For struggling children and their families, therapy offers hope and reassurance that things can change. Evidence-based practices like Cognitive Behavioral Therapy and Dialectical Behavior Therapy are effective for people of all ages, but pediatric therapists have a special mission to tailor these techniques for children and adolescents. Child therapy techniques provide kids and their caregivers with the skills they need to work through issues caused by a plethora of factors, including childhood trauma, abuse or neglect, mental health issues, and even autism.
These research-based techniques help the child or adolescent develop resilience and a sense of confidence. In turn, these skills often improve their behavior and benefit the overall family dynamic as a result. In this guide, we’ll take a look at several popular therapies for children, examining how they work and exploring specific examples of each type of intervention in action. By the time you reach the end of this guide, you should have a wealth of effective pediatric therapy techniques to choose from!
Parent-Child Interaction Therapy (PCIT)
The goal of Parent-Child Interaction Therapy is simple. With the help of a trained therapist, parents and their children learn to interact with each other in healthier, more positive ways. This form of therapy has been found to be particularly effective with younger children who are experiencing emotional, behavioral, or conduct issues or have developmental delays or other underlying mental health concerns.
How Does PCIT Work?
Through play-based interactions, parents gain new skills designed to reduce the number of negative interactions while encouraging healthier ways of relating. As a new relationship dynamic forms over time, children often experience a marked reduction in problematic behaviors. PCIT is typically conducted as the parent and child interact in a room designed to encourage active play. The therapist sits in a separate room, observing through a one-way mirror. The therapist coaches the parent through an earpiece worn during the session.
Two Phases of Parent-Child Interaction Therapy (PCIT)
PCIT has two distinct phases: relationship enhancement and discipline and compliance. The goal of the first phase is to strengthen the connection between parent and child by producing positive interactions through play. The child makes the decisions on the direction of the play. The parent participates, but does not provide explicit direction. This format provides an opportunity for the parent to implement previously-learned positive parenting skills under the direction of the therapist. Parents are encouraged to ignore mildly negative behaviors and avoid using corrective language like “don’t” or “stop.” In the relationship enhancement phase, the focus is on strengthening the bond between parent and child.
Once the bond has been strengthened, therapy progresses into the second phase of discipline and compliance. At this stage, the parent takes the lead, learning how to set clear expectations with defined consequences for both obedience and disobedience. The parent uses positive praise to reinforce compliance, with follow through on clearly-communicated consequences for ignoring directives. The goal of the second stage is to establish the parent as an authoritative figure who is able to set and maintain clear, reasonable expectations for the child’s behavior.
Play has proven to be a major way that neural pathways are formed in younger children. This activity, once thought to be frivolous, is now known to be incredibly important for healthy human development.
Why Play Therapy is So Effective
Play therapy has been shown to work especially well with youngsters who have experienced adverse early life experiences. The effects of trauma and other stressful life events are stored in the non-verbal areas of the brain like the hippocampus, amygdala, thalamus, and brain stem. Conversely, the area of the brain tasked with communicating and processing trauma resides in the frontal lobes. Play therapy creates a bridge between these two brain regions, effectively moving traumatic memories and feelings from the non-verbal to the verbal portion of the brain. This transfer makes it possible for children to express repressed thoughts and emotions within the safe space you as a therapist hold in a session.
During play therapy, the therapist provides guided opportunities for play, observing the child’s interactions with the toys presented to uncover clues on the child’s thoughts and feelings that may be too difficult or confusing to express. The relaxed nature of this type of treatment makes it easier for children to open up and express emotions they may not feel comfortable addressing in a more formal setting.
Play Therapy Activities
Play therapy can be directive or nondirective. Using a directive approach, you the therapist lead the play session, selecting the toys and guiding how the child will use them during the session. Nondirective play therapy involves allowing the child the freedom to play with very minimal intervention. In nondirective play therapy, you hold the role of an observer, seeking to gain insights into the child’s thought patterns or feelings as they express themselves through free play.
While the overarching concept behind play therapy is simple, this form of treatment can be delivered in a variety of unique formats. Here are several popular forms of play therapy.
- Color Your Life — In this creative play therapy strategy, the therapist and the child match colors with various emotions. The therapist then asks the child to draw something to represent an aspect of their life like home or school, using colors to depict how they feel.
- Storytelling — Using this method, the therapist provides a story starter and then allows the child to tell the rest of the story. As the story unfolds from the child’s viewpoint, the therapist looks for clues regarding underlying emotions, patterns of social interactions, or methods they use to resolve conflicts.
- Role-Playing — In role-play, the therapist and child act out an anxiety-producing event the child is struggling with, with the goal of showing the child how to work through the situation. Using the safe space of a therapy session, children find the freedom to work through the reasons why they find these situations stressful and learn coping strategies that may help lessen their anxiety when they’re faced with these situations in real life.
- Toy phones — As you might expect, this technique uses toy phones to mimic a phone conversation. The therapist and child both have a toy handset and begin a “telephone” conversation. As the dialog progresses, the therapist asks therapy-related questions. This method allows a therapeutic conversation to take place in an indirect format that may make the child more comfortable talking about difficult topics. If the discussion becomes overly stressful, the child is given the option to simply hang up.
- Puppet play — This strategy seeks to explore family relationship dynamics in a play-based setting. Puppet play involves both the child and their family. It begins as the therapist instructs them to act out a story together. As the characters interact with each other, the therapist is able to gather clues about patterns of interaction that the child and other family members may not have been comfortable expressing directly.
Group therapy involves a group of children or adolescents working together with a therapist. Groups are often formed with individuals who are experiencing the same type of challenge, such as eating disorders, dealing with loss, or struggles with regulating emotions in a healthy way. Research has shown group therapy to be highly effective with both children and adolescents. Often done in tandem with individual therapy, this form of treatment offers some distinct benefits that are difficult to obtain by using individual therapy alone.
Benefits of Group Therapy
The benefits of group therapy come largely from the sense of community that’s developed when young people with similar struggles have an opportunity to interact with each other in a safe, supportive space. By listening to other group members, participants learn that their issues are not unique to them. Also, children and young adults often find it easier to open up and express their feelings to peers in a group setting than in an individual therapy session.
Additionally, group therapy provides an ideal venue for the therapist to model healthy social skills like active listening and providing input to others in a sensitive, reassuring way. As participants practice these skills, they have an opportunity to improve their inter-relational skills. Simultaneously, children learn that they have the power to help and encourage their peers to tackle their unique challenges through using supportive language and constructive problem-solving. Especially for young people who have needed so much intensive help for themselves, recognizing that they have the ability to help others can be uniquely empowering.
Group Therapy Activities
Let’s take a look at some creative group therapy activities that you can put into practice. While choosing the right type of activity for group therapy will largely depend on what you want to accomplish in the session, here are a few of our favorites that can be easily adapted to meet a range of therapeutic outcomes. We snagged these gems from the Confident Counselors blog and the Expressive Therapist.
- Stand Up, Sit Down — The therapist begins by making a statement that may or may not be true of each individual participant. If a child finds that a statement is true of them, the child will stand up. If not, they will stay seated. This activity fosters healthy group dynamics while giving the therapist an opportunity to learn about various aspects of their clients’ lives.
- Feelings Hot Potato — As music plays, a “potato” (ball or other object) passes around the group. When the music stops, the group member left holding the potato shares their thoughts on a predetermined subject like naming a feeling or describing a favorite coping skill.
- Nerf Basketball — This technique pairs a favorite pastime with therapeutic benefits. In this activity, each member of the group gets a chance to take a shot at making a basket. If they miss, they have to share something relevant to the day’s topic.
- Powerful Ally — Kids are encouraged to name a powerful ally, a strong or wise person, real or imagined. They’re then prompted to recall a time they felt scared, uncertain, or anxious. Next, they envision that same difficult situation with the powerful ally on the scene. Group members take turns as they role play in one another’s scenarios. Each child plays themselves when it comes time to act out their own scene.
- How Animals Heal — Animals have an amazing ability to heal themselves when they’re hurt. Group members explore various ways creatures heal themselves in the natural world. Then, each child draws a picture of themselves as an injured animal with three means of healing themselves gathered from techniques you’ve shared with them or their original research.
Commonly misunderstood by parents and others as simply doodling a therapy session away, art therapy is, in fact, a highly-effective, research-based means of providing meaningful interventions to children and young adults. Unlike other forms of therapy, art therapy results in a finished product that is a visual representation of the child’s imagination, perception, or emotional state of being. Skilled art therapists lead their young clients through a defined process that results in a visual representation of their thoughts, feelings, and life experiences.
Benefits of Art Therapy
This mode of therapy has a number of distinct benefits. Art therapy allows children the freedom to communicate without words —expression through art offers a non-vebal means of engaging the visual, kinesthetic, and tactile modes of communication. This can be especially helpful for those children who have experienced traumatic events and are unwilling or unable to process through those memories verbally.
Observing a child participating in therapeutic art-based projects also allows therapists the opportunity to gain valuable clues about their client’s level of sensory integration, cognition, and emotional development. Additionally, art therapy allows for the powerful use of metaphor in storytelling around a drawing, painting, or other creative project. Under the careful guidance of the therapist, these narratives can act as a proxy for the child’s own challenging life experiences, giving them an alternate means of processing adverse events. Lastly, this form of therapy has been shown to increase the ability of children to self-regulate by improving mood and reducing mental or physical stress.
Art Therapy Activities
Not surprisingly, this type of therapy is rich with opportunities for specific techniques. While difficult to choose favorites, we landed on some particularly good ones at Positive Psychology and via Shelley Klammer at Expressive Art Inspirations. We’ve curated a collection of our favorites below.
- Words to Live By Collage — Designed to help older children and young adults identify and express their core values, this art therapy technique attempts to create a space where they can visually depict who they are in their most elemental form. In short, the therapist guides the teen through a self-reflection and mindfulness exercise before allowing them to create their own collage from words and images snipped from newspapers and magazines.
- Create a Family Sculpture — This tactile exercise is a great way to explore roles and relational dynamics within a family. In this exercise, the child creates a collection of clay models depicting their immediate family, along with any other influential members of their extended family.
- Draw Your Feelings — This technique employs minimal guidance from the therapist as the child simply draws what they’re feeling. Color choices, subject matter, and the way the child works on the drawing can provide the therapist with important clues on how a child feels or interacts with others.
- Creating a Safe Place — In order to thrive, everyone needs a space they can feel safe in. For kids and teens struggling to find that place, this activity is a good one. With this intervention, the therapist encourages participants to think deeply about a space where they feel safe, exploring why that space evokes that feeling. Then, using a range of crafting materials, the child creates a model of an ideal safe space. Afterwards, the therapist and child discuss the work together, processing how a similar safe space could be created in real life.
- Draw Yourself as an Animal — In this activity, the therapist asks the child to reflect on the type of animal they identify with the most. Then the therapist encourages the child to draw themselves as that creature. Through this exercise, the therapist can gain important insights into the emotions and thought patterns the child strongly identifies with.
The range of research-based practices available to therapists working with children and young adults is amazingly diverse. For young people struggling with anxiety, mental health disorders, or trauma, this broad range of child therapy techniques provides a proven toolkit.
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