Information for Parents

Assessment and Understanding of a Child's or Young Person's Mental Health Difficulties

Psicon’s Children, Young People and Family Services provide a full clinical assessment of mental health carried out by Clinical Psychologists. A standard mental health assessment takes 90 minutes, after which a full psychological understanding of the child or young person is written up so that parents (and anyone else they choose to share it with) can understand what is going on from a psychological perspective.

An example of this is that when a child has a panic attack, they often think they are going to pass out or be sick. A psychological formulation helps to show that is actually a misinterpretation of what their body feels like, and the lightheaded feeling or the nausea are actually just acute symptoms of anxiety, and their fears are very unlikely to become reality.

Psychological formulations can be very simple (as above) or very complex and involve family dynamics and relationships.

If you require an assessment (for a diagnosis or for psychological health and/or behaviour) or support for a young person with autism, ADHD, specific learning difficulties (such as dyslexia and dyspraxia) or an intellectual disability, please see our Neurodevelopmental Lifespan Services, where these services are available.

We offer this under a specialist service because, although neurodevelopmental conditions can impact on a young person’s psychological health (and that impact may be distressing), they arise through an ‘organic’ difference in the way the brain develops and functions, and therefore they require a service with expertise in that area. A child with autism may become very anxious – just as a child without autism might – but the psychological support of the autistic child should take into account the complexities that autism presents. Standard psychological support for issues such as anxiety may require significant adaptations for it to be effective for someone with autism.

  • One-to-One Therapy

    The types of therapy we use at Psicon include Cognitive Behavioural Therapy (CBT), Narrative Therapy, Attachment Based Therapy, and Systemic Therapy. If a young person or their family is keen on receiving a specific type of therapy, the Clinical Psychologist they work with will be happy to discuss it and suggest alternatives so that they can make a fully informed choice about what is best for them.

     

    We often work one-to-one with young people on issues such as panic attacks, low mood, stress, anger, self-harm, eating problems, relationship problems, phobias, obsessive compulsive disorder (OCD), generalised anxiety (excessive worry), anxiety relating to exams and school, post-traumatic stress disorder (PTSD) and adjustment disorder (big changes to circumstances).

  • Family Therapy

    Psicon’s Children, Young People and Family Services also offer family therapy, in which a Clinical Psychologist works with all members of the family at the same time. This type of work moves away from the idea of a problem being located in a single person and instead looks at the family as a whole and how issues are raised and influenced by each member.

    An example of this could be where a child develops behavioural problems during a time that their parents are having relationship difficulties. The behavioural problems serve as a focus for the parents, deflecting their attention from their own relationship issues. However, the tension in the house may contribute to the behavioural problems themselves, and a vicious cycle ensues.

  • Bespoke Treatment Options at Psicon

    Psicon’s Children, Young People and Family Services offer a bespoke service for families. After an assessment, the Clinical Psychologist will discuss treatment options. This can include having a member of the clinical team visit the family at home and carry out work with them there.

    This can be a very effective means of tackling behavioural difficulties, as parents can work with the Psychologist in ‘live’ situations. We have been very successful in supporting parents with children who refuse to attend school, have debilitating OCD, exhibit behavioural issues as a result of autism or have many other psychological and neurodevelopmental difficulties.

What to expect

One-to-One Therapy with an Individual Child

Starting work with a Psychologist can be really daunting for a child or young person. At Psicon, we try our utmost to make it as relaxed as we can. We pride ourselves on being able to make good connections with children and young people, and we don’t patronise them or make them feel uncomfortable.

When working one-to-one with a child, we believe the first (and probably the most important) goal is to establish a friendly, warm and safe working relationship. This means that, before any work on the presenting problems begins, we want to ensure that the young person feels comfortable with the Psychologist and how the work will unfold. Once this is established, we consider the type of work to do. This is often based on the problem that the child wants to work on and the child’s personality. Some young people prefer a more creative approach that involves drawing, writing and creating characters, whereas others prefer a more technical focus that involves developing specific techniques and skills to overcome difficulties. When working with a Psychologist, one or a combination of these approaches is possible and will be discussed with the young person and their family (where appropriate).


All Psicon clinicians have many years of experience of working with young people and can offer a wide range of ways to help. An example follows of a typical piece of work with a young person who was struggling with anxiety.

E (aged 13) was having panic attacks and was very worried that these attacks might preclude spending time away from home and flying. A common way of working with anxiety is to ‘externalise’ the problem so that the child stops feeling as though ‘something is wrong with them’ and instead begins to feel that there is a problem that affects them. This approach is called narrative therapy, and a key technique is to work with the child on developing a character who represents the problem; in this case the character was named ‘the purple panic monster’. We then get to really understand how the monster operates: when he comes, what he does, when he’s easier to tame and when he is at his most powerful. Once we know the monster well, we can start writing about him in story form. The following is reproduced (with permission – thanks, E!) from the work carried out.

 ‘I was half asleep and heard a little voice humming twinkle twinkle little star (slightly out of tune), and I knew exactly who it was. I opened my eyes a tiny bit, so I could just see what I was doing. It had stolen all of Millie’s colouring pens, and it was making a banner saying “I HOPE YOU SUVIVE ALL OF YOUR PANIC ATAKS THAT U WILL HAVE LOWDS OF AT GREASE”. I had to force myself not to laugh out loud at his bad spelling and untidy writing and the drawing of me that looked like a very ill potato. I had the perfect plan.

I woke up before anyone else and saw the monster triumphantly looking at the banner. It looked even more colourful and glittery than before.

“Is that for me?” I said, pretending to look panicked.

“It sure is!” he said, with a grin that he was trying to make look scary, but it just looked quite funny.

“I love it!” I said and scooped him up and gave him a really big hug. He looked very shocked as he tried to get free, and once he had got out the house, muttering to himself that his plan had gone wrong, he was never to be seen again that day.

I looked at my clock and it said 6.30am. Far too early, so I went back to sleep. Later that morning, when mum came to pick me up, I got into the car, yawning. Suddenly, I heard a little voice again, but this time it was signing Humpty Dumpty.

“She will never see this coming!” the Purple monster muttered to itself. I peeped over into the boot of the car and noticed the monster was slightly smaller than yesterday. He was wrapping a small book that was called “How to survive plane journeys”.

I looked over to the front of the car and saw a dolly that my sister had left lying on the seat. On the doll were a pink frilly dress and a small bonnet.

“I’ve got you a present!” exclaimed the little monster.

“I’ve got one for you too!” I said. “Really?” he said, as excited as a little child at Christmas. I handed him the present and he tore it open and an embarrassed look formed on his face.

“I thought it would suit you.” I forced the dress on the monster and at that moment, my sister came into the room, and I said, “Look I bought you a new toy! It talks.”

“I love it!!” she squealed, and picked up the monster and kissed it all over. It was horrified to move.

The furry little monster is now kept amongst all the other little pink dolls and teddies in my sister’s room and is given a daily scrub with a toothbrush, and, if it is lucky, a makeover with a pink lipstick.’

E was able to control the anxiety and enjoyed her flight and holiday.

Family Therapy

Family therapy involves all members of the immediate family and sometimes grandparents too! It takes the perspective that no single person is to blame for difficulties and that, although there might be an identified ‘patient’, they are seen as a symptom of the problem rather than the problem itself.

An example of this work is in the case of G, who presented with self-harming behaviours. By sitting with the whole family, it was possible to hear all points of view on the behaviour. This was particularly useful when the mum heard that the dad’s feelings towards the self-harming son were very sympathetic as she had thought them to be quite distant and uncaring. Through careful questioning, the dad was able to share that he had been through a similar experience at about the same age as his son. He had not wanted to admit this as he thought he should set a strong example, because he perceived himself as pathetic for having done it. Once the mum heard the dad’s perspective and the son heard both parents’ perspectives, the son felt much better understood and closer to his dad. This made the mum felt less inclined to put pressure on the dad to bond with the son, which consequently improved relations between both parents. In the end, the son stopped self-harming, and this further reinforced a more positive story in the family.

Another example of work with families:

J’s family came to us with concerns about his behaviour; he is 8 years old and presented with traits of autism and several challenging behaviours.

J is one of four siblings, but his parents did not express any concerns about his brothers’ and sister’s behaviour.

Initially, family sessions with Dr Simmonds (Clinical Psychologist) and Lucy Elias (Assistant Psychologist) were used to discuss the parents’ goals for Josh and the family. It was established that within the family home the parents had not implemented clear rules or boundaries, and this had allowed J’s behaviour to continue for over a year.

Under direct supervision from Dr Simmonds, Lucy worked with J and his family within Cognitive Behavioural Therapy and Systemic Theory frameworks. Initially, Lucy worked to establish a rapport with Josh so that he felt comfortable and able to discuss things with her. Using a gradual, stepped process, Lucy began to introduce some structure into the home environment. Working closely with J, his siblings and his parents, Lucy helped to develop a set of house rules. Reward charts for good behaviour, and consequence charts for when rules were broken were introduced for each child. A lot of work was done directly with J’s parents to help them to see the importance of consistency with the rules and boundaries, and also the importance of treating each child the same.

The family responded well to the structure, and the parents started to notice positive changes in J’s behaviour as a result of the clear boundaries and consistent rules. Once J’s behaviour had improved at home, we were able to begin more focussed work within a cognitive behavioural framework to help J manage some of his anxieties around leaving the house. He had rarely left the house over the past two years and as a result was being home tutored.

A graded exposure programme was put together for J and his family to slowly introduce him to leaving the house. This started with very small steps, such as asking J to talk about leaving the house, and once he was comfortable with this we increased the exposure, for example asking him to walk down the road outside his house. We continued to follow a graded exposure programme, amending it as J either struggled with a certain step, or made good progress.

This approach worked well for J and his family, and eventually J was able to return to school.

Work with Parents

It might not always be possible to work with a young person directly, for reasons such as they are too young, they do not wish to work with a psychologist or there are behavioural issues that the child does not have insight into. Through working with the parents, we are able to work with the young person indirectly. This can mean supporting parents to set up and monitor an effective behavioural management plan to tackle challenging behaviour or helping parents to develop new techniques in responding to their child’s emotional needs.

F was a 9-year-old child who lived with their dad. F became very anxious about attending school and, after weeks of becoming increasingly distressed in the mornings, eventually refused to attend. This was most distressing for their dad, who started to feel that he was failing as a parent. At this time, F also refused to work with a psychologist, so work began with dad. First, we conducted a full assessment to determine the exact nature of the problem and to help dad understand it from a psychological perspective. This can often help with a sense of failure as we begin to see how problems can develop over time for many different reasons other than poor parenting. We were also able to send a report of this understanding to the child’s school to help them understand what was going on and to manage their expectations (previously, their good intentions and proactive attempts to get the child to school had inadvertently made the child more distressed and even more reluctant to attend). The work then focused on explaining how behavioural management works (the underlying theory and why the techniques are as they are) before setting up a plan for the child. This was very detailed and addressed the initial conversation with the child through to specific responses to specific behaviour. Dad was able to apply these principles with great success, and through careful monitoring he was able to fine-tune the plan to be most effective. The child was able to attend school full time and in a far less distressed state within only a couple of weeks. The work is such that the principles are applicable to many situations and so, should any difficulties arise in the future, a parent will already have the knowledge and skills to manage them.

Work With Schools

After a shared understanding of a child has been developed, it is possible to share it with other people or agencies. This could be a GP or a teacher at school. The idea is that we all share the same understanding to ensure that all respond to the child in a consistent way. This is particularly useful if the child needs to be allowed to exclude themselves without too much fuss if they are trying to manage their anger or anxiety. With neurodevelopmental conditions such as autism and ADHD, the picture can be even more complicated, so being able to share an expert understanding with the school can really help the child to feel more comfortable in their environment.

Initial Appointment

The first course of action is to book an assessment. The assessment will be carried out by an experienced Clinical Psychologist who will spend 90 minutes finding out about the problem and taking a history of the person suffering from it. The child or young person will usually be accompanied by their parent(s) in order to gather details from early life. This is important to do in order to rule out any neurodevelopmental or health/physical causes of the problems. If the young person would prefer to be seen individually then this is also possible, and the assessor will always ask what is preferred.

Confidentiality

Confidentiality is a very important part of the work, and young people can be assured that the information they share will not be automatically passed on to their parents. We work from the perspective that the more we can share, the better, but we try and do this in collaboration with the young person rather than without their knowledge. This can add to the trust given to the therapeutic relationship and often can enhance the rapport between the Psychologist and young person. Of course, parents are entitled to all information written about their under-16-year-old and this will be given in accordance with the law if required. If a young person is suspected of being at risk to themselves then information will be shared by standard procedure with all relevant parties as a duty of care.