One of the most valuable things we can do as clinicians is to support parents in their day to day life with their children.  I truly believe parents and caregivers are the most important people in a child’s life.  
 
The healing principles of attachment and co-regulation drastically outweigh the support as a therapist that I can give to a child in one hour of therapy per week. Because of this I see parenting work as an essential part of working with children.  See more about emotional regulation HERE, and co-regulation HERE and HERE! 
 
The following metaphor was one I heard on the podcast Stuck Not Broken (which is amazing by the way!) that I use all the time when working with parents.  I LOVE a good metaphor, especially one that creates new insights or provides different ways of looking at things and ultimately leads to parents being able to hold the space that children need to heal. 
 
What I know about parents is the vast majority (with a few exceptions) are doing the best they can with what they have.  They are exhausted and trying everything they can to get their child to feel better and do the things they know their child wants and needs to do.  
 
And sometimes? Well, sometimes the only tool left in the toolbox is yelling. Sometimes parents take the parenting strategies that their parents used in an attempt to support their child.  
 
Some parents doubt that co-regulation (check out this guide I use with parents HERE!) is necessary or can be effective. This might mean having ideas that the child needs to “toughen up” and “just get over it”.  Other times I hear “yelling is the only thing that will work” or “I just didn’t know what to do - I lost it!”. 
 
During these times I like to share this metaphor: 
 
“You can’t get a turtle to come out of its shell by banging on the shell”. 
 
Let that sink in for a minute. 
 
Any time a child is not connecting with you and is behaving in ways that are dysregulated (throwing, crying, hitting, hiding, etc.) at the end of the day it means they do not feel safe.  
 
Their nervous system has a neuroception of danger. (Learn more about neuroception of safety in therapy HERE and HERE). 
 
The turtle in its shell is not going to come out unless it feels it is safe. 
 
Turtles don’t feel safe when yelled at or when something or someone is knocking on the shell.  Turtles have long game.  They stay in that shell until they feel safe. 
 
The same is true with children.  They will not...they CAN’T feel safe if we are yelling at them, looking at them with an angry face, or talking down to them.  Telling kids to “calm down” or “just get over it” has never in the history of parenting been an effective strategy for regulation.  
 
These strategies make children feel minimized or shamed for their emotions and more importantly they feel pretty darn disconnected from parents. AND when parents are upset, angry, or yelling children’s nervous systems tune into that and their dysregulation can increase. 
 
 I also think it’s not super fair to young people that we would expect that young people would be able to regulate (with an under-developed prefrontal cortex) better than an adult who is yelling, grumpy, or losing their cool. 
 
And hey! We all lose it sometimes, but a clear understanding of brain development can help parents understand that their child isn’t feeling safe and has less ability to regulate emotions than an adult. This understanding can help bring compassion from adults both towards themselves and their children. 
 
So….what does help? 
 
Justin Sunseri, LMFT has this wonderful Co-regulation Quick Guide HERE that I often share with parents and caregivers. 
 
At the end of the day getting the turtle to come out of it’s shell (or child to regulate) means being a safe external co-regulator.  
 
It means being able to give a child cues of safety so their nervous system can understand that there is not a significant threat of danger.  This might mean having gentle eye contact, getting below eye level, and being intentional on what you say. 
 
When children (or anyone) is in fight or flight mode their inner ear muscles turn off leading to tuning into sounds of danger (low pitched and high pitched) and less into human voices.  This can lead to difficulty with comprehension and understanding of words and language. 
 
Additionally the limbic regions are most active and the prefrontal cortex can go offline - ie decision making, logic and reason. So because those brain regions are not active and available to a child, parents may be saying the most brilliant things, but unfortunately their child is not in a place to be able to take it in and make sense of it.  It's not that they don’t want to, they just can’t. 
 
At the end of the day being a safe adult will allow the child to feel safe enough to regulate and have access to the prefrontal cortex.

​And that my friends? Well… that’s where the good stuff happens.  The conversations, healing, growth, increased understanding, and learning.  


Want to learn more about Play Therapy and the neuroscience of regulation? Check out this training HERE! ​​

 
Co-regulation is an essential concept for parents to understand in moving towards mental wellness for their child.  I do a deeper dive on co-regulation HERE and emotional regulation HERE, but wanted to address some of the most common misconceptions, questions, and concerns I get from parents when we talk about co-regulation.  
 
If parents have been raised in a family system with more of an authoritarian parenting style, have beliefs that their child should be “old enough” to do the things they want and need them to do, are used to structuring the environment to remove the majority of barriers and distress for their child, or are just plain exhausted they may be a little skeptical about co-regulation. 
 
I wanted to address the six biggest questions or concerns parents have when I talk about co-regulation and how I respond in session. 

1. “If I drop everything to regulate with my child isn't that "giving in"?”  
Sometimes parents will mistake co-regulating with their child as "giving in".  Like, if they stop and spend time with their child regulating that the child has “won”.  BUT this is absolutely not the case.  When we co-regulate we are giving the child what they developmentally need to calm their brain and begin to use the higher brain regions again – the parts of the brain that are logical, reasonable, and that are able to do what is needed and expected. One of my favorite quotes from Robyn Gobbel says it all “regulated connected kids who feel safe (and who know what to do) behave well".

2. “So I should just give in or give my child what she wants when she is upset?”  
Now sometimes parents use giving into their child as an actual strategy to regulate. Like giving the child who is sobbing and dysregulated at the cash register the candy they want to soothe them after a limit had already been set. This is such a tricky one because in the short term the child will likely regulate once they get what they want quicker than if they do not.  However, what this can reinforce and teach a child that dysregulation is a tool to get what they want - ie when I become dysregualted my parents give in.  It develops what we call a "secondary gain".  This can overall lead to increased levels of dysregulation. It also doesn’t help them widen their window of tolerance and ability to tolerate things in their environment when they are distressed.  

3. “So I can’t set limits, boundaries, or have natural consequences when he is upset and tantruming?”.  Some parents believe that if the goal is to co-regulate then that means there shouldn’t be any limits, boundaries, or consequences.  Well, it’s actually the opposite! Consistent limits and boundaries can actually make a child feel safer and regulate quicker. They know a parent is serious and will follow through. Limits and boundaries for safety can absolutely happen during dysregulation, however the child’s capacity to actually hear and understand consequences should wait until the child is regulated and has access to those reason and logic parts of their brain. Limits or boundaries set should use simple short sentences without any lecture or explaining and should be given with cues of safety.  

4. “If I set a limit or give a natural consequence after the tantrum she is just going to get upset again”.  Yes, that could be true! AND natural appropriate consequences are what promotes learning to help widen the window of tolerance and ability to handle distress.  Short term a child may get upset again quickly, but longer term skills will be built to increase distress tolerance. This also helps parents establish themselves as safe and consistent so the child knows what to expect. Also limits and natural consequences should be given with care, empathy, and connection. 

5. “So I should just let my child yell at me or say whatever they want to me?” I have many parents that say “okay - so I just let them walk all over me?”.  Well, not exactly.  You want to make sure as a parent you give safe and social cues (see above) and at the same time hold limits and boundaries (again see above).  One of the boundaries during dysregulation (if a child is physically safe) might be a parent sharing that they are willing to problem solve the math homework as long as the child has a calm voice.  

6. “So I can’t show my own emotion?” Yes! Parents can absolutely have and express their own emotions, as long as they are in their window of tolerance.  Parents can express they are sad, mad, anxious, or disappointed as long as they do so in a regulated controlled way.  If it comes out with yelling, violent behavior, the child feeling like they need to comfort the parent, or the parent centering themselves it is likely the parent needs a break.  This might mean taking some time to be alone in their room (modeling), regulating themselves, or seeking connection from one of their social supports.  It is always better to leave and have a break to regulate than staying in a conversation or situation where the parent is going to go out of their window of tolerance. 

7."Why should I change when yelling works?”.  Yup, sometimes it does.  This is usually because young people feel a threat or danger cue from the parent and feel unsafe and fearful to the point they can regulate enough to get through the situation.  Usually the feeling is repressed and the “expected response” is given at the expense of feeling safe within the relationship.  This usually leads to more dysregulation down the road (because if yelling “solved” the problem families would not be presenting for therapy) and harm to the attachment relationship.  If we expect children to be regulated we need to model regulation as adults. 

Want to learn more about Play Therapy and the neuroscience of regulation? Check out this training HERE! ​

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Emotional regulation is the ability of our nervous system to control or regulate emotional responses to something our nervous system deems threatening. It is the ability to stay mindful, present, and work through emotions while our prefrontal cortex (logic, problem solving and reasoning) stays active! Check out a deeper dive on emotional regulation HERE! 
 
Emotional regulation can be broken down into co-regulation (someone outside of ourselves is supporting regulation) or self-regulation (the regulation mechanisms we do by ourselves or on our own). 
 
Co-regulation is a complex process that develops within the attachment relationship and starts at infancy. It is developed through an attuned caregiver who is able to provide consistent and safe responses to an infant's distress.  The attunement, attachment, and regulation skills are imprinted in memory and form the basis for self-regulation. 
 
In short, co-regulation in the attachment relationship lays the foundation for self-regulation.
 
Dr. Allan Schore describes the attachment relationship as how a mother helps the infant regulate emotion.  And these neural patterns and connections?  Well, the infant takes these patterns as a map of regulation that the infant will use across their life. 
 
Going further Dr. Schore states that “attachment theory is essentially a regulatory theory, and attachment can be defined as the interactive regulation of biological synchronicity between organisms.” He also sees an early task of development as transferring regulation from exclusively externally driven (co-regulation) to internal driven (the ability to regulate self). 
 
Many of the young people we see may have had preverbal trauma, a dysregulated caregiver, or other distressing life events that disrupted the attachment relationship and led to difficulty regulating in the here and now. 
 
AND our need for co-regulation doesn’t stop once our capacity for self-regulation develops. As humans we never stop needing the support, understanding, validation, and empathy from others. 
 
So just what exactly does co-regulation look like?  
 
The three pillars of co-regulation according to Duke University are:

1. A warm responsive relationship by showing care and affection and identifying and responding to cues of distress, wants and needs.  This also means building strong relationships by supporting the child in times of distress and genuinely caring about the interests and world of the child.  A warm and responsive relationship also means showing the child respect and unconditional positive regard. 

2. Structure the Environment by providing a “buffer” against environmental stressors by creating an environment that is developmentally appropriate and physically and emotionally safe. This creates an environment where a child is able to learn and explore their environment in a safe way.  This also means predictable routines and expectations. 

3.Teaching and coaching self regulation skills through parent modeling, teaching, and practice. This also might mean the parent holds the structure and prompts skill use and reinforces successful regulation skills.  We can’t expect children to know how to regulate if they don’t have the tools in their toolbox!   
Another truth?  When you work with kids, you work with parents. AND you need to become really comfortable teaching parents about co-regulation with their child. Because co-regulation helps develop self-regulation!
 
Children who have deficits in self regulation capacity need a supportive, attuned, consistent, and safe caregiver to help them imprint and encode these neural patterns and connections until they are strong and engrained enough that the child is able to access them without their caregiver. 

Want to learn more about Play Therapy and the neuroscience of regulation? Check out this training HERE! 
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Nearly every child that walks through my door has difficulties with regulation. (I would say 100% but I am not an absolute kind of gal.)
 
According to the American Psychological Association emotional regulation is the ability of an individual to modulate an emotion or set of emotions.  (Check out my 4 truths about emotional regulation HERE! )
 
Due to early traumatic life experiences, genetics, and/or the attachment relationship most of the young people that come into my office are struggling with their gas pedal.  
 
Some are pressing down hard on the gas leading to high intensity of emotion (sympathetic nervous system activation with increased heart rate and breathing, upset stomachs, sweating, etc.).  These are the kids that are angry, throwing things, tantruming, having panic episodes, or crying. 
 
Other kids are slamming on the breaks or putting themselves in park.  These are the kids that are in their parasympathetic nervous system and might be hypoaroused where they are not having a desire to do anything, isolating, and/or are under the covers. 
 
Both are having trouble with their nervous system regulation triggering the fight or flight response. Both sets of responses mean young people’s bodies and nervous systems are deeming something in their environment as unsafe or dangerous. 
 
And this whole reaction? Well it is out of our conscious awareness. We don’t choose fight or flight - our bodies prepare us for action when we are in danger. 
 
Dr. Dan Siegel calls our optimal zone of nervous system arousal our “Window of Tolerance”.  Here we are regulated, able to move through emotions, able to access higher levels of thinking like reason and logic, are able to be mindful, and are able to be connected to our bodies and sense of self. 
 
And what we know is that with higher levels of trauma and stress we are triggered more often by smaller stimuli.  Or more simply - trauma and chronic stress shrink our window of tolerance. 
 
Lisa Dion identifies four threats to the nervous system in her book Aggression in Play Therapy.  They are:

1. Physical Pain
2. The Unknown
3. Incongruence in the environment
4. “Shoulds” and “unrealistic expectations”

 
When we look at this list we can begin to understand why transitions, attempting to hide things from children, or expecting things from children that they are not able to successfully achieve can be deemed scary, threatening, and dangerous.  The child’s amygdala deems these incidents as threatening and scary as if there were a lion in the room.  The nervous system reacts the same exact way.
 
When we go further and think about the filing and storing of trauma experiences we can further understand dysregulation.  We know that  “neurons that fire together wire together”.  This means that in traumatic experiences stimuli that are not connected with trauma can be encoded and stored within the trauma memory and can be an immediate cue for danger. AND it is likely outside the child’s conscious awareness.  
 
They child will not be able to tell you that a specific sound, smell, taste, expression, or body position was present during a trauma.  And at the same time their body is remembering and will start to become dysregulated and go into a fight/fight response. The body will see this stimuli just as threatening or dangerous as the initial trauma. 
 
As therapists we often hear parents say that moods shifted “out of nowhere” or comment that the child was having a great day and then something shifted.  It is likely that in all of the sensory data that is coming into their bodies.  I talk HERE about how our bodies process anywhere from 11 million up to billions of sensory bits of data per second, but only 40-50 bits are conscious.  
 
When we look at this information it makes sense that a child can become easily triggered and it might not make sense to the child or the parent.   
 
Once we can understand the neuroscientific principles that are underlying emotional regulation and dysregulation we can begin to support parents and children in widening the window of tolerance and their ability to tolerate distress! 

Want to learn more about Play Therapy and the neuroscience of regulation? Check out this training HERE! 
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​Agates are a beautiful metaphor for therapy and mental wellness.  When you find them they are dull, rough, and plain on the outside, but….with some polishing and care - they shine! 
 
And like people - agates come in many forms and colors.  Each one special with intricate patterns, bands, and colors - no two are exactly alike. 
 
Just like in therapy when young people can work on themselves we reveal the best parts of ourselves alongside the imperfect nicks, chips, and cracks. In essence - building a life where young people can live as the best versions of themselves.  Especially when being a young person means that sometimes you will get angry, cry, or have tough days. 
 
The best place to find them? Well..my driveway for one.  And gravel pits.  And sometimes if it is not too picked over the beach!  
 
Agates have been used for a metaphor in therapy by Ana Gomez, MC, LPC in her book EMDR Therapy and Adjunct Approaches with Children as well as a metaphor for not overlooking what makes us special in the book Agate by Joy Morgan Dey and Nikki Johson, local authors from Duluth Minnesota!
 
Agate is a moose who is surrounded by friends who are sparkling gems.  In this book we find out what is unique and special about all of Agate’s friends like Garnet the crocodile, Diamond the giraffe, and Emerald the lion.  
 
Agate feels pretty glum that around all of these gems he feels like a tinker toy project gone wrong. He compares himself to all his sparkling friends and can only see the positives about them, but struggles to see the shine in himself. 
 
At the end we find that Agate learns one simple rule:
 
“Let yourself shine, and let others find your a fabulous, knobbly, glorious, lumpity, terrific, bumpity, incredible, gangly, remarkable, splendid, magnificent, secret jewel!” 
 
This book is an AMAZING addition to your bibliotherapy library to help young people know their own individual strengths, especially those who compare themselves to others.  We can help young people be glad that they are them and appreciate the way others shine - as both are gems in life’s marvelous zoo! 
 
At the end of the book you can have young people draw an animal according to their birth stone (all are listed in the back) and write a page from the book about what makes them special.  
 
You can also do an activity with agates where you can find a picture, draw a picture, or have some agates of your own in your office.  You can have a child select which one they identify with and how they are like a “secret jewel”! 
 
Looking for more bibliotherapy interventions? Check out this training HERE! 

P.S. - those are also some of my favorite agates from home up above! 

In this blog HERE I talked about the 8 steps I use to help parents tell their child about going to see a therapist. 
 
I also wanted to share some of the things I recommend avoiding when talking to children about going to therapy! 
 
First we never want to use therapy as a threat.  Therapy should be an informed medical decision made by parents or caregivers, just the same as if a child were to have surgery, braces, or any other medical treatment.  We would not want to say “if you don’t start acting better we’re going to send you to therapy!” in the heat of the moment of an argument.  This can create negative associations with therapy as a punishment.
 
After therapy starts we want the child to have a positive engagement with therapy.  We don’t want to “tell on” the child in a difficult moment by saying “If you don't calm down I’m going to tell your therapist about this”. 
 
Second, we don’t want to tell them they are going to therapy in the car on the way to the appointment.  We want to give children a heads up when they are doing anything new or different exactly what they are doing, why they are doing it, and what it will be like (see more on that HERE).  This helps them prepare and get them ready for the appointment as well as have any questions answered.  By telling them right before feelings of betrayal, distress, or confusion are likely to come up for the child, which is not ideal to form a connection with the therapist and a felt sense of safety in the therapist's office.
 
Third, we don’t want to be ambiguous or vague about therapy. We don’t want to tell the child they are going to the “doctor” or "an appointment" but then nothing else.  These kids?  Well, they think they might be getting a shot. They will create a narrative about the type of appointment and why they need to go which will likely be wildly inaccurate and create significant distress. 
 
Lastly, don’t let a child’s negative response prevent them from starting the therapy process. Young people’s parents and caregivers bring them to therapy because it is medically necessary.  As therapists we can’t treat children (if we are accepting and billing through insurance) if they do not have a diagnosable medical condition.  Just like we wouldn't let a child’s anxiety prevent them from having a cavity filled, if they have a diagnosable medical condition that is impacting their daily life and necessitates therapy, then we can validate the upset feelings and calmly reinforce that the child is going to therapy, that it is safe, and parents will be with them to support them along the way.  Most children are able to resolve upset, anxious, or distressed feelings pretty quickly once they meet the therapist one or two times. 
 
Now a disclaimer to the last one - you as a therapist can do many things to help make a child comfortable with the therapy process and feel safe (more on that HERE, HERE, and HERE).  If a child has a significant adverse reaction to therapy (won’t get out of the car, won’t get into the car, is physically aggressive, etc.) you use your clinical judgement and theory to decide how to support the child and the family which may mean a referral to another type of therapy or service, working intensely with the parents, or another option that might be a fit.   
 
What about you?  What are the other things that may come up that you recommend parents avoid when telling their child about therapy? Drop a comment below! 

Gratitude is one of the foundations for mental wellness. 
​
In technical terms gratitude is gratefulness for what one receives or experiences either tangible or intangible. You can be grateful for a smile from a stranger, a deep conversation with a friend, or that your barista made your coffee just right.
 
Daily gratitude bullet journaling is something I often recommend to my middle school and teen clients, not just for warm fuzzy feelings, but because it is backed by science! 
 
Gratitude is shown HERE and HERE to: 

• Increase happiness 
• Improve sleep
• Build stronger relationships 
• Decrease feelings of loneliness and isolation 
• Increase traits of helpfulness, generosity, and compassion 
• Improve overall levels of positive emotions 
• Increase ability to handle adversity 
• Improve health
• Strengthen immune system 
• Increase the ability to forgive 
• Improve ability to be alert, alive, and awake 
• Improve optimism 

 
And these benefits?  Well...they can last for months! 
 
If you are looking to include gratitude in your work with young people grab my FREE Downloadable 30 Day Gratitude Challenge.  This free resource includes 30 prompts appropriate for young people to kick start their gratitude practice. 

You can use this resource in your practice in these three ways: 

1. Print off the list, cut out each prompt, and use each prompt as a conversation starter for one of your favorite therapy games.
2. Send the list home with the client and have them journal the answer to the prompt for the next 30 days. 
3. Send the list home with families and have them engage in a family 30 Day Gratitude Challenge where they all share gratitudes around the dinner table (or some other time of connection) each night for the next 30 days.

Then check in!  How did it go for your clients? What changes are they noticing?  Is it something that they want to keep as a part of their routine? 
 
Are you in? Grab the Free Downloadable 30 Day Gratitude Challenge now!  
 
What are your favorite ways to incorporate gratitude into your practice?  Drop a comment below!

One of the most common questions I get from parents when their child starts therapy is “how do I tell them they are going to therapy?”  Most of the time parents are anxious that their child won’t stay in the room with me or that the child will think that they are “bad” or something is wrong with them.  And I get it - these feelings of wanting to protect your child are really normal. 
 
The great news is that the child is living their own life and has a front row seat to the distressing things that are happening.  In short - it’s not a secret to the child that the child is struggling.  Grown ups also only have an experience of the child’s external presentation - the things they are doing and saying.  It’s likely that the child has an internal experience that is also quite difficult and distressing. 

When introducing therapy where a child is hearing about his or her struggles discussed in an empathetic and validating way, it can help young people feel seen and understood.  And actually, for a lot of young people, it can be a relief to know they are going to get help with the mixed up feelings and ways of acting that don't make them feel so great.
 
And most kids?  Well therapy, especially Play Therapy, is actually quite enjoyable.  They get to connect with an adult who gives them unconditional positive regard and speaks their language - the language of Play Therapy.  Even teens (who might not be all play) appreciate having a neutral third party who is there to walk alongside them (in a totally confidential way) to figure out and make sense of their struggles and difficulties. 
 
So when I have a parent concerned about how to tell their child here are the 8 steps that I recommend in my therapy practice:  

1. Schedule a time to sit down and create space for the conversation. This means the three minute window between snack and soccer practice is not an ideal option.  Schedule a time when you have at least 30 minutes to process any questions or concerns that come up.  Some kids it will take 5 minutes and others a lot longer.  Make sure you don't have important events to attend right after and give the child time to decompress.  Also, remove distractions such as the TV or other siblings coming into the space during the time parents are talking to their child. 

The next question is inevitably - okay so when sould I tell them? For older teens one to two weeks before, middle schoolers and late elementary students the week before, and preschool to early elementary the week of the appointment or several days before is a good timeline.  There is no exact science to this and every child is different.  Children that I see that are highly anxious usually benefit from a shorter time frame and kids that need space to think things through benefit from a longer timeline.  

2. Regulate your emotions as a parent. Yup, take a big deep breath.  If you can be regulated as a parent it sends a cue of safety to your child that therapy will be a positive and supportive experience.  If you are anxious or dysregulated it can send a cue of danger to your child that there is something wrong with therapy and can make them feel anxious right from the start. 

3. Identify the specific symptoms that are distressing to the child with empathy and compassion.  This might sound like “Noah, your dad and I have noticed that it is really hard for you to stop playing video games lately.  That you have a lot of mad and angry feelings and it is hard to control your body when this happens.  And, we get it - stopping playing something you love is really hard! We’ve also noticed that these angry feelings happen at other times too, like when you have to clean up after dinner, get ready for bed, or do your homework.  Your dad and I know that these feelings can be really hard to have in your body and a lot of times you don’t feel so good about the stuff you do and say when you are upset”. 

4. Normalize the symptoms.  This might sound like “Sometimes kids wonder if they are the only ones who go through something like this, but guess what?  This is actually something a lot of kids struggle and have trouble with”. This helps kids understand that they are not alone or the only ones.

5. Introduce therapy. This might sound like “When kids are struggling with big feelings and doing or saying things that aren’t helpful for them and don’t feel so good, there are many things we can do to help you feel better.  One of those things is talking to (or playing with) a grownup whose job it is to help young people make sense of their confusing, difficult mixed up feelings to help them feel better and make choices they can feel good about.  This is something that is called therapy, counseling, or special play time”.

6. Get specific about what therapy will be like. First it might be helpful to ask a child if they know what therapy is.  You can assess if there are any negative associations with therapy and clear those up right away.

If this is the case you can give an example that when someone has a broken arm they go to the doctor to have an X-ray and get a cast and have several check ups.  Some even need extra care like physical therapy.  Parents can then let kids know that the place where kids go to figure out their mixed up feelings, tough things that have happened in their lives, or difficult choices is therapy, counseling, or special play time.  

Parents and caregivers can show a picture to their child of who their therapists will be, use the therapist's name, and talk about (or show a picture of) some of the things that may be in the office.  Depending on the therapist and type of therapy it can be helpful to talk about what the child will do when they are in the office. For example, in Play Therapy a parent or guardian might say “You are going to visit with Ann and she has a lot of toys that you can play with when you are there.  Most of the time you will be in charge and can play most of the things you might like to with her!  She has dolls, legos, kinetic sand, and two big doll houses!”

7. Ask the child if they have any questions. Ask children both during the conversation as well as a couple of days before the appointment. 

8. Normalize response and connect with the child. Whatever the child’s response is, is okay! Most kids are a little anxious - which is totally normal for something that is new.  Some kids feel angry or upset.  Other kids are really excited and ready to play!  Again, everything is okay!    

Of course the specific dialogue will sound different if a child is anxious, has trauma, is depressed, has social difficulties, or anything else that a child may be struggling with, but hopefully the example above will get you thinking about some of the ways you can tell a child they are going to therapy. 
 
Check back in to The Playful Therapist blog in a couple of weeks - I’ll have some things that you should avoid when telling a child about therapy. 

Want more support on Play Therapy intake sessions and treatment planning?  Check out this training HERE! ​

Goal setting is one of my favorite things to do in my practice.  You help the client visualize the future and the treatment plan serves as your roadmap to where the client wants to be when they no longer need the support of therapy.  
 
Beyond the specific components needed in your Treatment Plans (grab my guide to the 12 essential elements in a treatment plan HERE) I wanted to give you the 4 questions I always ask to generate the specific information I use to develop the overarching long term goals and short term objectives in my treatment plans. 
 
Ready? Let’s dive in to the four questions I always ask when setting goals: 
 
What is the end point on the map?
Help the child and family paint a specific picture of what life will be like when they know they don't need the support of therapy. Get a dialogue going about the specific activities they would or wouldn’t be doing, how they would be feeling, what they would be thinking or saying. What activities would they be doing or not doing? What kind of student would they be?
 
Where are you now?
Get information about the symptoms and the problem areas now. What are the specific behaviors or symptoms?  What settings do they show up in?  Are there any triggers? What is the frequency, duration, and intensity?
 
What is the connection?
How are the goals directly connected to the symptoms and the diagnosis?  Are there any significant symptoms areas that your goals do not cover? 
 
Is the end point attainable?
Is what the client (or parent) wants actually achievable? If the goal is to never have an anger outburst again that would definitely set the parent (and child) up for failure.  If the goal is to get all A’s for two semesters that could be tricky - especially if there are learning challenges or a generally difficult subject.  (Hello high schoolers who take 6 AP classes in one semester!)  What if the goal shifted to turning in 95% of assignments on time or creating and following through with a study schedule for tests?
 
Bonus tip - I always love to write my goals with the positive expected behavior in mind.  “Abstain from outbursts 90% of the time he transitions from video games” might switch to “Calm and regulated body and voice 90% of the time he transitions from video games”.  
 
Looking for more inspiration in goal setting?  Grab my FREE Download with my collaborative goal setting activity for older children and adolescents! 
 
What are your favorite tips for goal setting with clients?  Share the love (and the tips!) below! 

Want more support for your Play Therapy intake sessions and treatment planning?  Check out this training HERE!