With children, the parent-child relationship is primary. The therapist is not the parent. There is no special therapeutic relationship that can or should replace the parent-child relationship. Parents are responsible and need support when they seek help for their child including the ability to communicate with their child about the issue. If a child cannot talk with his parent about serious issues, that is the problem. Parenting is 24 hours a day, 7 days a week, 365 days a year. Therapy usually takes about 45 minutes once a week and is intended to be a short term intervention. Leaving parents in the waiting room disempowers them. It says the diagnosis or behavior is the target, not the relationship.
Kids are not dry cleaning. You cannot drop them off, have them fixed up, return home and expect it to last without some work with the parent. A big part of therapy is normalizing issues and reactions to counter the shame that some client's feel about mental health services. Treating a child individually without parents exacerbates shame. It also puts the onus on the child to change. It says, "You are the problem." Working with parents and children together provides more bang for the buck; working on the issues, the communication about the issues, and the relationship at the same time. In fact, parents are the co-therapist for their children. Healing happens at home, not just in the therapist's office.
Some note issues of confidentiality. Children do not have confidentiality separate from their parents. Parents have a right to know what is happening to their child. No medical doctor can keep a parent in the dark about procedures conducted on their child, but child therapists play the confidentiality card all the time. A therapist will say, "I can talk about our progress but not about what the child said in session." Who are we protecting? The California Health and Safety Code and Family Code provide that children twelve or more have the right to consent to their own treatment, especially for sexual and substance abuse treatment, if informing their parents would be unsafe. The law also gives children the right to authorize or stop disclosure of their health information if informing parents would be dangerous. But in both cases, the therapist is expected to make repeated attempts to assess the reasons for excluding parents from receiving information and to make efforts to include parents in the treatment of their children. Otherwise, parents have a right to participate and receive a record of treatment.
Some therapists make a special case for adolescents. But despite growing independence, teenagers need more engagement and guidance from their parents, especially when difficult issues arise. Therapists spend a lot of time teaching teenagers how to talk to their parents. The parents need help listening and talking with their teenagers. How do you do couples counseling when only half the couple is in the room? In the case of the parent-child relationship, the parent has an even bigger responsibility to the relationship. The exception is when their is no safe parental figure and the therapist substitutes for that safe base. This is often the case when a child is removed from parents due to abuse and neglect, or placed in foster care or group homes and parents are absent. When there is a substitute parent, a grandparent, adult sibling, or foster parent, there is good reason to include the "parenting parent" in the session. The law allows some substitute caregivers to give consent for treatment. The court or non-custodial parent gives consent for treatment in child welfare cases, not child welfare workers or foster parents. However, the law allows therapists to discuss the care of the child with the foster parent or group home staff without violating confidentiality. It does not help the child to leave these "everyday parents" in the dark.
A child therapist will say, "I create a safe environment for the child." That assumes the home is not a safe environment. What is the goal then? For lasting results, should our goal not be to help create a safer environment in the home? The issues that face children; anxiety, depression, learning disabilities, and trauma, can be complex and require multiple interventions including parenting, education, medication, and therapy. This requires coordinating care not isolating the caregiver who should be the primary director of this treatment. Parents say, "I don't know what they do in therapy. They play games." How is this possible? Why are we not teaching parents to play with their children if we believe play therapy or other methods are so effective?
There are certainly times when, reportable abuse not withstanding, the home environment is so toxic and the parent so unable to participate in treatment, that working with a child alone is the only option for a therapist. In those cases, we provide the child a safe outlet for their thoughts and feelings and strengthen the child's coping skills. But this should be the exception and not the rule. Perhaps some parents just want their kids fixed and do not want to participate in therapy because they fear they will be challenged or asked to change their parenting. It is easy for a therapist to allow a parent to opt out to avoid losing clients. Yes, it is sometimes easier to work with children than to work with their parents or parent and children together. But it does not make it right, ethical, or ultimately effective.