Preparing to Take Your Child for Counseling

By William Schacht, MS, LCSW

Your child may have been referred or recommended for psychological evaluation or counseling to an agency outside of your school system by a school psychologist, school social worker, counselor, teacher or a pediatrician or clergy member. The following information can be used as a guide to assist you in helping your son or daughter secure psychological services that are useful and meet his or her needs. For further support, call Performance Enhancement Behavioral Health & Counseling Services at (414) 858-1014.

Question: Do you know for what reasons and services your child is being referred?

Ask what reasons the referral source is suggesting your child requires additional evaluation and/or service. Attention deficit, depression, anxiety, family situation adjustment are examples of such conditions. The agency or mental health professional will ask you why you are seeking services for your child. This gives the therapist a starting point with your child. If you describe in writing a set of symptoms or behavior observations and how long your child has been experiencing these problems will be helpful to the therapist.

Your child could be referred for the following services…

Psychiatric Evaluation Psychological Evaluation AODA Assessment
Individual Psychotherapy Family Counseling Psychological Testing
Drug/Alcohol Counseling

What agency and mental health professional you choose should be skilled in the area assessed as the problem for your child. For example, if your child is being referred for adjustment issues due to a divorce, ask the therapist about his/her experience in dealing with marriage, family, and divorce adjustment issues. How many cases of this type have been seen?

Question: How do I know which therapist will be best for my child?

Word of mouth referral is a good process. School professionals, your primary care physician, your attorney (in divorce situations), and friends can be a good place to start. If you hear one agency or therapist name come up consistently, that is meaningful.

Make sure the therapist and agency are properly licensed. When choosing an agency (or clinic) ask if it is “State Mandated.” This means it is accredited by the State of Wisconsin.

Ask the therapist if they are “licensed.”

Ask the therapist to tell you what his/her definitions are for…

“Psychological Evaluation” (Answer should include “accurate diagnosis, prognosis, and treatment plan with concrete measurable treatment objectives and measures of success and failure for each objective”).

“Psychotherapy” (Answer should include “your child will learn how to make changes in his/her thinking patterns, emotional responses, and behaviors consistent with his/her treatment objectives”).

Therapist should communicate his/her philosophy on using psychotropic medications as part of treatment (medication masks symptoms, but many times does not address the underlying cause of the child’s problem).

Ask therapist how he/she will communicate with school personnel and the child’s primary care physician in regards to your child’s diagnosis and treatment. Good therapists see treatment as a team approach with other professionals who provide care and support for you child.

Question: How does treatment begin?

All treatment must begin with an effective evaluation. A good therapist should inform you of evaluation findings including…

  • Diagnosis
  • Prognosis
  • Treatment plan with concrete measurable treatment objectives and a projected number of sessions for each objective.
  • Measures of treatment success and failure and what adjustments to treatment will occur if treatment fails.

If the therapist cannot tell you these things, consider finding a different therapist.

Good therapy and medicinal treatment can only occur with accurate diagnosis. Inaccurate diagnosis can lead to improper treatment. For example, if a child is diagnosed with ADHD when, in fact, the child is experiencing anxiety from a potential divorce situation, treatment can be detrimental, rather than useful. If a child is diagnosed with depression when, in fact, they are smoking pot twice a day and this is not known, treatment will not be useful.

Question: What is a “concrete, measurable treatment objective?”

For example, if your child is referred for social or performance anxiety, a vague, useless treatment goal would read’ “Reduce anxiety symptoms.” Of course! That is obvious!

A concrete measurable goal would read like these…
“Will attend speech class on every day he is scheduled to give a speech.”
“Will initiate social conversations with two other children in school she does not know within 6 weeks.”
“Will identify and eliminate obsessing about negative self thoughts in 4 weeks.”

These are real, meaningful type of objectives that are of immediate value to your child and you.

If treatment goals are not being met on projected timelines, ask the therapist for an explanation. If you are not satisfied, seek a second opinion.

Question: What should I be willing to pay for my child’s treatment? What is good value?

Insurance benefits in mental health are rapidly decreasing for most health insurance plans. Deductibles and co-pays are increasing. Some quality providers choose not to be part of insurance panels that have low reimbursements. So, getting quality care at good cost value requires good therapist selection and savvy consumerism.

Bad therapy is worse than no therapy. Make sure your child has an effective therapist for his/her problem(s).

Consumers are trained that treatment cost should be assessed by fee per visit. This is not an accurate measure of true cost or consumer value.

Cost should be calculated by the therapist’s projected cost for your child’s entire treatment, rather than the cost of an evaluation or a therapy session.

For example, a $30 co-pay for 25 sessions is more than a $60 co-pay for 10 sessions if the resulting therapy outcome is the same.

Also consider how expensive it may be for your child not to receive effective treatment for his and her problem. Marriage counseling that may cost you $3,000 out of pocket is less than $6,000 of attorney fees and family turmoil of a divorce.

Author: William Schacht, MS, LCSW is the President of People of Divorce, LLC and the President of Performance Enhancement Heath Services, SC of Wisconsin. He is a practicing relationship consultant and psychotherapist. He can be contacted by email at or by phone at 1-(866) 724-2000.

RED ALERT: Doing Right by Our Children When Separating, Divorcing & Blending Families ©

By William Schacht, MS, LCSW

We are doing some of our kids a major disservice.

For thousands of years, human beings have prescribed to a primary family structure: a father, a mother, and child(ren).  This is rapidly changing.  Due to decades of a near 50% divorce rate, over one-third of all Americans now live in blended family structures.  By the end of our generation, this is projected to increase to half of us.

Fueled by a reduction in religious influence and a more permissive, self-indulgent society, the departure from the basic family structure via separation and divorce is almost always the by-product of adult desire to end a painful current existence or create a perceived more pleasurable one.

Through the adult pursuit of a “better life,” our children are thrust into the scary dismantling of what they have known as their home and are faced with the challenge of new life structures and relationships they are not choosing for themselves.

Most adults, including the parents creating these changes, realize that family separation, divorce, and family re-blending can have a serious, terrifying impact on kids, even when their best interest may be at hand.  It is common for such parents to hear themselves say, “This is going to be to be tough on the kids.”

It is obvious that a baby bird thrown from the nest or a bear cub separated from its sow are in deep danger and will overcome great odds even to survive.  And, we accept that this chick or this cub will shriek in pain when suddenly the victim of such loss.

Our children, too, naturally react in crisis when the nuclear family is threatened or dissolved and many times when blended families are formed.

Too frequently, children in these situations will not outwardly show this internal distress.  Because they are angry at their parents, or they believe their thoughts and feelings will be dismissed as trivial, or because they sense that sharing their true thoughts and feeling might cause further pain for their parents, often kids will choose to keep what they are going through to themselves.

“Moodiness, anxiety, anger, rebellion, withdrawal …are all NORMAL responses to this difficult life challenge.”

Other children will show one or multiple symptoms: moodiness, anxiety, anger, rebellion, withdrawal, reduced school performance, lost interest in previously fun activity, and more.  These are all NORMAL responses to this difficult life challenge.

When they respond in such normal ways, parents don’t always know what to do to help.  And, because sometimes kids are scared or angry at their parents for breaking up the family or catapulting them into a new one, in some instances the kid won’t let them help.

These situations usually end up with the parent(s) thinking, “My kid needs to see someone,” because there is no other obvious help anywhere on the horizon.  So, off to the psychologist’s office they go, more times than not with the kid being the one labeled as the “patient.”  Sometime the child is willing; sometime the child resists.

It is important to understand that American insurance companies do not pay for marriage counseling or family counseling of any form.  Insurance companies pay for medical diagnoses, one type being a “mental disorder.”  And, most parents don’t have the financial wherewithal or psychological insight to pay cash for the therapist’s time.

The therapist could assign a non-mental disorder diagnosis (called a “V” code: V62.89 Phase of Life Problem, for example), but insurance companies will not pay for this. So, the child, who is now even more thinking that he/she is the “problem,” is nose to nose with a therapist who, to get the insurance company to pay for the counseling, assigns the kid with a DSM-IV psychological disorder diagnosis. This becomes forevermore a part of that child’s medical record.  And, when the child is told about this diagnosis it is further suggesting that, “Something is wrong with ME!”

This [diagnosis] becomes forevermore a part of that child’s medical record. And, when the child is told about this diagnosis it is further suggesting that, “Something is wrong
with ME!”

For an “Adjustment Disorder” to be accurately diagnosed, the client must present responses to the stressful situation which are “marked distress that is in excess of what would be expected from exposure to the stressor” (DSM-IV criteria).   If you awoke to a grizzly bear standing over your bed, would you consider your mad dash to the door or nearest window as an “abnormal” reaction to the stressor?  Surely not!

Yet, mental health professionals are doing just that in diagnosing children responding normally to stressful family changes.

Such diagnoses can have devastating consequences for the child later in life when applying for certain jobs (i.e. government classified, etc.), licenses (i.e. pilot, etc.), and insurances (i.e. health, life, disability, etc.).  Inadvertently, the “do good” of diagnostic based psychotherapy can result in unforeseen future unqualified candidacy and higher premiums or insurance rejection.

Children in these situations do benefit from and many times require significant support as they face the challenges of family separation, divorce, or blending of families.  It is critical that these kids…

  • Learn that they are experiencing the challenge of a significant life changing event. And, that periodic life change is a part of life itself.
  • Have their thoughts and feelings acknowledged and validated.
  • Understand that what they are experiencing in this life changing event is NORMAL.
  • Be supported in keeping communication active and effective within all important relationships.
  • Learn coping strategies and skills for challenging situations (i.e. “What do I say when dad introduces me to his new girlfriend for the first time?” etc.).
  • Realize that they have a responsibility to continue the pursuit of their personal potential, even in the face of difficult life situations. They must refrain from being a “victim” to what is happening around them, and keep focused on creating the joyful life they desire.
  • Create and act upon a life plan to actualize into their personal potential.

Without such support, some of these children can and will become lost in a myriad of scary thoughts and correlated bad feelings about their family change.

As a culture, we must stop the pattern of these children who are having normal responses to challenging life change inappropriately diagnosed and told they have a mental disorder.

We must provide safe and effective educational opportunities for these children to get the support they need in these family transitions.

All of Canada and American states such as Connecticut and Utah require adults going through divorce to take a course on effective parenting in a divorce situation.  Interestingly, no states provide such educational experiences for the children in divorcing families, even though they are the ones most psychologically vulnerable.

The process of Americans adults seeking better lives for themselves must not lead to their kids losing a joyful childhood and family experience due to the natural chaos associated with change.

Organizations like PEOPLE OF DIVORCE – The Association (CALL 1-866-724-2000) or Performance Enhancement Health Services, SC (CALL 1-414-858-1014) out of Franklin, Wisconsin are recognizing the need to provide support and education for children and adults in evolving family structures.   This companies offers educational program for children in separations and divorce and for adults and children who are entering or have entered a blended family situation.

Such offerings will become increasingly needed as the structure of “family” continues to evolve in America.  Their goal, as should be the goal of all Americans, is to help these kids feel normal and remain successful through the natural challenges of significant life change.


Author: William Schacht, MS, LCSW is the President of People of Divorce, LLC and the President of Performance Enhancement Heath Services, SC of Wisconsin. He is a practicing relationship consultant and psychotherapist. He can be contacted by email at or by phone at 1-(866) 724-2000.


People of Divorce


“So, You Think You Need Psychotherapy…!”

By William Schacht, MS, LCSW

You’re stuck and you know it.  Either the mirror or someone else said, “Maybe you should go a talk to someone.”  So you will.  You will go for “psychotherapy.”

Psychotherapy can be a wonderfully effective process to help a person get unstuck, back on track, and feeling good again.

But what, exactly, is “psychotherapy?”

Ask 100 licensed mental health providers this question and you’re apt to get 100 different answers.  A client saying any given sentence to 100 different psychotherapists will certainly get 100 distinct therapist responses.  This truth is mind-boggling to a human being in need of psychotherapy and a therapist to deliver it.

This is just as challenging for the psychotherapist because most clients enter their first session with little to no idea of just what psychotherapy is.

Let’s try to see through this fog.

For starters, allow me to suggest that psychotherapy is more like baseball pitching than house construction.  Every psychotherapist’s sentence spoken to a client is unique and may be extremely effective in one instance and may not be useful at all in another.

As a practicing psychotherapist for 38 years and a clinic owner for 25 years, allow me to define the process that I and the licensed mental health professionals I hire at Performance Enhancement Health Services, SC use to facilitate psychotherapy clients.  This process may be called a “functional focus” psychotherapy.

The process begins with an “Initial Evaluation” session which results in the psychotherapist forming a professional opinion regarding the client’s diagnosis/diagnoses, a “prognosis” (probability of success), and treatment plan.  The diagnoses referenced are in a book called the ICD 10.  Each diagnosis has a list of “symptoms” or circumstances that, to a degree, the client must tell the therapist are occurring or have previously occurred in their life for the diagnosis to be assigned.

The therapist may recommend an additional session or psychological testing to ensure that an accurate diagnosis is generated.

The therapist writes an “Initial Evaluation” document.  This document is is presented to the client (and the parents/guardian of a minor age child client), as professional opinion of the therapist and for acceptance of that opinion by the client.  The client is asked by the therapist to sign an informed consent form to begin treatment.

Psychotherapy treatment is the therapist facilitating the client through a 3-step process:


In this first step, the client identifies, in concrete measurable terms, what he/she wants to produce as the desired results of the therapy.  In business language, these are called “deliverables” – how the client and therapist will determine success or failure.

This is typically the hardest part of the process.  Some clients never succeed at this.

Most clients are good at telling the therapist what they DO NOT WANT.  “I don’t want to feel the way I am feeling.”  “I don’t want to be thinking these thoughts I am thinking.”  I don’t want these things that are happening to me to continue to happen.”

But, telling someone what you do not want for dinner has absolutely no correlation to declaring what you do want for dinner.

And, most clients are quite adept at declaring what they want in abstract terms.  When I ask couples in relationship counseling want they want to produce from their work, the majority will say something like, “We want to be better communicators and happier.”   Yes, everyone in the room, including the therapist, wants to be a better communicator and happier.  But, better communication can be defined in a gazillion different ways and what makes one human being happy may or may not be the cause of happiness for some other people.

It is essential that a client creates concrete, measurable desired results and that the therapist understands those results in the terms the client has defined them.  This mutual understanding creates synergy between client and the therapist and maximizes the potential for an enjoyable therapeutic relationship and client satisfaction.

Failure in Step I can lead to wasted time in therapy and the client not feeling in control of the therapeutic process.


Imagine that the moment you begin your first visit with a psychotherapist, you are a magnificent machine with four (4) distinct components (like a 4-cylindar car motor) that are all functioning in a particular way.  We can say you are entering psychotherapy in “Position A.”

The 4 components can be defined as…

You have an “Intellectual Self.”  You think.  You have the ability to produce thoughts, both consciously and non-consciously.  At any given moment you have a set of thoughts that exist and can be changed.

You have an “Emotional Body.”  You have the capacity to feel and you have feelings in response to countless stimuli you encounter each day from the world outside of you and your own thoughts.

You have a “Physical Self.”   You have a tactile or physical sensation of the world around you and of you.

You have a “Spiritual Self.”  You have the capacity to experience existence beyond what is seen and what science can explain.  This may be defined as a relationship to and experience of God.  This is also defined, at times, as the experience of collective consciousness or all things being connected.

What a client and therapist “LEARN” in STEP II is how the client is organized in “Position A” Intellectually, Emotionally, Physically, and Spiritually in relationship to the his/her concrete, measurable, desired results.

In other words, the client and therapist ponder, “Am I (client) organized intellectually, emotionally, physically, and spiritually today in a way that is consistent with the ability to produce my desired results?”  Either the machine (client) is positioned to produce the results or is not.  It is that simple.


If and when a client and therapist learn in Step II that there are inconsistencies between the client’s desired results and how the client is currently organized intellectually, emotionally, physically or spiritually the client, along with therapist support, creates a change plan of action that results in the client evolving to a distinct “Position B” from which the client can produce the identified desired results.

Example of Intellectual Discrepancy:

A client wants to get a college degree in engineering, but does not believe he/she can pass the required math courses of the program.

Example of an Emotional Discrepancy:

A client wants to date, but feels so terrified each time he thinks about asking a woman out for a date for fear she will say “NO” that he never asks.

Example of a Physical Discrepancy:

A client wants to lose 20 pounds but will not change current diet or exercise.

Example of a Spiritual Discrepancy

A client believes in God wants to have a good relationship and is angry with God because one of their children died of an incurable disease.

A therapist will use various treatment methods and techniques in which they have been trained to support a client in letting go of discrepancy positions identified and creating a distinct position from which the client is able to produce desired results.

From the new position(s), a client acts to generate desired results.

When a client achieves enough of a percentage of his/her desired results and has learned the skills associated with their change to the extent they can continue to use those skills, therapy can be defined as successful and discharge will occur.

In Summary…

When you choose your psychotherapist, you now have the option to present this article to him/her and ask if what is written here is consistent with his/her definition of “psychotherapy.”   You want to be certain you begin your therapeutic relationship with a shared understanding of the process.


ADD / ADHD Questionnaire

Does your child fail to give close attention to details or have difficulty organizing tasks and activities?  If you suspect that your child or teenager might struggle with ADD or ADHD, take our brief questionnaire.  This Questionnaire is completely free and anonymous and will help you to determine whether your child or teenager may be struggling with ADD or ADHD.  Get started, click to Download the PDF Version.

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