Children, teens, and parents can be nervous about starting the therapy process. Click the services below to learn about what you can expect during the first appointment and subsequent appointments.
The initial intake is the very first appointment. It will last approximately 55-minutes. The goal of this appointment is to better understand what your child is struggling with and if Dr. Hoffman is the right person to help. You will discuss early history, general background, current and past mental health-related symptoms, and goals for therapy.
If it seems like Dr. Hoffman can help, you will discuss the ways therapy will be approached to help meet these goals. If Dr. Hoffman determines she does not have the skillset to best support your child, referrals will be offered. If you or your child decide Dr. Hoffman is not a good fit, you can also request referrals.
If the child coming to therapy is 6-12 years old, the first appointment is for parent(s) only.
Teens 13 and older are encouraged to attend. The parents, teen, and Dr. Hoffman will meet together at the beginning of the appointment. There will be an opportunity for the teen and/or parent to meet individually as well.
Most often, weekly therapy sessions are recommended at the outset of treatment. To ensure availability, Dr. Hoffman encourages a “standing appointment” where appointments are scheduled the same day and time each week.* Sessions typically last approximately 53-55 minutes. Shorter sessions are available as clinically and developmentally appropriate.
Parents are often asked to participate in the treatment process. This is especially common and important for younger children and for parents who have found themselves intertwined in rituals, compulsions, and reassurance. Participation for parents of older teens varies considerably based on your relationship and the teens symptoms and preference.
Most often, therapy begins with education about the primary concern (typically, anxiety or OCD). A big focus will be on what tends to maintain symptoms and how that relates to the type of treatment recommended. As Dr. Hoffman reviews different models and approaches to treatment,she will discuss with you her recommendations and collaborate with you to determine what feels like the best match for your child/family.
One option will be for therapy to move into exposure/exposure and response prevention (ERP). In a nutshell, this means facing fears without any specific safety behaviors or habits. As it can be a challenging and scary treatment, Dr. Hoffman’s goal is to collaborate and find ways for your child to be in charge of this process. They are in the driver’s seat choosing how fast or slow to move and which turns to take. These sessions are unique for everyone, but often include a combination of reviewing ERP homework, planning new ERP tasks, and practicing ERP in session. Learn more about ERP here.
Another option will be for therapy to take a more cognitive approach, through Inference-Based Cognitive Behavior Therapy. Children and their parents will learn about obsessional doubt and the reasoning and stories a child uses that make these doubts seem reasonable. We'll work to better understand any core concerns (e.g. I could be a bad kid!) that make these stories so easy to get stuck in. Therapy will involve recognizing how a child gets pulled into an OCD "bubble" and some strategies for how to recognize this and choose a different path. We'll work on increasing trust in self and sense. To read more about I-CBT, click here or here.
Finally, a third option is for Dr. Hoffman to work primarily with parents. For various reasons, sometimes kids find it hard to be an active participant in therapy. That does not mean we cannot still work toward improving their life surrounding their OCD or anxiety. Dr. Hoffman works with parents from a SPACE-informed model and may help parents learn more about their role in maintaining OCD or anxiety and ways to help the child feel supported and regain trust and confidence in themselves.
Acceptance and commitment therapy (ACT) approaches are typically integrated into the therapy process. Your child will be encouraged to explore what is important and valued to them. We will work on taking steps toward those values. Dr. Hoffman will encourage your child to find ways to engage in life in a meaningful way without waiting for symptoms to disappear.
When it seems like a more integrated or different approach is warranted, therapy may shift to allow for this. If an approach Dr. Hoffman does not specialize in seems more fitting, we will discuss appropriate referrals.
*There may be an option to have alternating bi-weekly appointments. This will allow for weekly services with less disruption to a particular class or activity. As progress is made and symptoms improve, sessions typically are reduced to bi-weekly, followed by monthly, before officially ending or moving to services “as needed.”
Telehealth sessions are available for all services. In order to participate, all children/teens/parents must be physically in Indiana. The COVID-19 pandemic pushed providers into offering virtual services rapidly. Dr. Hoffman has discovered that for many, this is a great option. During our sessions, we can discuss the appropriateness of meeting virtually and make adjustments as necessary.
Telehealth appointments are a great option for those who would otherwise find distance or time to conflict with scheduling. For those doing ERP, telehealth sessions offer great opportunities to work on exposures we would be unable to address in the office.
During the COVID-19 pandemic, telehealth sessions are encouraged for those able to engage well virtually.
Services will be conducted over a secure, HIPAA-compliant video platform. A webcam is required. You will be asked to find a quiet, confidential space to hold your session and Dr. Hoffman will do the same.