Young Children in Therapy, Part 2: What to Expect from Treatment by Dr. Sandra Wartski
What to Expect if Treatment is Recommended
If it is decided that treatment is warranted, the therapist will outline the recommended course of therapy with the family. There are many types of therapy, and therapists use their training to choose the strategies that are most appropriate for a particular problem and for the individual child and family. The younger the child, the more involved the parents tend to be, depending on the issues or problems being addressed. In some cases, therapists may spend a portion of each session with the parents alone, with the child alone, and with the family together; in other cases, especially with older children, direct parent involvement in therapy may be less. Even when the child is seen on their own, there is often collaboration at certain points, whether in session or by phone, between the therapist and parents, particularly in terms of eventual sharing of impressions, development of treatment goals and following up of interventions to implement at home if applicable.
Part of what techniques are used in session will depend on the issues of concern. Child therapists are generally very well trained in helping children in working on relaxation training, practicing coping skills, building interpersonal skills, improving self-control and other forms of treatment geared towards specific common issues seen with younger clients. The type of intervention may vary depending on the chief concern, and the modality may include individual, family or group therapy. If, for instance, the parents of a young child present with concerns about increased tantrums or oppositionality, a therapist might use more of a Parent-Child Interaction Therapy model. This treatment involves coaching parents during sessions to learn new ways of interacting with their child, establishing a nurturing and secure relationship while increasing the child’s positive behavior and decreasing negative behavior. Another child may present with intensive anxieties from a trauma, and a therapist trained in Play Therapy might assist a child in using this self-guided method to assist the child in processing the experiences and integrate more emotional regulation. If parents are presenting with a child who is appearing depressed, the therapist may use Cognitive Behavioral Therapy strategies which help to restructure negative thoughts into more positive, effective ways of thinking. Family therapy may be suggested as the primary strategy if family members aren't getting along or group therapy may be recommended if a child is struggling with social skills. Although the training and specializations for child therapists differ, there is lots of overlap in the strategies used and commonality in that all child therapists have training in—and generally really enjoy—working intensively with kids and families.
Knowing When to End Treatment
In most cases, the decision to end treatment is usually a collaborative decision between the parents and the therapist and maybe even the child, depending on their age, can together develop. Although it is often difficult to picture at the outset, it usually becomes increasingly clear when the issue of concern is resolved or improved. Many child therapists think about it as “graduating from treatment” to suggest that the time in therapy is, for most kids, simply a portion of growing up time when they are learning new skills. Knowing when to stop treatment is so individualized depending on the difficulty, but we are generally looking to help children and their parents better understand the difficulties so they know how to better cope and manage with more effective skills in the future. This does not mean kids or their families have to be perfect or without problems—as this doesn’t really even exist—but rather that families are hopefully fulfilling their lives to the best of their abilities and know how to problem-solve as needed.
Sometimes therapy is also stopped if it is determined that a child is simply not ready for treatment quite yet or has gone as far as they can in the development of a given set of skills at their particular stage. There are times when there is more wisdom at that point in putting treatment on hold until a time down the road when they might be more receptive or until a new method of intervention has been found. There are times when it is suggested to parents that it might be better to stop treatment before a child becomes really negative or resistant in order to help them to be open to it in the future if/when needed. There are other times when the child might have less choice, such as if there are dangerous behaviors or very serious concerns involved; however, therapists aim to remain attentive to the motivation and cooperation of the child in treatment as much as possible.
What’s Different about Child Therapists
Child therapists are very accustomed to finding ways to work with children in ways that meet them at their level. There are times when the therapist may use more drawings, stories, role play, activities or games as a means of being able to better understand a child’s feelings and thoughts. Usually there is continual communication going on throughout the exchanges, but many children are often more comfortable and more able express themselves when other methods of interaction are used. The older the child is, the more direct verbalization is often used; however, even wonderfully articulate teens sometimes benefit from the use of a drawing or the tossing of a ball back and forth to help ease the discussion of sometimes difficult feelings. Parent feedback and observations are also helpful in this regard.
Most child therapists really appreciate the way in which children and teens usually bring such energy and enthusiasm to treatment. Kids often have fewer negative stereotypes about treatment—being used to having tutors and coaches in their lives—and are so often ready and sometimes even eager to work on skills. Therapists working with kids and their families often get to use creative, playful strategies—and this allows such a positive and hopeful approach to treatment in many ways. Working with young people also can feel so satisfying in that they often do not have habits which have been stuck for decades; it is certainly no secret that the earlier we change habits, the easier it is to change. Most child psychologists feel truly privileged to be able to be part of promoting emotional, social and psychological success of the children, teenagers and their families.
Sandra Wartski, PsyD
Licensed Psychologist, Silber Psychological Services
Immediate Past President, North Carolina Psychological Association
Member, American Psychological Association
National Register Credentialed since 1995