Play is the language of children. In play therapy, children are given the opportunity to play out their feelings, experiences and problems using toys and expressive arts. All the toys in the playroom have a therapeutic purpose. Some of the toys in playrooms are a sandtray with miniatures, water or water table, medical kits, puppets, paints and other art supplies, clay and doll houses among others. Play therapy helps children to express how they feel about an event, situation or problem, understand their feelings and learn to express their feelings in new ways (Riedel-Bowers).
The outcomes of play therapy depend on the goal of the child and/or parent(s)/caregiver(s). Children are able to build internal resilience and the family can learn new ways of understanding and interacting with their child to meet their child’s needs. Some outcomes may include the child being able to understand and express their emotions, play out their feelings of loneliness, anger or fear, learn coping skills when confronted with a situation where they are worried or scared, reprocess an experience or trauma or to overcome a specific fear. Play therapy can also be used to help children learn how to develop better interpersonal relationships, process the grief associated with the death or loss of a loved one, the onset of a childhood illness or disability or learn about a recent diagnosis. Outcomes can include having better relationships, doing better in school, resolving behavioural issues, learning how to regulate emotions and/or connecting more with the family.
Play therapy helps children and teens living with anxiety. Often Cognitive-Behavioral Therapy (CBT) will be used as a model for treating children or teens living with anxiety. Play therapy differs from conventional CBT approaches only in that it uses play and expressive arts to engage and assess, provide psychoeducation and treat children and teens. Play therapy is used to help children and teens learn about relaxation and mindfulness techniques, learn and understand their feelings, and how feelings are connected to thoughts and behaviour. Children can learn coping skills, develop a plan and implement exposure therapy. Parents will learn how to coach children in implementing their new skills at home and how to help their children learn these new ways of being in fun and creative ways.
There are many different types of play therapy approaches. These are based on different theories or models and are applied by the therapist to meet the needs of the child. Therapists may specialize in one or two different kinds of play therapy and others may use different approaches based on the child’s needs and goals. There is non-directive and directive play therapy. Child-centered play therapy is an example of non-directive play therapy where the child leads and decides the direction of play. An example of directive play therapy includes Cognitive-Behavioural. In this case, the therapist would guide the play based on the child’s goals and needs. Other types of play therapy include Psychoanalytic, Jungian, Gestalt and Adlerian among others. There are also family play therapy approaches including Filial and Family Theraplay.
Play therapy can be used for children as young as two years old. For this age, child- centered play therapy would most likely be used by the therapist. Despite the belief that play therapy is for young children, teens, adults and older adults all benefit from play therapy.
Play therapy techniques vary depending on the type of play therapy. One of the most widely used play therapy techniques is Sandtray-Worldplay (De Domenico), which involves sand, a sandtray, water and miniatures that the child and/or family/caregivers use to reflect, express and communicate their experiences (Fraser, 2013). Sandtray can be both directive with the therapist providing direction or non-directive with the child directing the play. Sandtray can be used in all phases of therapy. Another technique includes puppetry which can be used with a narrative model of play therapy. Puppet shows can be used in all phases of therapy and can also be used for the child to show the family what they have learned in therapy. Other techniques include the use of clay, doll houses, painting or drawing, dance and movement, writing, music and games, among others.
Therapists often start by telling the child about the playroom. In a child-centered playroom, the therapist will explain to the child that the playroom is a special playroom because the child can do whatever they want in the playroom, they do not clean up and the only rules are “no hurts for the therapist and no hurts for the child.” The therapist often explains play therapy and confidentiality with the use of books. The therapist will frequently ask the child if they know why they have come to play therapy and if the child has any questions. The therapist will often ask the child if they have any goals. Often the questions the therapist will ask has to do with the play or is part of a game. The questions therefore vary depending on the type of play therapy and the goals of the child and/or parent(s)/caregiver(s).
The goal of play therapy is to help children to reprocess experiences, express their emotions, heal and grow. More specifically, for young children the goal of play therapy is often developed between the parent(s)/caregiver(s) and the therapist during parent/caregiver consultation. Young children, teens and adults also develop their own goals for therapy. Even if a parent has a goal for therapy, the therapist will also work with the child to establish their own goals for therapy. Goals may include, for example, going to bed alone, resolving separation anxiety or learning how to express feelings among others.
Adolescence is a time of identity exploration which may include sexual identity exploration. Allowing your teen a safe place to question their sexual orientation can reduce the already compounding factors that can exacerbate mental health symptoms. There are more youth experimenting with identities today, but one does not turn “LGBTQ”. Sexual behavior can differ from sexual orientation. If your teen has come out to you, the biggest part is over. It means that your teen has trusted you enough to share a vulnerable piece of themselves. Provide a loving, caring, accepting, and validating space for your teen to flourish as the person they are meant to be. As a parent, educating yourself is beneficial. You may want to connect with resources such as PFLAG to help you navigate your own feelings and emotions.
Returning to school during a pandemic has challenged students to be flexible and adapt to a frequently changing environment. For some who struggle with bullying, social anxiety, and temptations for substance use on campus, it has been a relief that they will be using an online learning option this school year. Others who were looking forward to participating in school activities like band and sports are expressing confusion and disappointment over the changes to their expected back to school experience. It’s impressive to see that our middle and high school youth are showing great resilience during this challenging time.
Learning that your child is considering suicide or engaging in self-harm behaviors can bring up many overwhelming thoughts and feelings for parents. Kids are often fearful of letting their parents know that they are experiencing these challenges because they are afraid of how their parents will react. Regarding self-injurious behavior, it is important to understand that not all self-injurious behaviors are connected with suicidal intentions. Some youth may use self-injurious behaviors as a maladaptive coping strategy because they sincerely do not want to end their lives. However, it’s important to remember that self-harming behavior can still be dangerous so it is important to seek medical attention if necessary. If your child is engaging in self-injurious behavior or threatening to, it’s imperative that you connect them to mental health services for an assessment and treatment. Youth and adolescents can learn healthier coping skills. If a teen is making suicidal statements on social media or during conflicts with parents, it is important to take these statements seriously and not jump to the conclusion that it is simply attention seeking behavior or manipulation. Any statements about suicide deserve further discussion and assessment for safety. Parents can call The National Suicide Prevention Lifeline (800) 273-8255 for assistance in the US. Kids in the US can text HOME, to 741741 CrisisTextLine, and for Canada text HOME to 686868. For UK, Hopeline 0800 068 41 41. It is important to connect the young person with mental health services for additional support addressing these thoughts and behaviors.
Building mental resilience involves utilizing resources and learning to adapt to change and adversity in healthy ways. Adapting to change can be a messy and brutal process initially, and it can also be an opportunity for families to grow closer together. Cultivating connections and building a support network during this time can be vital in helping children cope with the negative effects of isolation. Online support groups are often a great resource for tweens and teens to connect with peers while developing social skills and gaining insight. Making sure that we are addressing our needs and engaging in self-care activities can help prevent burnout during these times. Keeping a schedule and staying consistent with routines can support us in getting enough adequate sleep, engaging in exercise and fruitful activities that feed our soul. Adapting to change also involves restoring our sense of fun and playfulness. Creating new ways to experience joy, humor and spontaneity together can provide a sense of comfort and connection during times of uncertainty. Creating a list of realistic activities to engage in can help provide variety, such as having family game nights or a baking competition together. This helps demonstrate to your child that the world is not dichotomous, that you can have experiences of joy amidst times of struggle.
Research shows that communication is key to reinforce desired behaviors and prevent undesired ones, such as fulfilling a chore without you providing multiple reminders or finishing school work without you asking. Set clear rules and expectations, have a menu of reasonable possible punishments ready in advance and communicate those ahead of time with your kids so they know what to expect (e.g. not completing school work due to electronics then lose privilege of electronics for one day, didn’t complete chore then need to add on additional chore). Pair a negative consequence with reinforcement of desired behavior. Be specific, time limited, and make the punishment fit the crime (e.g., if you’re out past curfew 1 hour, your curfew is 1 hour earlier next time). Apply the punishing consequence immediately, not a day or two later, or allow for natural consequences (e.g., you failed the test because you stayed up all night and were too tired to focus in school). Most importantly follow-through with the reasonable punishment and be consistent.
According to the American Academy of Pediatrics, gender identity can begin as early as one to two years old where children begin to notice physical differences between the sexes. By three years old, most children label themselves into a category of male/boy or female/girl, or a little bit of both, and begin to learn socially in early childhood development gender related behaviors, however it is also a continued learning process as they start to become their own person. It is normal for children to want to explore different gender roles and styles of play. Those who do not conform to a gender or the typical “boy/girl gender roles,” is also deemed normal for children and adolescents as they move through development. As children and adolescents begin to develop their gender identity, remember it’s most important to provide love and support that will help them to thrive as adults.
Relationships that involve the depth that comes with intimacy often require authenticity. Without authenticity, intimacy is hard to cultivate. When your child feels that their experiences are heard and seen, and they are met with acceptance instead of judgement or rejection, they learn that it is emotionally safe to be authentic with their parents. Learning the skill of validation can be helpful in connecting with your teen. Connecting with your child’s emotional world requires you to start connecting with your own emotions, both the pleasant and distressing ones. Being able to regulate your own emotional experiences in healthy ways while holding space for another can be challenging without exposure to healthy role modeling and tools. Engaging in your own personal therapy can help with developing distress tolerance and emotional regulation skills that you may want to role model for your child. If you can learn to accept the emotions and parts of yourself that you reject, you’ll be more available to connect with your child.
Teens may experience gender dysphoria which is a conflict between their biological sex and their gender identity. It is still unclear as to what causes this to occur. Theories point to interrelated factors such as hormones, trauma, social contagion, etc. It’s important to understand that teens who experience gender dysphoria are more likely to experience increased mental health symptoms including depression and anxiety. The bottom line regarding gender confusion is that kids need support, encouragement, and love. Keep in mind that labeling someone as “confused” with their gender can be invalidating and may contribute to their distress.
Different forms of parenting styles have both pros and cons. The most effective parenting style is the authoritative parenting style. With this parent style, parents allow their children to express their opinions in a safe place. Parents encourage their kids to develop critical thinking skills versus being told what to do or how to think. The relationship between parents and kids fosters independence and autonomy while providing necessary support. Discipline with this parenting style is collaborative and places limits and consequences in a way that discipline is meant for…to teach. This allows for the implicit message that although parents are “in charge”, there is an atmosphere for working together which helps kids create a buy-in to a fair system.
I believe so. Because play is a child’s world, and a natural way a child communicates. Play is a child’s language just as words to an adult. Can you imagine a 5-year-old sitting in a chair and talking to you about his/her concerns (for a whole 55 minutes session)? That would never happen!
When the initial concerns that they came in for are reduced and a child is able to manage or cope with the issues.
– Remain calm
– Fact check for validity of story
– Timeline of when things happened
– Retrace facts and time
– Cross check with others, if others are involved
– Out of the ordinary behavioral issues
– School refusal
– Sudden changes in moods or behaviors
– When child seems to struggle with any kind of changes in their environments, and seem unable to cope or adjust, with ease.
Decrease the stigma. Do not shame others because they go to therapy. In fact, I believe that therapy is for everyone. You do not need to have a mental health issue, in order to go to therapy. There is enough everyday stress that can be talked about and processed.
Child comes in to a playroom/therapy room and therapist would ask the child what he/she wants to do today and follow the child’s lead. Play therapy is child-centered/child lead. After the session, I would briefly tell parents what we did and if there is anything they need to watch for or do in between sessions.
Being playful, observant, curious, creative, and attentive.
Just as simple as asking, “How was your day?”, “What did you do at school today?”, “Did you play with anyone at school?”, “How are you with your mask?” I think it is better for us, parents, to ask directly the teachers and schools, what precautions they are taking to keep our kids safe from covid. Pparents can visit the schools to see the setup and understand the safety precautions/measures that the schools are taking. This will help us, as parents, be convinced and feel at ease that our children are going to be safe at school.
I always tell parents to trust their gut when it comes to their child. There are a few ways to tell if there is a problem with anyone’s mental or emotional state; a person will experience long lasting sadness or irritability; extremely high and low moods; excessive fear, worry, or anxiety; social withdrawal; dramatic changes in eating or sleeping habits. This may look differently across all age groups, but at the core, it generally falls into one of these categories.
The DSM V only lists Attention Deficit Hyperactivity Disorder (ADHD) as a diagnosis. It can predominantly be combined presentation, predominantly inattentive presentation or predominantly hyperactive -impulsive presentation.
Many people believe a child has ADHD if they are hyper, however there is much more to it than just hyperactivity or inattentiveness. It is imperative to note that two major criteria for ADHD are: a child’s behavior is not appropriate for their age and behaviors need to be present in at least two settings, (I.E. home and school).
Some top signs that your child may have ADHD can include being easily distracted, appearing withdrawn, forgetfulness, hyper-talkative, and/or exaggerated emotional responses. A complete evaluation can be completed by a licensed professional and/or your child’s teacher.
Covid-19 is a traumatic experience for the entire world. As with any trauma, it can have lasting effects on our children’s and adolescents’ mental health. Experiencing trauma at a young age can be a risk factor for depression or PTSD and most psychiatric disorders, as well as a lot of medical problems, including cardiovascular problems such as heart attack, cancer and obesity. It is important to strengthen our children’s resilience and provide them with an outlet to effectively express themselves.
There are so many videos and articles and podcasts out there, teaching people how to survive the pandemic. Some parents and families can absolutely thrive during Covid-19, though it won’t always be an easy venture. Parents, on-top of keeping up with their own mental health and constant changes that are occurring due to Covid-19, will have to ensure that their child is okay. This means ensuring your child maintains social relationships (usually via video), they are getting to spend some time outdoors, and keeping them stimulated throughout the lockdown. No one can say a family is or isn’t thriving during this time, apart from members in their own family, who will be able to describe their current level of functioning and overall happiness.
First thing a parent should do when searching for a therapist is decide exactly what are they looking for? What do you want your child to learn or accomplish once therapy is over? Secondly, is this something your child is going to be comfortable with? It is important to find a therapist that you and your child like. Fees are always a major issue of concern when it comes to parents seeking therapy for their child. If you have insurance, look for someone approved by your insurance, as that may ease some of the financial stress. Private pay can cost anywhere from $75-$150/session.
Therapy is for EVERYONE! At some point in life, everyone should go. Taking your child to therapy will not only normalize the process, but they will be able to learn coping skills and how to adapt to changes, useful life tools that can be utilized at any age. It also gives them a safe and judgement-free place to express themselves, allowing them to know that the option of therapy always exists.
Most of the barriers to parents bringing their child to therapy is based on the parent’s fears. Some reasons include:
-fear of how others may view them for having a child in therapy
-they don’t see an issue/problem with their child’s behaviors
-believe that they can assist the child without the need of a mental health therapist
-have their own experience with therapy, which may not have been pleasant
All in all, it comes down to fear – fear of failure is what many parents experience when considering bringing their child to therapy. Ultimately, it is the parent’s decision; however parents should push their personal fears aside and think of the benefits their child may gain by going to therapy.
Therapy is provided by a person with a particular skill set. A teacher or parent may be able to do it however, they have not obtained the same training as a child therapist. For example, I may think “I can teach my child how to read. I read all the time”. As you attempt to teach your child, you realize your child isn’t fully comprehending what you’re saying and much progress isn’t gained. You take your child to a tutor/reading specialist and now they are slowly beginning to read. Is this because you don’t know how to read? Absolutely not. It’s because the tutor/reading specialist has a special set of skills that is targeted towards helping children read. It is the exact same thing for child therapists. They assist your child in many different ways, using their special set of skills.
Speak with your child! Sometimes, a child is waiting for someone to ask them what’s wrong or how they can help. Speak to your child and see if you are able to uncover the issue. Sometimes, it’s a simple issue that may not require therapy. Other times, it may be much deeper than you suspect, which causes you to react with some urgency.
Here are the most important needs a child has for optimal mental health:
– To feel seen, heard and gotten (understood).
– At least one securely attached adult whom they feel safe to be vulnerable with, loved and protected.
– They must feel that when they reach for their care giver, the care giver reaches back and is there to provide the basic needs of life.
Especially during this time navigating and experiencing COVID and the restrictions the pandemic has created, it is extremely important for Parents to understand that our children are feeling a great deal more anxiety and they may attempt hiding it in a variety of ways. We need to be much more aware of their needs, even while navigating our own anxieties.
– “Hi Honey, it looks as if you are feeling sad/mad/ happy/ scared… Can you tell me a bit about how you are feeling right now”
– “It looks like you are feeling frustrated about something. Is there any way I can help you figure this out?”
– “Feeling mad can be really intense, would you like to bang on this drum, shake these maracas (or for older kids, have a good yell in your pillow), so that you can shake the anger out of your body?”
– “How are you feeling today?”
– “If you drew everything that came into your head, what would you be drawing right now?”
– “How is school going for you? Is there anything you would like to chat about?”
– “What things are most important to you in your free time? Would you like to do some sports or art? Would you like to have more quiet time where we do quiet things together more often?”
Tantrums and opposition are common in 2 year olds but tantrums which include hitting, kicking, biting or physical violence towards toward a Parent or another person may be of more concern.
– If your child attempts to injure themselves this may also by a possible sign of a mental health issue.
– If your child experiences a tantrum 10-20 times per day, this is outside of the “typical 2 year old tantrum”
– If your child’s tantrum lasts longer than 25 minutes and your child experiences an inability to calm themselves, this may also inform us that this may be indicative of a mental health issue.
Ask your child’s circle; Family, Friends, Teachers, Caregivers, if they notice your child to be withdrawn and does not seem to seek connection or commonly refuses making eye contact – these could be indicative of a mental health issue. In general if there is a lot of household stress being creating by this child, it wouldn’t hurt to have them seen by a mental health provider to rule mental health illness in or out.
Some mental health disorders can be genetic so in the beginning, gently being aware of this possibility is helpful to have in your back pocket.
Other than genetic possibilities, mental health illness in children is often caused when a child does not feel seen, heard or understood. A child must have their basic needs met as well. Making sure to take the time and have the patience to show your child you see, hear and understand them will help a great deal in preventing mental health illness.
COVID has brought upon us many avenues where a child is experiencing their world as completely different. Almost everything in their environment has changed and this is why meeting their basic needs during this pandemic especially is critically important.
They need to feel as safe, stable and supported as possible right now.
I would say that the top issues I come across in therapy with children and adolescents are feelings of shame and abandonment. These issues are true for both the children and the Care Givers within a family. Those who suffer from shame and abandonment can often develop coping mechanisms that can show up as Hyper Activity, Anxiety and Depression.
Also, family dynamics and the difference in how both parents parent their child can be a big issue. When the parents are not “on the same page” providing consistent messaging to their child, this can cause a number of issues for the child and within the family system.
Communication education has been a very common and important theme in therapy with my children, teenagers and Parents. When we can come together and learn how to effectively speak to each other, this can relieve anxiety and misunderstandings.
Children have many colourful and amusing questions they ask in therapy:
– They will ask about certificates on the wall.
– They will ask about any toys within the therapy office.
– They may ask how long they will be here in session today.
– They may ask about a favourite toy or activity they engaged in or with last session.
– They are often curious about whether or not I will be sharing with their Parents the issues or feelings they discuss with me in session.
The biggest tip for a Parent in between sessions is to practice their own patient responses and assist their child in activities that help their child regulate, such as breathing techniques. Assisting the child with any homework assignment provided is very helpful as well.
First, I might request a chat with the Therapist. Share with them what you are noticing within your child around their therapy. What is their mood like after session or even approaching a session.
Often times 1-3 sessions are required to build a safe therapeutic connection between the Therapist and child. Teens are especially known for disliking the thought of therapy but in my experience by the end of the second session they are asking me when their next appointment will be and they are already enjoying therapy.
If 3 sessions or more go by and the child is still not connecting, I might ask the Therapist to explore the lack of connection with the child to allow an attempt to shift the current treatment plan and take it in a different direction that would allow the child to connect in a more helpful way with the Therapist.
If that still does not work it just may not be a good fit. Discuss this with the Therapist and request them to refer you to a variety of other Therapists you can engage with.
We’ve seen so many families who were hesitant about teletherapy be surprised about their abilities to participate in teletherapy during the Covid19 pandemic. Depending on the age, we’ve worked to adapt therapy to make it achievable and approachable using teletherapy. For example, we’ve seen that younger kids, younger than eight, have a harder time tolerating participating in the normal length of a therapy session, particularly if they are struggling for attention. So I’ve adapted to doing more work with parents and helping adapt therapy skills to things they can be actively practicing with their child during the week. That often includes helping reframe language to talk about emotions or about the status of current events. And families have been very happy during this time to get extra support in parenting as new challenges continue to arise in the current climate.
For slightly older kids, we’ve seen that working to adopt to the way we connect to children is incredibly important. Although I’ve tried doing my own research on how to adopt games to video sessions, I’ve found that letting kids lead the way has been very helpful during this time. They know far more than I do about socializing through games and it helps build trust in the therapeutic relationship for them to take the lead! By building this trust, it helps us to address other fractures in their relationships as well as skill building to handle difficult emotions.
Children self harm for different reasons. Some do it as a form of self-stimulation while others use it as a form of coping with negative emotions and still others may be doing it as a means of expressing their emotion when they don’t have the language. Self-harm can be very scary for families and also can escalate to more serious behavior. A family who is seeing self-harm should first off consult with a mental health professional who can help assess patterns of behavior, function of the self harm, and triggers to the behavior. These are the factors that can help individualize plans and interventions to help a child who is self harming.
Parents who see their child self-harm often respond first to their own fears and emotions, and we often see that their first reaction can accidentally invalidate their child’s emotions. A parent might initially say “How can you do that to yourself?” or “You don’t have to feel that way.” While these are well intentioned statements meant to protect their child, a child in enough distress to self-harm might hear these statements as criticism. It’s possible to validate the emotion, without validating the behavior. It’s important for parents to validate that their child is in emotional pain while also not wanting them to harm their bodies.
When your child begins to work with a therapist, it is natural to wonder if it is working and how long it will take to work, if it works at all. At the same time, because the therapist is mainly spending time with your child, it is common to feel in the dark since you are not in the room most of the time. We know therapy works best when there is a strong therapeutic connection between the therapist and the client. All the specifics of what type of therapy and what it is for are important but unless that therapeutic connection is there, the most highly recommended and technically proficient therapist may not be the best therapist for your child. Ask your child how they are feeling about the sessions. Do they dread going and refuse to get out of the car before an appointment? Do they say the sessions are boring and pointless? What we hope to see as a therapeutic relationship forms over time is that your child will not mind attending and maybe even look forward to going once they get the hang of it and have built some trust with their therapist. For slightly older children you can ask them if they think their therapist “gets” them or if their therapist seems to get along great with you but really does not seem to be hitting it off with your child. Keep in mind it can take time to build trust in a relationship and develop into a nice rhythm in the sessions but by asking your child questions in a curious way and listening for any signs of authentic connection, you can get a decent sense of how it is going. Of course, over time you would also want to see improvement in whatever target behaviors or emotions brought your child to therapy in the first place. However, parents can often under-estimate how long it takes to see those changes so that is why focusing first on the therapeutic connection is crucial.
Ask a therapist about their orientation: therapists should be able to define how they think about a child and family and how that impacts their work! Orientations include psychodynamic, attachment-focused, mentalization-based, and cognitive behavioral. And these different orientations can influence how a therapist works with a family. Which you should also ask! Ask how frequently your child will be seen, the length of sessions, and what level of parent involvement will be expected. For younger children, you should expect higher levels of parent involvement and for slightly older, we see a reduction where parents may be informed but less actively involved. Ask about what the intake process will look like and when you will be able to talk to them about their treatment plan for your child and/or family. And also know that different styles and orientations will be better fits for different types of issues. A child with a specific phobia or obsessive symptoms will benefit most from a cognitive behavioral therapist specializing in anxiety, which is more focused and skill based. While a child struggling with difficult relationships or history of disrupted attachment will benefit from a mentalization-based treatment focusing on skills related to interpersonal functioning.
Distance learning may be particularly challenging for children with ADHD because they are expected to pay attention in the midst of many distractions around the house and on their devices and their teachers are not as easily able to redirect them. There is much less structure to the days, so writing down a schedule or to-do list to follow visually on a whiteboard can help. The schedule should have built-in breaks for movement, relaxing and eating. Striking the right balance of scheduled time and more unstructured time depends on each child’s needs. Rewards for working hard and getting tasks done can also be built into the routine. It is important that children with ADHD who are prescribed medications for it continue to take the medications regularly at the same time each day, even though routines have changed drastically. During the school day, parents can turn off any distracting notifications on the computer and designate a specific area in the house for doing schoolwork. There are also apps that can help with controlling unwanted electronic distractions. While classrooms often limit what kind of fidget toys can be used, one benefit of distance learning is that kids can use whatever fidget toys they want while working, if these are helpful. When there is less structure, “sleep creep” can occur that leads to kids staying up later and later which can lead to more problems with paying attention during the day. Sticking to a regular bedtime each night despite temptations to stay up later will help with focus and lessen irritability the next day. Also keep in mind that child and adolescent psychiatrists and pediatricians are able to evaluate children remotely during the pandemic, so if your child is in need of treatment for ADHD or needs their existing ADHD medication regimen adjusted, consider scheduling an evaluation.
It is very common for children to be reluctant to participate in therapy, whether it is in the office or online. Rather than surprise your child with a therapy session, it is best to tell them in advance that a session will be happening, explain that it is to help with “big feelings” or whatever is a developmentally appropriate way to explain therapy, and that you will be very open to answering any questions about it. Some children will assume they are in trouble or defective in some way, so it is also helpful to normalize that therapy is a helpful tool for people of all ages to learn skills to cope with all the stressful things that can happen in life. If parents go to therapy themselves, they can set an example by saying they go to their own therapy too and find it helpful. Once your child does participate, praise them for doing so and remind them it is a brave and important thing to do that makes you feel proud. If your child had specific fears about going, debrief with them after to check if their anticipatory anxiety matched what ended up happening. Ask them how it went and how they feel about going again. Also keep in mind your child’s therapist is likely well-versed in working with children who are reluctant to participate. Explain to the therapist if there are issues with participating and problem-solve together how to make the process go a little smoother.
How much parents and siblings are involved in therapy can be very dependent! For some kids, the therapy relationship is important as a safe space that can be separate from other relationships. Other times, parents and siblings play an extremely important role as agents of change. It’s important to open the conversation with a child and therapist with a gently curiosity and openness about how they can be helpful. Parents can ask their children or the therapist for language to talk about the specific issues. For example, I often help kids with anxiety externalize their anxious thoughts by giving a name to the anxiety. Parents and siblings can start referring to their observations of the anxiety by using that name, creating coherence amongst the family. However, it’s very important to get permission from the child to share and use that language. Otherwise, it can feel infantilizing or dismissive.
Parents also often want to get their child to “want to change,” and feel that they need to make that happen. It’s important for a child to build their own motivation to change and for families to recognize when the motivation is lacking. In the first scenario, that may mean allowing the therapist and child to collaborate on building motivation and a parent pushing to hard can make the child more resistant. It’s also important to differentiate between opportunity to build motivation and a child not having motivation to change. In these cases, parents working with the therapist directly for parent management training instead of the child being seen directly can often be helpful. I often say that the person who wants the change should be in the therapy room (or zoom), because they are the most likely to take action.
Children are having new anxieties about safety, school, and sickness during Covid19 and the social distancing mandates. So are the adults. One thing I’ve seen is children being acutely aware of their parents’ anxieties. It’s important to model the difference between healthy coping with anxiety and panic. Having language to name the feeling, validating the feeling, and saying out loud how you’re planning to cope with it is really important to model managing anxiety. It might mean saying “I’m noticing that I’m feeling anxious right now about all my work. I think my anxiety is trying to tell me this work is really important, but it’s also making it hard to concentrate. I’m going to go splash my face with water and take some deep breaths so I can concentrate more.”
It’s important to both validate the feeling, offer strategies, and be open to the rejection of both. Even if you don’t agree with everything your child is thinking about (e.g., “I’ll never see my friends again” may not be an actual fact), you can validate how stressful the situation may be (“That is such a scary thought!”). Offer a strategy to cope with the anxiety or problem solve along with the validation with a gentle curiosity (e.g., “Would it be helpful for us to find ways for you to connect online?”) If your child protests or becomes more upset, continue to validate how scary it might be to be worried in this way. Remember that rejection of problem-solving strategies is not a rejection of you, it’s the anxiety not being ready to problem solve.