Reasons for in-person therapy for children

[How to communicate after a contentious divorce...]

Hello again.

My fiancé is asking the court for mental health custody because her xBPDh continues to block her attempt to have the children see a therapist.  During mediation, her ex agreed to therapy, however, when she had her lawyer send a name of the desired therapist, he stated he wanted to use a therapist under their health insurance plan to minimize cost.  Unfortunately, the therapists covered by insurance are video/phone only.  No in person therapy at this time.  My fiancé and I feel in-person therapy is necessary for her children, so we will be going back to her ex stating we will pay all costs for both children so they can have in-person therapy sessions.

In order to prepare for court, my GF must answer why in-person therapy is preferred.  The children are ages 11 (Boy) and 8 (girl).

The son is slightly on the autistic spectrum and the daughter is an extreme attention getter and has trouble with anger management.  We'd also like to get her into play therapy. 

I'd appreciate any help from the forum on generating reasons why in-person therapy is better for the children.  Thank you.  CoMo

[CoherentMoose]

Hello again.

My fiancé is asking the court for mental health custody because her xBPDh continues to block her attempt to have the children see a therapist.  During mediation, her ex agreed to therapy, however, when she had her lawyer send a name of the desired therapist, he stated he wanted to use a therapist under their health insurance plan to minimize cost.  Unfortunately, the therapists covered by insurance are video/phone only.  No in person therapy at this time.  My fiancé and I feel in-person therapy is necessary for her children, so we will be going back to her ex stating we will pay all costs for both children so they can have in-person therapy sessions.

In order to prepare for court, my GF must answer why in-person therapy is preferred.  The children are ages 11 (Boy) and 8 (girl).

The son is slightly on the autistic spectrum and the daughter is an extreme attention getter and has trouble with anger management.  We'd also like to get her into play therapy. 

I'd appreciate any help from the forum on generating reasons why in-person therapy is better for the children.  Thank you.  CoMo

[Turkish]

Your kids sound like mine, 11 (ASD), and 9 (a Spitfire).

Is the boy officially diagnosed? That could help as a justification or reason. Also, do the kids desire in-person therapy? D9 didn't want to participate on a video call at all (I dragged her out of her room carrying her but she didn't face the camera), but kind of had no choice and opened up when we saw her T in person. Given virus restrictions (T only on-site 1x per week) it will be 3 weeks between in person appointments, but that's what D9 wanted.

[CoherentMoose]

Turkish,
No, the boy is not diagnosed.  His father is adamantly against his son being diagnosed and "labeled".  Several teachers have recommended that he be tested, but he's refused.  In our state, both parents have to agree to therapy or counseling.  My fiancé has been trying to get the children into therapy for over a year to deal with their divorce and issues with Covid and video school and he continues to block every attempt stating it's her parenting causing the issues and he doesn't have any issues with the children at his house. 

We've not discussed therapy with the children yet; however, their dad discussed it with them just last week when he had them so they are aware.  We were waiting until the legal process played out. 

The daughter would love in-person therapy.  "Spitfire" is a good description for her.  She would love the drama and attention.  The son will not be so inclined and will likely clam up for the first few sessions.  Hopefully, the therapist can draw him out.  He's actually a pretty thoughtful child when he's not so guarded or anxious.   

We verified the therapist we've selected will take in-person sessions tonight and even has sessions evenings and on the weekend so that works very well for us.  Also, she used to be an elementary teacher so that helps in my opinion. 

So far, we've come up the following as pluses for in-person:
  1.  Much better privacy for the children
  2.  Therapist can better observe body language, tone of voice, facial expressions, stress, anxiety..etc
  3.   More personal environment

What else?

CoMo

[Turkish]

Video might be better than nothing if the mom agrees to it rather than nothing. It's a start, yes? A partial win might be better than nothing.  Otherwise, it's an "all or nothing fight" in court.

If it were me, I'd think, "what's the downside or best side? Kids in therapy by remote or not at all?"

Remote, if agreed to, would be a start and beneficial more than not.  Win by losing. Things can change, and son might change.

[NotAHero]

 For a BPD and with the limited information presented it sounds like the dad is trying to be reasonable. He is not completely off.

 I think some show of good intentions might help. I agree with Turkish, start with remote therapy. As for the labeling, diagnosis should not be sought in the first place a trained therapist will eventually propose what they believe and second opinions can confirm or deny. Either way the dad opinion will not overrule the process.

 

[kells76]

Perhaps she can agree that it is completely fine for Dad to do video sessions on his time, she fully supports that. And, on her time, she will do whatever format she sees as best. The kids will probably do fine switching between video and in-person. If Dad objects to that, then he's really just trying to micromanage Mom's parenting. Mom can show that she supports Dad's preference of video sessions... on Dad's time.

In order to prepare for court, my GF must answer why in-person therapy is preferred.

So why isn't the onus on Dad to be required to answer why in-person is NOT preferred?

[CoherentMoose]

Thank y'all for taking the time and responding.

The xBPDh reluctantly agreed to therapy in the mediation session at the last second; however, when presented with a request to use the therapist my GF selected, her xBPDh stated he wanted to use a therapist provided by their company health care insurance due to cost issues. 

My GF researched therapists through her insurance (they both work for the same company) where she found they are video only.  We are going back to the xBPDh stating we will pay for the in-person therapy and informing him we will only schedule appointments when we have the children. 

If that attempt fails (likely...) to allow therapy, we will then fall back to attempting to get him to sign the insurance paperwork to allow video only therapy. 

We're taking a slow, deliberate step-by-step process collecting data to show how he's preventing the children from any mental health therapy or counseling.  Last year my GF made 10 attempts to put the children into therapy or school counseling where he either refused in writing, verbally, or ignored the requests.  Court is scheduled for Mid-November. 

We're also finding additional therapists that conduct in-person therapy so her lawyer can present three to pick from to her xBPDh. 

We feel strongly in-person therapy is warranted due to the age and personalities of the children, and the behaviors we are witnessing when the children are in our house.  I lurk on this web site quite a bit and I've read the many stories where a good therapist has made a significant difference for the children. 

We will, of course, accept any therapy we can get, but feel strongly enough about the issue to take it to the court for a decision.  We will be going to court for other issues, but therapy (by far) is the biggest rock.  Which is the reason for this thread.  What are the advantages to in-person therapy (if any) over video therapy for young children.  Thanks.  CoMo

[kells76]

I would suspect that play therapy (which could be appropriate for either of the kids, given the ages) would be incredibly difficult over video, as the practitioner needs to see what the kids are doing with toys/objects. If you can find a professional to attest to that, or perhaps an article on psychologytoday.com (for example), that could help.

If cost is the "reason" that Dad gives for wanting video, then yes, offer to pay 100%. If he still balks, then you'll know that the "issue" isn't really the issue, and it's more to document.

[kells76]

This could help:

https://www.psychologytoday.com/us/therapy-types/play-therapy


"Although sometimes used with adults, play therapy is a psychotherapeutic approach primarily used to help children ages 3 to 12 explore their lives and freely express repressed thoughts and emotions through play. Therapeutic play normally takes place in a safe, comfortable playroom, where very few rules or limits are imposed on the child, encouraging free expression and allowing the therapist to observe the child’s choices, decisions, and play style."

PT needs to take place in a specific location under direct observation of the practitioner.

"What to Expect
The parent or caregiver plays an important role in play therapy for children. After conducting an initial intake interview with the parent, when the therapist collects information about the child, and, often, a separate interview with the child, the therapist can make an assessment prior to beginning treatment. An assessment allows the therapist to decide the best treatment approach for the child. In the playroom, the child is encouraged to play with very specific types of toys that encourage self-expression and facilitate the learning of positive behaviors. Arts and crafts, music, dancing, storytelling, and other tools may also be incorporated into play therapy. Play therapy usually occurs in weekly sessions for an average of 20 sessions lasting 30 to 45 minutes each."

So there are specific materials required for play therapy (location and toys) that I suspect neither parent has at home.

[ForeverDad]

kells76 expressed my inclinations as well, that play therapy is impractical over screens and in-person is better overall.  If her ex's claimed reason (excuse?) is for insurance coverage, possibly only lowering the cost to a contracted copay, then the offer to cover the expense of in-person counseling ought to be appreciated in court.

My lawyer told me, courts love counseling.

In addition, most insurances through work reset annually, hard to predict when insurance polices or contracts with professionals might change.

[PeteWitsend]

...

 I think some show of good intentions might help. I agree with Turkish, start with remote therapy. As for the labeling, diagnosis should not be sought in the first place a trained therapist will eventually propose what they believe and second opinions can confirm or deny. Either way the dad opinion will not overrule the process.

 

I think you need more rights buttoned up on this earlier than later. 

Don't expect a pwBPD to acknowledge good intentions from their ex- and become open to agreeing to something else, or more cooperative after the divorce decree is in place.  He may realize at some point that forcing remote therapy, or no therapy, or keeping control over the kids' therapist is the only "leverage" he has left to interfere with his ex's life, and refuse all attempts to co-parent on behalf of the kids' interests.

It may make more sense to concede something meaningless to him in exchange for him agreeing to back off on the therapy issue, like "okay, you can have an extra half-hour on holidays," or something like that, so he feels like he "won" and can walk away from the issue. 

[PeteWitsend]

in my own case, when my BPDxw started saying she wanted to enroll our daughter in T to help her cope with our divorce, I was concerned she was planning to "forum shop" and keep changing T's until she found one that would go along with her blame-games and other nasty behavior.

My attorney had a child psychologist he knew vet three good ones, and from those we let my XW pick.  She couldn't say no to that, since we left the choice up to her, but it limited her ability to do whatever she wanted.  I could tell she was angry with it, but couldn't back out of claiming our child needed T, after making such a big deal about it.

We had some issues come up more recently where my XW tried to change our D's therapist (predictably), and the court wasn't having it.  Establishing a rapport with a T is key to successful therapy, and I was able to insist that after several years, our D should keep seeing him.  

[ForeverDad]

It appears this is the status currently.

(GF's Ex) ... Finally agreed to counseling but wants it only with counselors covered by work insurance.
   (1) probably on a contracted co-pay basis
   (2) counselors may be added or dropped as work insurance contracts
         may change annually

(GF) ... Asks for in-person counseling.
   (1) offered to pay full cost of in-person counseling

My thoughts... there is no need to settle and limit oneself to ex's stand.  Both parents have already agreed to counseling.  (Though it's possible her ex may try to withdraw that later?)  It's only a matter of reduced cost within insurance framework versus full price (or cash price) paid by the willing side.

Also, at some point in the future, precisely when is unknown at this time, the providers under insurance may open up to in-person visits.

I guess the big question is whether GF is willing to take it to court for a decision (with counseling already agreed to, just the manner in dispute).  The downside is the extra cost and it may take time to get a court decision.

If GF does decide to proceed to court, she may want to consider seeking medical or mental health "decision making" or "tie breaker" status, to reduce the risk of another stand-off like this happening again.

[CoherentMoose]

Hello all.  Thank you all once again for your time and advice.

As expected, her xBPDh said no to in-person therapy even if we pay for it.  Stated "if Kaiser doesn't offer in-person therapy, it must not be any good".  Another data point for court which is in November.  We are standing firm on asking for in-person therapy. 


Hope all is well with you and yours in these crazy times.

CoMo

[Turkish]

I am in the Bay Area. Kaiser offers in person therapy. It's limited because of covid.  D9 asked for it and got it. In person.

[CoherentMoose]

Copy Turkish.  Will research further.  We're in Southern CA.  CoMo

[kells76]

Stated "if Kaiser doesn't offer in-person therapy, it must not be any good".

Just because a pwBPD says something doesn't mean it's true. Would strongly suspect that he didn't actually do any real research.

I wonder if there's a way to put him on the back foot -- the vibe I'm getting from the interactions is that Ex makes some statement, and GF feels obligated, like the burden is on her, to prove why it isn't true, and why her way is good for the kids. How can that get switched around to put the work on Ex -- put the onus on him to prove why his proposal, which is actually way outside the norm, is better for the kids. Some mindset like "it's so obvious that what I am proposing is normal and accepted, that I have absolutely nothing to justify. In fact, the burden is on you, ex, to justify why your out-of-the-norm proposal should even be considered".

He's trying to play it like "remote video therapy for minors is the norm, and in person sucks and is not usual". How crazy is that!

I know I'm not offering any specifics, but I'm hoping you guys can do a mindset/stance shift, so that instead of treating his proposals as "just another normal proposal to consider, equal with our proposal", there can be a mindset of "I am strong in the knowledge that our proposal is completely acceptable, and it's not my job to justify why it is, it's YOUR job to justify your outside the pale proposal".

It's really subtle and I think a really common posture we have when interacting with pwBPD -- this sense that we should treat their statements as "gospel" or "normal things normal people say" or "I should be fair and consider it as equal with my proposal" etc. I think it takes time and inner strength/inner confidence to "have the vibes" or "project the aura" or whatever that you KNOW right away that you are actually correct, no matter how convincing the pwBPD is and for how many years you sort of believed them.

Of course, you are you and it's your GF making these legal decisions, having to interact with her kids' dad. I get it, I'm the stepmom, and it has been a hard journey to watch DH go from treating everything his kids' mom says as "must be true, she sounds like she knows what she's talking about" to "just because words come out of her mouth doesn't make it anywhere close to sane". He and I did have a "come to Jesus" talk after SD15 told us "Mom doesn't want us to go on the international trip with you". DH was all wound up, trying to figure out if he should email Mom, convince her that his plan was OK and safe, etc etc etc. I had to be super direct -- "When has appeasing her EVER made things better? She says this crazy stuff because that's how she processes her emotions. Don't engage with it, it isn't "real" ".

Engaging with the stuff the kids' dad says "as if it is real" is a recipe for disaster. I wonder if saying  "if Kaiser doesn't offer in-person therapy, it must not be any good" has NOTHING to do with reality and a LOT to do with defending a brittle sense of self. It's a real mind trip, but amazingly freeing, to stop interacting with statements from the disordered parent as if they are factual statements, and to start interacting with the statements (or, mostly, declining to respond) as if they are emotional pressure releases. Otherwise we get roped into the JADE-ing rabbit hole, where no amount of factual evidence will ever convince the pwBPD that they are 1000% wrong and you are correct. You could probably literally show him the web site saying "Kaiser is pleased to offer full in-person therapy for children 3-18 in Our Town, Our State" and he'd be like "that's not what it really means" or "I always wanted in person, I can't believe you obstructed me" or whatever weasel words it takes to preserve his fragile sense of self.

...

Anyway, wow! Guess I had some thoughts

Always a good idea for legal purposes to get the hard data. Glad you are following up on Kaiser's offerings -- do pursue that route. And keep in mind -- as a general, long term project -- how can you guys reposition your stance to be less defensive/reactive and more neutral-to-offensive/proactive.

kells76

[Turkish]

Just because a pwBPD says something doesn't mean it's true. Would strongly suspect that he didn't actually do any real research.

...

I had to be super direct -- "When has appeasing her EVER made things better? She says this crazy stuff because that's how she processes her emotions. Don't engage with it, it isn't "real" ".

Engaging with the stuff the kids' dad says "as if it is real" is a recipe for disaster. I wonder if saying  "if Kaiser doesn't offer in-person therapy, it must not be any good" has NOTHING to do with reality and a LOT to do with defending a brittle sense of self. It's a real mind trip, but amazingly freeing, to stop interacting with statements from the disordered parent as if they are factual statements, and to start interacting with the statements (or, mostly, declining to respond) as if they are emotional pressure releases.

This is a great way to summarize one of the site memes: validate the valid; don't validate the invalid.

It also helps to remember not to respond when feelings are portrayed as facts, throwing in validation as appropriate. I sometimes forget all of this and get mad over the odd "emotional releases" when it would be better to say to myself, "there she goes again!"    And remember "that's how she processes her emotions."

[CoherentMoose]

Thank you all again.  This is an amazing resource.  I appreciate you making some time to help.

Don't expect a pwBPD to acknowledge good intentions from their ex- and become open to agreeing to something else, or more cooperative after the divorce decree is in place. 
 
Pete, so true.  In our case, it doesn't matter whatever is suggested by my Fiancé, he disagrees and fights it.  She could say the sky is blue and it would start an argument.  We are going down the path of finding three therapists so he can pick in preparation for the court hearing.  Plus, we're going back to Kaiser to see when they will start in-person therapy.  We have a lot of evidence we've tried to get the children into therapy since the divorce.  We're up to 15 attempts where he's denied his permission so we're hopeful it will be evident to the judge who is the roadblock at getting these children help.

My thoughts... there is no need to settle and limit oneself to ex's stand.  Both parents have already agreed to counseling.  (Though it's possible her ex may try to withdraw that later?)

FD, it's my opinion your final sentence is a given.  He plays nice when in public, but the minute he's off the stage it's either radio silence or a no.  He's trying to string this out as long as possible, but we have a good lawyer and my GF is mad enough to keep pressing through to the end and let a judge decide.  His response to our Request for Order did not address any of our topics (other than no) and he added back in all of his topics like three two-week vacations, passports, and unlimited calls from him to the children when we have them.  The mediator slapped all of them down, but he's pressing on to see if the judge will be more accommodating to his requests. 

I guess the big question is whether GF is willing to take it to court for a decision (with counseling already agreed to, just the manner in dispute).  The downside is the extra cost and it may take time to get a court decision.

If GF does decide to proceed to court, she may want to consider seeking medical or mental health "decision making" or "tie breaker" status, to reduce the risk of another stand-off like this happening again.

The answer to your first question is yes, we're pressing to court.  Especially after his saying no after we offered to pay.  Obviously, it's not about the money.  It's about control.  And I think fear on his part too.  He's already starting in on the children attempting to coach them on what to say and not say.  Also, I've encourage my GF to ask for Mental Health Custody (tie breaker status here).  The good news for us is we are much better off financially than he is.  I guess he's willing to break the bank in order not to give my GF any win of any kind.  A sad observation, but reality.  We'll get the children into therapy eventually.

Kells, FD;
My GF is starting to understand her ex better.  She laughed at his "it must not be any good" statement.  He had a point about cost, but once we offered to pay, he lost that argument and fell back on that.  She still tries to be reasonable with him, and I finally had to ask her how that was working out for her.  He will never agree to anything she asks.  It's his nature to control everything, and the fact she left is the ultimate insult to him.  He's demonstrated several times he will use the children to get his way or in an attempt to hurt her.  Our only recourse is to get the children into therapy in an attempt to get him to stop using the children and to get them the help they need.  Maybe he stops using the children knowing they have a third party to talk too.  I doubt it, but at least we can start building a case to restrict his access to the children if he's unable to mitigate his behavior.  We'll see.  It's a long game and the first step is to get the children into therapy because they need it.  CoMo