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Wednesday, January 5, 2011

Children and Therapy - What Happens?

Whether a child has been referred for therapy by another agency or a parent  who has decided it would be in the child’s best interests to see a professional, the first thing that both parents and kids want to know is – what’s going to happen?

Therapy with children is not the same as therapy for adults.  Children process their feelings differently than adults and therefore, therapeutic interventions with children must take into account several things:
1.      What is the child’s level of maturity?
2.      What changes have occurred in the child’s behavior?
3.      What life events have occurred or will occur in the near future that affect the child’s sense of self or security?
4.      How is the child currently processing feelings?
5.      What does the child like to do and what are his/her interests?

Therapeutic interventions with children involve activities that don’t normally seem like therapy – but which actually do have a very specific purposes in a therapeutic environment.  For example, a child who has experienced trauma might best be able to express the event through drawings that represent feelings they experienced when the event occurred.  A younger child might express his feelings through imaginative play.  Adolescents can often make a connection through music.   A child who has experienced trauma might benefit from a more structured program of trauma-focused cognitive behavioral therapy.

Children process many feelings, especially trauma, on a sensory level – meaning they experience it through sensations rather than through thought processes.  This is why traditional “talk” therapy isn’t an approach we usually use to work with children.  Although your child might come out from a session and tell you they didn’t do anything but play with the dollhouse, we were actually doing some very specific work. Your child’s play tells me things about his or her feelings and experiences; likewise, through play, I can teach your child how to manage with those feelings  or help them learn alternative behaviors.

During the first visit, I usually meet with only the parent(s) in order to complete paperwork, discuss confidentiality, review policies, gather insurance or payment information,  and get a good history  (from the parents’ perspective) of what has happened to bring the child to therapy.  During the second visit, I meet with the child alone or, in the case of a young child, with the child and parent.  I always tell children what to expect from me, as well as what I expect from them. Then, we spend some time getting to know one another.

During subsequent sessions, we might engage in therapeutic play, art, games, or structured activities, where children learn to name and express their feelings in an appropriate manner. They learn to manage their stress and discomfort. They learn what things they can be in control of and what they cannot.  We work on building self-esteem and children learn they do have some power. More importantly, they can practice positive ways to use it.  

I speak with the parents briefly at each session, keeping them informed of their child’s progress and providing them an opportunity to ask questions or express concerns.  When appropriate, parents are included in at least some of the sessions.  I also make it clear from the outset that if your child doesn’t want to come to therapy, I will never force them to be there.  I do ask, however, they come for at least three sessions before they make a decision to quit.  Usually, by the third session they feel quite comfortable and want to come back for more sessions.  I also always make sure children know they can go back and forth from my office to the waiting room to touch base with parents as often as they want or need to.  This is especially important for younger children or those who have a lot of anxiety.  

I encourage anyone who wants to learn more about how therapy works with kids to call me and ask questions.  The idea of a child seeing a therapist doesn’t have to be scary for parents or kids and we are happy to answer your questions any time. We want for you and your children to feel safe and supported in an environment where healing may occur.