My New York Times Guest Essay

I’m so pleased to be able to share my guest essay that was published in the New York Times Opinion section on September 9. The shortage of child and adolescent therapists in the U.S. has become a crisis. In this essay, I offer my take on why there aren’t more of us working with children and teens and what policies might reduce the shortage.  Thanks for reading!

The U.S. Must Invest in the People Who Care for Children’s Mental Health

By Rebecca Bonanno

Dr. Bonanno has been a child and adolescent therapist for more than 15 years.

My stomach lurched when I answered the phone at my therapy practice. On the line was the latest worried and exasperated parent hoping to schedule a psychotherapy appointment with me for a child or teenager. I’m one of the few child and adolescent therapists in my area, and I dreaded telling this mother that my schedule is full. I listened to her, provided a couple of referrals and suggested some self-help or online resources the family can use while they wait for a therapy opening with someone else.

“But it’s urgent,” the mother said. Of course she’s right. Some parents try to keep me on the phone, hoping I’ll hear their desperation and agree to squeeze in an appointment for their child. And once in a while, I do break my promise to myself not to overbook. I know how needed my services are. But now that school has started and children’s availability for therapy becomes more limited, I can’t anymore.

There is a nationwide shortage of mental health professionals, but it’s especially acute for children and teenagers. The U.S. Department of Health and Human Services has estimated that by 2025 the nation will have 10,000 fewer mental health professionals than it needs. Even before 2020, many children and teenagers with behavioral struggles were not receiving services. The reasons included lack of financial resources, the stigma of mental health issues and, of course, the shortage of therapists trained to work with children.

High-quality training in child and adolescent therapy can be difficult to find. Most therapists in the United States, like me, are clinical social workers. We spend two years in graduate school and only a portion of our studies are spent on developing counseling and clinical practice skills. Any further child and adolescent therapy training often takes place in field placements (similar to internships), on-the-job supervised training and costly postgraduate programs. Clinical and school psychologists have opportunities for more focused and intensive training when working with kids, but these professions require lengthier doctoral-level education.

But there are other substantive reasons therapists back away from working with children, even as this population is so clearly in need.

Child therapy is not always intuitive for therapists who are used to traditional talk therapy, and talk alone doesn’t always work with children and teenagers. Instead, child therapists use play, activities and exercises, role-playing and other tools to communicate with young clients. This requires creativity, time-intensive prep work and a spacious-enough therapy office equipped with toys, games, art materials and books. These all come with price tags — both in energy and money — for therapists.

Speaking with parents, case workers and school personnel outside of the therapy session is also time intensive. These collateral contacts, as they are called, are not reimbursed by most insurers but are crucial to good treatment. Like all clients, kids tell their stories from their unique perspectives, and getting a bigger picture from the adults in their lives is necessary.

But there are only so many nonschool hours in a week. Young children have small windows between school, dinner and bed, and therapy can compete with sports, arts, tutoring, religious education and more. This means child and adolescent therapists frequently work late afternoons, evenings and often weekends to fill up even a part-time schedule with young clients.