In Part 4 of a Parents’ Guide, I considered what you as parents should expect of the relationship with your child’s therapist. In this fifth post I address the question of how a therapist can get off to a good start with a child, and not scare him/her away.
For most children initial meetings provoke anxiety. The therapist is after all a complete stranger. Not knowing what to expect, a child has all kinds of unspoken apprehensions. Will he give me a shot? Will he ask embarrassing questions? Will he judge me, criticize me, scold me? Will I feel uncomfortably exposed and want to flee? Or will I feel safe and comfortable?
In the context of these worries most children want the reassuring presence of one or both parents at least for the first meeting and even subsequent sessions until they feel at ease. And this is normal and to be expected.
In the first session(s), there is no need to focus directly on the problems that precipitated parents bringing their child to see me for two reasons. First, the child already implicitly knows why he is there, even if he were to maintain that he doesn’t. Second, focusing on the presenting problems risks the child’s feeling exposed, called out, embarrassed and made to feel ashamed, like he is the bad, crazy kid.
So what do I do instead? By being curious and interested in a child’s life, not just the problems, I implicitly state the terms that will govern our relationship going forward: 1) you are important and interesting to me; 2) you are much more than the problems that brought you here; 3) I want to learn and come to know the whole of you; 4) we will learn and share this journey together; and 5) along the way we will come to understand and work through the “problems” in your life.
These terms are not stated directly, but rather in the form of curiosity and interest. With more verbal and somewhat older children, I wonder about their lives. What is school like? What subjects do you like and don’t like? Who are your favorite and worst teachers? Who are your friends? What are their names? What do you like to do with them? Do you have a sport? Do you like music? What things do you do for fun? Curiosity and interest go a long way in starting to build our relationship.
Three to nine year olds typically prefer playing to talking. I show them around the playroom pointing out all that we can do and then follow the child’s lead. The child chooses the play, and I perform my part as directed. I am both a participant actor in and quiet observer of the child’s drama, whatever it may be.
In this process I keep in mind the central, core question: of all the possible play activities this child could have chosen, why did he choose this play and what does it mean? What is he telling me? In the metaphors of his play, I know that he is “talking” about himself, his mind, his conflicts, his concerns and his relationships with his family members.
Figuring out the meaning is challenging. Like decoding encrypted communications, the concerns that underlie the play are most often hidden and not readily apparent: deciphering the meanings takes time and repetition as play themes develop and become more defined and differentiated. Considering the range of possible meanings of the play’s content constitutes the art of therapy with children. Keep in mind that it is a shared undertaking, not just me as a therapist but the parents and me working together to make sense of the developmental issues and conflicts.
Some parents assume that their child will use therapy to talk about his problems, just like adults do and are disappointed when their child fails to discuss his anxiety, depression or difficulty getting along with his sister. Such expectations are ill-founded. Almost all children want to play, not talk. If pressed, a child will offer a few sparse sentences about his concerns and then want to get down to the business of playing. Some parents have complained to me that the play misses the point and is a waste of time. These judgments are various. “I didn’t bring my child here just to play. Of course he enjoys coming. Who wouldn’t want to play, but it doesn’t fix the problems.” From this perspective play is frivolous and indulgent waste of time that fails to address the problems.
This view represents a fundamental misunderstanding of the child therapy. When children play in therapy sessions, they are “talking” about themselves and their feelings. Play is the language of child therapy.
But why don’t children talk about their issues like adults do? It is primarily because children do not yet have the neurological equipment to think about their own minds in a reflective way, as we adults do. This capacity normatively emerges with the explosion of brain growth in adolescence, and these capabilities grow and strengthen as teenagers move towards their young adult lives. One of the great discoveries in child mental health care has been that children talk about and examine their world in medium of play. I will have a lot more to say about this subject in a later post.
In the next post I will consider what constitutes and psychological diagnostic evaluation and what recommendations would likely follow from an initial assessment.
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