Children and Parents

Evaluating and treating children who are struggling psychologically is forward looking: its purpose is to prevent a child’s developmental difficulties from solidifying into enduring and destructive life patterns.

Summary – Children and Parents

• Psychotherapy for children who are struggling psychologically is forward looking
• Child therapy requires that the therapist and the parents work together as a team
• The therapist also participates and consults with the school and other health care providers
• The initial evaluation – learning about the problems and developing a plan
• Importance of working closely with parents following the evaluation
• Free play is the primary engine of the therapeutic process with children
• Direct discussions with a child, as well as family meetings, are also important

Forward Looking – The troubles that grip adults’ mental lives seize children’s minds with no less ferocity and power. Treating children who are struggling is forward looking. The goal is to nurture and promote a sense of internal and relational well-being, so that by her early twenties or before, she will have wind in her sails and be prepared to engage in the fullness of life.

Teamwork – No child therapy succeeds without a strong, close working relationship between the child’s therapist and her parents; they are a team jointly committed to a twofold mission. The first is to help a child work through and resolve her conflicts and suffering. The second is to promote and strengthen the child’s relationship with her parents (and often siblings as well) and vice versa. Once these goals are achieved, the therapist can step away, while the child and her parents, enriched and strengthened by their shared efforts, can move forward with renewed balance and a firmer step.

Joining and Consulting with Other Professionals – The child therapist also joins with the child’s teachers, school counselors, tutors, pediatricians, neuropsychologists and whoever else may be involved in the child’s life — providing perspective and insight regarding the challenges that the child and her family are facing.

Evaluation – An evaluation includes a detailed review of the presenting issues, the child’s developmental history, how the parents’ met and started their family and the histories of each of the parents’ family of origin. In addition, reviewing testing, contacting the school, the pediatrician and other relevant parties are all important steps in the process. Often the therapist will meet with the parents, the family, and then with the child individually. The treatment recommendations grow out of this careful evaluation.

Meetings with Parents – Looking past the evaluation to treatment, meetings with parents continue to be important for three reasons. First, it is incredibly valuable to learn what is going on at home with a child, and reciprocally for parents to hear the themes that are coming up in the therapy. Second, it is useful to brainstorm together about what may be going on in a child’s mind and how to handle the feelings and problematic behaviors at home, at school and with peers. Third, it is useful to process the feelings that a child’s actions stir up in her parents, feelings that are often related to parents’ experiences growing up in their own families of origin.

The Role of Play in Child Therapy – Free play is the powerful engine of the therapeutic process with children. Without free play there would be no child therapy. The child therapist does not choose what to play: the child chooses it. The child therapist follows the child’s lead and becomes an actor in the play. Children “talk” about themselves and their lives in increasingly differentiated ways in the developing themes of their play. The therapist is both an actor in and observer of the play who listens for the themes implicit in play, and when appropriate, comments in ways that promote insight and reflection. In this process the child therapist asks, “Of all the play actions that this child could have chosen to do, why this particular play, and what does it tell us about the child’s mind and relationships?”

Can It Be Talk Therapy Like Adults Do? – Parents frequently urge pre-adolescent children to talk about their problems — their anxieties, troubled moods, angry thoughts, sibling rivalries, school issues — with their child’s therapist, just as adults do with their therapists. But even when the child’s therapist tries to comply, it seldom works. Direct questions to the child about her feelings typically lead to a couple of words, maybe a few sentences, signaled boredom and then an impatient request to play. Parents often worry that play means avoiding the issues, but nothing could be further from the truth. Children express and work through their issues and conflicts in their play. The use of play in child therapy is a core technique in treating children.

Is Play All You Do in Child Therapy? – While play is the primary therapeutic technique with children, it is not the only engine of child therapy. A parent may share with the child therapist something problematic that happened during the week. Since the child is unlikely to bring it up on her own, the child therapist raises the issue. “Your mom told me … So what happened? How did you feel? How might you deal with it?” At times a therapist specifically examines and recommends to the child a different way of thinking about herself or her relationships. It is often useful to meet with the parents or the whole family and the child together. Effective therapy requires flexibility in approach and technique: one size does not fit all.