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therapeutic alliance

Two Parents, Two Stories, One Thirteen-Year-Old: Getting Them on the Same Page (For clinicians)

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When one parent minimizes a child’s ADHD-related difficulties as normal (“tough love,” “just like I was”) while the other describes significant daily impairment, clinicians face a family split that resists ordinary diagnostic explanation. This piece reframes that split as expected rather than a credibility problem: even parents living together and observing the same child show only moderate-to-good agreement on symptom rating scales, and a minimizing parent’s own recognition in the child may reflect a real, unrecognized case in themselves rather than denial. Four concrete moves are offered – shared independent rating scales, naming the disagreement openly without taking a side, asking the minimizing parent directly about their own history, and negotiating one narrow measurable trial rather than a wholesale philosophy change – aimed at protecting the clinician’s alliance with both parents while the family works toward a shared, evidence-based account of the child.When one parent minimizes a child’s ADHD-related difficulties as normal (“tough love,” “just like I was”) while the other describes significant daily impairment, clinicians face a family split that resists ordinary diagnostic explanation. This piece reframes that split as expected rather than a credibility problem: even parents living together and observing the same child show only moderate-to-good agreement on symptom rating scales, and a minimizing parent’s own recognition in the child may reflect a real, unrecognized case in themselves rather than denial. Four concrete moves are offered – shared independent rating scales, naming the disagreement openly without taking a side, asking the minimizing parent directly about their own history, and negotiating one narrow measurable trial rather than a wholesale philosophy change – aimed at protecting the clinician’s alliance with both parents while the family works toward a shared, evidence-based account of the child.

The Session That Should Have Been Your Last: Deciding When Treatment Has Finished Its Work

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There is an old line that you never know what is enough until you have had too much. It is a fine description of appetite and a poor description of treatment, and the difference between the two is worth understanding before your next appointment.

You have been going for a while now. A year, maybe three. The sessions are useful in the way that a good conversation is useful. Nothing is worse. Nothing is dramatically better either, at least not lately. And when you ask yourself whether you still need to be there, you find you cannot answer, so you keep the next appointment, because keeping it is easier than deciding.

Your therapist, psychiatrist, psychologist, or coach cannot answer it easily either. That is not a knock on them. It is a documented feature of the work, and it has a shape worth knowing.

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