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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