8 Steps for Telling Children About Starting Therapy

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! ​

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