Principles of Treatment Planning

Clinical Description

When parents or guardians bring their child for evaluation by a mental health professional (especially a physician) they may be riddled with guilt, fearful of the diagnosis, and anxious about the potential of being blamed for the child’s difficulties. They may see their child’s failings as evidence of their inadequacy as parents.

The reason and source of referral for a child or adolescent receiving a psychiatric evaluation is essential to determine. Ask why the family is coming now. Begin the evaluation with as much clarity as possible about the process—first the evaluation, and then the feedback and recommendations for treatment. Treatment of psychiatric disorders tends to be shrouded in mystery and ambiguity for many people. Parents may fear the use of medication. They may be concerned about stigma. Clarify these issues early and often.

The feedback about evaluation findings should begin a dialogue about the child’s strengths, weaknesses, diagnosis, and target symptoms.

Key Point

Clarify the nature of confidentiality of treatment with the child and the family. In general, the younger the child the more that is shared about the general progress of treatment. It is important that the parents have a clear understanding of the treatment goals and methods, such that they understand the process of psychotherapy and pharmacotherapy. There can be confidentiality as to the content of the therapy unless there is a potential that the child is self-destructive or destructive to others. Suicidality, antisocial behaviors, sexual promiscuity, and substance use are issues that do not have confidentiality if the child is at serious risk of harm. Usually it is reassuring to the child and promotes a sense of safety when the limits of confidentiality are elaborated.

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