Child and adolescent therapy comprises about half of my practice. In my child therapy practice I see infants and young toddlers with their parents for a variety of issues including eating and sleeping problems, attachment-related concerns, and aggression, among others. Parent-Child play therapy (play therapy is defined below) may be recommended for toddlers under 3 years of age. Parent-Child Play therapy is regular play therapy with the parent present in the room as a participant. Also, parent counselling and guidance is usually an important part of any therapy I conduct with a child or adolescent.
For children 4-11 yrs old the most common problems I treat are associated with Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder, learning problems, anger and aggression, oppositionality, Obsessive Compulsive Disorder, anxiety, depression, and general relationship problems between the child and his parents. I also have a special interest in working with autistic children. Despite this, play therapy can be used to treat a wide variety of other issues as well.
After an in-depth assessment, which will carefully formulate working hypotheses about why your child is experiencing the challenges they face at this time, play therapy is usually one of the recommendations. Play is the child’s preferred activity for expressing what they are feeling and thinking about in an implicit, symbolic form. Children use the toys to tell a story that has personal meaning to them and can provide clues to the therapist about what the child experiences. For example, a child whose parent passed away will often play out a story of a family (of action figures, animals, etc) where one of the parents dies. A child who displays much anger will create very aggressive play narratives. When given the opportunity to creatively express ideas with little structure or rules, children tend to naturally show us what they are most worried about.
The therapist observes and participates in the play, and speculates privately about the meaning. This meaning doesn’t need to be shared with the child in order for the child to improve – some symptoms can improve without ever making the real issues explicitly verbal. In these cases, it is the play itself and the relationship with the therapist that provides what is needed to enable development to get back on track.
With other children the therapist may connect the play to the child’s real situation, and a conversation can unfold that makes the issues more explicit. For example, the therapist can say, “this story reminds me of what happened to your mom when she became sick….,”and the child may be able to respond and bridge play and reality. As children mature, they become more able to talk about their problems, but this is not a requirement for the issues to be addressed and for the child to improve.
As important as the play aspect of play therapy is, the relationship that develops between child and therapist is just as significant to why and how change occurs. This relationship is playful, informal, and supportive. The therapist is a trusted confidante who becomes a safe and predictable part of the child’s life for the duration of the treatment. The therapist is also a bridge to the child’s parents; child therapy usually strengthens the bond between child and parent. The therapist also has a relationship with the parents in parent counselling; meetings occur regularly to discuss therapeutic progress and offer support and guidance. I consider the parents of my child patients to be “co-therapists”: close collaboration can lead to the child receiving therapeutic levels of support in therapy and at home. This can lead to a faster and more complete result.