The Usual Go To Therapy For Children and Why It’s Not Enough

Many people in the realm of caring for children, especially teachers and pediatricians, are quick to refer children to behavioralists or to suggest cognitive behavioral therapy. These approaches miss the mark of how children actually communicate and learn. These assumptions regarding children and their needs can be harmful and provide a great disservice to children. Let’s look closer at what these approaches mean.
 
Behavioralists: This approach is rooted in the study of Pavlov’s dog. Essentially, when feeding a dog, they paired the feeding with a bell tone. This they proved led the dog to associate the bell with food, thus when the bell would ring the dog would salivate. Once the food was removed from the equation, leaving just the bell, the dog continued to salivate. Essentially this is about creating new associations. I see this as a more antiquated approach to behavior, and here we see it is actually rooted in working with animals with less complex brains than humans.
 
Cognitive Behavioral Treatment: Here we are working on the idea that if we change how we think, we can change how we feel, and thus behave.  In this approach, we are also fully engaged in the analytical areas of the brain and the frontal cortex. Here is the problem, this part of a child’s brain is still developing. In fact, we now know the human brain continues to grow until the age of 25. Frankly, this higher-level thinking is the exact approach adults are using before a child arrives at my office. Everyone has already tried similar approaches through various forms of reasoning, and there has been no resolution. I also feel this kind of approach is fairly accessible through a Pinterest or Google search.   
 
When it comes to children, I believe both approaches are overly simplistic. Their common go to by professionals who work with children, both inside and outside of the mental health field, is rooted in essentially a lack of more complex thinking and education about children, their development, and it is an underestimation of children.
 
I agree with the idea of forming new associations that are positive. I also agree with the idea of teaching new ways of thinking to children, and new ways of coping.
 
But, I believe SO. MUCH. MORE. First of all, I know that by the time children arrive at my office, these two approaches have been tried and exhausted. This is how the world already approaches children, whether by parents, teachers, coaches, or whoever. And it is EXACTLY what has NOT been working. So, I ask you, why would I repeat that cycle? Parents, teachers and the like often expect me to. It might even be how they evaluate me, by how I can prove I am teaching them.
 
Instead, play therapists know how to reach the child where they are. In play therapy, the child goes to exactly what they need to work on in the play therapy room, without me directing them and telling them what they need to do - or should do. And frankly, kids are directed in their lives more than 80% of the time. In fact, I believe with all of my experience, training, and witnessing of children in play that if I did take the lead and direct it, I would only delay their healing process by getting in the way of that process, because…
 
Children know exactly what is causing them disruption in their lives, and somehow they know (when given the right conditions and support that we provide as play therapists) that it is safe to go there, and that is where they go. They may not consciously be aware of it, but at a deeper level they know it exactly. By not relying solely on words and abstract thinking (which fits for adults, and is how adult brains function), this frees up the child’s psyche to go where it needs to go, deeper and more fully than words permit.
 
This can take repetition. After all, our brains learn best by repetition. Through these processes there can be alleviation, processing, assimilation, and learning new ways of being in the world.
 
An Example:
I knew an adult who kept sending her daughter to a behavioralist at age 3, then again at 4, and then again at 5. As they focused on changing her behaviors, no one worked to address the real problems she was struggling with, that a therapist acting in the role of teacher, focusing on how to shift her behaviors could never get to:
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• The child witnessed significant domestic violence in the early stages of life.
• The child had spent the last two years watching her primary caregiver slowly and steadily getting sicker and sicker, going in and out of hospitals and care facilities. Her mother was essentially dying.
• Daily life was focused on surviving day to day, and the home environment was fairly chaotic.

 
Nothing was being done to help her process her trauma. Nothing was being done to explore how the grief of watching the most important person in her life dying was affecting her. Instead, the system of adults involved in the child’s life were trying to change her behavior.
 
But I ask you, who wouldn’t be in a high state of turmoil given these realities? We as adults would be as well, yet somehow we perceive her, a small child living in a daily environment of stress, turmoil, and grief, as the problem. Here is the larger systemic break down that was occurring among the professionals involved with this family:

• Everyone felt really good about what they were teaching her, they could write this down and say, wow, look what we did. We did good. We gave her SO much.
• Insurance was happy with the service as it was concrete and measurable in tangible steps. The school was happy as it was very educational. The parent was happy as they advocated for their child and did what they could to support her and meet her needs. Everyone could feel “good” about their efforts and how they tried.
• Their treatment sounded great on paper. Everyone could say they tried and contributed.
• Except, nothing really did change, or it was very short lived.

 
But here is the biggest disservice of all: the failure that is then placed on the child for not changing.

• Can you imagine what short- and long-term consequences this may place on this small child? What might the diagnosis be? Might there be a decision toward long-term medication? Yet, what the child really needed was to have their early childhood trauma addressed. What the child really needed was to express what life was like with their mother slowly deteriorating, every day of their life.
• How would this impact you, an adult? Now imagine how it would impact you as a small child with a limited vocabulary to express these very complex realities. It’s difficult for adults to put into words. How can we expect a small child to?
  
  

I look forward to a future where all child therapists are play therapists, because play allows children to express their inner reality in a manner that isn’t limited by words. We really need to move beyond our adult limitations and see children as unique and complex people with a language of their own. And if we hope to reach them, we need to learn how to bridge the language gap. Play is the vehicle to do this.