THE WHO, WHAT, WHERE, WHEN, AND WHY OF CHILD THERAPY

Jessica D. Wall, L.C.S.W.

As one enters psychotherapy there are feelings of wonder, anxiety, and hope. But what if the treatment is for your child. What does this mean for you and your child? How will it help or not? What will the therapist attempt to do with the child and parent? What is expected from the therapist and the treatment? In this paper, the writer wishes to introduce parents to the process of child therapy by answering these essential questions. This is not an exhaustive discussion but simply an entry into an important consideration and process for your child and family.

Who could benefit from child therapy?

In this discussion I'm referring to children 12 years and younger. Although adolescent patients can be considered in this discussion; their needs are often different and the structure of the process may be altered based on their developmental demands. Psychotherapy, or more specifically play therapy, is accessible for all children who have the capacity to be related, expressive, and interested in learning about themselves. Along with these qualities, children are most amenable to treatment when there is a sense of collaboration and interest by the parent/s and the therapist alike. In addition, the therapeutic process is successful when the child has permission to make use of the therapist and can build a sense of safety in sharing her/himself.

What is child therapy?

Depending on the age and character of the child, children have many different ways of sharing themselves with the therapist through play, communication, and nonverbal exchanges. In play therapy, the child makes use of various forms of play such as dolls, art, and games as methods for expressing their experience, concerns, and conflicts to the therapist. Some children, on the other hand, enter treatment speaking directly to the therapist about his/her concerns. Either method or combination is effective and is decided by the child's needs, capacities and comfort level for expressing oneself.

Through the play, the child tells about his/her self, internal world and reflects back his/her internal and external struggles, conflicts, anxieties, excitements and ideas about his/her world. The therapist interacts with the child in recognizing these feelings, acts, and stories of the self and others through the representations in the play. By engaging in the play, the therapist interfaces with the child’s primary source of communication, the play. In doing so, the desired outcome is to reduce the concerns and ultimately to bring resolution to the presenting concerns, behavior, and/or difficult feelings.

Where does a parent obtain services for their child and family?

Each family has many preferences in determining the place to obtain services such as: financial/insurance demands, time availability and flexibility in schedule, families’ knowledge of mental health services and systems and much more. Psychotherapy is available through community mental health centers, community centers, hospitals with a psychiatric component, and private practitioners. There are benefits and limitations within each setting. However, the essential element of obtaining treatment is gaining a sense of trust, respect, and knowledge from and for the therapist.

When does a parent bring a child to treatment?

There are many situations that can overwhelm a child's capacity for understanding, impede the child’s development, and/or bring on intense emotional states that seem unresolvable for the child and parent. These situations are located in three general areas of the child: internally, externally, or environmentally. Of course it may be and often is a combination of these domains. Through the course of treatment and the support of the parent, the presenting and underlying issues may be reconciled with a reduction of certain feelings, increased maturation, and an ability to talk with others.

Some examples are provided within each domain that may warrant treatment:

Internal:

Extreme nightmares • Childhood illnesses • Delayed development, unrelated to medical condition, such as speech, potty training • Child reports a persistent worry, anxiety that hinders functioning and happiness • Problems with transitions to school, new home, parent’s remarriage, birth of sibling.

External:

• School/ learning difficulties • Major loss of a parent, sibling, significant friend or relative • Traumatic divorce/separation in family • Separation issues.

Environment:

• Poor parent-child fit• Parent is concerned about some aspect of child• Traumatic divorce/separation in family • Abuse/neglect issues within a family • Serious illness, drug abuse, and/or alcoholism within a family.

This list does not represent all the possible reasons for considering psychotherapy but is available as a sample.

Why might a parent bring a child to therapy?

In these domains of the internal, external, and environmental, a child may be struggling greatly without sufficient relief. Some struggles can be so consuming that a child’s internal and eventually external capacities become focused in solving this current difficulty and causing the child to abandon his/her inherent growth process. As adults, we can relate to having an ongoing concern that follows us in our thoughts, days and dreams. A child is no different except for the fact this is a child. Meaning that, a child has not yet gained all of his/her capacities to modulate feelings, solve problems, and understand tremendous conflicts. Without assistance to these struggles the child’s natural process for growth and pleasure may be blocked. The longer the block remains in place the greater the impediment to the child’s development.

What will happen when you bring your child to a therapist?

As the parent contacts a therapist a number of steps will take place. An initial appointment will be arranged either with or without the child so that the parents and therapist can gain a sense of fit and rapport in working together. Once this first step has begun an understanding of the presenting concerns from the parent/s, child, school, pediatrician and all other influential sources is gathered. Along with gaining knowledge of the presenting concerns, the child’s developmental history is taken together with the history of the families formation as related to the child. In gaining this information, the therapist will gain knowledge about the family and the child’s place within it.

An assessment of the child will occur that is likely to include an appreciation of many dimensions of the child such as: mother’s pregnancy and birth of the child, physical/ cognitive development, emotional nature of the child, relatedness to others, feelings and anxieties, and use of the environment. A beginning therapeutic plan will be arranged with the therapist, parent/s, and child to address these presenting concerns.

Some questions the parent/s may look into are: how often will the child/parents be seen, the cost of the sessions, length of the session, and overall length of therapy. With these questions addressed there is a basic guideline for how the process may evolve over time. Parents expectations and goals for their child and their relationship need to be articulated to appreciate the outcome hoped for as well.

As the parent and therapist have an understanding of the presenting problem and symptoms a treatment plan is then developed. The plan and the understanding may be adjusted throughout the process as the child, the family and their experiences are better understood with the therapist. The therapist will begin to either meet with the child alone, or with family members based on the concerns presented. Often a child and therapist meet weekly to build familiarity, comfort for the child with the process and the therapist. From the initial appointment forward, an ongoing exchange between the parent/s and therapist will occur in terms of the progress of the child, parent’s reaction, and the treatment course.

How will the child and the parent respond to therapy?

Each child and parent has their own unique reactions to the process. The therapist would invite all questions, concerns as they arise. There may be increased intensity of feelings and/or behavior as the child, parent, and therapist begins to unearth the concerns and related issues connected to the presenting difficulties. This is temporary and in time there is a reduction of these struggles as they are articulated and there is an increased appreciation of self, family, and their connection.

How long will my child require treatment?

Like adults, children vary in their ability, motivation, and engagement in the therapeutic process. Therefore, many elements decide the length of service and cannot be fully known ahead of time. Some criteria for considering the length of the treatment process include: the length of time the presenting concerns have been apparent, the depth of difficulty, the level of support for the child, and the capacities of the child and family to be engaged in this process.

What does it mean for a parent to enlist a therapist to help their child?

Similar to seeing a pediatrician or other specialist, at times, children may have difficulties that require an outside resource to help reduce the presenting difficulties. When a parent recognizes their child as possibly benefitting from therapy and acts on this, this speaks to the parent’s tremendous concern and willingness to help their child. Through increased communication, relatedness, and acknowledgment of the importance of the child's needs and growth the parents are promoting the essential qualities for their child’s vitality.

What you might want to know from the child therapist?

In the initial assessment the parent is gaining a sense of the therapist as a person, clinician, and his/her style of working with people. Besides the experiential aspect of meeting with the therapist, some facts to learn from the therapist may be the therapist’s education, training, licensure and experience with children and parents, as well as their philosophy of treatment.

What is the therapist's view of child therapy?

The struggles of children can be surmounted with support, focused attention, time and willingness to work toward an understanding of the communications of a child to his/her self, parent/s and community. In working with children and their parents, the role of the child therapist is to partake in the child's experience, facilitate the child's ongoing growth and well-being through a process of freeing up the child from blocks, and to enhance the maturation process for the child and family. The therapist ideally is to become a useful other assisting the child and parent to regain a sense of well-being at this essential time.

In closing, psychotherapy, play therapy, are wonderful opportunities for growth, expression and awareness of oneself that are the hallmarks of ongoing maturation and happiness. A child engaged in and in need of treatment can be seen as an opportunity for alteration and further adaption to their lives that may free them from past losses, unnamed feelings and experiences that previously had been unknown to him/herself. This writer hopes this paper has been useful in acknowledging some initial questions that may be of concern as a parent considers psychotherapy for his/her child and/or family.