Dr. Rachel Rokach, PhD.
Senior Clinical Psychologist
Psychotherapy with adults and
adolescents in Israel since 1983
Hebrew and English
Adress: 3 YISHAI ST., JERUSALEM
● The clinic is accessible to the physically handicapped.
● I work with the following medical insurance plans: Bikurufe, Elite, Harel-Shiloah, and Matan-Meitar, and with Kupat Holim Klalit.
HOW DO YOU ASSESS THE PROBLEM?
The assessment process looks like this: I see the parents once to get as much information about the child and the family constellation as possible. I give them a questionnaire for the day-care provider or teachers. Then I meet with the parents once together with the child if he’s young; or with the child alone. In the third session I meet the parents again to give them my feedback and clarify the major issues the counseling should address.
HOW LONG DOES THE COUNSELING TAKE?
In my experience 20 sessions is a good framework: 12 once weekly, then 8 every other week. This allows us to go into things intensively at the beginning and clarify what behaviors the parents are going to focus on; and to do the introspective work with the parents that will help them make changes in their behavior. The second phase gives you plenty of time to apply the plans we make together and to adjust them according to the results.
IS GUIDANCE A FORM OF THERAPY?
Parental guidance takes a lot of its principles and techniques from therapy, in that it assumes that a major engine for behavioral change is better self-understanding. However, it is different because it is clearly and consistently focused on the relationship with the child, whereas in therapy by definition the focus is on the person himself. Parental counseling also has a lot to do with giving information—about child development, about handling specific difficulties and situations, about interpersonal dynamics—which has little or no place in therapy.
It sometimes becomes apparent during the process of parental counseling that one or both parents could use individual help with issues that are affecting their functioning as parents. Then they have to make their own decision as to whether to go for therapy.
WHY DO YOU ASSUME IT’S THE PARENTS WHO CAUSED THE PROBLEM?
I do not and neither, I’m happy to say, does accepted wisdom in education and child psychology nowadays.
In this context it’s crucial to differentiate between criticism and description. If you’re thinking about getting parental guidance, apparently something about your child’s behavior or your relationship with them is worrying you. In order to work on that we need to see very clearly what it going on; you wouldn’t expect to fix something without knowing what’s not working right, would you? This description, don’t forget, is going to show us the strengths and successes of the relationship as well as the glitches, so we’ll know what resources we can draw from.
Since most parents care so much about doing a good job for their kids, it’s easy to develop guilt feelings about whatever isn’t going right. That’s too bad, because guilt is not a constructive emotion. It’s a spoiler, diverting energy from creative thinking about change to self-recrimination. The counselor and the counseling process are not looking for guilty parties; we’re looking for resources within the family and for points of entry for change.
WHEN DO YOU REFER KIDS TO OTHER FORMS OF THERAPY?
Physiotherapy is called for when a child is having trouble with gross motor coordination and with muscle tone. In most cases these children are being treated long before they reach me, thanks to their Well Baby care or pediatrician. When fine coordination (graphic skills, cutting, pasting, sculpting) is problematic the child needs occupational therapy; many are referred by their teacher before I ever see them. Difficulties with sensory regulation (hyper- or hypo-sensitivity to sounds, smells, strong or light touch, motion) also require the attention of an occupational therapist. Language therapy is called for when the child’s language or communicative development lags behind her/his age level.
WHAT DOES ALL THIS HAVE TO DO WITH ME?
When parents understand the emotional consequences of such difficulties for the child—primarily low self esteem, a build-up of frustration and aggression, exaggerated need for control, or a tendency to avoid and withdraw—they can learn parental behaviors that support the child, minimize frustration, and mediate between the child and his/her environment. This adds up to a very significant contribution to the child’s coping, and to avoiding emotional problems.
I DON’T WANT TO STIGMATIZE MY CHILD.
I’D RATHER THE TEACHER NOT KNOW I’VE SOUGHT COUNSELING.
It’s very important for the counselor to have the teacher’s (or day-care provider’s) opinion. You undoubtedly realize that a parent has a hard time viewing their child realistically. Parents tend to either over-emphasize a problem out of their sense of responsibility or guilt or anxiety; or under-emphasize it, for the same reasons. The teacher isn’t “objective” either, nobody is, but is probably closer than the parent.
No less important, though, is getting a picture of the child’s functioning in a different setting. I need to know (and so do you) whether the problem that’s worrying you shows up in the child’s other life-situations, and in what way. That will help us trace the parents’ contribution to the problem and to its solution. And of course it is often important to provide some guidance for the teacher too. In my experience, it’s been years now that most educators have given up the tendency to stigmatize a child because of therapy or counseling. They have realized the value of early intervention, and tend to respect parents who make the effort to get help. Don’t forget, if there’s a problem the teacher is also dealing with it, and has an interest in seeing it solved.
I FEEL WE NEED COUNSELING FOR OUR CHILD BUT MY PARTNER REFUSES TO PARTICIPATE.
WHAT SHOULD I DO?
Of course it’s optimal for both parents to come for counseling together. The parental coalition is the most important resource for helping a child. Each parent has a lot to contribute to their child’s well-being. Every kid needs to feel their parents’ investment in them.
But I am practical. I believe that when it’s impossible to engage one of the parents, you work with what you’ve got. I’d rather do a less-than-ideal job than no job at all, where a child in need is concerned. You must know, though, that legally a child cannot be treated if one parent objects; it’s essential to have both parents’ agreement, if not participation