Child & Adolescent Therapy

What makes therapy different with children and adolescents, and what is play therapy or family therapy?

Therapy with children and adolescents is an animal of a different color compared to the more individualized and analytic notions about adult therapy that Hollywood places into the minds of the public. Often, one will see a very competent verbal adult sitting on a chair or laying on a couch reflecting on their feelings as an empathetic therapist listens closely to each word. The basis of this type of therapy is the client’s experience at that moment with the therapist and how it relates to their life as a whole. Adult clients are able to tell the therapist their feelings, and are able to discuss their experiences. Children and adolescents, on the other hand, do not tend to be this reflective in their thoughts, and are not able to share with therapists the quality of their experience in words and eloquent phrases. And, whereas adult clients have a world of experiences outside of their family in work situations, with other adults, and on and on, children and adolescents experience the world through their families. The family constitutes their environment — their world.

So, here we have two very noteworthy differences between adults and children/adolescents; first, that adults are able to describe in words and phrases their experience of the world fully, while children, and adolescents to a lessor extent, cannot. Second, the world adults respond to includes a wide variety of experiences, whereas the family is the “world” for a child, and again to a lesser extent for the adolescent. As a result, children and adolescents respond not only in a different fashion than adults do, but also to a different environment. Therefore, different therapeutic approaches are required for working with children and adolescents.

Let’s first deal with the issue of communication. As any parent will recall, at some time early in their child’s development, cries and gestures meant certain things. This was how the child expressed their desires and needs as they did not have the verbal ability to say “I want this or I need that.” Sometimes, once their children have grown, some parents tend to expect these children to act like little adults, with the ability to clearly say what they want. While in some cases children may be able to request certain things verbally, in many other ways they are not able to make their needs known fully through verbal communication. Instead, their actions may tell you what they need, or an imaginary friend’s behavior might be an indication, as their vocabulary at this stage in life is limited. So, as adults use words to communicate feelings or thoughts, children use actions or imagination. As with everything else, adolescents are stuck somewhere in the middle of this process.

Using the most basic example of the difference between children/adolescents and adults centers on one well established method for dealing with the limitation of communicating with children, play therapy. There, a child is able to convey their experience through the act of play. Play therapy involves simply a different language, a symbolic language that requires a well trained professional to decipher. Frequently though, skeptical parents may say “all the therapist does is play with my child.” But, this play has a special language to it, a language that children and well trained attentive adults understand. It is not so simple as board games or the like, rather an open ended form of expression that allows the child to utilize the full extent of their own symbolic language to convey their message, to communicate about the problems they are facing.

Like adults, children and adolescents are not always sure what it is they are trying to communicate. They might even say “I don’t know what’s wrong.” However, bringing out the nature of the problem that a client is wrestling with is the essence of therapy, and consequently the reason that therapists have a hard time telling their clients how long therapy will take. “It depends,” they will frequently tell you, and it depends on the client and both the nature of the problem the client is struggling with, and how long it takes to understand the problem in a way that is therapeutically helpful.

Another important factor mentioned above, is that a child or adolescent’s world is their family. While adults respond to a wide variety of experiences in their lives, the world of a child or an adolescent centers on the family. Each individual is born into a family and eventually separates from that family into the experiences of the world. But, unlike adults, where any number of factors may effect their emotional life, the clearest source of conflict for a child or adolescent is their family. The family is a child’s world, and as such, when something is wrong with their family something is wrong with their world. Many times, a troubled child or adolescent may be noticed at school. However, it is much more likely a troubled child or adolescent is experiencing some distress about their family. It could be something so minor as they misinterpreted one part of their parent’s conversation, and this young person broods about it for weeks. Or, it could be something serious, as their parents may be having martial trouble. What ever the case may be, when something effects their family, it effects their entire world. In such cases, focusing solely on the child in therapy is not the answer. While techniques like play therapy are helpful in these cases, therapeutic efforts need to be concentrated on the family.

The two key elements of family therapy are that a client, usually a child or an adolescent, and their family share responsibility in the problem(s), and that, by design, family therapy is aimed at modifying communication among family members so that the so called problem(s) can be dealt with in a therapeutic manner. Family therapists understand that the child or adolescent’s behavior, like a child’s behavior in play therapy, is symbolic or representative of a larger, more troubling, problem within the family. Family therapists encourage communication to take place in the session which turns these symbolic behaviors into words and phrases that the rest of the family can understand, and therefore, begin to work with.

Our discussion above, has moved us some distance down the path of making sense of children’s and adolescent’s behavior, and the very different treatment requirements that follow. Understanding that their behaviors are their words and phrases, and that their world is the family, takes us some distance in understanding the relevance of different therapeutic techniques such as play therapy and family therapy. And, while no specific therapeutic technique was mentioned for adolescents, the task of therapy is to make certain rebellions and other “over the top” behaviors understandable to both the adolescent and the family. In each case, once the behaviors are, for lack of a better word, translated, then the process of healing begins. Healing not only with the child or adolescent, but also within the entire family.