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The Case for Co-treatment

The Case for Co-treatment

At Elmhurst Counseling, we often receive referrals that are best served by combining the expertise of multiple therapists. The most common examples are Occupational Therapy and Speech Pathology. OT and social work are similarly intuitive. The credentials and expertise of these specialists blend naturally on behalf of the child. Let’s consider these two examples.

Many kids fall short of school district thresholds for speech & language and/or occupational therapy services. Yet each of these children displays concerning symptoms, whether that be difficulties with motor planning or self-regulation. What is a parent to do?

You can wait for the kiddo to ‘grow out’ of their symptoms, assuming the lag is within the developmental norm. Or you can engage your own resource network proactively with the understanding that early detection pays dividends.

It is probably no surprise that both speech and motor delays are partnered with most kids. The same goes for sensory processing and social pragmatics. An hour with either the Speech Pathologist or the Occupational Therapist addresses many of the same developmental challenges. When you put them together in the same room with a child, magic happens.

The same magic occurs when you add a Social Worker to the mix. It is the rare ‘OT’ or ‘SLP’ client who doesn’t have a strong social-emotional component to their clinical picture. The ability to address the childhood traumas and family dynamics that impact normal development is, in essence, prevention. Speech/language, social work, and occupational therapy interventions thus all become strengthened in a multidisciplinary approach.

The cost/benefit analysis is clear. Collaborative interventions in co-treatment models have measurable clinical efficacy. It’s just hard to find a practice that offers hybrid services. Most often, parents need to act as project managers and patchwork professionals together on their own. If you can find a clinician that partners in an interdisciplinary practice, sign your kid up!

About the Author

Steve Ritter, LCSW is the Founder and Executive Director of Elmhurst Counseling. He has served as a teacher, author, consultant, human resources director, health care administrator, and licensed clinical social worker since 1977. A fellow of the American College of Healthcare Executives, Steve has provided coaching, therapy and team development services to thriving schools, businesses and organizations.

The Best Medicine for Kids

The Best Medicine for Kids

The human brain evolved outdoors. It was made to notice passing distractions, evaluate priorities, and become fully absorbed in the objects worthiest of our attention. Evolution favored early humans who could successfully scan the landscape and follow sparks of instinct, like reading a compass pointing true north – except the needle pulled them toward a primal understanding of the world.

Likewise, kids’ senses are built for capitalizing on interactions with their environment to bolster their development. Children are natural prodigies of untamed, unstructured experience. When they are given outside play time without an agenda, they transform into their best selves. Exploration begets discovery. As they immerse themselves in the physical world by climbing trees and observing ant hills they gain valuable insight, most of all about themselves.

Anyone who has watched a child indulge their innate curiosity without adult intrusion has seen the beautiful intensity of this phenomenon. You can actually see growth unfolding in real-time. But why does it seem to be so particularly powerful outside in the wilderness of our backyards, parks, and forests? One answer is as mystical as it is simple.

We exist, now and always, as beings made up of the same matter as the rest of the ecosystem. We can only understand ourselves if we’re able to see ourselves reflected in the giant and unfathomably entangled web of other beings. Learning to relate to nature – following animals and insects with our eyes, our hands, and our hearts – allows us, simply, to become ourselves…by becoming one with them.

The most recent results of cognitive research show with scientific authority what we feel in our souls: the growing brain needs this ‘other,’ a partnering incarnate subject that consists of living matter, for healthy cognitive and emotional development. To put it more poetically, children need their gaze to be returned by the surrounding aristocracy of life in order to effectively tap into their own depths.

Unfortunately, our modern society appears determined to pull kids away from both the visceral connection to each other and to the wilderness waiting outside their door. Technology beckons for their attention with ever more seductive hooks to their brains’ reward centers. According to recent Gallop data, by the age of 8, children spend up to a whopping six hours of screentime a day.

The deviation from time spent in our living and breathing outdoor environs to a flat, virtual world is stealing more than just emotional self-awareness from kids. It throws salt in the wound by disabling their capacity for sustained engagement as it becomes constantly punchier and more stimulating, feeding young brains their next addictive fix within milliseconds. The beckoning forest doesn’t stand a chance

Young kids’ neurons are exploding in a million different directions and looking for interrelation. Space to run free in nature actually helps them develop better brain machinery. Juvenile rats who are restricted from play in wide open spaces fail to fully develop their frontal lobes (which control executive function) and have impulse control and social interaction problems. However, rats given just 30-minute unrestricted play sessions released brain growth factors and activated hundreds of genes in the frontal cortex.

If that’s not convincing enough from a brain-body standpoint, here’s some more compelling evidence for you: kids who spend more time in nature also tend to sleep better, have elevated attention and problem-solving skills, host healthier internal microbiomes, enjoy more robust immune systems, and develop overall stronger and more agile physiques.

So what’s a concerned parent, grandparent, or caregiver to do? The solution need not be complex or intimidating. Simply begin by getting your kids outdoors (and join them when you can – benefits exist for you, too)! Encourage them to take walks, dig holes in your yard, and get dirty. Give them regular opportunities to experience the freedom of being set loose outside. Respond to the “I’m bored’ declaration with the suggestion of a wild adventure. It’s really that easy!

Encouragingly, some societal shifts are also occurring to help out. The number of nature-based preschools and primary schools is growing, and more companies are forming to provide ways for families to reconnect with nature. Traditional summer camp registration has seen huge surges in enrollment since 2021, and many of them offer family stays. Getaway House, a burgeoning business launched in 2015, makes it easy to leverage family vacation time by renting out fully-equipped tiny cabins set up in the woods all around the country, for essentially the same cost as a hotel room.

It’s a worthy cause. The effort to get kids outside has big payoffs. When children are left to their own devices to roam in nature as in generations past, they learn to see themselves as part of a great, magical universe. They shed their self-conceit and experience the fragile interrelatedness of all life. Best of all, they nurture their capacity for empathy, care, and kindness – exactly what this world needs, now more than ever.

 

 

About the Author

Kerry Galarza, MS OTR/L is the Clinical Director and a pediatric occupational therapist at Elmhurst Counseling. She provides specialized assessment and intervention with children of all ages and their families. Kerry engages clients with naturally occurring, meaningful home-based methods to empower autonomy and maximize functioning.

Let Your Children Be the Bosses of You

Let Your Children Be the Bosses of You

We’re still in the time of year when many of us (in spite of ourselves) feel the temptation to make resolutions. If you’re like me, you’ve been pondering ways to become a better all-around person. In my case: more patient, attentive, and affectionate.

But I always grapple with the question of whether to broadcast my goals to anyone else. What if I fail? Better to keep my resolve quiet. On the other hand, if I tell someone I’ll probably feel obligated to try harder.

It might be better to go public, after all.

Common wisdom tells us that once you make your goals known, you’ll become more motivated to accomplish them. Aside from a couple of exceptions (including a 2009 study that found students acted less on their goals once they were shared because announcement gave them a false sense of completion), social scientists agree that external accountability helps.

And here’s something you may not know: it’s been proven that sharing your goal with a person whose opinion you value gives you a huge boost. Not only are you giving bigger life to your resolve, but you’re also now receiving implicit support and approval from someone who really matters to you. It’s almost like you’re doing it for them – like following through with your resolve is a gift.

So if your goals include being a better parent, like mine, I propose going straight to the source – your kids. Who better to share the gift of your resolve?

Let them know what you’re hoping to change, and why. Invite them into your heart and soul. They’ll feel the love conveyed in the message and probably be more than willing to hop on board to support you. You can be sure they’ll hold you accountable!

Little successes will become self-reinforcing – and you will have already taken the first step in your goal to become a better parent by simply telling your kids how much they matter to you.

About the Author

Kerry Galarza, MS OTR/L is the Clinical Director and a pediatric occupational therapist at Elmhurst Counseling. She provides specialized assessment and intervention with children of all ages and their families. Kerry engages clients with naturally occurring, meaningful home-based methods to empower autonomy and maximize functioning.

The Kid In The Mirror

The Kid In The Mirror

Whenever we catch our reflection in a mirror, we hope to see good stuff reflected back. If we’re ok with what we find, we might sneak an extra peek. It feels great to experience affirmation about the best of ourselves. It’s not really vanity or narcissism. Just an innocent and normal desire for reassurance.

In fact, that desire goes well beyond physical appearance. We all want to know that our ideas and opinions are valid, so we seek out places they’re reflected back to us positively. Technically, it’s called confirmation bias. When other people feel what we feel and think what we think, we can breathe a sigh of relief. Phew, we got it right!

Whether with politics, ethics, status (money, degrees, job title), or culture (music, art, literature, diet, fashion), we often look around us to find out if we’re on the right track with our decisions. When we’re feeling disordered inside, it’s especially appealing to find reflections of our understanding that can help settle us down.

With kids, however, this process is largely unconscious and nonstop – babies all the way up through teens are in a constant state of refining their core understanding of themselves. It’s like living in a room full of mirrors.

When I was young, the validation I sought out wasn’t always reliable or available, so I found it wherever I could. I had an idea about what relationships should be like, and I attached myself to shows and movies that confirmed my expectations. I was a deep thinker and sensitive kid (in other words, I often felt like a weirdo), so I became drawn to books with characters who fought solitary inner battles and prevailed with quiet cunning and wit.

I crafted my own self-perceptions without an official roadmap and few personal guides. Most of my reflections came from self-selected books and media, which was fairly limited in the 1980s. Today, our kids are drowning in social apps and pop culture influences, whether they ask for them or not. Algorithms lure them down numerous questionable paths that feed them endless material.

While I could curate my own influences and strategically shape my identity through gradual developmental stages, kids these days are at risk for having their sense-of-self engineered at an addictive level. Taking away their screens doesn’t scratch the surface.

It’s normal for parents and educators to want to steer the media narrative, but it’s usually a losing battle. The onslaught is becoming too big and insidious. This is where the mirror concept becomes useful. Because kids typically seek reflections that match what they feel about themselves, caregivers can lay the groundwork early to help them see themselves as responsible, grounded, and thoughtful people. In this way, they’re empowered to act as their own best filter.

Here are some ways to guide them:

  • Name and support their natural strengths – particularly the ones that aren’t always noticed by others.
  • Help them to notice and highlight the natural strengths in everyone else around them.
  • Model optimism and proactive problem-solving, even when the odds are stacked up.
  • Create ways to let them use their unique gifts to make other people’s lives a little bit better.
  • Teach them to think of mistakes as opportunities for learning, rather than a cause for shut-down.
  • Normalize, describe, and let them sit with big feelings – especially the uncomfortable ones.
  • Provide them with chances to apologize, repair, and grow from any damage they may cause.
  • Encourage them to forgive others and seek to understand why other people behave the way they do.

Our kids develop their self-image based upon the reflections that are around them. Luckily, the most powerful ones will always come from the adults in their lives they love and who love them back.

About the Author

Kerry Galarza, MS OTR/L is the Clinical Director and a pediatric occupational therapist at Elmhurst Counseling. She provides specialized assessment and intervention with children of all ages and their families. Kerry engages clients with naturally occurring, meaningful home-based methods to empower autonomy and maximize functioning.

Q and A with the Elmhurst Counseling Leadership Team

Q and A with the Elmhurst Counseling Leadership Team

Steve, our Executive Director, and Kerry, our Clinical Director, have a combined 60 years of experience treating kids and families in our community. Just when we think we have seen it all, a complex set of circumstances leads to a request for therapy that requires a new lens for assessment and treatment methods. What follows is a conversation about important questions that arise in our practice.

 

Have you noticed any new themes and patterns in typical family struggles since COVID?

Steve: While it can’t necessarily be fully attributed to COVID, we are seeing a marked increase in anxiety symptoms. During the pandemic, kids, teens, and adults were challenged to cope with circumstances they had never before faced. The degree of safety concern was off the charts and previously acquired coping skills weren’t enough. In the end, crisis creates opportunity. The need to step up coping strategies results in strengthened skills. You must fall to learn how to get back up.

Kerry: Many children are still catching up from lags in social learning. Social and emotional regulation development comes from multiple sources. Kids need to practice self-regulation out in the community where they’re able to take part in all different types of feedback loops. COVID altered some of that learning. Additionally, caregivers who are coping with significant changes and stressors are often caught between a rock and a hard place when it comes to meeting everyone’s needs, and this can have a rippling impact on relationships and resiliency.

 

What is the most common issue presented when families begin therapy?

Steve: Interestingly, it is a regression in development. This is the inevitable consequence of trauma. When our worlds are turned upside down, we return to the last successful coping period. For instance, if a child who has just mastered potty training goes through their parent’s divorce, the most likely symptom will be bedwetting. We all step back one stage to enable comfort when under stress.

Kerry: Regardless of the behavioral difficulties families are experiencing, there’s almost always a ‘systems issue’ occurring underneath that needs attention. This could be in the form of a mismatch between abilities and expectations (occurring outside of the individual), or a disruption of internal body signals and processing (occurring inside the individual). Once we figure out where the root of the problem lives, we can begin targeting it at the source.

 

The behavioral health system seems to be stretched. What’s going on?

Steve: Need has outpaced resources. Acuity levels are higher than ever and the more experienced therapists who manage high acuity have full caseloads and waiting lists. The intensity of care has led many clinicians to leave the profession. It has become unfortunately common to make a call for services once your family has reached crisis level and not get a callback. Our practice is similarly at capacity and we are struggling to offer alternative referrals when we are unable to take a new case.

Kerry: Our society has been experiencing an unprecedented youth mental health crisis for a number of years. Extra psychosocial pressures created by the pandemic and current cultural climate (uncertainty, routine disruption, physical risk, social isolation, loss, etc.) have expounded on this. When adults are stressed, kids are impacted. The stigma around therapy has also been evaporating at a more rapid rate. People aren’t hesitant to seek professional support for themselves and their kids.  

 

What’s the best way to select a therapist?

Steve: Word-of-mouth referrals are always the most reliable. The goal is to find the ideal match between the family’s needs and the therapist’s skills. Beyond that, chemistry matters. Research shows that the greatest predictor of positive clinical outcome is the degree of connection between the client and the therapist from the client’s perspective after the first session.

Kerry: It’s important to find someone who you feel comfortable with, someone who takes the time to understand your needs and your goals, and someone who is willing to do the hard work required to address them. It’s equally important to find someone who fits the logistics of your situation – it doesn’t make sense to drive an hour away if it disrupts the flow of your family and creates new difficulties. Family, friends, and educators are often dependable sources for referrals.

 

What should clients expect when they embark on a therapy engagement?

Steve: First and foremost, respect. We want to understand the world through your eyes. No judgment. Unconditional acceptance. We begin with the understanding that everyone is doing their best. We seek to collaborate with our clients in answering the question, “What would need to be true to make this situation make sense?” Once we’ve gathered an accurate picture of the family’s challenges, we partner in solving problems and strengthening resources.

Kerry: As in any relationship, sufficient time is taken to build rapport and establish a level of trust. This can be especially important in pediatrics, when oftentimes the child themselves didn’t initiate the therapy process. Creating a safe, welcoming environment for younger clients is vital because when kids are comfortable, the engagement is more meaningful, and true growth and learning begin to happen at a much higher caliber.

 

Do you have any guidance for families whose everyday struggles don’t cross the threshold for needing professional help?

Steve: Although counterintuitive, don’t be too quick to make the symptoms of struggle go away. Looking the problem straight in the eye helps you understand its source. Although relieving discomfort makes you feel better temporarily, the roots of the problem grow deeper when unattended and the symptoms are sure to return. There is always a reason for struggle, even when it isn’t immediately apparent. Enduring the pain until the reason becomes clear not only fuels understanding, but it builds coping skills.

Kerry: It might sound simple, but slowing down the pace of life regularly enough to have open-ended and nonjudgmental conversations with key family members can be a tremendous help in resolving struggles. All families benefit from routine check-ins to safely explore viewpoints, feel heard, acknowledge hurt, and problem-solve together – and yet, we rarely take the time to do this. Community support can also be tapped less formally in the form of educators, caregivers, neighbors, and friends. You’re never alone in your struggle, and odds are great that somebody nearby can relate to your plight. It just takes reaching out.

 

What makes the Elmhurst Counseling practice special? Families have many options. Why your team?

Steve: I am proud to anticipate our 40th year helping Elmhurst families when the calendar transitions from 2023 to 2024. We know the community and the community knows us. We have come a long way since 1984, and we have adapted effectively to the changes in the delivery of healthcare services. We are fortunate to have a deeply experienced interdisciplinary team of clinicians with open-minded diagnostic approaches to today’s family challenges.

Kerry: Elmhurst Counseling takes a wide-lens approach to therapeutic services that incorporates mind, body, and environment. We recognize that symptoms of our individual struggles can appear in both our psychology and physiology. The merging of these elements gets to the heart of the challenge, and ultimately, leads to the most effective path of treatment.

 

The choice to engage a therapist is a big decision. You are essentially inviting a professional into the delicate web of your family dynamics. Whether treating the child, the marriage, or the whole family unit, everyone in the system is impacted. In the end, our job is to put ourselves out of a job by equipping families to be their own therapists, so you no longer need us. Until then, we are humbled to be invited into your home.

About the Author

Steve Ritter, LCSW is the Founder and Executive Director of Elmhurst Counseling. He has served as a teacher, author, consultant, human resources director, health care administrator, and licensed clinical social worker since 1977. A fellow of the American College of Healthcare Executives, Steve has provided coaching, therapy and team development services to thriving schools, businesses and organizations.