Amy Stambuk, LCSW
Licensed Clinical Social Worker
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Maybe my child's problems aren't "big enough" for therapy.
I want to nip this in the bud before things get out of hand.
I think I may have waited too long to call--things are out of hand.
At times, I feel like I have failed as a parent.
I doubt anything is going to be able to fix this.
It is never too late to get some help for your child. Kids are so resilient and usually respond well to the right kind of therapeutic support. My approach to working with kids involves focusing on the context of your unique family rather than working just from general principles. I am creative and practical, and I aim to help your family make changes that really work. I work with children from toddler through teen and young adult years. I work with families experiencing simple, practical struggles that can be addressed quickly, to more severely traumatized kids that need more guidance and longer-term support. I work with parents who are simply looking for more powerful parenting strategies and families experiencing ongoing chaos and conflict. Have a look at the following scenarios, and see if any of them sound familiar (I'll start with a toddler and move on from there).
You and your partner survived infertility treatment and finally got pregnant. You were elated with the news of a baby boy. You struggled with the decision to pause from your high-powered job as an attorney but eventually decided to do so. The first couple of years were challenging but you stepped up. Lately, your partner notices you are cranky when he gets home, and less available to hear his work stories. You feel disconnected from others even though you made a point to plug in with other moms. You wonder about your worth as a person outside of being a mother (and most days you doubt your ability to even be a decent parent). Part of you wants to return to your career and part of you has no idea what you want. You procrastinated on calling preschools and are now scrambling for options. You thought the terrible twos were bad but now that Liam is almost three, you are about to lose it. Other moms call kids like Liam "spirited" and you are at your wits' end with just getting to 5 o'clock. Your son refuses to go to time out, and bedtime has become a never-ending power struggle. Your husband has a more laid-back approach to parenting (as the youngest boy in his family, he was doted on by three older sisters). Your approach is sterner and lately you are yelling and using empty threats. You grew up in a house with parents who used spanking routinely. You and your partner are getting into heated arguments over how to handle Liam's behavior.
Dealing with behavioral issues is so incredibly common during toddler years. Though Liam is expressing his autonomy in line with developmental norms, you are understandably overwhelmed. As the therapist, first I would play with Liam, getting a sense of his personality and where he is at developmentally. Then, I would invite you and your partner to come back without Liam. This would give me an opportunity to hear what you are each struggling with and how it's impacting your relationship. I would listen carefully to key challenges you are facing and pick one we could all rally around (such as bedtime). Experiencing success in turning disciplinary problems around is critical and will allow you all to come together.
Often the ways we were raised show up in our parenting practices, so it's important to get mindful about what we are doing, to keep what works and discard what doesn't. If you and your partner are unable to get clear about your differences and create a solid, combined parenting philosophy, your relationship may be at risk. You need more than date nights at this point. Your career may be another vital topic. It's such a personal and often financial decision to return to work or not, and in what manner. How could I support you around this question and allow you the time and space to come up with answers that work for you and your family? Lastly, throughout my interactions with you I would check in with you about the range of what you experiencing and what might best support you.
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Your six-year-old daughter has always been on the shy side. Maggie gets overwhelmed easily with groups of people. She is quite sensitive to stimuli and is picky about what she eats. As a toddler she tended to play by herself. She frequently wanted to be carried and you gave in just to stop the incessant whining. This is her second year in kindergarten. You are a month in and she continues to cling to you at drop off and spends the first twenty minutes at school crying in the reading area. This is how last year went except it was worse. Her older brother is outgoing and energetic. Is it just a personality thing? The teacher says it's getting better and she will grow out of it eventually. But the truth is Maggie doesn't even enjoy going to birthday parties and on play dates she winds up circling you. The bigger truth is that you struggle with anxiety yourself and are not sure what to do. Do you get help or just wait and see if it will pass?
Starting play therapy with Maggie seems the obvious choice, but often children experiencing separation anxiety need security. I bet that Maggie would not work with me alone in the play therapy room, so I would invite Maggie and you in together. I would introduce you both to the space and use a nondirective approach... I take Maggie's lead. I spend a lot of time observing and witnessing her play and supporting her choices. I allow her to struggle with frustration and nudge her to do for herself. I do not direct her play, she does. Over time Maggie may get comfortable with me and the space and we might successfully move you into the waiting room: a "trial run" separation.
If successful with these practice goodbyes, we might then brainstorm ways to decrease anxiety around separation in the real world. Using sandplay may be a relaxing way for Maggie to express her fears and tell me about her world. In addition to continuing play therapy with Maggie, I would schedule regular meetings with you and perhaps reach out to her teacher. This will support your capacity to help support Maggie's independence and capacity to reach out to peers and other adults. I would get creative about how we might "play" with this in the real world. How might we stage manageable risks for Maggie to try out? Meanwhile, throughout our time together I would explore your personal journey with anxiety and what has been most helpful or not helpful in managing your symptoms. I would troubleshoot potential steps you might take to address this just for yourself.
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You are a single mom and have been divorced since your son was three years old. Your ex-husband is not really involved in your son's life but at least pays child support. You are a working professional and just trying to balance it all. Owen is now in second grade and is just plain angry. Your son has always been willful and moody and often uses physical aggression when things don't go his way. He is not doing so well in school and lately has become the class bully. He has difficulty focusing and seems distracted and impulsive most of the time. He seems to follow his own set of rules and you often catch him in lies. He also tends to downplay his behavior and blame others for his misdeeds. His teacher is fed up and you are well beyond using sticker charts for good behavior. Your relationship with your son is tenuous at best. You love your son but you don't always like the way he behaves. You are worried things may get worse.
"If left untreated, things will get worse." This is what I would say to you. I would then ask you what you think is going on with Owen and what your hopes and fears are as he develops. I would also get to know Owen and just allow him to interact with me without going over the laundry list of his problem behaviors. I might set up a time to observe him in the classroom or have a meeting together with his teacher and you. I would also be very interested in working with Owen and you together. How could we change the weather in your relationship so you actually enjoy each other more? What emotions are underneath your interactions that may need expressing? I would explore the areas of Owen's life that make him feel great about himself or help you seek out activities that may help develop this.
After gathering more data, I would consider doing further assessment and testing. I would help you figure out the best means of navigating this process. Does Owen have learning challenges that are influencing his behavior? Could he have difficulties with attention span or hyperactivity? When I work with kids that have more disruptive behaviors, I often like to help parents rule in and rule out what could be going on--to assess what is going on with your child from many different vantage points. It's essential not to jump to conclusions. Sometimes changing parenting practices or making adjustments in the classroom environment can make a huge difference. Sometimes providing individual counseling for children provides enough of a vehicle for positive change. Sometimes it's more like a multilayered cake and different levels of support are required.
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Your fiancÚ's son, Alex, is a fourth grader at a charter school with a focus on science and math. Alex is bright and excels in school but also has a sensitive side. He loves art and making miniature sculptures out of stuff he finds around the house. He sort of likes throwing the football around but is not on any team sport. Alex's parents got divorced a few years ago. He describes his relationships with his parents as "good." Same thing when he describes his relationship with you. He just doesn't share much about what is going on in his life or in his head. Alex's mom brings him to therapy after several incidents at school in which he locked himself in the bathroom during recess and refused to come out. Alex refuses to talk about what happened with his peers but you have a sense that they have been verbally bullying him for some time. His best friend that he has known since kindergarten also just moved away and will be living on the west coast. You are doing some research online to figure out some options for helping Alex. He's a great kid, and it's breaking your heart how unhappy he seems under that quiet exterior.
After the first meeting with Alex it is clear that he is not a talker but it is also clear that he has a lot bottled up inside. With Alex I would assume a lot of adults in his world have been unsuccessfully trying to get him to talk. I would respect his choice to keep things to himself and simply find another way to connect. Often with kids this age, particularly with boys, I find it helpful to engage in an activity to ease us into conversation. So playing Jenga or some other game may work. I am still lousy at chess but I often ask kids to teach me a skill because it gives them a sense of mastery. Alex seems to be on the creative side so art may be a great way for him to express bottled up feelings. I would wonder how successfully he dealt with his parent's divorce and the emotional toll this has taken on him. I would really be sad for Alex about the loss of his friend moving away and talk with him about the good times they have had over the years. How does he plan to stay connected? Who else is cool in his class?
Eventually I would get around to the bullying and the strategy of locking himself in the bathroom. It's clear he needed to get away and was taking care of himself in the moment. I would take Alex's lead and let him share what is comfortable for him to share. It's not important what he tells me about these incidents--it's more important that he feels safe talking about it and that I am not judging him. I would wonder what other ways he might regulate himself when he gets overloaded. I would explore which teachers he really connects with and maybe find an ally to help in times of distress. I have noticed that Alex is slightly overweight and learn he is an emotional eater. I would talk with grownups offline about ways to eat more healthily and how to incorporate more physical activity... subtle shifts so as not to be shaming. After some solid work with Alex individually I would perhaps have a session with his father and one with you and his mother. This would allow me to work through what hasn't been resolved from the divorce and to highlight strengths that Alex and his families bring to the table. Kids who experience divorce often continue to feel torn and divided. I like to validate this experience but also find ways to honor the unique relationships they have with each parent (and each stepparent).
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Jasmine is highly gifted and has been on a roller coaster from the get-go. She's now in the sixth grade and just transferred to a new middle school. Her last school was much smaller and more protected, and now you and your partner feel like you have released her into the wild. Jasmine is a savvy kid. You and your partner are a same-sex couple and have raised your daughter to be quite open. The truth is she has always been a worrywart, and since moving to this school she is taking it to a whole new level. In her last classroom, she was the top performer and now other students have raised the bar. She constantly needs reassurance from her teacher and is quite demanding of her time. She is convinced she is not measuring up and since she expects nothing less than perfection, she is overdoing it with homework. She is unable to work successfully in groups with other peers. Her social scene is not steady and different names keep popping up. The sad thing is Jasmine is often concerned that others don't like her and yet she seems to push them away. She just seems so stressed out lately. And the worry train just doesn't stop. She worries about the weirdest stuff. You have a business trip coming up and are afraid to go because she recently watched a news report on about an international plane crash and is freaked out about safety. She constantly needs to know about little details ahead of time and has trouble with unexpected events. You both are trying to be supportive but are just plain frustrated.
I truly love the complexity and fun of working with gifted and talented kids. They have so much to offer in terms of intellect, drive and creativity. They often need ongoing support in successfully managing their emotional life and their social scene. Counseling is a great way to provide a safe haven for them to just air what's on their mind and in their heart as well as a place to practice needed skills. In working with Jasmine's anxiety, I would start with simply putting myself in her shoes, really feeling with her about what she is experiencing day to day. I would then encourage her to take a step back and look at how her "worry brain" takes over at times. I might help her name the "worry" part of herself so she starts to notice how she assesses risk, how to tell big worries from little ones. We might use art or sand play to externalize her anxieties and find creative ways to talk about what is going on with her thinking patterns. What's realistic? What are some other ways she might respond to a particular situation? I often help kids with anxiety solve social dilemmas by incorporating acting and role-play. This gives them a chance to try on different ways of being and then they get to "report back" on the experiments they try out. Reaching out to Jasmine's teacher would provide another way to support her social and emotional growth. In addition to one-on-one work with Jasmine, I would collaborate with you as parents on how you could more effectively respond to her "spirals." I would be curious about how you have navigated your relationship and your role as parents. I would ask you what kinds of support would be the most helpful.
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You're not sure what is going on with your 14 year old.... She just seems to have lost her shine. You vividly remember your daughter charging down the soccer field and starring in school plays. Lately though, she seems to have collapsed inward, to just be going through the motions with school and friends. Emma spends so much time in her room either on technology or (reportedly) doing homework. When you try to reach out, she only talks to you about surface stuff and you are not sure what she is really thinking and feeling. Emma is going to a new high school this year and seems a bit nervous about this change. Many of her close friends have moved on to other schools. She also is spending a great deal of time getting ready in the morning, choosing outfits and getting ready for the day. You just want her to feel confident--to get her shine back.
I think I might take the "anything is game" approach with Emma, lightly trying on a series of theories to see which one fits for her. On the one hand, she may be struggling with some body-image issues and adjusting to her new school, which is quite a lot to deal with, by the way. On the other hand, there may be deeper issues such as depression or self-harming going on. Or maybe she recently had a negative experience with friends or a relationship break-up. Or maybe she's questioning her sexuality. Or perhaps you and your wife are dealing with conflict in your marriage and she's feeling anxious about this rift. My approach with her would be about joining, relationship-building, and curiosity. I would be interested in hearing about who her friends are and what she is into. If she has stopped doing things she enjoys, I would listen for what she used to like to do. I would ask her about school and which classes she likes the most. I would wonder about her hopes and dreams for the future. I would talk with her about her relationships with her parents and other people in her life. Whom does she admire and look up to? Whom can she lean on and trust? If she is feeling all alone, I would ask about outlets like journaling and exercise. I would explore what it has been like for her to move through puberty and how she feels about her body-image in general. I would gather a sense of what she was like as little girl as well as a middle school student. After building trust and a clearer picture of her world, Emma and I would come up with some concrete goals to work on in our sessions together. Eventually, I would invite you and your wife into some of the sessions so you could learn better ways to connect with and support your daughter.
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Your son, Roberto, is 16 years old and sleeping all the time. Roberto seems so irritable lately and is getting into it with his brother whom he absolutely loves. In fact, he recently hauled off and punched his younger brother in the face, which is why you decided even to consider counseling. He stays up all hours of the night reading or listening to music. Sometime you see tears come to his eyes, out of nowhere. That, and his thoughts seem a little gloom and doom. It's a little creepy. He sometimes makes references to death, but he is kind of lost in his own world so it's hard to know what he is meaning. You think he just broke up with his girlfriend but aren't sure. They only thing he likes to do is drum and even this has fallen off lately. You and your ex-wife do a fairly decent job with the whole shared parenting thing and your kids seem to have gotten used to it since you've been split up for years.
With Roberto I might first suggest a conjoint interview with you and your ex-partner if you are agreeable to meet with me together. This would allow me get a clear picture of family history and your individual perspectives on what is going on with your son. I would ask specific questions about what you notice about changes in his mood and behavior. In meeting with Roberto individually, I would get a sense of his openness to counseling and hear whose idea it was for him to come in. I would learn pretty quickly that he has been struggling with depression for some time and is having difficulty functioning day to day. I would ask about suicidal thoughts and his tendency to be "gloom and doom." Roberto would share that he feels terribly guilty about hitting his brother and that he is having trouble controlling his anger. He has been responsible for caring for his younger brother for years and though he loves him, it's sometimes a burden. I would also learn that Roberto has lots of pent up feelings about his parents' divorce and how grown up he had to be from an early age. He never went to counseling when he was younger. He would also share his worries about upcoming decisions about college and whether or not he even wants to go. I would ask Roberto about what he loves about drumming and what this means in his life. I would listen for what kind of books he is reading and what kind of music he likes. In continuing to work with Roberto, I would set up regular sessions and have him to commit to counseling. I would monitor if Roberto's well-being seems to improve with counseling sessions. If we do not see significant change, I would suggest that the family seek further consultation to see if a change in treatment or the addition of medication may be helpful.
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