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Children &  Psychotherapy

Some children really love therapy. They feel they have a trusted ally and like the creative activity. Other children can feel threatened by therapy and make strong complaints about going, even though the therapy may be helpful. If the child complains, parents and the therapist have to determine whether the complaints are part of recovery.


Kids who have gone through significant trauma may need more help in developing the ability to keep out troublesome thoughts and worries. With these children, the therapist needs to be careful not to move too quickly to speak about the painful events because the child can experience this as a repetition of the trauma. Before remembering the painful experience, the child must get permission to forget and take part in living. When the child has developed emotional skills and strengths they can start to remember the trauma, which can be helpful. Being forced to remember too soon can be another painful demand. The child has to feel safe enough and ready to remember the painful experience.


It is important that the parents be committed to the theraputic process and understand that emotions can be stirred up in the process. Parents need to be prepared for what might be a lengthy process.


Basic Concepts and Components of Psychotherapy

For children to flourish, they need to learn certain skills that allow them to relate to other people. They need to know how to express their feelings effectively when interacting with others. Children should be able to experience a wide range of feelings without becoming overwhelmed. In their relationships, children should be able to play cooperatively and competitively with peers. With adults, children should be able to put up with the reasonable demands of authority, and make their wishes and concerns known.


These skills are usually learned in the family setting and early school environment. When children have difficult temperaments or they have a challenging situation at home, it can be hard for them to develop these skills. Beginning psychotherapy early can make a big difference in bringing development back on track. For children, play is the language of the imagination and feelings. Play allows children to express their strongest feelings and conflicts. In this way, play provides an avenue into the child’s inner world. In the context of play, difficult thoughts and feelings can be expressed in a non-threatening way. Play offers a controlled setting where a child can try out new behaviors. 


Problematic behavior is often an attempt to manage anxiety and feelings of danger. In psychotherapy, safety is created by the relationship between the child and the therapist. The regular meetings, the therapist’s consistent and careful focus on the child’s worries and the therapist’s acceptance of the child, all add to an increased sense of security. When the family understands the nature of the child’s behavior, it can help them find more effective responses. As things begin to feel safer in their environment, children can take the risk of leaving their old methods of managing anxiety behind, and can begin to develop new, more positive behavior.


It is important for parents to understand that throughout the course of psychotherapy, children may have intense positive and negative feelings toward their therapist. This is part of what allows therapy to reach the child at the deepest level.


Description of a Typical Session

When I work with a child, I begin by meeting with the parents. I gather information about the nature of the child’s difficulties and the family’s background. After getting a history of the child’s development, I meet with the child. Often children will want their parents to stay with them during the first session. As a rule of thumb with younger children I encourage parents to participate in most if not all of the sessions, since I believe that the work that starts in the therapy-room should continue at home. During the session, children are invited to play with the toys and art supplies in the office. As the therapy continues, the child’s worries and concerns are expressed increasingly through play and drawings. As the child starts to trust the therapist, there is room for the therapist to begin to talk with the child about how the themes in the child’s play may be connected to issues and feelings in the child’s own life.


When working with teenagers, I explain to them what I have been told about their situation and ask them to give me their perspective of themselves and their family. Some teenagers are quite ready to speak about their thoughts and feelings. Other teenagers may feel unsure about opening up with a stranger. With these teens, I work hard to create a more comfortable context for discussion. We may begin by speaking about music, movies, images, things they read or write about or other ordinary topics and allow this to become a springboard for more personal conversation. After meeting with the child for several sessions, I will then schedule another meeting with the parents. At this time I will talk to the parents about my impressions and talk about a possible course of treatment. It is important for parents to understand the reason for treatment, and to have a good sense of the commitment involved. 


Average time per session last 50 minutes, one to four times a week. Therapy tends to work best when children have at least two sessions a week.


Estimated Length of Time Before Change Can Be Expected

With most children, therapy requires time for enough safety and trust to be established. This process can take a few month and at times it can take up to a year or even longer. 


Suggestions to Make Psychotherapy More Effective

Parents should meet with me regularly: once a week to once a month. You shouuld keep me informed about the events in your child’s life. I will coach you on ways to be more effective at home. Parents sometimes have the idea that children should talk about their troubles with the therapists. Parents must realize that, for the therapy to go well, there has to be room for play. Parents should understand that conflict and strong emotions are an important part of the therapeutic process, and that during difficult periods in the treatment they should collaborate closely with me.


Different Methods of Psychotherapy for Children & Youth

There are many different forms of psychotherapy for kids, some of the methods I use are: Psychodynamic, Play Therapy and Expressive Art Therapy.


Areas In which Psychotherapy With Children Can Help

Psychotherapy can help kids with depression and anxiety, as well as with problems at school, attention and learning difficulties, adjustment to loss, divorce, or death, impulse control, defiant behavior and aggression,  social skills, peer and sibling relationships, loneliness, history of trauma/abuse or neglect, coping with troubled family members or parents with addictions.




Therapy with Children

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