Family Concerns: When to Refer

April 19th, 2013

Many seminarians in their introductory Pastoral Care class hear this cardinal rule for any counseling work they will do in their capacity as a congregational leader: Know when to refer.

This mantra is both for the benefit of the clergy themselves and the people seeking help. Without it, pastors may find themselves in over their heads, unable to handle the complexity or seriousness of a psychological condition, or drained of their time and energy by perpetual appointments with congregants who would find more appropriate help elsewhere.

Sometimes, it is clear when a parishioner’s problem is beyond the pastor’s pay grade, so to speak.  A few premarital counseling sessions are one thing, but ongoing therapy to repair a marriage on the brink is quite another. It is fairly obvious that a college student who has attempted suicide, or a mom addicted to her child’s Ritalin need not just professional therapy but probably some inpatient treatment as well. Pastors should have a list of appropriate therapists or pastoral counselors to whom they can direct people in need.

But what about when it isn’t clear whether professional help is needed? This question can be especially fuzzy for families struggling to get along or parents frustrated by a child’s bad behavior. A chat with the pastor might offer some encouragement and a sounding board for the family’s concerns, but is the situation so dire that you need to refer them for professional counseling? The family may not be sure either, and look to their pastor for guidance.

Family therapists David Thomas and Sissy Goff see a lot of uncertainty in this area.

“Parents are quick to jump to thinking something is really wrong,” Goff says. Parents wonder what is normal and whether their child’s behavior is cause for concern.

At Daystar Counseling in Nashville, where Thomas and Goff are Directors, counselors offer “parent consults” without children present, to help determine whether the child (or whole family) needs to begin counseling.  Around 30 percent of parent consults result in a child starting therapy, Thomas estimates.

For most families, however, professional help is not needed—not right away, at least.

Start at Home

Thomas and Goff recommend that parents try to address issues at home before calling in the professionals. Even for major problem behaviors, parents have the power to effect change, they say. But consistency is key.

In their recent book, Intentional Parenting, Thomas and Goff devote an entire chapter to the principle of consistency—right up there with being spiritual and patient. Many parents try a new disciplinary technique for a week or less, conclude that it didn’t work, and move on to the next thing.

“If you are consistent over a matter of months and there is still no change,” Thomas says, “then consider getting professional help. The problem is parents aren’t patient enough.”

Parents also seem to lack trust in themselves and their ability to effect change. Parents think there are “secrets” out there that will miraculously make their children turn out right, writes Melissa Trevathan, founder of Daystar and co-author of Intentional Parenting. Many parents seem to parent reactively, out of fear and anxiety, which actually hinders good parenting, says the authors.

The rise in awareness of mental health issues can make parents even more anxious, with news stories about bullying, depression, violent children, and teen suicide. If a child is expressing thoughts of suicide or is at risk of immediate harm to himself or others, parents should contact a mental health professional immediately. In most cases, however, parents can take a slower approach in which they become intentional about their interactions with and discipline of the children, improving the child’s behavior and emotional well-being through a closer relationship and consistent instilling of the family’s values and expectations.

Third Party Input

Parents likely approach you as pastor when they simply want an objective, third-party perspective on the issues they are facing. If parents are disagreeing about the severity of the problem, it is important for them to get on the same page and present a unified front, whether in terms of discipline at home or the decision to go to therapy. Good cop/bad cop situations are not helpful. Such disagreement causes insecurity in kids and hurts the relationship with the “bad cop,” which is usually the mom, Goff concedes, if only because Mom is with the kids more.

Adolescents may resist the idea of going to therapy, thinking it means something is wrong with them. But adolescents may benefit from seeing a counselor even in less severe situations (than younger children), Thomas says, because they may get to the point they shut down and won’t even talk to their parents. An outside party can help them open up.

Adolescents are especially tricky when it comes to assessing their need for help, because their normal emotional development can mimic depression, Goff says. (Picture the stereotypical sullen teenager, isolating herself in the bedroom.) A good test, however, is to watch how the teen acts in various contexts; a normal adolescent may be antisocial with family but perk up immediately when around friends. Consistent sullenness may indicate depression and a need for professional intervention.

Anxiety as well is on the rise with children and youth, Goff says, and is being identified in younger kids than ever before—ages 4, 5, and 6. Some are calling it a new childhood epidemic. Some anxieties are school-related; others fixate on what the child perceives as the worst possible thing that he could experience—something happening to a parent, for example. Overarching, irrational fear and anxiety that impairs the child’s functioning, that he or she can’t be logically talked out of, definitely merits professional assessment and counseling.

What Churches Can Do

There is a lot church leaders can do to confront this epidemic of anxiety in children and the general anxiety among parents about their children’s behavior and development. Equip and support parents with resources from books to Bible studies to video-based programs. Bring in speakers on parenting and child development.

Helping parents to recognize and address their own issues can also go a long way to improve family relationships as well. Traumas from one’s own childhood can cause a parent to be “stuck” at a certain age or on a certain issue. “Behaviors, beliefs, and emotions connected to unresolved childhood experiences can still be triggered today,” says Trevathan. “For an adult who is stuck, parenting can be one of the most profoundly triggering experiences of your life.”

Seminars or sermons on forgiveness, reconciliation, or closure could help “stuck” individuals to grow up in the ways they still need to. Children feel safest when the parent is in charge, says Thomas, and need parents to be the grownups of the house. Fortunately, adults today are more willing to examine themselves and their difficult memories than in times past.

“We’re seeing evidence of parents wanting to be more present and self-aware than ever before,” Thomas says. “That’s really exciting.”

And that is a wide-open door for churches to do their part to nurture healthy families, before the household dynamics get so broken that outside intervention is necessary. If and when some families do find themselves in need of deeper help, you’ll know who to call.

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