Hi! When you think of therapy, what is the first thing that comes to mind? When watching a film and television portray therapy you usually see it as someone sitting or lying on a couch talking while another person sits across or near them in a chair with a notepad asking them “how do you feel about that?” This is rarely how actual therapy is conducted. And when working with children, it definitely does not look like that. 

So you have decided to get your child or family into therapy and you may be wondering how that works. In this post, I go through what that first session may look like and a bit about what interventions may be used in sessions thereafter.

Disclaimer: The statements made in this blog are not medical advice. If you need medical help please reach out to a physician or other medical provider. You may also contact the U.S. national crisis line by dialing 988.

So what does therapy look like?

That First Appointment

During the first session, usually called an evaluation, a therapist will meet with you AND the child to discuss what brought you to treatment. They may also ask about family history regarding mental health, who lives in the home, substance use history, etc. When asking kids what brought them to therapy, most of the time they say they are in my office because mom, dad, grandma or whoever brought them and they have no idea why. This is NOT a good way to start therapy. If you feel your child will benefit from therapy, talk to them about it before setting up an appointment. If your child feels they are being dragged to something is less likely to engage, thus making therapy less effective.

Once you and your child have discussed with the therapist the reasons for seeking therapy, a treatment plan is developed. The plan is usually a set of attainable goals–I don’t like to make more than two or three–that everyone decides on together. When creating goals, you should be as specific as possible. An example of a good goal would be “Learn 1 or more coping strategies to handle stress.” A goal of “I want them to be happy” is not good because it is too general. Happiness looks different for everybody and your definition of happy may be different from the child’s definition.

Ongoing Therapy

Depending on the treatment plan a child may meet with a therapist individually, or others with them. Many factors go into deciding this including what the reason(s) are for being in therapy. Is the kid fighting with a sibling? Is a caregiver having a hard time communicating with a kid? Most therapists will ask the kid if they want an adult in the room with them past the evaluation appointment.

Even though your child is a minor, they have a legal protection of privacy when in therapy. When making that first appointment, you should receive paperwork that explains a client’s right to privacy so make sure you read that carefully. I always ask my clients if they want others to know what we have discussed. If they say no then I do not share what has been discussed in sessions. There are exceptions to this. If a therapist feels there is a safety risk such as a child having suicidal ideation or someone is hurting them, then the appropriate people are told. This can range from caregivers to child protective services.

What I Do as a Therapist

Remember what I said in the beginning about the media stereotype of laying on a couch talking to someone about your problems? That is not how it is done. I have conducted sessions in an office sitting across from families, but I have also conducted sessions outside with a kid while tossing a football or writing on the sidewalk with chalk. Every person is different and therapy should be conducted in a way that makes that person comfortable but also still ethical. 

Working with kids, especially young kids, I use a lot of play therapy techniques. If you have been around kids for any length of time, you know there is no way a kid is going to sit and just talk for 50 to 53 minutes. Of course, there are exceptions to this as I do see kids who do just that. Employing play therapy techniques allows a child to feel more relaxed and thus able to talk more openly with me.

Therapy Treatments

CBT or Cognitive Behavioral Therapy focuses on behavior and the thoughts that might contribute to that behavior. This therapy is about working on changing one’s thoughts so that the behavior may also change. It is used a lot for people with anxiety or those with behavior issues. 

Dialectical Behavior Therapy is based on CBT, but focuses more on intense emotions. This therapy has been shown to help those with mood disorders or experiencing suicidal ideation. This therapy is very structured and may involve worksheets. 

TF-CBT stands for Trauma Focused-Cognitive Behavioral Therapy. This therapy is used for kids who have experienced trauma. For a therapist to use this therapy, they have to be certified or working under the supervision of someone who is certified. A person does not need a diagnosis of PTSD to receive TF-CBT treatment. I have used this therapy on kids who have experienced sudden loss and kids who have witnessed violence. This therapy is primarily conducted in individual sessions, with check-ins from the therapist to the adult. 

Play therapy involves incorporating play into therapy sessions. There might be a dedicated play therapy room or a therapist may have tools in their office to use. This can be anything from dolls to card games.

Once you have completed that initial evaluation session for therapy, a therapist will then decide what interventions they are likely to use in sessions. If you have researched therapy treatments, you may have come across acronyms like CBT, DBT or TF-CBT, along with a plethora of others. These are interventions that have been researched and proven to help those in need.

To find a therapist trained in TF-CBT you can visit the website www.tfcbt.org and enter your location. Or, if you are interested in any other type of therapy you can visit www.psychologytoday.com There you can enter your zip code and filter the search to what you are looking for. 

Conclusion

There are many more therapies that can be used in a session. I might make another post to explain more interventions that could be used. Some therapists are trained in a specific therapy, others use a combination of several. There is no one size fits all when it comes to therapy. 

If you or anyone you know are in crisis, please reach out for help. Dial 988 to speak with a trained professional or visit your nearest emergency department.