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:
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:
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!
One of the most essential things I cover in my informed consent is how long it may take a child to work through the therapy process, from saying that first hello to meeting goals and wrapping up the therapy process. It is so crucial for therapy retention that parents and children have an appropriate expectation of everything that therapy may entail and how long they can expect the process to take.
When you take the time and care to be open about this at intake you can avoid some of the painful differences in expectations that parents or caregivers may have when they come into the third session quite disappointed and frustrated that the therapy process is not done and symptoms are not resolved.
This may even prompt them to say something like “Therapy isn’t working, he should be better by now”. And I get it. As a parent you want relief for your child and family system. You want them to be living a life they love to the fullest instead of having a painful struggle.
And at the same time parents will show up differently for the therapy process if they can realize that it is a marathon, not a sprint.
Part of giving a good informed consent is discussing length of therapy and prognosis. This is where we communicate the expected results of treatment including the length of time expected results may take. This is where we gently remind parents that, yes, angry outbursts are totally normal, teens want to spend time in their bedroom, and sometimes all kids lie.
It’s also where we paint the picture of what is possible for their child and how long it will take. It is the complicated clinical judgement that goes into identifying that two clients with the exact same symptom profile on paper may take significantly different lengths of time to complete treatment or may require different therapeutic supports.
So what’s the difference? Well So. Many. Things. I wanted to detail out the 12 areas I consider when thinking about prognosis, pace of therapy, and the therapeutic journey:
So there you have it! The 12 areas that I consider when I evaluate for prognosis of therapy.
This is by no means an extensive list - drop a comment below about what other areas you may consider when thinking about prognosis for your clients!
Want more support on 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!
Engaged and intentional goal setting in your practice sets a strong foundation for the entire therapy process. Check out this sweet (and totally free) worksheet I use with clients to engage them in goal setting HERE and why I think there is pure gold in goal setting HERE!
Now that you know why goals are ohhh so important (and the fact that they are also a requirement) as well as getting your gears turning with some fun new ways to get young people engaged to set goals, I wanted to share with you my absolutely free download on the 12 essentials you need to include in your treatment plans. This is the guide that walks you through just what needs to be in your treatment plans.
Some of the basics of the essential components include:
Want in on all 12? Grab the guide HERE!
Okay - disclaimer time. You knew this was coming right? This is the way I was trained to complete treatment plans in Minnesota. These are the headings that various agencies I have been a part of have trained on and have passed insurance company audits (double disclaimer - these are guidelines and are definitely not a guarantee of everything you will personally need in your practice/state/etc.). You or your agency might have slightly different headings but the good stuff - the meat and potatoes - are likely the same!
Want more support for Play Therapy intakes and goal setting? Check out this training HERE!
What exactly is your relationship with goals? Therapists either love them or hate them.
I happen to be planted firmly in the LOVE IT camp! And secretly (but not so secretly) I hope by the end of this you might be too.
Ok- so beyond needing to take a big ole’ deep breath as you type in all the information that maaayyy be a little dry into your electronic medical record there is definitely gold in goal setting. In both the process itself and how it seres as a guide for the entire therapy relationship.
Check out my four reasons I love setting therapy goals with clients:
1. Enhanced parent and child engagement and “by in”
Let’s face it - most young people aren’t requesting to come to therapy. Usually a parent, the school, or a physician has noticed difficulties with mental heath, big feelings, or change in behavior and recommend the child receive therapy. And as much as we know young people need the support of therapy we can also have empathy that they didn’t exactly sign up for this. If you have ever (willingly or not so willingly) committed to doing something you didn't want to do, you can definitely relate to the feelings of dread, anxiety, and even anger that come up when it’s time to actually do that thing.
Research has shown that collaborative goal setting is actually associated with higher levels of engagement and therapy retention. When we can join together with young people and figure out what they want to get out of the process they can take more ownership over their own therapy. And - likely will have some fun in the process!
2. Identify a clear baseline of symptoms
Having a clear baseline of symptoms and symptom profile when a client enters therapy is essential for knowing what to do next. A client’s exact symptoms (including the frequency, duration, and intensity) helps you clarify next steps in a client’s treatment. Grounding yourself in what the symptoms are and the intensity helps you make a plan about what type of therapy is going to be most effective for your client.
3. Clarify realistic expectations
Oftentimes parents and young people come to therapy with the hope of what their life will look like as a result of putting in the hard work of engaging in therapy. Sometimes that picture is realistic and achievable and...well...sometimes it isn’t. It is in the goal setting process that we can set realistic expectations for what therapy can do - and what it can’t. We can help parents understand that their children are not going to be compliant robots that always turn 100% of their homework in on time, never sass back, and always have a clean room. We can help young people understand that having big feelings like sadness or anxiety is a normal part of life and that therapy won’t erase completely the bad things that may have happened in their lives.
4. Help evaluate progress
Maybe it is just me, but how often do you hear parents or young people say “therapy isn’t working”? And sometimes that is true. Maybe the client needs a higher level of care, different service, or different type of therapy.
However, most often the thought that “therapy isn’t working” isn’t really true at all. Remember above when we got a great baseline of symptoms? Well, we can use this valuable piece of information from goal setting to help pain the picture of where the client was when they started therapy and compare that to today when they are sitting in front of you in your office. You can use this as a tool to highlight their strengths and progress towards their goals.
And these moments? Well, they just happen to be some of my favorite moments in therapy. When a client can acknowledge their growth and have pride in how far they have come!
Okay - now your turn! Do you have a love or hate relationship with setting therapy goals? What are your favorite (or least favorite) parts? Drop a comment below!
Looking for more support for goal setting and intake sessions? Check out this training HERE!
The relationship you have with a child is the number one factor for client change. Really! Research shows the relationship is even more powerful than any technique or theory! (Don’t cringe too much - all the schooling, degree, and extra training you have is really important too!)
The therapeutic relationship is also described as the “most important ingredient in successful therapy” by Athena Drews and Charles Schafer when talking about the therapeutic powers of play. It is the relationship that opens the door to make the other powers of play possible.
In short - if a client doesn’t trust you or think you are someone safe they can talk to, it doesn’t matter how skilled you are, how many trainings you have attended, or protocols you know. None of that will matter because the child won’t feel safe enough to engage.
Okay, so now that we know that rapport and the relationship are not only important but essential - what next? Here are four of my biggest tips to build and foster relationships with young people!
Get cued in to the child’s window of tolerance
Having a good read on the child’s nervous system and looking for cues of hyperarousal (fight/flight) or hypoarousal (dorsal vagal collapse / shutdown) is essential, especially in the early stages of therapy. If the child is going outside their window of tolerance it is your job as therapist to regulate your own nervous system and give the child safe and social cues to help them regulate. Paying attention the small cues of dysregulation can help you pull back from activities or topics before the client floods.
When the relationship is stronger a child’s window of tolerance may be wider for certain techniques, types of therapy, or activities. Pushing too far earlier on can be a significant detriment to the relationship and can damage rapport. Want more information on neuroscience and Play Therapy? Check out my training HERE!
Have a collaborative relationship
The child and family are experts in their reality and what it means to be living in their unique family system. They are also coming to you as a therapist because they are struggling.
Working together with the client and parent in collaboration as opposed to making goals or recommendations from the position of an expert can significantly increase buy in from both the child and the parent. Ask the child what their strengths are, what areas are a struggle, how they see their symptoms, and what they want to be different in their lives. AND hold their answers with care both in the way you set treatment plan goals and how you work towards those goals in therapy.
Be open to feedback
In my first session with families I let them know that the relationship is the number one factor for therapeutic change (see above). I welcome them to give me feedback on my approach and style and have openness that there might be something about my approach that doesn’t fit well with them.
As therapists we need to be sensitive and curious about whether approaches, techniques, theories, or models are not a good fit for the client, or if they are struggling for some other reason. And sometimes….well, we find out that what we have to offer and our specific style of therapy is not a good match for the client. I mean we are human beings after all and one therapist is not the perfect fit for everyone!
In this case we put on our referral hat and figure out what therapist might be a better fit. All in all when we can be open with families about this from the beginning they feel more confident to speak up, which increases retention and engagement!
Repair Any Ruptures
Working with children is complex and multilayered. You are not only working with the child as an individual but also with parents and caregivers. In a climate where parents and children can often disagree about the symptoms that are the presenting concerns and factors impacting symptoms, your role as therapist to maintain rapport within the family system is difficult.
Sometimes you are put in a place to make parenting recommendations that are in the best interest of the child, but don’t often feel good to the child. Hopefully you can relate if you have ever made the recommendation that unrestricted media time and activities could have adverse effects on mental health!
And sometimes, well...you just mess up. You are human after all. I think we all have those moments where we wish we could re-play the tape and say or do something differently in our sessions. The best thing you can do for a therapeutic rupture in rapport is to repair it. Take ownership, apologize, explore the impact on the client, and work to fix it. And this process? Well some research has shown that it actually makes the therapeutic relationship stronger! Wheew - we can all feel a little bit better now!
These are my favorite strategies for building and keeping rapport with clients along with Carl Roger’s core conditions of genuineness, empathy and unconditional positive regard. Children have excellent detectors for grown ups who are not congruent!
Let me know your favorite ways to build rapport and relationship with the young people you see in the comments below!
Looking for more support on intake sessions and rapport buildign? Check out this training HERE!
Goal setting is one of my favorite things about the intake process. No, really!
When you can fully understand a client’s current level of symptoms when they start therapy, it is incredibly clear to see if they are improving in their mental wellness. And although there are external life stressors that may make it difficult for a client to progress, most of the time when you update goals you can see changes, improvement, and progress! Woo Hoo! High five!
This is also extremely helpful when you have parents or caregivers that don’t feel like their child has changed. Well….the initial treatment plan says that your child was tearful 2x per day and now they are having 2 crying episodes per week! Amazing news!
Sometimes parents (or children for that matter) don’t notice the micromovements of change that come during the therapy process and it might feel the same or normal to them but when you give them a clear picture to look back on it can make all the difference! It can allow them to give themselves credit and celebrate their successes!
Now, I am a firm believer that goals should be done collaboratively with the client, not just you typing away alone at your computer to wrap up the paperwork. For younger clients this might be heavily guided by their parent. However, for late elementary school students to teenagers they have the ability to think more about what they want from the therapy process.
And at the same time articulating goals to insurance standards for young people can be, well...tough. Does “I want to feel better” count for a quantifiable goal?
To help engage middle to older adolescent clients I developed a FREE interactive goal setting worksheet. Now updated with two font options!!!
This worksheet is an adaptation of the Wheel of Life activity developed by Paul J. Meyer for coaches to use with adult coaching clients. I adapted it to use with my middle school and teen clients to help them take personal responsibility and ownership for goal setting, which can be difficult at any age!
In this worksheet young people are encouraged to rate themselves on the 8 most common areas goals are typically set with young people and it also accesses the right brain visual centers which is a huge bonus!
Grab your FREE interactive goal setting worksheet HERE! (now updated with two font options!)
This worksheet assesses the 8 most common areas where I see young people struggling and needing to set goals. The first step is to fill out the self assessment sheet of how satisfied they are with each area on a scale of 1-10. Areas include things like peer and family relationships as well as self esteem.
Once all of these areas are rated the client colors from 0 -10 in each category their level of satisfaction. Any color that seems right! At the end you process the circle.
Sometimes I will use a wheel analogy and let young people know that in order for us to be operating as our best selves we want our wheel to be as full as realistically possible and a wheel that could roll down the street. Nobody will have all 10s, but sometimes it is difficult to live life as what I call a “whole happy person” if there are several areas where you are at a 1 or a 2. That leads to a stuck wheel!
Client goals in therapy should be targeted at helping increase client’s abilities to live their life in a way that feels good to them (and keep their wheel rolling)! By filling out the goal setting worksheet you can get clearer on what brought your client to therapy and what areas of their life they want to improve!
Grab your copy to use in assessment sessions HERE! Now updated with two font options!
Looking for more resources and support for your intake sessions? Check out this training HERE!
I'm Ann Meehan, an LPCC, RPT-S, and EMDR Consultant. I help other therapists grow in their passions as play therapists, trauma therapists,and child and adolescent therapists.