HealthQ’s Cara Anthony and Blake Farmer share know-how for parents navigating the decision to seek out mental healthcare for a child.
Divorce rocked the lives of Marcela Cabay and her daughter, who was a preschooler at the time. Counseling didn’t begin until years later, when Cabay noticed her daughter tensing up during storms or before separations.
“She was experiencing a lot of anxiety, constantly thinking worst‑case scenarios and struggling in daily life,” Cabay, a life‑insurance broker in Austin, Texas, explained.
Initially, Cabay tried to help her daughter herself, offering coping strategies and hoping the behavior would fade. Over time, the anxiety intensified.
“That’s when I finally thought, ‘It would be really good for her to talk to a licensed third‑party—not me,’” Cabay said.
The daughter’s counseling started unevenly; after two months of weekly sessions with no progress and out‑of‑pocket costs, they switched to a better‑fit therapist. Within six months she showed substantial improvement, allowing Cabay to pause the weekly visits.
Deciding when professional help is needed can be challenging, especially given the time and financial commitment involved. Therapists suggest three simple criteria—frequency, duration, and intensity—to evaluate concerning behavior.
1. Frequency: Is the behavior recurring?
Frequency is the easiest metric. For example, if a child refuses to leave the car at the playground because of anxiety, an isolated incident may reflect a bad day. Repeated avoidance, however, signals the need for additional support, says licensed clinical social worker and play therapist Paris Goodyear‑Brown.
2. Duration: How long does the behavior persist?
Goodyear‑Brown, clinical director of Nurture House in Franklin, Tennessee, notes that some separation anxiety is normal. If a child’s distress lasts for hours on a regular basis, professional assistance is advisable.
“A child who briefly cries, ‘Mommy, don’t leave me,’ but then engages with teachers is different from one who cries inconsolably for three hours and cannot learn,” she explained.
3. Intensity: Does the behavior disrupt daily life?
Intensity is less about length of time and more about impact. Obsessive‑compulsive habits—such as repeatedly arranging toys or checking doors—can indicate a need for therapy. Equally concerning is emotional numbing or dissociation.
Goodyear‑Brown adds that certain life events, including any of the ten adverse childhood experiences (ACEs) like abuse, neglect, or parental divorce, may warrant counseling even without overt behavioral changes.
Guidance, Not Certainty
These three criteria help parents gauge whether behavior is overly disruptive. “If you can’t carry out your normal routine because of a child’s emotional state, that’s a red flag,” says Becky Evans, a licensed professional counselor supervisor in Fort Worth, Texas.
Assessments remain subjective: what feels frequent or intense to one family may not to another. When uncertain, therapy is generally beneficial, and parents benefit from having a “teammate” to avoid unintentionally reinforcing anxiety, Goodyear‑Brown advises.
Some psychologists caution against over‑pathologizing normal developmental challenges. Licensed marriage and family therapist Christina Confroy of Nashville notes that parents often mistake age‑appropriate behavior for a disorder. She encourages parents to trust their instincts while seeking professional input when needed.
People and Policy
Confroy, like many counselors, has left insurance networks because billing often requires a formal diagnosis, creating administrative burdens and low reimbursement. Out‑of‑pocket costs averaged nearly $150 per session in 2023 (Health Affairs Scholar). Confroy charges $195 for a 50‑minute session but adjusts fees based on need.
“People don’t budget for counseling the way they do for groceries. It’s a significant financial and time commitment,” she says, recommending school‑based services and other low‑cost options as first steps.
“You might not want another podcast or book; I’m a big proponent of using existing support systems,” Confroy adds.
This installment is part of HealthQ’s series on caregiving in the Sandwich Generation. For more, see the series archive.
Katherine Ruppelt and Emily Siner at Nashville Public Radio contributed to this report.
HealthQ is a health series from reporters Cara Anthony and Blake Farmer, offering approachable guides to an often‑unapproachable healthcare system. It’s a collaboration between Nashville Public Radio and KFF Health News.