Is Your Child in Need of Therapy? Learn the Signs from a San Jose Child Therapist

Most parents who call me aren't sure they should be calling. They've gone back and forth for weeks, sometimes months, about whether what they're seeing is a phase or something more. Somewhere in there is the question nobody says out loud: am I overreacting?

You're not. If it's big enough to worry you, it's big enough to talk about. That doesn't automatically mean your child needs therapy. It means your gut has picked up on something, and your gut is worth taking seriously.

I'm Hannah Ly, a child therapist in San Jose and the founder of Your Therapy Nook. This is how I'd help you think through whether your child needs therapy: the questions I ask, the signs I pay attention to, and when I'd tell you not to wait.

How do you know if your child needs therapy?

It's almost never one behavior. Every child melts down, slams a door, says something mean to a sibling, has a terrible week at school. When a parent describes their child to me, I'm listening for the pattern around the behavior, and five questions get at most of it.

• Has it lasted more than a few weeks? A rough patch after a move or a new school year usually eases as the new thing becomes familiar. When it isn't easing, or it's getting bigger, that tells me something.
• Is it showing up in more than one place? Home and school, or home and friendships. (Some kids keep it together all day at school and come apart the minute they see you. That's a pattern too, and a common one.)
• Is it getting in the way? Of sleep, school, friendships, family life, or your child enjoying the things they used to love.
• Have the things that used to work stopped working? The bedtime routine, the calm-down corner, the talk in the car. Most parents I talk to have tried a lot before they call.
• Is your child saying it? "Nobody likes me." "I'm stupid." "I want to talk to someone who isn't you." Kids say true things sideways. Take them at their word.

If a few of those are a yes, it's worth a conversation. Not because something is wrong with your child, but because something is hard for them and they haven't found their way through it yet.

Signs your child might need therapy

Children rarely tell us what's wrong in words. They show us. Some of it is loud and gets a lot of attention, and some of it is quiet and gets missed.

The louder signs

• Meltdowns that are bigger than the moment, or coming more often (the wrong cup, the sock seam, "not right now" about a toy)
• Hitting, kicking, or throwing things, at a sibling or at you
• Calls from school, or getting sent home
• Fighting every morning about going to school

The quieter signs

• Pulling away from friends, or saying they don't have any
• Going flat: "fine," "nothing," "I don't care," about things they used to care about
• Stomachaches and headaches with no medical cause, especially on school mornings
• Changes in sleep or eating, nightmares, wanting to sleep in your bed again
• Perfectionism that hurts: tearing up the drawing, starting the book over, one B that ruins the week
• Going backwards: wetting the bed again, baby talk, clinging in ways they'd outgrown

The loud kid usually gets labeled a behavior problem. The quiet kid usually gets labeled fine. Both are communicating. Behavior is how a child tells you something they don't have words for yet, and in therapy my job is to work out with them what that something is.

Big changes that are worth support, even before there's a problem

Sometimes it isn't a behavior at all. It's a change in your child's life that's big enough to plan for. Therapy can help a child make sense of a change while it's happening, instead of months later when it comes out somewhere else.

• A separation or divorce, and the back-and-forth between two homes (child therapy for divorce)
• A new partner, a remarriage, or new step-siblings
• A death in the family, or the death of a pet, which is often a child's first experience of grief (how to explain death to a child)
• A move, a new school, or a parent away for a long stretch
• Adoption, foster care, or kinship care (adoption and foster care therapy)
• Something frightening: an accident, a hospital stay, a scary event (child trauma therapy)
• A new baby

Not every child going through one of these needs therapy. Plenty of kids get through a move or a new sibling with steady parents and some extra patience. But if your child was already showing a few of the signs above, a big change is often what tips it over.

When not to wait

Some things don't need weeks of watching. Get help now if your child:

• talks about wanting to die, not wanting to be here, or hurting themselves
• is hurting themselves (cutting, scratching, hitting their head on purpose)
• is seriously hurting other people or animals
• has stopped eating, or you're seeing signs of drugs or alcohol in your teen

If your child is in immediate danger, call or text 988, the Suicide and Crisis Lifeline, or go to the nearest emergency room. Once things are steady, a child therapist can help with what comes next.

What happens if you call

The first step at Your Therapy Nook is a free 15-minute phone call with me. You tell me what you've been seeing, I ask some questions about your child, and I tell you honestly whether I think therapy would help right now and whether we're the right fit. If we're not, I'll tell you who might be.

If therapy makes sense, younger children get play therapy, because play is how they show us what they can't say. Older kids and teens get real conversation, drawing, and games, not a clipboard and a list of questions. And you get parent sessions every four weeks, without your child, so you know what your child is working on and what to try at home.

Not sure yet? Start with a phone call

Asking the question doesn't commit you to anything. If you've been wondering whether your child needs therapy, book a free 15-minute call. If we're a fit, I'll pair your child with the therapist here who suits them best: me, or one of the therapists I train and supervise, at our San Jose office or our Redwood City office. Therapy in Spanish is available in San Jose.

A phone call won't answer everything in fifteen minutes. It will give you a clearer next step than another night of reading about it.

About the Author: Hannah Ly, San Jose Child Therapist

Hannah Ly is a Licensed Marriage and Family Therapist (LMFT #129711) and the founder and clinical director of Your Therapy Nook, a boutique child and teen therapy practice with offices in San Jose and Redwood City, CA. She is a child therapist, play therapist, and teen therapist, trained in Synergetic Play Therapy and Brainspotting, with a long background in adoption and foster care. Hannah does every family's first call herself, and every therapist on the team practices the way she does. Every family gets child-led play therapy or teen therapy plus parent coaching every four weeks.