Hopscotch Blog

As the number on the thermometer increases, the number of client bookings on your calendar may be shrinking. Rest assured, this is absolutely normal. Children and families go on vacation, children get shuffled off to summer camps, or clients decide to take a summer break from therapy. So before you rush to fill the void on your summer calendar with other clients, pause for a moment, and after taking a close look at your budget, ask yourself:

What needs to be addressed in my personal or professional life?

Since the Pandemic, counselors, therapists, psychologists, and just about everyone else operating within the mental wellness industry have been experiencing a collective burnout along with the rest of the world. COVID-19 put tremendous strain on mental wellbeing, and therapists went above and beyond to meet the nearly overwhelming influx of their clients’ psychological needs.

As a result, there are likely many areas of your personal and professional life that have been neglected over the past couple of years, and now may be the perfect time to indulge in some self-care or devote some much-needed attention to your personal and professional bucket list.

Not sure where to start? Here are six savvy suggestions for how to navigate the summer slowdown!

1. Reflect and refocus. So much has happened over the past couple years, and even therapists need some time to process changes. Reflective insight will always provide you with the wisdom required for being intentional with your future choices, so take a moment to breath, think, and feel. Here are some suggestions to guide your reflections.

• What is working well vs. not working well within your practice?
• Is there a niche or topic that tends to energize or drain you?
• Did you notice any patterns or themes in your relationships with your clients?
• Is there any certification or training that you could get that would benefit both you and your clients?
• Is there an area of therapy you would like to further explore and become more skilled at?
• Is there any aspect within your private practice to realign and refocus on?

2. Find ways to be proactive and plan for your business’s future. Once you are fully armed with insight, see if there are some productive opportunities for you to proactively set yourself up for future success. For instance…

• Reduce seasonal financial stress by reconfiguring your budget to accommodate a slow season.
• Pre-book and set up your fall schedule with clients who are taking a break. This way their spot is reserved when they return, and that’s one less thing to do when you ease back into the busy season.
• Revisit your overall business strategy. Is there an opportunity to add a new service like coaching or parent training? Would now be a good time to branch out and start a private practice or group? If so, our HIPAA-Compliant platform will support you in expanding the communities you serve. Learn more about Hopscotch.

3. Catch up on your professional to-do list. Administrative and marketing tasks are often the first action items to fall by the wayside when business picks up, and after a while, these tasks can start to pile up and impact your ability to be productive and professional. Take a moment to check back in with the backlog of work such as:

• Organizing your office, desk, or computer files
• Redecorating your office
• Giving your office or play therapy room a deep clean
• Assessing your marketing efforts
• Updating your website
• Re-ordering brochures/business cards
• Attending networking events

4. Reconnect with the relationships that matter most. It is not uncommon for a therapist to feel as if they know their clients better than their own family and friends. A slow season may be ideal for enjoying some work-life balance and spending more time with loved ones. As a therapist, you already know how valuable those relationships are to your wellbeing, so consider this a friendly reminder to reconnect with the people who matter most to you.

• Make a list of the people that you have not had time for or were unable to connect with due to COVID-19.
• Use downtime to schedule a catch-up call, meet up for a coffee, or plan a weekend trip to visit parents, friends, college friends, etc.

5. Take some much-deserved YOU-time. Therapists need time for self-care just like everyone else. If you have been prioritizing client care before self-care, summertime may be the buffer you have been craving to give some attention to your own needs.

Self-care ideas for therapists:

• Take a vacation
• Sleep in
• Get a massage
• Enjoy a quiet summer
• Spend more time in nature
• Catch up on your favorite show
• Exercise
• Learn how to cook a healthy, new recipe
• Commit to a nourishing morning/evening routine
• Start a new hobby (If you are not sure where to start, take that class you’ve always wanted to try and see if you like it. Remember – it’s about the process, not the product.)
• Seek therapy for yourself

6. Do nothing. The idea of making the most out of a slow season is to recharge. If revisiting your personal and professional “bucket list” is not exactly what you need right now, then that is more than ok. Sometimes one of the best ways to cure burnout is to embrace Il Dolce Far Niente – which is the Italian concept for “the sweetness of doing nothing.” Why not try it? The power of active rest will have you bouncing back stronger than ever.

Be kind to yourself. Self-compassion is for therapists, too!

Whether you choose to simply just be and breathe this summer, revisit goals, or plan ahead, let this summer be a time for you to rest and rejuvenate. The important thing is to pace yourself and try not to do too much at once. Remember that the best joys are the simple ones, and productive progress happens one sustainable step at a time.

Before we talk about how to encourage healthy attachment between your child clients and their caregivers, let’s take a closer look at what we mean by attachment, and the four major attachment styles.

What is attachment style?

Based on the principles of Attachment Theory, an attachment is a relational bond, and an attachment style is the specific pattern of behavior that characterizes the type of bond. The very first bond an individual will develop is with their primary caregiver(s), and this first relational experience forms the beliefs, attitude, and expectations an individual will have regarding relationships. As a result, the way a child’s primary caregivers interacted (or did not interact) with them during the first two years of their life plays a highly influential role in not only developing the child’s attachment style, but also setting the foundation for all future relationships the child will experience.

What are the 4 attachment styles?

There are four primary types of attachment styles: 

• Secure Attachment
• Anxious Attachment (Or Preoccupied Attachment)
• Avoidant Attachment (Or Dismissive Attachment)
• Disorganized Attachment (Or Fearful-avoidant Attachment)

Signs a child has a secure attachment 

Children with a secure attachment style will generally respond positively to caregiver initiated interactions, and when experiencing fear, a child with a secure attachment style will seek comfort from their caregiver(s). Generally, a child with secure attachment will clearly prefer their primary caregivers to other caretakers. Children with secure attachment styles also generally tend to play well and get along with other children more so than children with a non-secure or insecure attachment style. 

Signs a child has an Anxious Attachment style 

A strong fear of abandonment is dominant for children with an Anxious Attachment style, and a child with this attachment style may seek constant reassurances to remedy the anxiety they feel regarding the security of the parent/child relationship.

Symptoms of Anxious Attachment style with children/adolescents include:

• Emotional insecurity
• Clinginess
• Intense separation anxiety
• Lack of conviction that they are loved
• Strong fear of abandonment
• Excessive wariness of strangers

Signs a child has an Avoidant Attachment style

A child/adolescent with an avoidant or dismissive attachment style may not outrightly reject their caregiver(s), but they will be more inclined to avoid seeking interaction and/or comfort from them. As the child/adolescent grows up, they typically find forming new relationships difficult, and they avoid investing much excitement or interest in their relationships. When a relationship ends, children/adolescents with an Avoidant Attachment style usually don’t show much (if any) distress.

Symptoms of avoidant-dismissive attachment style with children/adolescents include:

• Avoidance of parental interaction
• Aversion to being comforted
• Parental/stranger indifference
• General sense of dismissiveness 
• Lack of interest in expressing thoughts or feelings

Signs a child has a Disorganized Attachment style

A Disorganized or Fearful-avoidant Attachment style is a bit like a blend of Avoidant and Anxious attachment styles. The primary characteristic of a Disorganized Attachment style is confusion, and that confusion is the result of the child feeling conflicting emotions towards the caregiver(s). For instance, a child with a Disorganized Attachment style has likely experienced both fear and comfort from their caregiver(s), and when a child experiences both reassurance and intense distress in their interactions with their caregiver(s), a disoriented attitude towards relationships typically develops. Disorganized Attachment is typically identified by the dazed, hesitant, or apprehensive attitude a child may adopt towards their caregiver(s). 


Symptoms of Disorganized/Fearful-avoidant attachment style with children/adolescents include:

• Apprehension – especially with decision making
• Hesitant communication style
• Confusion
• Dazed or frozen attitude
• Avoidant behaviors
• Spastic responses
• Excessive expressions of fear
• Resistance / obstinance

Older children may take on the role of caregiver and attempt to provide parental care to the caregiver(s).

What causes a non-secure attachment style?

A child’s attachment style is generally formed during the first two years of their life. If (for any reason) a child perceives that their needs are going unmet, then the child will be at a disadvantage for forming a secure bond with their caregivers. While the parent-child bond is the overarching influence on a child’s attachment style, a child's attachment style is based on a variety of different factors in addition to caregiver/child interactions. The following circumstances are a few examples of the many different influences that play a developmental role in the creation of a child’s attachment style: 

• Children who have experienced trauma
• Caregivers who have experienced trauma 
• Breaks, stops, or major changes in a child’s attachment timeframe such as with foster care transitions or adopted children
• Children with mental health concerns
• Caregivers with mental health concerns
• Personality

Can attachment styles change? 

How to fix an insecure attachment style

Research suggests that around 35-40% of people do not have a secure attachment style. Attachment styles are deeply rooted, but they are not permanent and change is possible. With time, effort, and awareness, an attachment style can be either reinforced or unlearned throughout the course of an individual’s life.

7 Ways child therapists can encourage healthy attachment between parent/child

There are many ways child therapists can encourage healthy attachment between a parent and child, and many of these ways are highly accessible to every caregiver. However, It’s important to remember that many caregivers did not receive the nurture and attention they needed to develop healthy attachment styles to their own primary caregivers.  Therefore, prior to recommending a parent or caregiver take a particular course of action to build attachment with their child, pediatric therapists must assess how the parent’s own history can make it challenging (or unhealthy)  to carry out the suggested recommendations and consider whether a referral for parent counseling may be appropriate to support the caregiver.  If the parent/caregiver is willing and able to support their child’s healthy attachment, here are 7 ways a therapist can encourage healthy parent-child attachment.

Encourage caregivers to schedule routine caregiver-child playtimes.

Enjoying quality playtime with parents is one of the best ways for children to learn trust, self-regulation, and relational safety, and purposeful play nurtures healthy and secure attachment. The age and interests of a child should determine what forms of play or games are performed, and if any play activity emotionally triggers a child in an upsetting way, then the game or activity should be immediately paused to practice some emotional regulation and soothing techniques. 

Encourage caregivers to give their child genuine compliments.

Children are naturally inclined to seek the approval of their caregivers, and they respond extremely well to positive reinforcement. Encourage caregivers to be specific and show authentic admiration for their child’s creativity, imagination, kindness, smile, etc.

Encourage caregivers to spend quality time with their child on their child’s terms.

Children, and especially teens, have unique personalities, and they may simply not be interested in bonding with their caregivers the way a caregiver may prefer. Encourage caregivers to be open minded and express interest in the child’s individuality. Children will be more emotionally invested if they get to play an active role in deciding what constitutes quality time. 

Encourage caregivers to develop routine stability. 

Children find comfort, security, and belonging when there is a reliable, predictable environment surrounding them. One way to reinforce emotional stability is to create an enjoyable routine or ritual for the family to enjoy together such as always having dinner together, always going to the park on weekends, always singing a goodnight song, etc.

Encourage caregivers to practice respectful affection.

All children require affection, but some children may be more or less touchy-feely than others. Encourage parents to be respectful of their children’s boundaries, and find appropriate ways to express affection such as with hugs, high-fives, pats on the back, fist bumps, etc.

Encourage caregivers to give their child their undivided attention.

Adolescents and teens get called out often for “being on their phones” – but parents are often just as guilty. One of the best ways for parents to practice attunement with their child and develop positive attachment is to put the phone on silent and give their child their undivided attention. Children don’t just want attention, they need it, and research shows that giving a child even just 10 minutes of undivided attention each day can be enough to instill a sense of belonging and reinforce relational connection.

Encourage caregivers to attend (or keep attending) family therapy. 

Improving parent-child attachment takes time and sometimes professional support. Encourage caregivers to be patient and remind them that you are there to help and support them.

Millions of families watched this summer’s Olympics, which may inspire countless children to join a soccer team or take up swimming lessons. While youth sports bring many physical and mental health benefits to children, they also can elicit worry and anxiety. Anxiety may manifest as a child who complains of a stomachache before every Little League practice, or one who is overly self-critical of their performance on the track team. There are several approaches you can take to assist your clients in working through sports-related anxiety. 

Normalize the Experience

Kids who experience sports-related anxiety may feel different from or isolated from peers who express only excitement about participation in athletics. Therefore, clients can experience some initial relief by learning that anxiety is a common experience, and one that they can learn to manage. Early in the therapy process, you can provide general psychoeducation about anxiety using age-appropriate books. My favorites include Ruby Finds a Worry by Tom Percival and Wilma Jean the Worry Machine by Julia Cook. More specific to sports, Olympic medalist Laurie Hernandez authored a children’s book called She’s Got This about a young athlete who finds courage to continue her gymnastics routine after falling down.

Openness about mental health is becoming increasingly common among professional athletes. Most recently, tennis star Naomi Osaka and Olympic champion Simone Biles have withdrawn from major competitions to care for their mental health. The significance of this public acknowledgement of mental health challenges – including anxiety – cannot be underestimated. You might help clients identify athletes that play their chosen sports and have been open about pre-game worries and anxiety. Depending on your client’s age and developmental level, you might share interviews that athletes have given to the press in which they discuss pre-game coping strategies or share that they work with a therapist. Youth benefit greatly from role models and may take comfort in the knowledge that their sports heroes take steps to care for their mental health.

Teach Coping Skills

Learning some specific coping techniques to manage anxiety can empower children to take control of their own experiences in sports. Anxiety is exacerbated in uncertainty, so coping skills should focus on building predictability. When children develop an understanding of what happens in their body when they worry, they become better able to gain control of their anxiety. You can help clients build body awareness using simple exercises. For example, with Hopscotch’s Physical Symptoms Identifier, clients can use an image of a body to indicate their physical responses to stress and anxiety. When they click on a body part, they are able to select symptoms that apply to them. You can refer to the exercise as you teach coping skills to your client. You might say something like, “I see that you feel your worries in your belly. Let’s practice some exercises that help your belly feel better before baseball practice.” 

Introduce Visualization Techniques

One skill set that can be valuable to a child who experiences anxiety prior to a sports practice or competition involves visualization. Depending on the nature of the client’s anxiety, you might help them to visualize stepping onto the playing field or imagining themselves having fun during the game. While building up visual imagery, encourage clients to imagine what each of their five senses might be experiencing (example: “I smell the grass. I hear the referee’s whistle. I see my teammates sitting on the bench”). Having a clear image of what they can expect to experience during their game or practice removes the uncertainty that fuels anxiety. This exercise is particularly helpful for kids who become most anxious on the way to their sports practice or game.

Target Relaxation Exercises

There are many benefits to learning relaxation exercises, and kids can use such exercises before, during, or after practices or games.  A very common exercise, sometimes called “Belly Breathing,” encourages one to place their hands on their stomach before taking deep breaths in and out. Often when we ask someone who is anxious to take deep breaths, it is hard for them to do so. Have a hand on the stomach allows one to feel breaths going in and out; if the breaths are deep enough, one can feel the stomach moving in and out.  Teach your clients to slowly count while doing this exercise: they can count to three while inhaling, count to one while holding their breath in, and count to three again while exhaling. You may need to work with your client to find a rhythm that feels most comfortable for them. Children can learn to use this exercise whenever they feel anxiety spike, and it is important for them to practice it during calm moments to build up their comfort in using the technique.

Partner with Parents

Parents can play an important role in helping children play sports in a fun and safe manner. It’s important to partner with parents as you support your client in developing a coping plan for anxiety. Parents may be confused as to why their child begs not to go to their sports practice, yet always seems to have fun when they finally set foot on the field. This can be a frustrating experience for parents, and it’s important to convey empathy to the entire family. You can provide parents with psychoeducation about anxiety and invite them into the planning process for your client’s coping plan. 

Does your client’s anxiety spike on the car ride to practice? Encourage parents to keep conversations light or listen to some upbeat music on the way. Does your client tend to worry about the score of the game or focus on mistakes that they have made? Encourage parents to use language that highlights what the client has done well, or parts of the game that the client appeared to be having fun (Example: “I think I saw you laughing on the bench while your team was batting. I’m so glad you are having fun on the baseball team”). Parents can set the tone for their children’s experiences in sports. If a parent focuses conversations on having fun, learning new skills, and teamwork; a child is less likely to become hyper focused on winning or individual mistakes.

Know When to Refer Out

Some young clients, particularly adolescents, may experience sports-related performance anxiety that requires more specialized intervention. If a client is a high-performance athlete, one that has hopes to compete in the NCAA or the Olympics, a qualified sports psychologist could become a valuable part of the treatment team. Sports psychologists are trained to help athletes optimize their performance and can assist athletes in working through mental blocks. You can find a qualified sports psychologist through Division 47 of the APA (Sports and Exercise) or the Association for Applied Sports Psychology.

About the Author

katharine-wenocur is a visiting assistant professor in the Community and Trauma Counseling master’s program at Thomas Jefferson University, and coordinates the program’s Child Trauma and Play Therapy concentration. She maintains a private practice in child and adolescent therapy. She is also a former competitive gymnast who coached the sport for several years.

While the “back to school” transition is typically an interactive and exciting time, returning to school can cause intense distress for some children and adolescents. If a child or teen is refusing to go to school, it is important for therapists to work collaboratively with caregivers to determine if the child’s anxiety is standard jitters or if it is Separation Anxiety.

What is Separation Anxiety?

Separation Anxiety with children/teens is an extreme unwillingness expressed through intense distress to be separated from a primary caregiver. The specific “fear” of Separation Anxiety for children, is that something bad or frightening will happen during the separation. For teens, the fear is often that something bad will happen specifically to the caregiver during the separation. This fear can lead to clingy behavior, refusals, meltdowns, constant phone calls or texts, or severe tantrums. If the Separation Anxiety persists for over four weeks and/or interferes with daily functioning, then Separation Anxiety may become a Separation Anxiety Disorder.

What causes Separation Anxiety?

Separation Anxiety is a normal part of childhood and adolescent development, and the CDC claims that 4-10% of children ages 3-17 experience Separation Anxiety. While Separation Anxiety is more common in younger children, it may reappear at milestone moments in an adolescent’s life such as at the start of middle school and high school. In recent years, the percentage of children and teens with Separation Anxiety has increased due to many reasons, namely bullying, school shootings, and COVID-19.

Separation Anxiety triggers include:

• School – Because school is typically the most frequent, pro-longed separation, school is a primary trigger for Separation Anxiety.
• Parents – Anxiety and fears can be learned, and caregivers may inadvertently pass on worries to their children.
• Periods of togetherness – It is common for children to feel closer to their caregivers following an extended time at home, such as during quarantine or summertime, and they may panic when the comfort they’ve become used to goes through a transitional change.
• Life events and changes – Moving homes, divorce, or death of a close friend or loved one can all trigger Separation Anxiety.
• Overnight separations – Anytime separation occurs, Separation Anxiety can be triggered, especially with overnight separations such as with sleepovers at friend’s houses or when a caregiver goes on a business trip.

Separation Anxiety Symptoms

Young children typically struggle to identify complex emotions (such as Separation Anxiety) and generally lack the ability to verbally express feelings. Thus, parents should be counseled to be alert for physical symptoms such as a headache, upset stomach, or change in appetite. Children with Separation Anxiety may also follow their primary caregiver from room to room or refuse to sleep alone.

Adolescents or teens may text or call their caregivers constantly to express concern for their wellbeing, and if caregivers are unable to immediately respond to texts or pick up the phone call, the adolescent/teen may suffer panic. If Separation Anxiety is severe or continues for more than four weeks, adolescents and teens are especially at risk for developing depression-like symptoms and may internalize their distress through self-harming acts. Other symptoms such as nightmares, insomnia, lack of self-confidence, and social phobia are also common symptoms for teens coping with Separation Anxiety.

For caregivers, Separation Anxiety can lead to intense frustration, feelings of helplessness, and stress over managing work and life obligations amidst calls from the school regarding their child. Caregivers may even develop fears of their own, such as fear of poor work performance, fear that the situation will not improve, fear of the teen dropping out of school, etc.

Strategies for working with parents

The good news is that there are many effective strategies for successfully treating and managing Separation Anxiety. Cognitive Behavioral Therapy (CBT) and Exposure Response Prevention (ERP) have proven to be highly effective with helping children cope with excessive fears or panic over separation. Additionally, here are 9 strategies for supporting families with children suffering Separation Anxiety during the back-to-school transition.

1. Remove blame
   Remind caregivers and children that Separation Anxiety is a normal part of development. Extend empathetic reassurance, encourage self-care, and remind caregivers that therapy can help support their anxiety and stress as well.
   
   
2. Explore potential causes besides back-to-school
   Sometimes divorce, remarriage, moving, illness, or death of a close family member or friend can trigger intense Separation Anxiety. Understanding the cause of the Separation Anxiety will help guide therapeutic efforts successfully.
   
   
3. Instill confidence through positive reinforcement
   Children and teens respond well to verbal affirmation, and caregivers are the primary people that anxious children/teens want affirmation from. Advise caregivers to reward their children with encouragement every time they reunite with their child following a separation such as at the end of a school day. Positive feedback is effective for reinforcing healthy behaviors in children and teens, and even something as simple as caregivers saying, “I’m proud of you for being courageous at school today!” can go a long way.
   
   
4. Give them a comforting object
   Sentimental objects such as a piece of jewelry from the caregiver or a special picture can help remind the child/teen that the Caregiver is always with them in spirit even while they are away at school.
   
   
5. Avoid avoidance
   While it is important for caregivers to be compassionate and supportive, avoidance of separation only makes Separation Anxiety worse, and it is crucial for caregivers to help their children/teens face their fears in a positive way.
   
   
6. Encourage parent and school alignment
   Coping expectations for the child at school should be similar to at home, and parents, caregivers, teachers, and school counselors should all be on the same page for Separation Anxiety problems to be handled as consistently as possible. You might also suggest that the caregiver identify a safe adult for the child to turn to at school when they experience emotional distress. Responses and expectations for what criteria should warrant picking the child up from school should also be discussed with the chosen safe adult in advance.
   
   
7. What caregivers can do at home
   There are many things caregivers can do at home to help children coping with Separation Anxiety. First and foremost, caregivers should be on the same page as their partner to ensure consistency. The second most effective at-home strategy is education. Being able to recognize anxiety and its symptoms is the first step in soothing Separation Anxiety for many children. Encourage caregivers to remind their child that anxiety is normal, and that there are many self-calming exercises (such as art, music, deep breathing exercises, stretching, holding a comforting object, etc.) that can help them through tough times so that they can enjoy important and fun experiences.
   
   
8. Prepare children for transitions
   Mental pivoting is a skill that children and teens need support with developing, and children need to be given time to warm up to changes - especially separations. For example, caregivers should not wait until the day of or the night before to tell a child that they are going to school or that a parent is going on a business trip. Giving the child a heads up allows them to feel more prepared for the change when it arrives and less afraid.
   
   
9. Avoid solving Separation Anxiety problems with isolation
   Some parents consider homeschool or cyber school as a solution for children with intense Separation Anxiety, and while there are certainly times where this may be appropriate, research maintains that it is best for behavioral and psychological development needs to be learned, supported, and addressed through social community. Navigating social communities outside the home is essential for well-rounded, academic, and interpersonal development.

When it comes to childhood development, research has concluded there is no other influence more profound than the child’s primary caregiver. While child therapists certainly have an impact and help facilitate positive change, caregivers are the true Agents of Change and one of the strongest factors contributing to a child’s well-being. Because caregivers have an innate ability to impact their child’s well-being, they need to be (and deserve to be) fully involved, and because child therapists are the experts, it is their responsibility to advocate for and facilitate parental involvement. Thus, explaining to caregivers why the parent check-ins are so important and communicating the framework for how parent check-ins function must be a priority for every child therapist. 

5 Reasons why parent check-ins are so important 

1. Parent check-ins really are necessary. 
   From a social and environmental perspective, parent check-ins benefit the therapeutic process in many ways. Whereas most psychotherapeutic methodologies are based on an individual therapy structure, children/adolescents do live and operationally function within the context of a family, which makes children/adolescents psychologically, socially, relationally, and emotionally dependent on filial dynamics. Therefore, the family system needs to be understood and family unit leaders must be included in the child/adolescent’s treatment process.
   
2. Parent check-ins provide an avenue for meaningful caregiver involvement. 
   It is not uncommon for child therapists to lament a lack of caregiver involvement; however, it is the responsibility of the child therapist to solicit and coordinate caregiver involvement. As the child therapist, you are the “expert,” and caregivers will look to you as the expert to communicate why, when, and how caregiver involvement is expected.
   
3. Parent check-ins make therapy more efficient and effective. 
   Parent check-ins provide the necessary context for making therapeutic efforts as appropriate as possible, and it is a uniquely instrumental time to explore unique, child-specific ways to optimize the therapeutic process.
4. Parent check-ins help establish rapport. 
   The parent check-in is a significant opportunity for child therapists to build rapport, an essential ingredient for cultivating in-session growth. 
   

5 Tips for child therapists – How to facilitate a parent check-in framework 

Child therapy is a collaborative process that does its best work when the child, therapist, and caregiver work together as a team, and one of the best ways to facilitate this collaboration is to have a structured framework for the parent check-in. While there is no one best parent check-in framework to accommodate all clinicians and clients, these five, therapist-inspired tips are proven ways to help child therapists successfully facilitate a parent check-in. 

Tip #1: List out your expectations for caregiver involvement.
Start developing your parent check-in strategy by listing out your expectations for caregiver involvement as appropriate to your practice. Whether you meet with caregivers every week, every two weeks, or once a month, try to develop a clear structure and general cadence for when and how you intend to facilitate parent check-ins. 

Tip #2: Clearly communicate your expectations for caregiver involvement to caregivers.
Communicating caregiver involvement expectations is ideally done during client intake, but expectations can be re-visited anytime to ensure utmost clarity. Be sure to specify booking structure, payment, duration, cadence, and any other contextual information caregivers need to know in order to successfully comply. Essentially, you are helping them help you help them. 

Tip #3: Define what a parent check-in means.
Caregivers may not be familiar with what a parent check-in is, or they may have a pre-existing notion about parent check-ins from a past experience with a different therapist. It’s important to ensure that caregivers know exactly what parent check-ins mean to you so that all perspectives are aligned with what the parent check-in is, and what it is not. 

What is a parent check-in?

The parent check-in is a designated, scheduled time for collaborative, interactive dialogue between the therapist and the caregiver. The parent check-in is different from a filial session, which is a therapy session that includes both the child and parent. Although circumstances may vary, children are often not included in the parent check-in. (Note: With insurance, the parent check-in session is generally billable as a family session without the client present.) 

What is NOT a parent check-in?

The parent check-in is not the same as an e-mail or text update. Besides the fact that there are some major privacy concerns with e-mail/text updates, an update is not a check-in. It’s an update, and while updates are important, an update is not the same as involving caregivers in the therapeutic process.

The parent check-in is also not the last/first five minutes of the session. For one thing, it’s never only five minutes, and even if it is, five minutes is not sufficient time to accomplish the goal the parent check-in is meant to achieve. At best, it is an unsustainable way of connecting with parents. Those five minutes can quickly turn into 15 which not only throws off your whole schedule, but deprives caregivers of the incentive and opportunity to book a time for some collaborative dialogue.  

Tip #4: Consider including the child/adolescent in the parent check-in process.

Imagine your boss telling you that they are going to have a meeting about you with another manager… and you had no idea what they were going to say about you. All you knew is that you weren’t invited to the meeting. But… you can wait outside the meeting room door. 

Sounds awful, right? 

It’s a tough situation for anyone to be in, including children, and that’s why there are so many reports of little ears pressed up to the door and parent check-ins getting interrupted by an understandably anxious child. 

While it is possible to create a safe environment to neutralize such anxieties, it is also not entirely uncommon to include the child in the parent check-in. Of course, every situation is different, and depending upon the information to be shared, there is value in considering how allowing the child to be present in at least part of the session in the parent check-in may be beneficial for all involved.

Including children in the parent check-in can provide a great opportunity for child therapists to model validating feedback, positive parenting, and co-regulating skills. It also provides child therapists with an in-the-moment chance to gently reframe unhelpful parenting statements and help caregivers talk about a child’s difficulty with respect and compassion. 

Tip #5: Be upfront and honest with the child regarding the parent check-in. 

Sometimes, however, there are things that the therapist and caregiver need to talk about, and including the child/adolescent in the parent check-in may not be prudent or appropriate. When this happens, it is important to address any potential anxiety or nagging curiosity a child may have in a direct, honest, and age-appropriate way. Often, simply telling the child before the parent check-in that the therapist and the caregiver have some hard work to do together (since children aren’t the only ones who need help) is sufficient. Afterwards, at the next child-session, it’s a good idea to ask the child if they have any questions they would like to ask, and if not, a brief, age-appropriate overview of what you and the caregiver discussed typically appeases any of the child’s potential anxieties.