Dr. Diane M. Agresta, Psy.D.

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PSYCHOTHERAPY

| Evaluation | Adults | College Students | Young Adults | Toddlers | Preschoolers | School Age Children |

| Families | Couples | Parenting | Trauma | Common Questions About Child Therapy |

 

The goal of psychotherapy is to improve mental health. Treatment is based on recommendations resulting from evaluating the particular problems you are experiencing. There are many different psychotherapy methods which may be used to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit. It requires active effort on your part. In order for the therapy to be successful, you will need to work on things we discuss both during and outside of sessions. Since psychotherapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable emotions. However, the work has many benefits. Psychotherapy can lead to better relationships, provide solutions to problems and significantly reduce distress.

 

During the first several sessions, while we are working we will both be conducting a mutual evaluation of your problem. After this period, we will discuss the evaluation and your comfort level and agreement with the treatment plan. As part of the evaluation, the possible need to be seen by other professionals will be considered.

 

The duration of treatment, method, and techniques used to help you will vary with the problems and issues you bring in as well as your stated desires and needs. You will be asked about these things and a treatment plan will be developed based on your input.

 

 Evaluation

An evaluation of your difficulties is always done in the first session. In some cases, it may take several sessions, as described in the Psychotherapy section.

    

Evaluations using psychological testing may also be done by your request or because it is the best way to assess your situation. These may include intellectual and emotional testing. If you have an academic, work, or medical need, a report of this testing can be sent to other professionals. These reports are individually written to protect your privacy and to provide only the information that is needed to other people.

 

Sometimes physical problems can masquerade as psychological difficulties. If there is any sense this might be the case, it will be recommended to you that you make an appointment with a physician, neuropsychologist or other medical professional. TOP

 

Adults

It is easy in today's world to become stressed, anxious and even depressed. Coping strategies that have always worked in the past can fail you, or new challenges can occur that don't have obvious answers. Whether you wish to change something about yourself, work on emotional issues that are recent or long term, learn new strategies, perspectives or skills; consulting with a psychologist is a helpful way to begin. TOP

 

College Students

The anxiety of succeeding in college, living on your own, taking on greater responsibilities, socializing and setting life goals can be overwhelming. At times, students are only aware that they are unhappy, confused or depressed. Having someone to help you sort through the confusion and find confidence in yourself and your own direction can be very helpful. TOP

 

Young Adults

The first years of adulthood present many challenges. You can't always anticipate the problems. Unexpected things can happen. Life may feel overwhelming as you try to navigate the first years of work and independent living. Parents give advice and support, but sometimes aren't the right people to ask about private feelings, depression or personal problems. A therapist can help you, whether it is to understand your feelings, define your goals or help you to find the path that is right for you. TOP

 

ADOLESCENTS

The teen years, from middle school through high school, are a time of great change. Although we don't often think about it, these are the years when our children learn to be adults. It is a complicated time when emotions run high and the gaps between their growing sophistication and their inexperience can be confusing and frustrating to both adolescents and their parents. Moodiness, academic problems, or trouble getting along with peers or adults are reasons to consult with a psychologist. TOP

 

TODDLERS

The first two to three years of life set the stage for the future. During these early years, a child learns self-regulation and the sense of safety and stability which are the basis for confidence and success. It is important to know not only what is normal developmental behavior at this age, but how to handle behaviors so that they do not become future problems.

 

Toddlers who are in stressful situations or experience trauma will react with emotional and behavioral changes. Some will adapt after a short period of time. If your toddler doesn't, child therapy can help them to move beyond those events and be a happy youngster again. TOP

 

PRESCHOOLERS

The years between three and five are important for consolidating, practicing and expanding the young child's world. Your child should be doing more, becoming more competent daily, and having ever greater understanding of his world. The issues which might bring you and your preschool child to a child psychologist are the same as those for a toddler (SEE TODDLER). TOP

 

SCHOOL AGE CHILDREN

By the time your child is in school, they should be able to follow rules and directions from adults other than their parents, enjoy learning, have friends, and generally be happy and content with their lives. Unhappiness in school, difficulties with peers or adults, or behavior problems should trigger a call to a child psychologist.

 

Children have all the emotions an adult has, but they often lack the experience to identify what they are feeling or how to handle it. A child psychologist can help both your child and yourself understand what is going on and how to resolve it. TOP

 

PARENTING

In any situation where a child is encountering difficulties or a parent has concerns, a consultation can be a useful way to describe the problem and find effective ways to parent. A parent consultation can cover any concerns that you wish to discuss.

 

When a child is being seen individually by a psychologist, parents are seen as well to help them understand what is happening to their child and answer questions about responding to problem behaviors, changes that occur during the course of treatment, or any other parenting concern you may have. TOP

 

FAMILIES

Sometimes, as we go through the routines of accomplishing everyday tasks, things go wrong between family members. Miscommunication, frustration and bad feelings can effect everyone in the family. It's easy to become stuck in ruts and be unable to see a way to change things for the better. Family therapy is a way to set up rules, boundaries and workable ways to communicate between everyone. TOP

 

COUPLES

An intimate relationship with another adult requires ongoing effort; sometimes minimal, sometimes much more. The balance between giving and receiving, understanding and being understood, is an ongoing adjustment. Couples become quagmired, or reach points in their lives that are more difficult and challenging than they had expected. Consulting with a psychologist can help overcome problems by offering a new perspective and skills to maintain and enhance your relationship.

 

If you find that your significant other is not willing to come for couples therapy, take the advice given so often by Dear Abby and come yourself. If one person in any group changes, it often results in changes in the other members of the group. TOP

 

TRAUMA

Whenever a person of any age experiences a trauma, it effects them dramatically. The support and comfort of family and friends is always helpful. However, if a person continues to have symptoms a psychotherapist can often help them relieve distress and move past the event.

 

Dissociation is a particular kind of reaction to trauma or abuse. The person feels detached, removed or may even lose time. Dr. Agresta works with people who have experienced traumas in their lives, as well as people who experience dissociation. TOP

 

Common Questions About Child Therapy

 

What Is Child Therapy?

When adults have emotional problems or are worried or anxious, they see a therapist to talk about their problems and resolve them. Children and younger adolescent often do not have the vocabulary to talk about their difficulties, so they are usually seen in a playroom where they can show their problems to the therapist. TOP

 

When Does A Child Need Therapy?

All children exhibit troublesome behavior once in a while. Seek help when a child keeps doing the same thing over a long period of time or the behavior appears very suddenly. Generally, consult with the pediatrician first to make sure there isn’t a physical problem causing the behavior. TOP

 

What Will My Child Be Allowed To Do In Therapy?

During their session every thought and action of the child is accepted with the exception of hurting themselves, the therapist or destroying property. Thus, there is more freedom in therapy than in other areas of your child’s life. This acceptance allows the child to trust the therapist enough to reveal fears and problems that are bottled up inside. There is no such thing as bad behavior in therapy. Instead, the therapist uses your child’s behavior to help them resolve problems. TOP

 

Won’t My Child Expect That Much Freedom Everywhere?

No. Even very young children quickly learn that there are different rules in different places. They know the limits that you expect, and even though all children test limits occasionally, they will not expect what the therapist allows to become the normal way of living. If your child does happen to test limits by saying they can do something in therapy, simply remind them that the rules are different at home. TOP

 

What About Home and School?

It is helpful to the therapist to know of recent events in the child’s life, especially those to which they have reacted strongly. Please do not ask the child to report these events. Asking them “to be sure and tell their therapist…..” may seem like punishment. It is better if you call before the child comes to therapy and let the therapist know what you are seeing. Occasionally, you may wish to understandingly suggest “This is something you might want to work on in therapy.”

 

Sometimes it can be useful for the therapist to speak to your child’s teacher. The therapist will speak to both you and your child to get your permission before doing this. Some parents feel that the therapist is not trusting them to report accurately. This is not the case. Rather, the therapist can often gain a better understanding of the school difficulties and help the teacher effectively handle them in the school setting; much like parent sessions that you will have to discuss progress and difficulties at home. TOP

 

Could My Child Become Worse After Therapy?

Childhood is a time of change. As children go through developmental stages, some are pleasant and some are trying. Children with problems often become stuck in immature stages of development. Once they begin therapy and find relief from their problems, they will begin to go through normal stages of development – sometimes quite rapidly, until they catch up to where they should be. This means that temporarily a child’s behavior might appear worse. This is a sign of progress. Be thankful for it even though it is uncomfortable. The therapist can discuss how to handle these times with you and refer you to books on normal childhood stages of development if you have further questions.

 

There are other possible reasons for behavior changes. One reason might be that the child is struggling with some new situation in their life. On occasion, children come to a critical point in therapy where they are struggling with new ideas about themselves. Children react differently about accepting themselves. Some are relieved, some excited and others ill at ease. Some children spend time daydreaming for a few weeks. Temporary changed in behavior are common at this time. Your child may have trouble sleeping, be irritable, be giddy or find it hard to calm down. Being patient and aware, and giving them some space for a while will probably help them the most at this time. Please let the therapist know about any rapid behavior changes. TOP

 

How Will I Know What My Child Does In Therapy?

You won’t. Therapy is successful mainly because the child learns to trust the therapist never to reveal what they say and do in therapy. Parents want to know if they are doing something wrong and wonder if they need to change their approach to the child. This is generally not determined from the session, but by working separately with the parents. Whether a child’s problems stem from real or imagined sources does not need to be determined for therapy to be effective. Instead, sessions with parents are suited to discussing any parenting changes they may wish to make. TOP

 

Am I To Blame For My Child’s Problems?

Most people feel guilty if something goes wrong in their lives, especially with their children. One of the nice things about child therapy is that blame is not placed on anyone. The child simply learns to cope with feelings and problems. The therapist does not judge their beginnings. If you would like to learn new ways of handling children, the therapist can discuss how new parenting ideas might effect your child or offer suggestions of things you might try. TOP

 

How Should My Child Dress For Therapy?

Your child should wear casual clothing to therapy. Remember, there are fewer limits, they may spill paint, sand or water on themselves. These things are hard for some parents to accept, but they are a necessary part of therapy. Try to set aside easily washable clothes for therapy days. Most therapists try to use water soluble play materials that will come out in the wash or with the help of a stain stick. Try to accept the occasional spill calmly. TOP

 

How Do I Talk To My Child About Therapy After Sessions?

Even though it is held in a playroom, children are doing the hardest work in the world – looking at oneself and at painful feelings deep inside. While it is appropriate for you to say “You must be tired after working hard for an hour”, avoid asking your child questions about the session. It is fine if the child volunteers to discuss what has just happened. Some children are so excited about discoveries they have made about themselves that they want to share them with you. However, everyone is different. Some children want to be very quiet after a session so they can keep thinking about what just happened. Others will go about their lives as though the session had not occurred. Regardless of their response after therapy, all children plan for the next session. Please try to cooperate if they need time alone to think a day or two before the next session. TOP

 

Why Does My Child Need To Come At Least Once A Week?

Sometimes parents wonder why they can’t just make an appointment for therapy when their child is demonstrating problems, and not come when he is doing fine. Unfortunately, even though you may see improvement or the disappearance of the problem that brought your child to therapy, they still need to come for awhile to become comfortable with the changes they have made and to work our solutions to any unexpected feelings or problems they may have after they change. This is a good thing. It insures that your child will maintain the gains they make in therapy and teaches them to handle future problems. The fact that children do plan ahead for the next visit makes it necessary that they know that every Tuesday at 2, for example, is their time and that they can count on it. Changes in schedule should be made as seldom as possible. If changes do occur, make sure to tell your child as soon as possible. TOP

 

How Do We Know When Our Child Is Ready To Stop Coming?

It is clear to the therapist when the child is no longer using the time. In other words, when they are merely playing with toys instead of working on problems. There are two reasons for this behavior. The child is either avoiding dealing with a problem they have not worked on before or they no longer need to attend therapy regularly. The therapist knows from previous sessions if they are on the brink of new gains or if they have come to terms with their problems. If the child seems to have faced and resolved their problems, then they are ready to stop. Naturally, they will continue to have problems. Usually they do not need to return again after a series of successful sessions. If they do, it is often for a brief time.

 

Unfortunately, money problems sometimes eliminate the possibility of the child continuing in therapy for the length of time that they need. If this is the case, the child will be told in advance when they will be ending. This will often help the child rush though facing and resolving problems. It is not ideal. It is always better to have the opportunity to work out the new problems and feelings which occur with change. However, a little therapy is still better than none. Your child is also told that if they feel the need to have more sessions they should let their parents or the therapist know, and if it can be arranged, they can return. TOP

 

What Can I Expect After My Child Has Completed Therapy?

If your child has attended therapy until they have resolved their problems, you should expect a child who is much better adjusted. They will go though normal developmental stages, some pleasant and some trying. But they should be able to cope with the problems of everyday life without becoming withdrawn or continuing to display the difficulties which initially brought them to therapy. Child therapists do not guarantee you a beautifully behaved child. Testing limits and striving for independence are a normal part of growing up; and normal is what the therapist is trying to help your child attain.

 

The therapist may give your child a small memento to remember therapy by. It is a way for your child to remember what he has learned and achieved. While it may not be important for some children, others may wish to take it places with them or treat it specially. It is helpful to allow your child this specialness. After a time they will set the toy aside as they have done others. TOP

If you have any questions, please call. Most people have had little experience with therapy. Therapy can help your child. But the more that therapists and parents communicate, usually the more rapid and complete the progress.

 

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Dr. Diane M. Agresta, Psy.D.

321 South Main Street, Suite 209 • Ann Arbor, Michigan 48104 • 734.665.9890

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