Play Therapy: The Parent Check In
Imagine this…your boss has scheduled a meeting between you, herself, and her boss. They have vaguely told you it is about performance at work, but nothing else. Zip. Zilch. Nada. As you arrive at the meeting your boss stops you at the door and says they are going to meet first about you…without you. Why don’t you have a seat outside?
My palms are just getting sweaty typing this. Can you picture this? What kind of thoughts would be running through your head? I guarantee not warm and fuzzy ones. You might be wondering how you messed up, racking your brain for what could be wrong, and likely having some symptoms of anxiety. Off the top of my head I’m thinking that racing heart, sweaty, can’t breathe feeling. The worst.
I imagine this is what it feels like for a child who comes to a therapy office where the parent checks in alone (or guardian). It has certainly been my experience that when I am in the therapy office alone with a parent (which happens for a lot of different reasons) and the child is either tucked outside or in the waiting room, eventually comes the little knock on the door for ANYTHING. Like, sometimes just to say hi. Maybe it’s to ask what is for lunch. To tell a parent they got a text message. Or, sometimes from what my admin tells me, their little ear is pressed to the door straining to hear what we are saying.
This is the reason that I check in about the week with parents and young people together. Now, I’m certainly not saying that I do this with 100% of my sessions or ALL of my clients, and we will definitely dive into that part. I am also not saying that you can’t create an atmosphere of a child that feels well regulated, safe, and secure during times when you check in with a parent alone. However, I want to make a case for a joint child/parent check in session as a respectful and helpful part of a child therapy practice. Checking in about the week as a team.
My informed consent with families is loooong, and it is intentionally set up to create a neuroception of safety and consistency that both the child and parent can count on. In the initial session informed consent about the check in process usually sounds something like this:
“Most sessions will look like us checking in together about your week, your goals, and anything else important that I need to know. I want to know what your strengths are and how you are succeeding during your week, because I know that you make so many great choices each and every day. I also want to get curious about the times you are struggling to see what could happen differently to support you in ways that feel better. Most of the time we will check in together with your parent, but sometimes parents need to do some hard work too or there might be some adult issues we need to discuss and I may want to check in with them alone. Sometimes, some kids get really nervous, angry, sad or anxious, or don’t like to check in together for whatever reason, and that is totally fine! Let me know and then I can make sure that your parent and I check in alone and you have something fun to do while you are waiting! The great news is, that you get to decide what works for you and what you are comfortable with.”
Do you know how often kids are like “nah I’m good, check in with my parent without me?” – rarely ever. Even on the tough days. On these days when there have been some rocky stormy times, maybe even a tornado or two, I always re-check back with young people to make sure that they feel comfortable with participating. Most want to stay.
Most often during these check ins we are rating two or three of the child’s goals. The parent and child rate separately and I make a HUGE deal by emphasizing that the ratings will not be the same, and likely won’t be until closer to the end of therapy. I use this as a compass to know if families are on the same page about what the level of distress is. This could sound like “on a scale of 1-10/10 how big was your worry? “, “how many friends did you play with on the playground this week?”, or “how many calm days did you have?”. MOST kids can answer these questions with practice, and if they can’t than you pivot. It could look like small, medium, or large ratings or a gesture of size with their hands. Some kids even get creative with sports metaphors for types of penalties. Sometimes we evaluate if it was a “game misconduct” or a minor infraction. It is so important to me to rate goals weekly so we can keep our treatment plan at the forefront AND so we can get curious about what factors are working for the child when they are doing well and what are the struggles when they are having difficult weeks.
Now, some of the feedback I hear about this practice sounds like this: But isn’t it disrespectful of the child to talk about them? Won’t it be to distressing for them to hear about their behaviors? What about when you need to have a hard conversation about parenting skills? Or other “adults only” related things? These are all great questions and valid fears!
Let’s tackle the first one – respect to the child! I think the big thing to get curious about with this, is not whether the child is present or not, but what is said while the child is present and how it is said. AND instead of talking about them we are talking with them. They are on the team. This does not OR should not look like both the parent and therapist staring the child down, shaking their fingers, and listing off all the ways the child misbehaved over the week. Definitely not therapeutic.
The parent/child check in time is a great opportunity to model what it looks like to give positive feedback to a child, validate emotions, how to handle tough behaviors with a child, reframe, have empathy, and how to pull out their strengths each week. I am ALL ABOUT strengths. Even when the child and parent may be discussing a distressing tantrum or meltdown, I usually can pull out some strengths. Was the meltdown shorter than usual? Did the child apologize after? Did the child pick up the mess without asking? I emphasize all of these positive points even in the tough mucky stuff. Parents look at you like you are an alien at first, like – why are you pulling out strengths about this epic meltdown? Eventually, over time, it can produce this wonderful shift about the way that they see behaviors. It can also be an opportunity to gently reframe the way a parent talks about a child’s difficulty. And to be really honest, most families are on their best behaviors (not always) in the therapy space. A lot might get said to the child that is similar to less filtered or in the heat of the moment at home - that's life! This is a great learning opportunity of how it can be said a little differently, gentler, or with a smoother delivery. Other times, when a parent is rocking at describing a dynamic or behavior, or providing their child with validation or reinforcement, you can jump in on those positive moments too. Take time and space to highlight this wonderful moment in the relationship!
Now, on to the second concern about how distressing this can be for the child. Again, the great news is they are in control. But, I am also a realist. The only person that has been with this child 24 hours per day, 7 days per week, is this child. Young people know how their week has been, they know when they are doing well and when they are struggling. By not having the child a part of the conversation, it gives them the message that they are too fragile and not strong enough to handle talking about the muck. If children become dysregulated it is an awesome opportunity to model parenting skills (or just good human interaction skills) of identifying feelings, validating the child’s experience, and co-regulating. Not to mention empowerment! You might say to the child “I am noticing your voice is getting a bit louder and you have an angry look on your face. What is going to work for you right now? Do you think you want to sit on or would you rather step up for a minute?” Those moments can be so powerful!
When young people participate in these discussions, like are truly a collaborative and active participant, wonderful and magical things happen. The young person is the expert of his or her world, not myself or even their parent. It is during this time you can see the young person’s confidence grow, the shame lift, and when he or she becomes truly empowered.
Now what about the last concern? Those truly adult level things? This might look like something with divorce or custody that the child should not know, or something with a court proceeding. This also could look like a parent who may need more space and support given the specific dynamics of the family. Sometimes there is something that comes up or is ongoing where a parent needs more support than a 5-15 minute check in. All of this (and more) definitely warrants a parent only session.
For these, most often the parent comes without the child and the child is told that the therapist and parent have some hard work to do together- because kids aren’t the only ones who need to put in hard work – am I right? I will literally say that to them. It is one of the core things I do in my practice is model that adults make mistake and can grow too. I will also talk about how the young person gets to spend the MOST alone time focusing on what he or she might want to (especially with Child Centered Play Therapy) and sometimes a parent needs to focus on some things too. At the next session with the child I always ask the child if there are any questions for me or their parent. I will give the child a brief overview of what we talked about, and that usually suffices. The young person is usually just ready to play.
Other times I deviate from checking in with the child and parent before the session when the check in has chronically creeped into the session time. For my time managements sake or at the request of the parent, we might pop it to the end of the session. This is usually a good indicator that a family may need more support. And again, the child is always in control of using their voice and saying that they want to wait outside. For other children this may be altered if through assessment and collaboration with the parent it feels as though the child cannot use their voice, are significantly distressed by the check ins, or some other factors that would deem it damaging. I think it is wise to not draw absolutes and flex when they need to.
I find myself frequently saying and reflecting on that parents are the most important people in a child’s life and it can be tricky and complicated to balance both what the child will need as well as the family system as a whole. An intentional check in strategy can help move you towards this balance and structure. I am a strong believer that children can’t change in isolation (heck it is SO HARD for adults to change) and that therapy with children is so much more than just you and the child, it honors the family system.
Overall, I am hoping this gets your gears turning of how you structure connecting with parents, sometimes considering a different perspective allows you to engage in a deeper evaluation of your practice. Sometimes it clarifies that what you are already doing makes the most sense for the way you work with children. I would love to hear how this looks in your practice and WHY! Drop a comment below if you have a check in strategy you love OR if you are struggling!
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3/21/2020 05:51:27 am
I am trying to find your suggestions for telehealth.
3/21/2020 01:04:08 pm
I'm so glad I stumbled across your page. All of these resources are amazing and validating. Thank you!
3/23/2020 09:32:26 pm
2/27/2023 04:54:11 am
I love all your suggestions and techniques and your blog is so insightful and inspiring !
3/6/2023 03:00:30 pm
Thank you so much for your kind words Theresa! I'm so glad you find it helpful!
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I'm Ann Meehan, an LPCC,