When working with younger children, a much more flexible approach is required than when working with adults. Developmental stage, temperament, and relationship history all affect the way a child experiences and expresses their feelings. I therefore believe that working with the family is very important to ensure the best possible outcome for the child. If the child has been involved with other mental health professionals, I may also seek to speak with them to gain a well-rounded sense of the chlld's behaviour over time.
My office is very informal. With young children, I do not want them to feel like they have been brought to me because there is something "wrong" with them. I want them to feel like they are visiting a family friend.
I usually begin my assessment by meeting with the child and at least one parent. Sometimes I may have an initial session with the parent alone if preferred. If the child is comfortable speaking with me alone, I will ask the parent to complete a form that provides me with more detailed information regarding the child's development, health, and temperament. I prefer to see young children (pre-pubertal) in person if at all possible. Children often need help to express their feelings verbally, and I will use pictures, diagrams, and also invite them to make their own drawings to explain themselves, if they wish. Some children do not have the words to express what they are feeling, and need to be taught some simple terms that they can use. If the child wants their parent to remain with them, I am happy to begin the discussion with the parent and child together. Sometimes with very shy children, the parent is better at helping the child to express themselves than I would be on my own.
I am very careful to not lead a child in any particular direction, and try to ask open ended questions as much as possible. If this is too difficult for the child, I will provide several different examples of answers that they can choose from. I am also careful to ensure that the child feels that any answer they may wish to give is equally acceptable and appropriate, so that they do not sense any pressure to respond in a particular way. This is very important because children are very clever when it comes to intuiting what adults expect or want them to say.
I also use various structured questionnaires as appropriate in order to gain additional objective information about the child's experience as well as to gauge their current level of distress. All of these questionnaires have been validated through research and are used at multiple centres around the world. Although I hope to gain as much information as possible, I never lose sight of my primary goal, which is to help the child to feel safe, to reduce their distress, and to make sure they feel supported. I am therefore always sensitive to the child's behaviours and responses and definitely believe that developing a good relationship with the child must take precedence over obtaining detailed information. Depending upon the child, it may take several meetings before I feel I have sufficient understanding of the child's concerns to be able make concrete recommendations as to what would be most beneficial for them going forward. Throughout the process additional feedback from parents and/or caregivers is always welcomed.
For teenage children, I require at least two 75-minute sessions to complete a basic assessment and write a report. For parents of teenage children who wish to discuss any concerns they have, scheduling a separate session is preferred.