Start with their experience and knowledge base
Ask directly whether they’ve worked with children who have chronic illness or chronic pain — sickle cell specifically is ideal, but chronic illness experience matters. You want to understand how familiar they are with medical trauma, because repeated hospitalizations, painful procedures, and unpredictable pain crises create a very specific kind of emotional residue in children. A good follow-up: “How do you think about the difference between a child who is anxious and a child who is responding normally to something genuinely frightening?” Their answer tells you a lot.
Probe for cultural competency honestly
This is worth being direct about. You might say: “Our family’s faith and extended community are central to how we cope. How do you work with that?” or “Have you worked with Black families navigating the medical system, and what have you learned from that?” You’re listening for curiosity and humility, not a rehearsed answer. A therapist who gets defensive or vague here is showing you something important.
Understand their approach to pain
Ask: “If my child tells you they’re in pain, what’s your framework for responding?” You want someone who will not interpret pain complaints as avoidance, manipulation, or anxiety — a mistake that happens more often than it should with SCD children. They should understand that pain is real, unpredictable, and exhausting, and that their job is to help your child build a relationship with that reality, not question it.
Ask how they’ll involve you
Some therapists work almost exclusively with the child and keep caregivers at a distance. Others actively include the family. Neither is automatically wrong, but you need to know which approach they take and why — especially if your child is young. Ask: “How do you see my role in my child’s therapy?” and “How will you keep me informed without breaking my child’s trust?”
Find out how they handle the hard conversations
Your child will eventually bring big questions into that room — about death, about fairness, about why their body works differently. Ask the therapist: “How do you approach conversations about mortality or serious illness with children?” and “What do you do when a child says they don’t want to come anymore?”. Resistance and avoidance are part of the process — you want someone who knows how to navigate that without forcing or abandoning.
Get practical and logistical
- Don’t skip these even if the conversation is going well:What’s your cancellation policy for days when my child is in the hospital?
- Do you do telehealth if we can’t travel?
- Have you ever coordinated with a pediatric hematology team, and would you be willing to?
- What does progress look like, and how will we know if this isn’t working?
Trust your gut on the fit
After the call, ask yourself: Did they ask me questions about my child, or did they mostly answer mine? Did they seem genuinely curious, or were they going through the motions? The best therapists for medically complex kids tend to lean in — they want to understand your child’s specific world, not fit them into a general framework.
