You are worried that something is wrong with your child. Perhaps worse, you doubt your own ability to fix it, and so you are bringing your child to see me, a therapist. It seems only fair, under the circumstances, that I should tell you up front what I can do for you and how I will go about it in psychotherapy sessions.
When I see a child for treatment, I generally regard the family as the client. At the outset I will see the child together with one or both parents and sometimes also with siblings. Thereafter we will decide together—you and I—whom to include in sessions. We will do whatever you and I feel makes sense. Most often I meet with parents alone, with the child alone, and with the family as a whole.
When children come for a first visit, I tell them that in individual sessions with me they are the boss. They decide whom to invite into the consulting room (parents, siblings, other relatives, and friends) and whom to exclude. I tell them they can kick out of a session anyone but me. If the child is in charge and the child sets the goals, the child will take responsibility for the work that is done.
I put the kid in charge of deciding what we talk about and what we do. I also explain that I do not force children to talk about anything they don’t want to talk about. I give kids a complete tour of the premises so that they can see the equipment available for use. I have hundreds of toys and games in the consulting room and the adjoining waiting room.
I tell your child that I see myself as a consultant. People come to see me, I ask them what they want, and once I know what that is, we figure out together how to make it happen. I say, “If you don’t tell me what you want, I can’t do my job. I can’t promise to get you all of what you want, but I can get you some of it.” (I say the same thing to my adult clients.)
Where confidentiality is concerned, I typically tell all parties that I will not repeat what a child says to me privately unless it involves harm (or potential harm) to the child or to someone else. In other words, I won’t keep secrets about cigarettes, sex, alcohol, drugs, cutting, weapons, or illegal activity.
Other sorts of things that I think parents should know about may come up in sessions, however, and I tell the child that when they do I will support him or her in telling the parents. At the end of the first session I check to make sure the child is willing to see me for additional sessions.
When I work with a child, I always expect to see the parents alone some of the time. When you and I meet, I will ask about your concerns; take a developmental, social, educational, and family history; and offer a preliminary array of resources based on my first impressions of what’s needed. Sessions alone with parents give me the opportunity to get valuable information and learn about issues that are best discussed out of the child’s earshot.
In addition, I can verify that you parents agree on house rules, parenting principles, and family values generally. After all, if you don’t agree, your child will become adept at playing one of you off against the other. Sometimes, too—for instance in cases of separation or divorce—conflict between the parents is directly related to the problems that brought the child into treatment. It is occasionally possible for me to resolve the issues without ever meeting the kid!
My view of myself as a consultant has certain implications for my work with you, the parents. At best I am putting in a cameo appearance in your lives. You will see me off and on for a matter of months and always for just an hour at a time. I will probably see your child no more than once a week and, after a month or two, less frequently.
You, however, see your child every day for hours on end. Consequently you, not me, will always be the true therapist or change agent. I will be pinch hitting, offering suggestions and resources, and getting feedback from you as to what works and what doesn’t. Unlike me, you will always be on the front line.
At the outset, during the first few sessions, we will need to do a brain transplant from you to me. You, the parents, know your child far better than I. I will need to tap into your expertise and insight to formulate some ideas about how to proceed. In time I will assess the child as he or she interacts with me, with you, and with other children in the family.
When I meet with the child alone, our sessions are devoted to support, encouragement, enrichment, and development of the child’s relationship with me. I like to ask kids about things that are important to them—favorite pets, foods, friends, games, and dreams. Together we may build a marbleworks maze or play a strategy game or run the race cars.
I will learn by seeing what your child selects for us to do, how he or she plays with each toy, and how he or she treats the rules and me as an adult companion. After I have won the child’s trust and respect, and when the child feels heard by me, we can often talk about problems at home or at school but only when the child is ready to bring them into a session.
When problems do reach the agenda, I highlight the child’s choices. It’s very important for the child to feel that there is more than one way to proceed. I may also ask about the strategy the child plans to use to reach goals. So for instance I might ask a teenager, “How do you figure that the bad language your mom hates is going to help you persuade her to buy you an electric guitar?”
Sometimes I help a child decide how best to ask the parent for something. Often, when children start arguing about a privilege that the parent is denying, I will counsel them to ask instead, “What would I need to do before you would allow me to do this?”
When whole families first come in for a session, I like to ask what they do together. Do they eat dinner together, play games, go on weekend outings, visit frequently with extended family, and have weekly family summits? What is dinner table conversation like? How do the children get along? What are some of the best times everyone remembers? Eventually I will ask each member to say what he or she likes best about this family. Then I will ask each member to name something he or she would like to change.
It often happens, in the course of preliminary discussion, that the family identifies a source of tension or conflict. Once the problem has surfaced in the consulting room, we can talk about it openly. Session rules always include stipulations that when one person talks, everyone else must listen; that language must be polite; and that no one is to be punished after the session for things that were said during it.
I try to include a game for the last part of the family session, for several reasons. First, a good game will often ensure that the session ends on a positive note. Also, families usually need to learn more ways of having fun together. This point is very important. If people don’t have fun together, where will they get the energy to undertake the hard work of solving problems?
The only board games many families know are often ones designed for very young children that bore adults and, worse, take a long time to play. I like to introduce people to strategy games—some American, many European—that have few rules, can be enjoyed equally by youngsters and adults, and can be played in ten or fifteen minutes. Some of my best games reinforce family ties, create positive memories, and make people laugh.
Games show me how family members deal with conflict, boundaries, and demands for respect. And when families go out and buy their own sets, I know that the experiences they have had in the consulting room are reaching into their homes and improving the quality of daily life.
In my opinion, the issues that families and children bring into treatment generally revolve around communication. The questions I ask myself most frequently are (1) how (or whether) people’s feelings are being heard and respected by other family members and (2) whether family members are able to ask for, and get, what they need from each other. In family sessions I can usually persuade people to honor their feelings and to get (or give) feedback. Relationships are key.
Individual sessions seek to improve children’s appreciation of their talents, their abilities, and themselves generally. By encouraging children to try different activities and to pursue their special interests, I hope to plant seeds that will bring to light lifelong passions. Such passions are important tools for combating stress in childhood and in adulthood as well.
By normalizing and validating a child’s feelings, I can help him or her become more confident and secure. I want children to enjoy therapy and to experience it as a process of exploration and self-discovery. Children who let their feelings guide them to sources of joy—whether these are people, places, or the child’s important work in the world—become stronger, more self-aware, more resilient, and happier.