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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)

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