Understanding the unique needs of our younger clients, we offer therapeutic services specifically designed to help children and adolescents. Given that younger clients frequently have difficulty putting their feelings into words, children require therapists who understand and specialize in their developmental and emotional needs.
Because of my extensive experience working with children and families, I know that comprehensive treatment often requires more than an hour of therapy per week, and that therapy must reach beyond my office in order to be truly effective.
Therapy with children and adolescents can take a variety of forms. Most importantly, the connection with parents is critical to the development of children and adolescents and the ability to make progress in therapy depends on their involvement. Frequently I will use play therapy, which relies upon using the language of a child’s imaginary play to provide a greater understanding of the young client’s emotions. Adolescents will often engage in more traditional “talk therapy,” but specialized techniques may be used to help create an easier way for him/her to relate to the me and the objectives.
When indicated, and with parental consent, I will work collaboratively with schools, teachers, coaches, and allied professionals in order to evaluate and treat difficulties that might be occurring in multiple settings. My role is to assist parents in advocating for necessary services, and to promote coordination and consistency among providers. This can often be an essential element towards building-up the kind of daily structure that strengthens encouragement and promotes greater goal achievement for the child or teen.
Commonly Addressed Issues Include:
- Adjusting to recent changes in family or school
- Managing anxiety, depression, and mood swings
- Enhancing educational performance and motivation
- Improving anger management and frustration tolerance
- Dealing with social pressures and joining healthy peer groups
- Improving judgment and making positive choices
- Developing positive coping skills
- Effective ways of handling peer pressure
- Improving positive and clear communication
- Improving compliance at home, school and in the community
- Developing a healthy and positive sense of self
Individual Therapy with Children
Meeting with children individually gives them an opportunity to present their difficulties-as well as the family’s challenges-from their perspective. Children, though, usually do not choose to begin therapy; most often, it is parents, relatives, teachers, clergy, etc., that have identified a need for therapy. The child’s motivation and interest is created through the development of the therapeutic relationship: rapport, trust, and safety are crucial, necessary elements for progress, growth, and healing. The challenge is engaging children so that therapy is not a boring, uncomfortable,scarey chore, but rather, can become a place of comfort and acceptance; or, a place where exciting and vital adventures in self-discovery can happen.
Working with children differs greatly from the traditional adult “talk therapy” session. It is important to have an understanding of child development and to work with each child at his or her own level. Children (even very bright, verbally sophisticated children) often do not know how to identify or explain the causes for their sadness, fears, or behaviors. Sometimes, it is embarrassment, shame, or traumatic experiences that are an obstacle to direct verbal expression. Part of the work with a child is to help them find images, symbols, gestures, and words instead of symptomatic behaviors, to express themselves, and to start again on their path of healthy development.
I engage children in the therapeutic process by using:
- Play therapy as a way to reduce anxiety and guardedness. Play provides a structure and context that is comfortable for children, while allowing indirect yet experiential expression of feelings, needs, traumas, and hidden strengths
- Art therapy to help encourage free expression of familial, social, behavioral, and emotional themes, and to creatively search for solutions
- Sand Tray therapy using small toy figures and objects, enabling children to symbolically enact healing story themes
In many situations, I have found Cognitive-Behavioral Therapy (or, CBT) to be an extremely effective model for working with children struggling with a variety of commonly-seen emotional and behavioral problems. CBT explores, challenges and replaces skewed thoughts and perceptions, helping clients achieve a more realistic and positive self appraisal, and to attain measurable goals by using new coping skills. Although it might seem that CBT is not compatible with children’s capabilities, children actually respond very well to this approach when it is woven into a format or presentation that is attuned to their developmental level. Using child-friendly materials; I help parents and children to work together to develop a plan to measure specific behaviors at home and at school; to use new ideas and approaches for making desired changes; and to feel a sense of reward in achieving those goals. This approach allows the child to actively participate in their own success as we identify and track their progress. The parent too, often feels once again a sense of joy and hope as they see their child naturallydevelop ways to think, feel, and behave in a healthier more appropriate way.
Although I have treated children as young as two years old, I don’t see kids alone. I see children as a function of where they are within their family. It’s not OK to have parents in the waiting room while I “cure” their child. Parents need to be in the therapy room with us, contributing solutions to the problems, and working on changing their contributions to the difficulties. If a child improves, but his or her home life remains the same because there was no parental involvement in the therapy, then the child will regress back to the previous negative behaviors. [top]
Individual Therapy with Adolescents
I have a great deal of empathy for teens as they experience so much change all at once. Hormones trigger physical growth; academic and social pressures increase; expectations change at home and at school; dating and sexuality emerge; and a more cognitively, emotionally mature sense of self begins to develop. Adolescents are discovering their personal power for the first time, and often struggle with how to effectively use assertiveness to communicate their needs, resolve conflict amicably, and make beneficial choices. At the same time, parents have new demands placed on long-established roles, and often struggle to adjust their parenting approach. The entire family shifts as the adolescent develops and strives for autonomy, making for one of the most challenging stages in the life of any family.
Any one (or more) of these growth-areas can exceed coping capacities, becoming stressors that are more than enough to create functional and relational difficulties for teens, parents, or for the family as a whole. The therapeutic issues that arise with adolescence can significantly improve with intervention, however, as with younger children, engaging the adolescent in a therapeutic alliance is a vital first step. I have found that teens often respond to and benefit from variations of the same rapport-building and therapeutic approaches as those used in child therapy. In addition, the developing adolescent is also more readily able to benefit from direct communication and insight-oriented therapy, as well cognitive-behavioral approaches.
I treat teenagers, again, within the context of their families. I usually alternate between individual and family therapy. I love rebellious teenagers. I love unhappy teenagers. I love the teenagers who can’t fit in.I remember being there not too long ago. (OK, maybe 25 years is long ago.) I deal head-on with drug and alcohol use/abuse/experimentation. I understand the anguish a teenager feels. I talk openly and directly about peer pressure, sexual concerns, body image issues, why parents “just don’t understand” and the struggle between fitting in and being unique. I treated an 18-year-old and his family recently, and the kid had a bumper sticker on his car that said it all: “I Hate Everything.” Doesn’t that perfectly sum up the position of disenfranchised youth? [Note: When doing individual and family therapy, the teen and the adults need to understand issues of confidentiality, and this will be carefully explained.] I feel a combination of individual and family therapy is the only effective way to achieve lasting change. [top]
Children & Adolescents: Special Education Consulting
Children’s behavior and emotional challenges are rarely confined to the home. Frequently, their difficulties are also evident in their school setting, and can greatly impede their educational progress and social development. At some point, special education services may become a necessary and helpful component of a child’s planned curriculum. Still, it is very difficult to hear that your child has been identified as possibly having a learning or behavioral problem that effects their success at school. In addition, interacting with the special education system can be intimidating for many parents: unfamiliar terms such as SST, IEP, 504 Plan, and AB 3632 are often confusing and can heighten anxiety.
I have more than ten years of experience in supporting parents who are facing this challenge for the first time or who may already be engaged in the special education process. In conjunction with psychotherapy, I help parents to understand the impact their child’s issues are having at school. This can involve examining report cards, talking to teachers and school psychologists, and making sense of information or recommendations provided to them by their school. Additionally, I educate and assist parents in navigating through the special education system in order to make decisions that will most benefit their child. This includes:
- Working collaboratively with the school by attending meetings and providing data that will aid in identifying and accessing appropriate educational resources
- Maintaining contact with school staff to ensure academic and behavioral objectives are being met at school and are consistent with overall treatment goals
- Providing referrals for specialized testing or educational advocacy when necessary [top]
Children & Adolescents: Anger Management
One of the more common themes I see working with children and adolescents is the inability to appropriately express anger and frustration. Anger can be the result of a child’s experiences of loss, trauma, or rejection, or accompany many of the difficulties that present with mood, family, or learning issues. Children and teens can manifest anger externally (through tantrums, destructiveness, hurting others, conduct problems, etc.) or internally (seen as depression, anxiety, self-destructiveness, or emotional detachment). Either form can be alarming, and can be disruptive to the child’s functioning at home, school, and in the community. Left untreated, anger problems can grow into serious mental health issues, lead to restrictive interventions at school, or provoke legal difficulties. Early and effective intervention can be a key element in preventing ongoing emotional distress and negative consequences.
A therapeutic focus on anger management seeks to:
- Normalize and treat anger from a practical and developmental perspective
- Identify the often hidden sources of anger, as well as stressors and triggers that maintain the cycle of anger
- Teach anger management techniques such as yoga, toning, and meditation
- Develop healthy behavioral & emotional redirection of feelings, rather than use “control” approaches that hinder emotional expression and recreate frustration
- Help parents model and reinforce successful use of positive anger coping skills [top]
Children & Adolescents: Divorce
Children and adolescents who have experienced divorce have unique needs. Even in relatively amicable circumstances, stress, conflict, and loss all happen at once, and this can become overwhelming for parents and their children. Parents struggle with guilt, fear, and anxiety as they try to maintain the provision of support, love, understanding, and comfort to their children. Children see the physical and emotional split happening between their parents, and then try to adjust to conflicting parental messages, disruptions in stability and consistency, and the possibility of blended family issues. It is common for children and adolescents to act-out or deteriorate due to misguided feelings of self-blame and guilt, or as a means to bring parents back together, heroically attempting to restore the lost family. Parents need strong support and guidance as they make their own transitions into new individual and parenting roles.
Through a therapeutic focus on divorce issues, children and adolescents have learned:
- To reduce feelings of guilt and to recognize, they are not the cause of their parents’ divorce
- Positive coping and adjustment strategies to altered family roles and rules
- Identify loss, sadness, anger, and fear in ways that promote healthy expression
- To develop a sense of hope about the future and about relationships
My work with parents dealing with divorce issues focuses on:
- Helping to develop consistent parenting at both homes, and avoiding child and adolescent manipulation and “splitting” dynamics
- Helping move away from bitterness and blaming, and move towards practical problem-solving
- Helping parents focus on nurturing and supporting their children despite their own relationship challenges
- Provide successful tried and true co-parenting techniques and skills [top]
Children & Adolescents: Social Skills Training
Many of the clinical issues that bring children and adolescents into therapy can also disrupt their social functioning. The support, encouragement, and empathy they find in a therapeutic relationship can sometimes serve as a secure base from which to begin developing a new or rediscovered sense of their unique gifts and strengths as social beings. In addition, children and adolescents that are anxious, withdrawn, and have a negative self-image need to learn new skills that improve their ability to establish and maintain positive social relationships. Through Cognitive-Behavioral or group therapy approaches that utilize role-modeling techniques, as well as exercises that build self-esteem and friendship skills, young clients become socially engaged in ways that are fun, non-threatening, and rewarding. Children with special needs, such as Non-Verbal Learning Disabilities or Asperger’s Syndrome, can learn how to appropriately respond to non-verbal social cues, give appropriate contextual facial and vocal expressions, and improve social problem-solving skills.
Social Skills Training focuses on:
- Helping shift unrealistic and critical self-beliefs that contribute to anxiety, social withdrawal, and negative self-image
- Practicing comfortable ways of engaging others positively and with confidence.
- Setting gradual, achievable social goals that reduce apprehension and reinforce success and hope
- Finding healthy, positive peer groups and learning skills to combat peer pressure [top]
Children & Adolescents: Substance Abuse and Dependency
Substance Abuse and other addiction problems remain an issue of utmost concern for all parents. Much like adults, children and teens use substances as a way to manage symptoms and/or escape emotional pain. Substance use and addiction issues appear so prevalently as part of other clinical disorders that they have been recently termed Co-Occurring Disorders. In addition to the obvious health and safety risks, substance use and addiction problems can affect every level of a child’s life and future, whether at home, educationally/vocationally, or in the community.
Through my extensive experience and training in this aspect of clinical work, I know this to be a most challenging problem area, but one that can be successfully treated. It is important that young clients have a safe place to learn how to tolerate and explore their painful feelings; to understand how substances deceptively appeared to help; and, perhaps most importantly, to develop and practice healthy coping skills. The provision of ongoing familial, social, therapeutic, and medical support throughout this process is a key element in successful, lasting Recovery. Clients identified as either at-risk for substance use, or those working on Recovery, respond well to a clinically-coordinated mixture of Cognitive-Behavioral Therapy (CBT), family interventions, group therapy, and adjunctive community-based supports such as 12-Step work. In this context, CBT focuses on finding new ways of coping with family and social pressures; on developing new and healthy peer groups; and on building relapse-prevention strategies. Family therapy can play a vital role in finding expression for deep, emotional sources of the addictive process, as well as providing the basis for rebuilding a strong, loving home foundation. Peer group and 12-Step meetings add a social dimension to the healing process by reducing shame, sharing practical wisdom, and reinforcing success. All play a crucial role in substance abuse treatment.
A clinically-coordinated treatment approach focuses on:
- Assessment of current substance use and evaluation of appropriate course of treatment. Level of overall psychological functioning, degree of risk and harm (based on drug of choice/frequency of use/available supports and resources) are factors that determine appropriate treatment milieu and interventions
- Providing structure and containment so that chaotic, destructive functioning is curtailed
- Setting attainable and realistic goals. Harm Reduction Therapy has been proven to help reduce “all or nothing” thinking while moving towards sustained abstinence
- Maintaining an ongoing treatment focus on sobriety, hopefulness, and creating a thriving future [top]
