There are many issues I can help children work through in individual therapy. Anxiety and depression are big ones. Kids will do much better working through all of their issues if their parent is actively involved in the therapy, because parents can support their kids every day in practicing the skills they learn in therapy. But there are some key issues that I really can’t do much about in individual therapy. Some things, kids have to learn by doing.
Parents often ask I if I can talk with their kids about why they need to behave better at school and at home. They ask if I can teach their child to use her words rather than throw a tantrum. “Can you have a conversation with him about how there are some things you have to do in life even if you don’t want to?” “She wants to be the one in control all the time, can you work with her on that?” I wish I could!
There are some things I can do in individual therapy to help with these issues, but they are limited. I can help kids use coping skills to practice when they are upset or frustrated, including when they don’t get their way. I can address underlying problems of low self-esteem or anxiety that might exacerbate behavior problems. And for older kids who are motivated to change, I can have productive conversations about the above issues. But for the most part, parents and teachers are the ones who have to help their children to learn these things.
Children’s emotional development progresses in gradual stages, just like learning to walk, use scissors, or ride a bike. Young children are very concrete thinkers and don’t understand figures of speech, for example. Young children are also very self-centered and this is perfectly normal. Empathy is learned slowly over time. Parents do have to consciously teach this, but expect it to be a process.
Children also initially learn about right and wrong based on their experiences with reward and punishment. If an action leads to a reward, it is good. If it leads to punishment, it is bad. This is a necessary stage for children to go through as they begin to understand right and wrong. Children do have a strong desire to please their parents and other authority figures, but their desire to keep playing, or keep watching TV, rather than put their toys away, is likely even stronger. In elementary school, children are learning that rules are important, and can even become a bit obsessed with rules. If your nine-year-old has ever given you a heated lecture on the minute flaws in your ping pong serve, you know what I’m talking about! In the preteen years, kids begin to understand right and wrong in terms of what will win them social approval. Adolescents then begin to understand that the concepts of right and wrong are important to keep society functioning. But at first, kids just need their parents to enforce the rules, calmly and consistently, and this will teach them right and wrong. An explanation of why we have the rule to share our toys is also helpful, but keep it short and sweet!
Some children, especially children with anxiety, do have a stronger need to be in control than the average child. In individual therapy, I can help the child to learn to work through the anxious feeling she gets when things don’t go the way she expects. But she also needs to learn experientially when her parent or teacher tells her to put the toys away before she’s ready, and she experiences that feeling of frustration and distress and then gets through it.
I can teach children strategies to regulate their emotions and calm down when they are upset, but kids have to be motivated to use these strategies at home and at school. This motivation is cultivated through experience. For example, I routinely become emotionally dysregulated when I’m on the phone with insurance companies. If I could, I would still love to throw a huge tantrum in those moments. (And honestly, if a huge tantrum would get the insurance representative to help me, you’d better believe I would throw one at age 43!) It is because experience has taught me that losing my temper will make the situation worse, that I use my learned coping strategies to calm myself back down. That is the piece that kids have to experience with their parents and their teachers (see my blog on handling temper tantrums).
In Parent-Child Interaction Therapy, I coach parents to give their child instructions, praise them if they follow directions, and give them a consequence if they do not. Sometimes I will coach the parent to tell the child it is time to put away the toy he is using and get out another one. It is this experiential learning that helps the child begin to accept that sometimes he has to do things he doesn’t want to do. Gradually, kids will start to use their emotion regulation strategies of their own accord to get through those difficult moments. For more ideas to support your child, see my post on helping kids handle big feelings.
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