How did you find a good child CBT therapist?

[sste]

So six year old DS speech improving steadily, wild improvements in OT/handwriting, visual perception issue substantial improvement and no signs of dyslexia (it is something about physically copying shapes that seems to have been very hard for DS) . . . however, he is becoming more anxious and volatile. A fair amount of anxiety about safety, dying, health and diet, making mistakes/failing (perfectionism). Also very rigid, never satisfied, always planning. Will pitch hysterical crying fits, genuinely heartbroken sobbing over seemingly minor issues that we would never have predicted -- who shuts the van door, who spoke first, whether a single sentence was uttered by someone during his science documentary!!

Anyway, DS is highly responsive to intervention and we want to find a good child CBT. We had two great leads but one has a 6-8 month wait list and the other had jacked up his rates to $250 per hour, no insurance taken which left a bad taste in my mouth and also would become expensive fast. My insurance network is ridiculously limited, esp for children and we have zero out of network coverage (though that will change next January).

How did you go about finding a child CBT? Did you pay out of pocket? Do public schools ever provide CBT as part of an IEP?

thanks in advance

[vludmilla]

Sste, Good news about all the progress your DS is making but I'm sorry to hear that he's showing some anxious symptoms.

I have a private practice as a cognitive behavioral therapist and I am a school psychologist. I do offer some CBT to students that I work with but I think this is fairly unusual. I happen to work in an extremely well-resourced school district that has 4 clinicians for 700 students so...I have the time to offer services that few school psychs can. Many school psychs would probably say that they don't even have the training to provide CBT.

I would be cautious about looking for a deal with a CBT therapist...too many therapists claim to do CBT when really they offer eclectic therapy or supportive, interpersonal psychotherapy with maybe a touch of CBT. If I was going to bring my DD to a therapist for CBT, I would pay for the expertise of a well-trained therapist who really does CBT day in, day out. A high quality CBT therapist with a specialization in children will likely be able to be effective with your son in a few months. Personally, I'd rather pay $1000 a month for 6 months and have really made some serious progress (and probably be able to discontinue the therapy) than pay some small copay but find that I didn't get anywhere in 6 months and, in fact, the behavior and distorted thinking was just more ingrained.

I'd look into if you can have HSA money deducted from your paycheck (pre-taxes) to pay for the therapy as this can effectively reduce the cost by about 20%, more or less, depending on your tax bracket.

As for usual costs...in the NY metro area, the really great, truly CBT therapists charge at least $200 an hour and don't accept insurance. It is not unusual at all to hear of $250 and $300 an hour (and the hour is really 45 minutes).
In any case, you can check out the ABCT website for referrals (Association of Behavioral and Cognitive Therapies- THE organization for any CBT therapist).

I am a member of the ABCT listserv and if you want to PM me your location, I'll post on the listserv looking for referrals for high quality CBT therapists for young children.

Good luck.

[sste]

Vludmilla, thank you!! I am going to PM you.

I am in a metro area but a significantly less expensive on than NY area. I am pretty sure here child CBT ranges from 140-180 for highly specialized practitioners (the fairly famous one I am waitlisted for that does alot of speaking, tv, writing, etc is 180 per hour for example). If I have to pay $250 I will but I want to explore all other options first! Part of our issue is that DH has had some very unexpected, rapid, and specialized psych. issues develop this year and our OOP for his specialized care and then the subsequent couples counseling we have needed as a result of his issues is around 800-1k per month. So to pay for DS OOP too would bring us to almost 2k per month!!! On top of the 1k per month we pay for our insurance which doesn't cover very much mental health wise.

I asked him point blank what about his experience, technique etc was the reasoning behind his 40-50% above market average rates and he mumbled that he was aware he was charging that much more and then something about having alot of experience. Anyway, DS is pretty mild and if at all possible I would rather save the massive outflows of money for when/if he develops more intractable issues.
Thanks again.

[sste]

deleted . . .mis-post

[egoldber]

I would agree that that is too high. Around here, almost no mental health practitioners take insurance and most charge in the range of $130-$160 per 50 minute therapy session.

Personally, I think it is more important to find a therapist that will really get your kid and click with them than someone who has the most documented expertise. And I know you weren't saying that.

I honestly did not look very hard, so maybe we got lucky. I went to a very well known private therapy group that offered a variety of treatments (individual therapy, group therapy, social skills groups, neuropsychological and educational testing, etc.) and talked to a therapist there. I liked her credentials (well known school for her degree and fellowship at a large well-known children's anxiety clinic) and her description. We talked on the phone for awhile and I liked how she said she approached things. Fortunately for us, she and older DD really clicked.

The other thing I like is I don't feel like she wants us to just keep coming and coming when there isn't something specific to work on. When DD was younger they worked on CBT for awhile. After she felt like DD had learned a lot from that, she recommended a group situation that she thought would address other needs. We have seen her on an ad hoc basis after that to address specific issues as they arose. This year DD is struggling more with depression and self esteem issues vs. anxiety, so they have moved to a more processing type therapy.

She also was a school psychologist in our district, so she knows the school system, went with us to an IEP meeting recently and is able to give specific recommendations based on what she KNOWS the district is able and willing to offer students.

So it has actually been a very good fit for us that the therapist is able to offer a variety of modalities depending on what the current needs are.

[Indianamom2]

This is probably not what you want to hear, but in our case, we never did find one. We searched, we were willing to travel a little (it had to be within reason) and we did our research. But even other doctors and specialists that we had been consulting with told us that it was virtually impossible in our area. There is just an unbelievable shortage of good child therapists period, much less those who specialize in CBT. And just as vludmilla said, some will say they do CBT, but they don't, at least not the way I understand it to be practiced. So, I guess if you have found one that comes highly recommended and is truly a specialist, it might be worth the cost. I hope you have success because I know how difficult this can be.

[sste]

Thank you everyone! Vludmilla I think my pm box was full but I have now cleared it out -- I got a message your pm couldn't go through. If it is not too much trouble, could you resend. And thank you!!

Egoldberg, what a wonderful therapist find! That is what we need exactly. What I have been leery of is that many therapists list "CBT" but when you talk to them many of them have done a weekend workshop or less and really are not CBT proficient or oriented. A few of our friends locally are psychologists and I think they have gone to the other extreme and given us the most stellar and famous names -- who are unfortunately not accepting patients or crazy expensive! Indianamom, I am so sorry your search didn't yield a therapist -- not that it helps but I think this problem will be solved in the next ten years. My understanding is that most psychologists/social workers currently in training are being well and thoroughly trained in CBT at most programs. Older clinicians are less likely to have that training -- they would have needed to acquire it independently. One friend suggested to us that we consider newly graduated therapists and post-docs as opposed to the more experienced clinicians on that basis.

[sste]

Semi-Update should this be helpful to anyone! I think I may have found someone covered by my insurance -- at a teaching hospital pediatric dev. center. We actually saw her a few years ago for some behavioral issues with DS and when I called her to get referrals she gave me some names but also said that a significant part of her practice is anxiety CBT. She usually starts with the "Coping Cats" program. Is anyone familiar with this or have any views on it?

Also, in case this helpful to anyone, in my talks with multiple CBT therapists, this is what I was told about anxiety/cbt -- bearing in mind that they are of course selling a service!
** Apparently, the most recent research really cuts against wait and see. A very well-regarded therapist told me that if there is a family history of anxiety disorder she recs treatment at the earliest signs of life-impairing anxiety (that is not your typical kid afraid of the dark for a period of time)

**This is interesting to me because I have long thought this would happen -- the child anxiety field is moving to an "early intervention" model. One therapist I talked to met with children as young as three, of course for short mini-sessions and using an age-appropriate response. I was concerned age 6 was too early but what I heard from multiple therapists was to try to start therapy very soon, before things get too ingrained and also before school stress ratchets up with first grade.

**Apparently a lot of evidence that the treatment is effective. I am blanking on exact numbers but apparently kids who rec'd CBT anxiety treatment were 30% or 40% less likely to meet the criteria for anxiety disorder in adulthood.

Now if we can only get more practitioners!! Best of luck to everyone who has struggled/is struggling to find a CBT child therapist.

[Kindra178]

Semi-Update should this be helpful to anyone! I think I may have found someone covered by my insurance -- at a teaching hospital pediatric dev. center. We actually saw her a few years ago for some behavioral issues with DS and when I called her to get referrals she gave me some names but also said that a significant part of her practice is anxiety CBT. She usually starts with the "Coping Cats" program. Is anyone familiar with this or have any views on it?

Also, in case this helpful to anyone, in my talks with multiple CBT therapists, this is what I was told about anxiety/cbt -- bearing in mind that they are of course selling a service!
** Apparently, the most recent research really cuts against wait and see. A very well-regarded therapist told me that if there is a family history of anxiety disorder she recs treatment at the earliest signs of life-impairing anxiety (that is not your typical kid afraid of the dark for a period of time)

**This is interesting to me because I have long thought this would happen -- the child anxiety field is moving to an "early intervention" model. One therapist I talked to met with children as young as three, of course for short mini-sessions and using an age-appropriate response. I was concerned age 6 was too early but what I heard from multiple therapists was to try to start therapy very soon, before things get too ingrained and also before school stress ratchets up with first grade.

**Apparently a lot of evidence that the treatment is effective. I am blanking on exact numbers but apparently kids who rec'd CBT anxiety treatment were 30% or 40% less likely to meet the criteria for anxiety disorder in adulthood.

Now if we can only get more practitioners!! Best of luck to everyone who has struggled/is struggling to find a CBT child therapist.

SSTE, I know a great one here. Do you want me to ask if she recs anyone closer to you?

[sste]

That would be great but don't go to any special trouble, only if you are seeing her anyway. We are waiting to see if our insurance covers the place we just went to this week (went well!) but if not we are back to the drawing board . . .

Thank you!!