Creating Your Child Therapy Office: Now that the school year has started I have been getting a lot of questions from new therapists/interns wanting advice on setting up their offices.
Click here to view an article I wrote for SocialWorkHelper with tips for new therapists. Topics include putting together a basic starter kit, cost saving ideas, creating a mobile/portable office, your first sand tray, DIY tutorials, office decor, and a toy-list.
Control is something that comes up often during my sessions. Survivors have had their power taken away from them in the worst ways, and regaining control in their life can be difficult. It’s even harder for teenagers, who already have little control in their lives as it is. When clients tell me how they are feeling overwhelmed due to feeling like they have little control in their lives, I have the create “Control Circles”.
On a sheet of paper I have the client draw a small circle, and a bigger circle around it. In the center circle, I have them write all the things they can control (sometimes they may need help this section; if they are having difficulty, ask them if they can control what they eat, what they wear, how they handle their feelings, how they treat others, etc.). On the outside circle, I have them write things that they can’t control in their lives (try to gently direct them to keep it more on an individual level of things that affect them, otherwise they may have a pretty big list of things that may not actually be currently affecting them, such as war).
Most of the time people will list more things they can control than they can’t. In this case, this activity is a great tool to help them keep things in perspective. Remind them that although they may feel overwhelmed by the things they can’t control, they still have more power in their life than they realize. If a person lists more things out of their control than in their control, use it as an opportunity to assist them in exploring what they could do or change to help them feel more in control (i.e. setting boundaries, time management, cooking, etc.).
I have found this to be useful for working with both teens and adults. Idea inspired from The Creative Counselor
Feelings Hide and Seek
- Print and cut out feeling faces or write different emotions on cards.
- Hide the cards around your office before the child arrives, or while they are not looking.
- If they can express certain emotions with ease, hide those in plain sight or an easily findable spot. More difficult feelings or ones that are they attempt to suppress can be hidden more carefully. For those that tend to cover up their true emotions, hide feelings together (ex. putting “happy” on top of another card). I often write the hidden emotions on larger pieces of paper to illustrate how avoiding feelings makes them stronger in the long run.
- Have them start looking for the cards. Each time they find one, they bring it back to you and talk about that feeling (ex. Describe a time they felt that way, Discuss ways they attempt to hide/avoid that feeling, etc.) This game is easily modified to fit different ages and therapeutic issues (Photo Source)
The way I phrased things wasnt clear (sorry!). The kids I see have serious behaviors and affect dysregulation. I wasnt referring to specific disabilities (though we do see those kids too). Trauma and the other issues I mentioned all have a profound impact on early brain development. The developmental delays our psychologist assess for include socio-emotional dev as well as motor, communication, etc. So the kids I see have behavior issues related to their development/trauma, rather than primarily due to to something like a need for more parenting skills (though we do work on that as well). Does that make sense?
So there is the Mental Health Therapist (me), Child Psychologist, Pediatric Neuropsychologist, Pediatrician, Public Health Nurse, Occupational Therapist, and Speech Therapist. We also have “Parent Partners” that help parents with the school/special Ed/IEP process, and “Family Partners” that provide “wrap-around” services in the home and connect families to other resources (ex. housing, food, etc.). Child welfare social workers are also invited to be involved in treatment planning meetings (though they dont usually attend). Our location that deals with adults provides any services the parents need for themselves.
That’s a good question, and it certainly varies on the problem in question. For very young children (i.e., < 8 years old), you’re often working closely with parents and teachers to help the child. Lots of CBT-based techniques will still be effective for children, they are just delivered in very different ways than for adults or even older adolescents. An example might be Coping Cat, which is a program to reduce anxiety in young children. Another example might be basic behavioral interventions delivered by parents and teachers for ADHD. Exposure therapy for phobias has also been found to be effective for younger children.
Basically: Often [but not always] with the younger kids, there’s greater attention given to the child’s “system,” where you are trying to get the family/schools to enable the child in more systematic ways.
Alex answered this well. A far as the question about how EBPs are implemented differently with kids, the manuals often use play to break down concepts and deliver interventions in a developmentally appropriate way. Worksheets and more adult methods are used within sessions, but kids often can only handle this in small portions. So for example, I post lots of super simple feelings activities, etc. to break up sessions. Coping Cat is a good example but isn’t widely used anymore and is a little too workbook based for my taste (it’s no longer an LA county EBP). LA also uses MAP, which is a computer database of EBPs/decision-making tool where you plug in client info throughout treatment. Alex’s response to the exposure question was great. That also begins with play in early stages.
For the question about therapy with a 2-year-old, the main models are Child-Parent Psychotherapy and Child-Parent Interaction Therapy. There are also some groups (ex. Incredible Years) and parent-only trainings (ex. Tripple P). Interventions focus a lot on systems and are often combined with multidisciplinary assessments and services (ex. I work with a team of more than 10 different specialists/community partners).
Elimination disorders, anxiety, general temperament, hyperactivity, etc. Typically the bar is set a bit higher, where serious one-on-one treatment is not pursued unless there’s very clear impairment. So a child who is hyperactive but within an average level usually isn’t given intense psychotherapy, for example. Often there’s more parental empowerment in such cases, and families are equipped to monitor potential symptoms so more serious help can be pursued in the event that symptoms worsen or do not subside over time.
I agree that the bar set higher as far as what kind of issues receive formal treatment for 0-5s. For kids that young, treatment is often linked to development. So the kids I see have developmental delays (including social-emotional dev) due to experiencing trauma, abuse, neglect, prenatal drug exposure, etc. (75% of our kids are involved in the child welfare system) and have serious behavior and attachment issues. If there are behavior issues without delays then it’s more likely a parent-only model (ex. Tripple P). It’s great to see that one of your followers is interested in early childhood mental health. It’s a population not many clinicians work with (I do 1 day/week) that is vastly under researched.
DBT Skills Resources: Model for Describing Emotions
The Emotion Regulation Handout 4: Ways to Describe Emotions
DIY Crayon Wall Art: Crayons are cheap and can easily be made into cool office art. Click the links below to view directions on how to create each of the pictured pieces (numbered from left to right, top to bottom).
I recently terminated with a client, and wanted to make a special ritual for our last session. I printed out a picture of a tree (or you can have the client draw or paint their own tree), and told my client that on each branch, I wanted him to write different things he’s learned in counseling.
It’s a great way to help your client review how far they’ve come, what kinds of progress they’ve made, and opens up for discussion any concerns or thoughts they may have.
He discussed his long-term plans for maintaining his progress. He was very thankful for all the interactive activities we did, and was so proud of himself (and he had every right to be)! It was a very touching ending to our therapeutic relationship.
You can find where I got the idea and picture from here
Click here for a free ebook featuring a compilation by Liana Lowenstein of engaging activities for children and adolescents.
DIY Magic Wands: You can learn a lot about a child through their deepest desires. Wand play can be a fun way to engage children in this conversation and segue into some more CBT and solution-focused work. Follow the links below for some DIY ideas.
Printable in-session signs. Click here if you want to download free PDF versions.