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Hello, thank you for your post today. I think I can assist you with your question.
Do you need more information?
I have been a therapist for more than 20 years. I have seen this often.
It may be more related to social anxiety, generalized anxiety.
Has the girl been evaluated for this?
No...she briefly went to counseling 4 years ago, but the therapist stated that her problems were related to her parents relationshi'
Some children are hypersensitive to the school environment- "eaten alive" by the size, activity, noise etc.
She functions well a church youth group which raises some quetions
It can related to separation anxiety, issues with parents. That is often the case. I would ask a lot of questions about what is happening at home. Getting a better picture of the entire picture.
She spends most of the time with her father. She states she is getting closer to her mom, but does not like to stay the night because no separate room for her
mom left the family. Dad was not in favor of divorce
It's rarely because they want "attention"- I often take a closer look at the family dynamics. Bring each parent in- separate if not together.
More specific to school, I would have dad connect with someone at school, guidance counselor etc. to work as a team on this.
It's typically not the best idea to take her completely out of school- that anxiety can actually worsen.
If she is completely refusing what can the parent do? is the goal to set up a schedule of going to a couple of classes and working on add more?
A first step may be for her to see a medical doctor to rule out any physical stuff, nothing physical I would look at evaluating her- if it's anxiety, depression, family stuff. I tend to think it is more related to the family. The girl is trying to "fix" something- to bring attention to something.
They have ruled out physical. she just saw her MD for stomach issues and she was given a clean bill of health
What would be the first step as it pertains to her going or not going to school?
If she completely refuses, yes, could consider something more gradual, fewer classes. Allow the father to talk share the story of the girl and the family with you- validate dad's struggle with this. That can go along way if he feels supported. Stomach issues are often anxiety related. Is mother involved? Is it just the dad coming in?
First step would be for someone to further evaluate her and if it is anxiety get specific treatment for that, counseling etc.
Mother is involved with her. She has agreed to her daughter seeing me, but is not wild about the fact that I am a Christian. Her daughter wanted a Christian Therapist to talk to.
It's okay to take your time on this to gather information. Even telling the father you need to first talk to all involved and that there is not a simple answer to this. If you can get a hold of a school refusal assessment scale that would be helpful.
Has she been connected with a youth pastor at church?
yes, but there has been changes in the leadership, so there has been loss there too
is that scale available online?
You could try doing a search on line for this. It is from School Refusal Behavior in Youth.
It is important to take some time to gather the information and it's okay to tell the dad you need to do that first.
So your recommendations at this point would be to encourage that she be evaluated by a psychiatrist
Next build a team with school. My concern is that she is saying she will not attend public school. That they are filled with not nice people
If the girl is more comfortable with a "christian" therapist she may be more open to the idea of counseling? A psychologist is where I would begin after I gathered the info. from dad, girl, mom, school, etc.
If a smaller classroom or school is an option certainly they can look at that.
would it be worsening the anxiety to change schools at this point?
Right- do not want to change too much- maybe look at it later as an option.
I know I keep reiterating the same question, but as I sit with dad tonight, and he wants to know what to do tomorrow when she refuses, I am still not sure what to tell him. I can tell him we need to collect more info, but each day she misses she is falling further behind, and she is an average student at best.
Someone helping the girl first identify what triggers her fear and anxiety and then teaching her things to manage this may help. Working with the girl and the family as a system is ideal. I'm inclined to have both parents bring her to school if he feels an urgent need to get her there asap.The longer she is away from school the more difficult it can be to get her back.
Have dad call school and see if they can assist him with this too.
In some sort of way this may be her effort to bring her parents together- and they may need to work closer together to sort this out.
When dad comes to your office you certainly can problem solve with him- but it's not unreasonable that you do not have the answer yet- until you gather more. Talk to him about his options.
It's hard to make a recommendation if you have not gotten to know the bigger picture. It is a process, takes time.
School may have some specific ideas for him??
ok.....I will start there.
I would allow dad to talk, share, give you history- he is probably quite frustrated- I would focus on gathering info. and really validating Dad. Telling him you want to support, help, but need more info.
The listening, validating, offering support goes pretty far with a frustrated parent.
Validating his concern, worry, that he wants the best for her etc.
I think mom needs to be an equal part in this.
I will ask him to invite her
We as therapists do not magically have all the answers.
i guess i put pressure on myself to be able to have the answers
It's okay to sometimes say you are unsure but will gather more info. or you are willing to be part of helping them come up with a plan. Have them identify all the options. Do not work harder than the client!!
You are a guide.
You are welcome!
Trust the process of therapy- it happens in a sense just being present.
Would you be so kind to rate my answer so I can get credit- much appreciated!
Thank you- good luck!