How to prepare and what to talk about

By Karla Cloete (HPCSA Registered Counsellor)

Disclaimer: The content of this blog is not intended to diagnose or treat, and all information is intended to promote psycho-education in the community. Please consult with a relevant healthcare provider before taking any mental health advice.

First counselling sessions can be daunting- for kids and parents. You might even feel like taking your child to a mental health practitioner means you have failed as a parent. This is the farthest thing from the truth as therapy is an important step in safeguarding a child’s emotional and psychological well-being.

Before the session

-Prepare Your Child and Your Family

If your child has never been in counselling before they may feel very nervous or worry that they are in trouble. Set aside some time to prepare your child for the first session by explaining to them how the process will work in an age-appropriate way. Let them know they aren’t in trouble and that the person they are going to see is a safe adult who is going to help them feel better.

Depending on where live and your child’s age you may also need your child’s assent. Since children are under 18 years of age they cannot legally consent to therapeutic services, according to the Children’s Act. However, some practitioners will require that children provide verbal assent as this is an ethical requirement according to the HPCSA.

Next, you may need to discuss the upcoming appointment with the child’s other guardians. Some practitioners may require your spouse or the child’s second guardian to give written consent before therapy can begin. This depends on their legal parental rights and any custody agreements. If this may be a problem due to current family conflict, discuss it with your practitioner beforehand. In some cases where there may be parental alienation, a deceased parent or removal or parental rights your practitioner might ask you for proof. This might include an affidavit, death certificate or court documents. This doesn’t mean your practitioner doesn’t trust you, in fact it is a normal part of the process to safe guard your child and shows the practitioner wants to ensure they are being ethical.

-Do Some Necessary Research

Before the session you may want to gather some information such as the medical aid the practitioner accepts, payment plan options and modes of therapy (in-person or online) they have on offer.

It is also wise to enquire about your new practitioner’s cultural competence. The social factors impacting a child’s function and dysfunction must be understood through the lens of culture. A family’s cultural worldview and values impact their parenting and therapeutic goals and are important factors in the healing process (1).

Practitioners who are culturally competent can implement more appropriate and effective interventions and preventative care (2).

-Anticipate Some Basic Questions

During the first session, the practitioner will try to ascertain a picture of your child’s and family’s functioning, their social systems and their general background and development. They will also want to know your reasons for bringing the child to counselling, whether it is behavioural issues or preventative care.

Be prepared to answer questions such as past diagnoses or trauma history, medical conditions or chronic medications, their development during infancy, and any pregnancy complications. As well as their performance at school and their general behaviour and temperament. If any of this information isn’t available to you due to adoption or separation from the child let the practitioner know.

The psychologist/counsellor may also ask questions about the child’s birth parents and their mental health history since some disorders have genetic components (3).

Other questions can include family functioning, parent occupations, and questions about siblings, the child’s friend and extended family.

The psychologist/counsellor may desire collateral information to supplement or confirm the concerns you are sharing. This may include speaking to their other guardians, caretakers or teachers. Consider if you are comfortable with any of these options.

All these questions can feel intrusive or just plain strange.

“What does the pregnancy have to do with my 13-year-olds school avoidance?”

“My child is 7 and they don’t remember the trauma from when they were 2 years old?”

All this information helps practitioners to create a full image of your child’s developmental path and why they are functioning/not functioning in the present. The more information you can provide, the better your practitioner can choose the right tools and approaches to help your child.

During the session

In the first session, you can expect to fill in paperwork regarding the child’s presenting problems, family history, billing and medical aid information. You may also need to sign an agreement with the psychologist/counsellor. The psychologist/counsellor will also explain the limits of confidentiality and their legal obligations. They may give some background about themselves or their chosen therapeutic approaches.

Be sure to let your practitioner know about any potential transport or health issues, safety concerns, communication barriers or other interfering stressors as this may interrupt your progress and provisions must be made.

Practitioners who are allowed to assist with practical and psychosocial barriers have more engaged clients (4).

-Be Honest and Up-front

Speaking to a stranger about your parenting concerns and your child’s challenges is intimidating. Be assured that practitioners are not in the business of passing judgement. The more honest and accurate information you can provide, the more effective interventions can be designed to assist your family. Be honest about anything you aren’t sure about and don’t be afraid to ask questions. 

-Suggest a Collaborative Goal Setting Approach 

Collaborative goal setting can occur with the psychologist/counsellor between the child, parents and educators. A collaborative approach which involves the child enhances their self-efficacy and feelings of independence while increasing their participation in said goals (5).

When parents, specifically mothers, engage in goal setting with the practitioner they take on collaborator and active participant roles (6).

Practitioners who use collaborative goal setting and psycho-education for parents have greater parental involvement and improved outcomes (7).

 -Look For Ways To Become Involved and Engaged

Parent participation and engagement create improved outcomes across various domains (8).

Parent participation in a child’s treatment increased its effectiveness (9).

Parental engagement and involvement can range from parent training, psychoeducation or family therapy. Ask what your practitioner thinks would be most effective.

Parent-child and/or family therapy found a moderately improved effect in comparison to individual-child treatment (9)

Fathers generally have lower participation in children’s treatment, but some research suggests their engagement can improve and sustain therapeutic outcomes (10). Thus it is important for fathers to be involved where possible. 

Parental engagement, such as in a parental training program, was shown to be more effective with behavioural problems, especially in families dealing with poverty and high levels of stress (11).

Ask your practitioner how you can be involved. Whether it be my recommending resources or by providing you with homework and new strategies to implement. 

-Ask For Referrals

The practitioner may suggest a psychiatric evaluation, psychometric testing or additional occupational therapy, depending on your child’s needs. Ask the practitioner for specific referrals and a referral letter to other trusted professionals in their network. This can help ensure your child gets appropriate and urgent assistance, while relieving some pressure from you. 

After the session

-Check in with Your Child

Like any new experience, a first counselling session can be emotionally overwhelming for a child. Ask the child for their feedback on the session. Be open to answering any of their questions or concerns. 

-Reflect on the Therapeutic Fit 

Based on your session and your child’s feedback, you may need to take some time to reflect. The match between a practitioner and their clients is an important predictor of good outcomes. Especially the practitioner’s genuineness and empathy (12).

Consider if you felt understood, supported and comfortable. The new therapeutic relationship may need some time to grow. However, if you feel offended, frightened or uncomfortable with the practitioner it is well within your patient’s rights to seek out a different professional. 

1. Gone, J. P., & Kirmayer, L. J. (2010). On the wisdom of considering culture and context in psychopathology. In T. Millon, R. F. Krueger, & E. Simonsen (Eds.), Contemporary directions in psychopathology: Scientific foundations of the DSM-V and ICD-11 (pp. 72–96). The Guilford Press
2. Luis Sanchez, B. E., Klein, C. C., Corcoran, F., & Barnett, M. L. (2023). A mixed-methods study of clinician adaptations to parent-child interaction therapy-what about culture?. Evidence-based practice in child and adolescent mental health, 8(2), 269-285.
3. Sullivan, P. F., Daly, M. J., & O’donovan, M. (2012). Genetic architectures of psychiatric disorders: the emerging picture and its implications. Nature Reviews Genetics, 13(8), 537-551.
4. Ingoldsby, E. M. (2010). Review of interventions to improve family engagement and retention in parent and child mental health programs. Journal of child and family studies, 19(5), 629-645.
5. Costa, U. M., Brauchle, G., & Kennedy-Behr, A. (2017). Collaborative goal setting with and for children as part of therapeutic intervention. Disability and rehabilitation, 39(16), 1589-1600.
6. Forsingdal, S., St John, W., Miller, V., Harvey, A., & Wearne, P. (2014). Goal setting with mothers in child development services. Child: care, health and development, 40(4), 587-596.
7. Martinez, J. I., Lau, A. S., Chorpita, B. F., Weisz, J. R., & Research Network on Youth Mental Health. (2017). Psychoeducation as a mediator of treatment approach on parent engagement in child psychotherapy for disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 46(4), 573-587.
8. 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, 133-150.https://link.springer.com/journal/10567
9. Dowell, K. A., & Ogles, B. M. (2010). The effects of parent participation on child psychotherapy outcome: A meta-analytic review. Journal of Clinical Child & Adolescent Psychology, 39(2), 151-162.
10. Klein, C. C., Gonzalez, J. C., Tremblay, M., & Barnett, M. L. (2023). Father participation in parent-child interaction therapy: Predictors and psychologist/counsellor perspectives. Evidence-Based Practice in Child and Adolescent Mental Health, 8(3), 393-407.
11. Acri, M., Chacko, A., Gopalan, G., & McKay, M. (2017). Engaging families in treatment for child behavior disorders: A synthesis of the literature. The Wiley Handbook of Disruptive and Impulse‐Control Disorders, 391-409.
12. Nienhuis, J. B., Owen, J., Valentine, J. C., Winkeljohn Black, S., Halford, T. C., Parazak, S. E., … & Hilsenroth, M. (2018). Therapeutic alliance, empathy, and genuineness in individual adult psychotherapy: A meta-analytic review. Psychotherapy Research, 28(4), 593-605.