How does therapy with children work...

A Sneak Peak inside a Child Therapist’s Office

Your 4 year old just cannot master toilet training even though you have read the books and followed all the instructions; your 5 year old has been very aggressive at preschool and kindergarten hitting other kids and the teachers are complaining; your 6 year old is struggling to keep up with the other students in learning the new skills 1st grade teaches and expects.  

These are all issues that bring children into the offices of child therapists sometimes at the urging of the teachers or the pediatricians and sometimes just from the parents’ own frustrations. 

Since this is a new experience for most people it can be a bit scary to start this process without knowing much about how it all works. As a child therapist with 20 years in the field, it is one of my first tasks to help the parents feel comfortable with bringing their children in to see me. 

If you are finding yourself in this situation and are thinking about taking your child to a therapist then perhaps a “sneak peak” inside a therapist’s office would be helpful to you. 

Along with the usual couch (and chairs) found in an adult therapist’s office, a child therapist’s office will also have a lot of toys, games, dolls and art supplies. This is because child therapists firmly believe that “play is the language of children”. Children communicate differently from adults and use the play material to express what’s on their minds. They use the play material in what we call “symbolic play” which is how feelings they might not even be aware of can be expressed. They play out themes that reflect what is going on in their lives and with the therapist’s help mastery can be gained over difficult, painful and sometimes even scary aspects of their lives.  

The therapist directly observes and participates in the play with the child. Our job is to create as comfortable an environment as possible so the child will feel safe enough to freely communicate his or her worries and concerns. We strive to be as non-judgmental and as accepting as possible and allow the child to play without having to worry about being messy or criticized. 

An example of how this works includes a child who was adopted at an older age and who in the therapy room used the dolls to express some of her deepest feelings and worries. At the child’s prompting the therapist was instructed to “give birth” to many babies who after they were born were usually treated harshly and thrown away by the child. The play reflected her feelings that this is how she had been treated. Allowing the child patient to have a safe space to express these painful feelings was very healing and helped her to begin to master and overcome her difficult beginnings. 

Another example of child therapy involved a boy past the usual age for toilet training who very obstinately refused to use the toilet for bowel movements. In the therapy room this boy used the play to show me his inner world and created a character that we had to run and hide from while they piled up lots of dirt under the furniture. After many months of playing this game and confronting this scary character, the boy eventually mastered the use of the toilet and became less afraid of many other activities he had avoided as well. 

Other children use the play in different ways. Older children who feel like they never win in life frequently gravitate to the board games to show me what it feels like to always be on the losing side. It is not uncommon that no one in their lives helps them to win or to feel like they are a winner. In the therapy room, I try to create the environment where both of these things are possible and work towards improving the child’s skills and self-esteem.  

In order to accomplish real change for the children, in addition to the play therapy, it is important that the parents are part of the treatment. The therapist meets separately, but regularly with the parents so she (he) can learn more about their child’s history and current living situation. This helps the therapist to better understand what the child is trying to communicate in the play. Work is also done towards helping parents better understand and relate to their children. If parents are flexible and amenable to understanding their role in their children’s difficulties, then the work can be even more productive and successful. This can be hard, but is an important aspect of the treatment. 

Play therapy can produce long term change. Children need a safe, comfortable, non-judgmental atmosphere if they are going to reveal their innermost selves. This is the most important part of the work and in this aspect is no different from what is needed for therapy patients of all ages.  

I hope that this peak into a child therapist’s office will make it easier for struggling parents to feel less trepidation in seeking out a child therapist if and when the need arises.

(Reprinted from my article in Special Child magazine November edition)