“But how can you do therapy with my young child...?”
As early childhood therapists this is a common question we hear, so it seemed worth taking a moment to talk about the process of providing therapy to young children. Forget about the depictions of going therapy that you’ve seen in movies. You know, that idea that you come in of your own free will, sit (or lay) on the couch, and talk about your feelings for an hour and then calmly leave with new insight or understanding. Throw out the notion that therapy with young children is a scaled down version of adult therapy.
So many of the parents and caregivers who reach out to us for therapy have young children struggling with listening and following directions, transitioning from place to place, regulation and temper tantrums, etc. We have heard from these parents and caregivers, “but how can you do therapy with my kid?” For the sake of this post, let’s focus on what it looks like for a 3 year old to come to therapy at The Center for Family Wellness.
First, a 3 year old coming to therapy is always accompanied by a parent or caregiver. From initiating services, entering the building for an initial session, sitting in the waiting area, transitioning into the therapy room to engage in treatment, even to the bathroom, and leaving session, a 3 year old attending therapy is always accompanied by an adult. As the therapist treating the child, we expect that the parent or caregiver is prepared to support the child through the entirety of the therapy experience. (This is even different from common therapy work with school aged children as parents and caregivers sometimes wait in the waiting room until the child is finished with their session).
Second, a 3 year old coming to therapy is not there of their own free will; as early childhood therapists we acknowledge this. We do not get offended when a 3 year old wants to stay in the waiting room playing on their parent or caregiver’s phone instead of transitioning to our office and we typically perceive this experience as an opportunity to guide the caregiver‘s skills. At times we may even respond creatively to a 3 year old’s resistance to transition— maybe with a simple, “do you like toys?” or with the wave of a magic wand to teleport us into the office. Transitions are hard for young children, and we have a lot of tools and strategies for supporting a child‘s regulation during these times.
Brittany DeNucci, a therapist on our team who works with this population, shares, “there was one 3 year old I saw for therapy who every time we transitioned from the waiting room to the office, we all had to become tigers crouching down the hallway, making nearly silent growls, and the 3 year old was the tiger leading the pack. Once we got into my office, we were no longer tigers but this is what they needed to feel in control and safe. I coached their caregiver to follow their lead to support the child in this transition as they were able to remain regulated, which was a goal of theirs for therapy. You wouldn’t see me acting as a tiger with an adolescent but with early childhood clients and their caregivers, I am playful and that serves their development.”
Third, a 3 year old is a busy body whose brain is not developed enough to allow them to remain calmly sitting in one place for the entirety of a therapy session. They are often moving about the room and encouraged to do so. It is completely expected that a child may be sitting in their parent or caregiver’s lap on the sofa, climbing on the furniture or even hiding behind it, laying on the floor playing with toys, standing on their tippy toes looking out the window, and even dancing and singing because all of a sudden their favorite song came into their head. They are not stuck in one spot because it is not developmentally appropriate to have that expectation.
Fourth, a therapy session with a 3 year old and their parent or caregiver will be based in play. Young children communicate via play. It is a safe way for them to explore feelings, thoughts, and experiences, and an opportunity for caregivers to see and join in their child's inner world. We have many excellent toys that inspire creativity, imagination, and exploration for our families.
Fifth, our role is to support the parent/caregiver to support the child. We expect caregivers to interact with their child directly in session. One way this happens is by having the adult make observations, such as “you picked the red car!” This demonstrates engagement and attunement to the child versus asking “why did you pick the red car?” Commonly adults get stuck “playing” by asking adult-focused questions, so we demonstrate and encourage parents to make observations and verbalize what they’re seeing with some reflection on what it may mean, or how it makes them feel to see their child playing in such a way.
Finally, not all early childhood sessions are held with the child. We frequently ask for the caregiver to be present without the child. This allows us to have uninterrupted adult conversations that may not be appropriate for children to hear, and to provide specific support to caregivers. We may also ask that the caregiver completes special assessments that we use with children under the age of six that help us to understand their development as a whole.
Hopefully reading this post helps clarify what it’s like to have a young child in therapy. We especially hope that it is clear for parents and caregivers who will be attending sessions with their young child so that we all come into a session with the same idea about what’s to be expected. And please know that laying on our couch and talking about their feelings is also perfectly welcome.
The Center for Family Wellness