope you have a wonderful rest of your day today and I will connect with you again next week back here on the podcast.