Mistakes and Learning. Developing our online course.

We are so excited to see our 200th enrolment in our Creative Ways to Help Children Manage Emotions online course recently! We learnt so much along the way as we created the course and it caused us to reflect on how important mistakes are in the process of learning. We thought we’d share some of our mistakes and learnings with you, along with some of our reflections on how to support children and families with this in therapy.

Filming our Creative Ways to Help Children Manage Emotions online course was certainly a learning experience. We made so many mistakes along the way and we sometimes wondered whether it was worth persisting. Like all new learning experiences we’ve had to sit with the uncomfortable feeling that not knowing creates, and we’ve had to acknowledge our disappointment and frustration in our mistakes and be willing to learn from these and try again.

Learning a new skill takes a lot of resilience. It requires a vulnerability – a capacity to fail and to try again and again, all the while believing that to do so is worthwhile. It’s a skill we need to promote in the children we see. Talking about our mistakes normalises the experience for children and allows us to demonstrate how mistakes help us learn. Indeed those of you who have our book, Creative Ways to Help Children Managing Big Feelings, may be familiar with our Mistake Jars activity. Similarly when working with students or supervisees we often share some of our mistakes as a way of normalising their experiences and supporting them to value the learning that mistakes foster.

So it is with a playful sharing spirit that we offer up some of the mistakes we made and the learning we gleaned when filming our online course:

We learnt that –

  • We have facial expressions we’ve never noticed before.
  • Filming a workshop takes a lot longer than presenting it face to face.
  • A good quality microphone will pick up a dog sleeping on a beanbag and a budgie chirping in the next room.
  • It is not a good idea to try to film anything when you have six children around.
  • When you manage to arrange for children and pets to be off set you will still have to deal with neighbours’ lawn mowers and power tools.
  • Most importantly, we learnt that it is essential to check that the camera is turned on, focussed, and set to take a video not a series of still photos!

We were able to learn from our mistakes and resolve all these issues, with the exception of our facial expressions, which we’ll need to accept! We have been so pleased to see the positive response to our online course.

Thinking about thoughts: Considerations for working therapeutically with children

Working with thoughts is a key part of our work as child therapists and it is an important area to reflect on.  When working with children we need to ensure that we approach thoughts in a developmentally appropriate way and in a manner that reflects what we want to convey about thoughts.  What follows is a reflection on some of these aspects as well as an activity that I find useful for introducing thoughts to children.

 

Developmentally we know that young children use private speech; words spoken out loud that they use to guide their behaviour and manage their emotions.  So in working with children under 7 years we keep our work on thoughts quite limited and utilise private speech, creating activities in which children say helpful words aloud.  Over time however this private speech becomes internalised and children in middle childhood increasingly use inner speech to make sense of their experiences, guide their behaviours, and manage their feelings.   Children in this age group however still need support to notice and understand their thoughts and their parents often need guidance to be able to talk with them about thoughts at home.

How we introduce thoughts into therapy is important and will be influenced by the theoretical models that we use.  We take the view, consistent with ACT, that thoughts are just thoughts.  Part of this model involves normalising both comfortable and uncomfortable thoughts and distancing ourselves from thoughts or not holding them too closely.  The model also involves understanding that thoughts come and go.

If we consider each of these elements in turn we can think more carefully about the way we might introduce these in therapy.  How we distance ourselves from thoughts is important and requires us to be mindful about the language we use.  For example, “I’m thinking…” implies a closer relation with the thought than “I’m having the thought that…” or “My mind is telling me…”  This distancing reduces the power of thoughts and reinforces the idea that they are ‘just’ thoughts.

The language we use around thoughts can also help us reflect their temporary nature.  “Right now I’m having the thought that…” or “sometimes I have the thought that…” implies a time limited experience and helps the child to understand that thoughts come and go.  It suggests that another thought might very easily replace the current thought.

In therapy I often share my thoughts, noting that they are thoughts as I do so.  This helps the child to understand thoughts and often makes them more willing to share their own.   Importantly however, it also enables me to demonstrate that thoughts come and go and to normalise the experience of both comfortable and uncomfortable thoughts.

I often begin with simple thoughts like “I’m having the thought that we should play a game”, integrating these into the session naturally rather than focussing on thoughts too much initially.  Often later in therapy I will move into sharing some uncomfortable thoughts, helping the child to understand by doing so that having uncomfortable and comfortable thoughts is normal.  Understanding that we all have comfortable and uncomfortable thoughts is another element that we usually want children to understand.  You’ll notice that this language is very ACT based and differs a little from more traditional CBT where we might talk about helpful and unhelpful thoughts.  Again the language that you use around thoughts will depend on your theoretical model.

One activity that I often use to assist children to notice and articulate their thoughts requires a Connect Four or four in a row game.  I suggest to the child that we play a game though with each piece we place we make the statement “Sometimes I have the thought that…” and complete this sentence.  For some children my aim in using this activity might simply be to have them notice and name thoughts, in which case I can stick with thoughts such as “Sometimes I have the thought that it’s hard to talk and play this game”.  For other children I might want to elicit thoughts that are around a particular area.  For example, if I’m wanting a child to talk more about their worried thoughts I can share something related on my turn, such as “Sometimes I have the thought that I’m going to mess up when I have to give a talk”.  This can free children up to add some of these thoughts on their turn, while still allowing them the space to choose what they do or don’t share.  If children can’t think of a thought they are still able to place a piece and the game continues.  The game still enables you to model thoughts, which is valuable.

You can also notice thoughts in your session in a similar way.  For example, you can make comments like “It sounds like you are having some thoughts about your friend Ryan.  What is your mind telling you about Ryan?”  Parents can support children to notice thoughts at home by articulating their thoughts in a similar manner.  When discussing challenges with their child they can also be encouraged to say something like “It sounds like you are having the thought that…” or “I can see that thought is really bothering you…”

Interestingly it is easier for some children to engage in thought work than it is for them to engage around feelings.  This is not to say that we should stop noticing and naming feelings for these children.  Indeed continuing to do so is essential, however working on thoughts can sometimes progress the work more quickly and adds an important element, particularly for those children who get caught up in their thoughts when they are feeling anxious or angry.

Sometimes I have the thought that… being thoughtful about working with thoughts is essential.  It is important that we think carefully about what we want children to understand about thoughts and how we convey this.  Activities are part of communicating this to children however it also involves us being thoughtful about how we interact with children and families and what we communicate around thoughts.

Dr Fiona Zandt
Clinical Psychologist (Child and Family)

Three top tips for therapists new to working with children

1. Learn about child development

Children are not little adults! As child therapists, sometimes our role involves helping parents to understand that their child’s responses and emotions are normal and expected for their developmental stage. Other times, our role involves helping parents to recognise and understand developmental delays or difficulties their child is experiencing. Always, our role involves gaining an understanding of the developmental stage of each child we see and modifying our therapy approach to fit with where that child is at cognitively, socially and emotionally. Having an understanding of child development and its implications for therapy is essential for us to do this.

2. Commit to working with families (and schools too)

Children are embedded in a family system and also a preschool or school system, and working effectively with children means working effectively with these systems. Children generally come to therapy with parents, and as child therapists, we need to build a good rapport with the parents as well as with the child. For therapy to be effective, children need support to practice and generalise the skills they learn with us, and for that, we need the assistance of the adults in their day-to-day lives. Effective therapy often involves a combination of child, parent and family work, as well as communication with teachers too. Taking a systemic approach like this adds so much complexity to child work. At the same time, it provides us with wonderful resources to assist us in creating positive change for the children we see.

3. Prepare to be playful and creative

Children learn by doing – by exploring, experimenting and experiencing. For children to understand therapeutic concepts, we need to translate them from the traditional, adult-oriented talking therapies into a form that is more concrete and meaningful. We do this using play, art, games and metaphor, using hands-on and creative activities that allow children to engage in therapy. Being playful and creative gives children a means to communicate and learn in therapy. It also makes therapy fun – for children and for therapists!

If you would like to learn more about the practical implications of child development for therapy, how to work well with families and schools, and how to be both playful and purposeful in your therapy approach (including lots of fun, creative therapy activities), please check out our Creative Child Therapy Workshops. We offer an online course, in-person workshops, books, and free resources on our website, that are suitable for new and experienced therapists working with children.

Dr Suzanne Barrett

Clinical Psychologist
Creative Child Therapy Workshops

This new card set is a treasure! Why I like Dr Karen Treisman’s ‘A Therapeutic Treasure Deck of Grounding, Soothing, Coping and Regulating Cards’.

As a therapist working with children and adolescents, it is essential that I have hands-on materials to support my young clients in exploring therapeutic concepts and engaging in conversation.  Card sets can be one such hands-on resource and can provide a physical and visual prop to scaffold therapeutic conversations. They can also take the pressure off the conversation and reduce its intensity, by giving the young person something to do with their hands and their eyes as they choose and hold the cards and by providing a normalising context.  Card sets have the further benefit of providing many ideas and examples for the young person to choose from, reducing their need to generate the ideas and also reducing the need for me as a therapist to suggest ideas. Instead, the cards can make the suggestions, and the client can be empowered to choose which cards best suit him/her.

When I heard that Dr Karen Treisman was publishing a card set focusing on grounding, soothing, coping and regulating strategies, I was quick to order them, as I had found her recent book very helpful in working with children and adolescents with developmental trauma and I liked her creative approach (Treisman, 2017a).  Dr Treisman has also previously published the card set ‘A Therapeutic Treasure Deck of Feelings and Sentence Completion Cards’, another great resource (Treisman, 2017b). I was not disappointed – these new cards are great and have become one of my favourite sets.  There are 70 cards in the pack, each depicting a different strategy, with lovely and clear pictures. They are simple enough that children can understand them, but the design is not childish, so they can appeal to adolescents and parents too. What I love most about this card set is the huge variety and broad range of the strategies that are included. There are strategies to calm the body as well as the mind, strategies that are active or physical, creative, cognitive, imaginative, sensory, activity-based, and mindfulness-based. Some cards have a number of examples on them to allow clients to personalise the strategy further. Everyone I have used them with has been able to find at least a couple of strategies that they find appealing and would consider trying.

A simple way to use the cards is to spread some or all of them out across the floor and allow the child or adolescent to choose cards that seem interesting to talk about or that they might like to try out for themselves. I find when young people choose strategies for themselves, they are more likely to try them, than if I suggest some strategies. It gives them more control in the conversation, as they can guide the suggestions, and helps me to be collaborative in the process rather than be perceived as expert. Once they have chosen cards, it is helpful to explore and expand on the strategies, and many of the cards have ideas for this outlined in the booklet they come with. Certainly it’s important to try the ideas in session, and to find a way to send them home, whether that is simply lending the child the cards, taking a photo or making a booklet with photocopies. The cards could be used to generate ideas for the child’s physical calm box, where we place tangible, hands-on objects that the child can use for calming or regulating their emotions, such as bubbles for breathing or sensory toys. The ideas could be incorporated into a drawing representing their strategies, or represented visually in a ‘bag of tricks’ or on a paper ‘chill out fan’. The booklet contains many different ideas for creative reminders of the chosen strategies, as well as different ways the cards can be introduced and used in therapy.

This small box contains so many ideas – it certainly deserves its name of a therapeutic treasure deck! I’m sure it will continue to be useful for me in supporting the children and adolescents I work with as well as their parents, to acknowledge their existing ideas and to further widen their repertoire of coping and grounding strategies.

Dr Suzanne Barrett
Clinical Psychologist
Creative Child Therapy Workshops.

 

References:

Treisman, K. (2018). A Therapeutic Treasure Deck of Grounding, Soothing, Coping and Regulating Cards. Jessica Kingsley Publishers: UK.
Treisman, K. (2017a). A Therapeutic Treasure Box for Working with Children and Adolescents with Developmental Trauma. Creative Techniques and Activities. Jessica Kingsley Publishers: UK.
Treisman, K. (2017b). A Therapeutic Treasure Deck of Feelings and Sentence Completion Cards. Jessica Kingsley Publishers: UK.

Some of my favourite commercial resources

As a therapist working with children, I’m always on the lookout for new resources and ideas for making therapy fun and engaging for my young clients. Commercial resources can be a great way to keep sessions interesting and to broaden my therapy tools and activities. At one of our recent Creative Child Therapy Workshops, we had some favourite commercial resources on display, and one of the participants mentioned it would be great if we had these written up in a list. I hope she reads this blog and sees that I liked her idea! Here is my list of favourite commercial resources for therapy with children…

Feelings cards by St Luke’s Innovative Resources – It was too hard for me to choose which set of St Luke’s feelings cards to include in my list, as they have several lovely sets! The Bears are a classic, and have been loved by many therapists over the years. They now exist in an app too. Funky Fish Feelings and Stones…have feelings too! are also terrific feelings cards, and are perhaps more appealing to older children. Having feelings visuals is essential for working with children. You’ll find St Luke’s Innovative Resources at www.innovativeresources.org.

Mood Dudes Poster: How are you feeling today? – This may be my most used commercial resource, as it hangs on my wall making it accessible to any clients who are trying to find the word to describe their emotion. The Mood Dudes are pretty cool, though any good feelings poster could be helpful for this. I found my poster at www.lighthouseresources.com.au.

Eggspressions by Hape – These are gorgeous wooden eggs each depicting an emotion. They have lovely faces and a nice smooth texture so are great to hold. They can be a nice visual prop for children to communicate their feelings, or for imaginative play with the eggs as characters showing emotions. They come with little stands so they also look great on an office shelf!

Emoji stress balls or ‘stress eggs’ – These are cheap, squishy balls with emojis (or eggs with feelings faces) that I picked up in junk shops. It’s helpful to have some tactile, visual representations of feelings, and these are great because they can be thrown around in games incorporating discussion of the feelings.

Pocket of Stones by St Luke’s Innovative Resources – A little bag containing 12 hand-crafted ceramic heads, each one depicting a different facial expression. Tactile feelings resources are great to have though harder to find, and these ones are gorgeous.

Thoughts and Feelings: A Sentence Completion Card Game by Bright Spots – These are cute, colourful cards, that I have found helpful to incorporate in ‘getting to know you’ games with children.

Totika – This is a Jenga-like therapeutic game, with coloured blocks, and cards with questions corresponding to the coloured block you move. There are a number of card sets with different topics, such as icebreakers, self-esteem or life-skills, which seem best suited to older children or adolescents. It’s a fun, non-threatening way to explore these topics. If you like the idea of creating your own therapeutic Jenga game, so that you can simplify and modify the questions to suit your clients, check out our blog “I wanna play a game! – Playful child assessment and how to make your own therapeutic Jenga.”

Human Brain Cross Section Model in Foam – I have found my foam model of a brain useful when I’m talking with children about the feeling and thinking parts of the brain. I bought mine from Haines Educational online shop at www.haines.com.au. Unfortunately, it didn’t show the amygdala, so I drew it on!

Strengths Cards for Kids by St Luke’s Innovative Resources – St Luke’s strengths cards have been favourites of mine for many years, as they are lovely colourful cards depicting a broad range of strengths. They have a number of strengths cards sets that are suitable for children – I found it hard to choose!

Bundle of Stickers by St Luke’s Innovative Resources – I love the way St Luke’s have sticker versions of their popular card sets. It is so important for us to be helping children generalise their learning from therapy to other environments by sending them home with reminders and prompts. Stickers are a great way to do this! If you are like me and can’t choose between sets, you can choose their Bundle of Stickers which has a sheet of stickers from each set.

A Therapeutic Deck of Grounding, Soothing, Coping and Regulating Cards by Dr Karen Treisman – This is one of my most-used card sets, suitable for children, adolescents, and their parents. The range of strategies covered in this card set is huge, and the variety is impressive, with physical, sensory, cognitive, imaginative, activity-based and mindfulness-based strategies, designed to calm the body and the mind. Available at www.jkp.com.

Commercial resources can be fun and engaging, and provide different ways to incorporate visual and hands-on materials into therapy with children. They can be a starting point for therapeutic conversations and they can inspire creative activities to extend on the concepts. We would love to hear about your favourite commercial resources – please share in the comments!

Please note that these are some of our favourite resources and we are recommending them in the hope that others also find them helpful. We are not receiving any endorsements for these recommendations.

Two awesome Australian picture books for helping children with worries

Stories are powerful. They can inspire, entertain, reassure, and teach us. In therapy with children, stories can provide a different perspective on a problem, normalise experiences, educate and provide ideas and metaphors to continue to reflect on. Most children are familiar with picture books, so reading a story together can provide a non-threatening and enjoyable context to open up a conversation with an anxious child. We sometimes find it helpful to read a short book together in a therapy session, or to send the book home for a family to read together. There are many lovely picture books available that may be helpful for worried children. Here are two recently published Australian books that we love…

 

I Have a Worry – by Tanya Balcke

I Have a Worry is a short and very simple story about having a worry, so even young children are likely to enjoy and understand it. In the book, the child’s worry is depicted visually as external to the child, and the author does a lovely job of exploring and normalising the experience of worrying and encouraging children to share their worries with others.

Why do we like this book?

The accompanying colouring-in book is fantastic! It allows children to actively engage with the book through colouring and activities, and in doing so they can explore and personalise the messages. For example, they can draw their own worry, consider what they’d like to say to their worry, and consider who can help them carry their worry. These activities and the metaphor of a worry as being like a creature sitting on the child’s shoulder effectively externalise the worry – the worry is not the child and not part of the child, but is instead separate from the child. This is a powerful therapeutic technique. The therapeutic approach of scaling a worry is also gently introduced (sometimes it is small and sometimes it is big), and the messages of it being normal to have worries and helpful to share worries are very clear.

 

Hey Warrior – by Karen Young (author) and Norville Dovidonyte (illustrator)

Hey Warrior aims to educate children about anxiety in order to empower them to better manage this strong emotion. It has a lot of content and because of this may be best suited to children aged over about five or six years old. It provides accurate and thorough psycho-education which allows children and their parents to understand the function of anxiety and why it feels the way it does in the body, mixed with powerful, positive messages.

Why do we like this book?

We love its friendly depiction of our amygdalas as powerful warriors who protect us by preparing our bodies for action! Warriors who are protectors and doers not thinkers, who sometimes work too hard and prepare us for action unnecessarily. Anxiety as a helpful, functional response, not something to be avoided or feared. It helps children and their parents to understand and accept – even value – their amygdalas and the role they play related to anxiety. At the same time, it empowers children to be in charge, and teaches them how to relax their amygdalas through calm words or breathing.

These are now two of our favourite children’s books! We’d love to hear about your favourite books for helping children with emotions.

Connecting families with wool – Why play is so important when working therapeutically with children

A therapist recently described using an activity from our book that involves using wool to connect family members to make visible the ways in which their feelings and actions impact upon each other. Following the session the child who was being brought to therapy articulated some of what she had learnt to her Mum. She said that she now knew that if she died, everyone would be really sad, and that not everything was her fault. Her comments reflected some key messages that the therapist wanted to convey – namely that she was part of a family who cared about her and were all being affected by the difficulties they were experiencing. Blame was removed and the responsibility for change was shared, laying the foundation for the therapist to work effectively with both the parents and the child.

It was a lovely moment for the therapist who was finding engaging all of the family members challenging. When I asked her about whether she thought this could have been conveyed by sitting and talking with the family the clinician was emphatic that she did not think so. Through play, she was able to convey a key concept both to the child and the family in a powerful way.

Our early theorists highlighted the importance of play for children. Child psychotherapists emphasised play as a child’s language and argued that a child’s play reflected their inner world. Of equal importance was the contribution from developmental psychologists, such as Piaget, who argued that children think differently to adults and learn through doing. Therapists who work with children understand the value of play, both in terms of assessment and therapy. Play can be therapeutic in and of itself and this is central to approaches such as child centred play therapy. Play is also an ideal medium for conveying therapeutic concepts and can be readily integrated into therapies such as cognitive behavioural therapy and family therapy.

Therapists and researchers both agree that cognitive behavioural therapy needs to be modified if it is to be successful with children. Modifications that are typically recommended include focusing more on behavioural strategies, reducing language demands and the provision of hands-on activities. Similarly when engaging young children in family sessions we need to use games and play. Play allows us to convey therapeutic concepts to children in a developmentally appropriate manner. It provides us with another way of communicating that relies less on language and is action based. Through play, we provide children with an experiential approach and assist them to generalise from the therapy room to home and school. Play, therefore, is central in adapting therapy for children.

Perhaps most importantly though, play is engaging and fun. It makes therapy less threatening, breaks down barriers and helps to build relationships.

Child Mental Health Assessment: Reflections on the Complexities and Possibilities

As a student completing my clinical child psychology studies, I would become frustrated at times with what seemed like an endless emphasis on the details of assessment and formulation. I wanted to spend more time talking about interventions and therapy – actually helping people! It is only with hindsight that I fully appreciate the strength and importance of this extensive training in assessment. Our assessment formulation is our understanding of the child’s presenting difficulties in the context of an understanding of the child, their family, and their cultural and community influences. This is not only necessary to guide all therapy work; it can be therapeutic in itself. Through this process of assessment and formulation, we are weaving the parents’ understanding of their child with the context and developing a shared understanding with the child and family. The family’s understanding of the presenting difficulties and how to best manage these becomes richer, which breeds empowerment and hope.

Assessment of a child’s emotional and behavioural difficulties is a complex task. In addition to knowledge of mental health, it requires a systemic and a developmental perspective. Systemic because children are embedded within a family system, and for older children, a school system, as well as broader systems such as treatment services, communities and cultural influences. Developmental because child assessment requires an understanding of typical childhood development as well as the individual child’s developmental stage. We need to hear the perspectives the child, the parents or caregivers, and often the preschool or school staff. These perspectives often differ, and are often expressed in different ways. For example, adults may be able to express their views using language during an interview, while children may communicate through behaviour or play, and may require concrete activities and scaffolding to express their views.

Practically, this complexity means that child assessment requires several components. Family sessions, child-focused sessions, parent interviews, questionnaire measures, and preschool or school observations can all be helpful. Family sessions can be particularly helpful early on, as they provide the opportunity to observe family dynamics as well as engage all family members in the therapy process. Family sessions, like child-focused sessions, need to involve more than just talking. To engage children, we need to include hands-on, creative, or playful activities. Even activities as simple as playing with Playdoh or drawing family pictures can help children to relax, engage, and communicate their thoughts. Asking the family to join in the activity can provide further opportunity for observation and reflection – and may help the parents to relax too! If you would like more ideas about playful activities to use with children and families, you might like to read our book, ‘Creative Ways to Help Children Manage BIG Feelings’

It can feel like there is a lot of information to collect to complete a thorough child assessment. Certainly, we have a lot of headings on our Child and Family Assessment Template! However, keep in mind that assessment and formulation are dynamic and ongoing. We are often adding to or adjusting our formulations as we move through the therapy process with children and families. When providing supervision to other psychologists about clients they are finding particularly tricky, we often return to their formulation and assist them to re-consider this in order to move forward in providing effective therapy. Assessment should be ongoing, with our understanding of the child and family deepening over time. At the same time therapy begins with our first interactions with the family and our initial assessment sessions should provide understanding and hopefulness, mobilising the family to begin the process of change.

I’ve suggested that incorporating developmental and systemic perspectives adds to the complexity of child assessment. However, these aspects also contribute to my passion for working with children and my sense of optimism for positive change in the children and families I see. The fact that children are embedded within a system means that we have multiple means for creating change for them. We can work with the children, parents, other family members, educators, and any combination of these, providing many possibilities for change within the child’s system. The fact that children are still developing means that there is always hope for change. It also means there is more scope for both assessment and therapy to be creative, playful, and fun.

If you would like a copy of our Child and Family Assessment Template, you can download one for free at our free resources page. It covers all the areas we suggest you consider when assessing a child with emotional or behavioural difficulties, and is in printable form with space to jot your notes.

 

Our shared resources and posts are aimed at providing ideas for qualified professionals and are not a substitute for appropriate training and ongoing supervision.

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