How Do Psychologists Do Psychotherapy With Children?

If you have thought about taking your child to a psychologist for treatment, you might be wondering what happens in the therapy room. When people think of therapy with adults, usually talk therapy comes to mind. But what does psychotherapy “look like” with children?

When you meet with the psychologist for the first time, he/she will conduct an initial assessment. This usually involves some time with just you (and the child’s other parent, if they are also available), some time with your child alone, and some time with the two of you together. Sometimes there are questionnaires and other paperwork to fill out to give the psychologist a clearer picture of your concerns. At the next appointment, the psychologist will discuss your child’s diagnosis with you and let you know what they recommend for addressing the issues identified during the assessment.

Here are some common ways that psychologists do psychotherapy with children. The psychologist will choose the specific methods they believe will be best for your child.

Play Therapy

In the same way that adults talk through things to work through feelings, children use play. Play therapy focuses on helping children process emotions and events in their lives through play. Play therapy can be non-directive, in which the psychologist witnesses the play and provides occasional feedback to the child to help with processing. Or it can be directive, in which the psychologist plans a play activity to help the child process an event or learn important skills.

Games

Games can be used in various ways, depending on the nature of the game and the goals for the therapy. Simple games can accomplish many things at the same time, including engaging a child in the therapeutic process and developing trust for the therapist, learning to take turns, practicing cognitive skills such as planning and sequencing, and providing opportunities to inhibit impulses and receive immediate positive feedback for doing so. Certain games are made specifically for psychotherapy and help children learn to identify emotions or practice social skills.

Sand Tray Therapy

Sand tray therapy (sometimes called SandPlay- a specific type of sand tray therapy) involves the child setting up small figures and objects, called “miniatures”, in a container of sand. The miniatures are symbolic, and setting up a sand tray functions much the same way as dreaming, allowing the child to process their emotions through metaphor, without needing to talk.

Art Therapy

Art therapy may involve drawing, painting, or craft activities to help the child explore emotions or learn skills. Like play therapy, the art activities may be directive or non-directive.

Skill Building

Psychologists often teach specific skills to children. Many children benefit from being taught to recognize when anger or anxiety is building, how to handle a panic attack, or what to do in specific social situations. Coping skills, such as deep, slow breathing are also highly effective when practiced regularly. The psychologist may also teach your child to recognize thought patterns or beliefs that are contributing to the problem, and how to replace the unhealthy thoughts or beliefs with healthier ones.

Specific Treatment Protocols

A number of treatment protocols have been developed and tested for specific problems. For example, Self-Instructional Training (SIT) helps children with ADHD learn to talk themselves through tasks and better regulate their behavior. Trauma-Focused Cognitive Behavior Therapy (TF-CBT) is used for treating trauma and Posttraumatic Stress Disorder. Exposure with Response Prevention (ERP) is used for treating Obsessive-Compulsive Disorder. Habit Reversal Training (HRT) is used for Tourette’s, Trichotillomania, and other related disorders. These treatments involve a set of skills and exercises that are introduced and practiced in a specific sequence.

Talking/Support

Older children and adolescents often have things on their mind that they would like to talk about, in the same way that adults talk to a therapist. If “talk therapy” is being done with your child, the therapist may provide pages to color while talking, or they may play a simple card game or other low-key activity together to help your child feel more comfortable expressing their thoughts and feelings.

Working with You and Your Child Together

There are a number of therapeutic methods for working with a child and parent together. These methods have different goals depending on the specific therapy protocol. Some goals include: teaching healthier interactional patterns, building the bond between parent and child, treating depression in children or adolescents, or helping a child overcome an eating disorder. There are specific treatment models that can be used, and other times the psychologist may simply facilitate play and other interactions between the parent the child. Some psychologists bring the whole family together and treat the family as a unit instead of singling out one particular person.

Parent Component of Therapy

Research has shown that regardless of the type of therapy that is done with children, it is most effective when there is some type of parent involvement. The frequency and nature of parent involvement varies. Some psychologists will bring the parent in for a few minutes at the beginning or end of every session, some will bring the parent in only occasionally. Some schedule separate sessions for parents only.

Parent involvement involves a combination of several components. These are: the psychologist keeping parents informed about how the child is progressing in therapy, parents keeping the psychologist updated about events and concerns in the child’s life, and the psychologist providing instruction and planning for how parents can help their child at home.

With older children and adolescents, there is a concern about the need to balance the adolescent’s need for privacy with the parents’ legal right to know what is happening in the sessions. In order for the adolescent to trust the psychologist and benefit the most from therapy, it is best to have an agreement with the psychologist that you will respect your child’s privacy in sessions by not requiring your child or the psychologist to tell you exactly what is discussed in the sessions, while at the same time trusting that if there is something serious you need to know (such as any danger your child may be in), that the psychologist will let you know. It is best to discuss at the outset, what these parameters will be for your family so that everyone is on the same page before your child divulges personal information to the psychologist.

It is also important to know that legal requirements about the privacy of minor patients in psychotherapy vary by state, with some states allowing adolescents of a certain age to obtain therapy without parental consent or knowledge. Also, in many states, a child’s other parent has the legal right to the child’s therapy records even if they are not involved the child’s life, unless the primary parent presents a copy of a court order showing that the other parent’s parental rights have been terminated. Make sure you understand your state’s requirements and the psychologist’s policies and at the outset of therapy.

There are many ways that psychologists can work with children in psychotherapy, allowing treatment to be tailored to your child’s unique needs and personality. You and your child’s psychologist are a team, working to help your child be the best they can be, and open communication will help the treatment be the most effective.