What is Prolonged Grief Disorder, and How Does it Affect Kids?

How long is too long to grieve? We all have our own ways of dealing with loss, and there’s no right or wrong way to respond when a loved one dies. Grief never really ends, but mental health experts recently created a new diagnosis for people who grieve intensely for over a year: Prolonged Grief Disorder. Both kids and adults can receive this diagnosis, and attend therapy designed to help them move through their feelings of grief.

Is it really helpful to put a timeline on someone’s grieving process? How can you tell if you or your child is experiencing prolonged grief? Let’s talk about what Prolonged Grief Disorder is, and how you can help a child who is struggling after a loss.

Prolonged Grief Disorder is a New Diagnosis

Grief is a universal emotion, but until very recently it wasn’t considered a mental health issue. Most of us will experience grief during our lifetime. As painful as it is, grief is a healthy, natural response to losing someone we love. Many mental health problems, like anxiety, involve having a big emotional reaction that is out of proportion to the situation. It’s hard to imagine having a reaction that’s too big to the death of a loved one.

Still, grief can seriously impact a person’s life. Like trauma, it can affect a survivor’s relationships with others, their worldview, and their hopes for the future. For a small number of people, grief has a major and lasting effect on their ability to get through daily life. They may feel numb or have a hard time adjusting to the reality of what has happened. They might feel hopeless about the future, or cope with their feelings in unhealthy ways. Prolonged Grief Disorder was created to give a name to people with these kinds of struggles.

Not Everyone Agrees That Grief is a Mental Health Problem

You can find Prolonged Grief Disorder in the DSM-5, the “therapy bible” that therapists use as a guide to diagnose and treat people with mental health conditions. However, not everyone agrees that it should be there. The idea that grief should be listed alongside mental health problems like depression and OCD has been a little bit controversial.

Some critics think it’s not helpful to decide when grief “should” be over, because everyone’s process is so different. Who is to say that one year is the right or wrong amount of time to grieve? The diagnosis could make grievers feel added pressure to “get over it” or “just move on” with their lives after a death. Some grievers already feel this pressure, as phone calls and support from friends tend to fade away in the weeks or months after a funeral.

There’s also worry that putting a label on grief could make a hard time even more difficult for grievers. There is still stigma around mental illness, and being told you have a “disorder” could make a grieving person feel ashamed or as though their feelings are not valid. Many people already feel self-conscious about how they have responded to their loved one’s death—will getting this label make that feeling worse?

On the other hand, getting a diagnosis makes it much easier to get into therapy. People benefit from therapy after all kinds of life transitions, including deaths, and it doesn’t mean the feelings they’re having are wrong. Hopefully, adding Prolonged Grief Disorder as a diagnosis will help therapists and grievers find new ways to get help and heal after loss.

The Symptoms of Prolonged Grief Disorder

According to the American Psychiatric Association, prolonged grief happens when a person has been intensely mourning a loss for a long time. For adults, this means grieving for over a year. For children and teens, this means grieving for over six months. Prolonged Grief Disorder is more likely to happen after the the death of someone very close, like a parent, child, or spouse. It’s also more likely if the death was sudden or unexpected, like from an accident.

Some symptoms of Prolonged Grief Disorder include:

• Shock and disbelief

• Yearning or longing for the deceased person

• Feeling like a part of your own identity is gone

• Feeling emotionally numb, or feeling extreme emotions like sadness or anger

• Trouble returning to day-to-day activities

• A belief that life is hopeless or meaningless

• Avoiding people, places or things that remind you of the death

These symptoms don’t just happen once in a while: they’re present for most of the day, almost every day. They are so frequent and so severe that they make it hard for the griever to keep moving forward in life.

When Children Experience Prolonged Grief

Children grieve differently than adults, and this is true when it comes to prolonged grief, too. You might have noticed above that kids and teens only need to have prolonged grief symptoms for 6 months—half as long as adults—in order to get a diagnosis. Children, in general, move through grief more quickly than adults do. They also tend to work through grief a little bit at a time rather than all at once, giving them time between spurts of grieving to focus on just being a kid.

Kids who have lost a parent, sibling, or other close relative or friend are at risk of developing prolonged grief, just like adults. In addition to the symptoms listed above, a child’s grief may show up in other ways, such as:

• Difficulty believing their loved one isn’t coming back

• Tantrums and intense emotional outbursts

• Focusing on or reliving the details of the death

• Worries that they somehow caused the death with their thoughts or actions

• Anxiety about bad things happening to other family members

Many grieving kids will have some of these symptoms, but kids with prolonged grief will have them most of the time, on most days of the week. Over time, they can lead to social isolation, or added trouble with depression, anxiety, or other mental health problems.

Grieving Children Are More Emotionally Vulnerable As They Grow

Grief on its own is not a mental health problem, but it is a tremendous stress and sometimes even a traumatic event. Grief is painful no matter your age, but it can be especially tough for young children who lose an important person early in life. Bereavement affects kids both in the short term, causing problems like depression, and in the long term, leading to struggles at school, difficulty in relationships, and substance abuse.

Not all bereaved kids will develop these mental health issues. In fact, most children will find healthy ways to keep living and growing through grief. All kids need lots of help from caring adults to understand death, grief, and loss. This is especially true for kids dealing with prolonged grief.

Help for Grieving Kids and Families

As a parent, caregiver, or someone who loves a grieving child, you are your child’s biggest source of support. Many grieving children do not need to attend therapy. Simply having an adult who listens and cares reduces their chance of developing mental illnesses later in life.

You can help your child understand their feelings and find ways to remember and honor their special person together. If you need help finding ways to do this, A Parent’s Guide to Managing Childhood Grief offers over 100 activities you and your child can complete together. Using simple materials and play-based learning, you and your child can share your feelings, learn age-appropriate information about death, and regain a sense of safety after loss.

If you suspect your child may have Prolonged Grief Disorder, a child counselor can help. Therapy gives children a safe place to work through feelings at their own pace, and learn how to cope with the strong feelings that come with loss. If you’re located in North Carolina, Florida, or New York, I may be able to help with in person or online child counseling. You can also run a search for therapists near you using Psychology Today or a similar directory.

Intrusive Thoughts in Children, Explained

Every kid worries from time to time. It’s normal (and even healthy!) to wonder about fitting in before the first day of school, or to imagine the worst-case scenario before taking a big test. Usually, these worries are easy for kids to talk about, because they know other kids have felt the same way. They also tend to be time-limited: once the test or first day of school is over, the worries are over, too.

For some kids, worries aren’t so easy to talk about. A troubling thought or mental image might pop up out of nowhere, when a child isn’t expecting it. Their worries may be repetitive and feel very difficult to control. Often, these thoughts are really scary and upsetting. They can be dark, violent, or about a taboo subject. These kinds of worries are called intrusive thoughts.

Kids don’t want to be thinking these things, and know they would never act on the thoughts they’re having. So why do they keep happening? In this post, we’ll be talking about what exactly intrusive thoughts are, why they happen, and when to seek help.

What Are Intrusive Thoughts?

Take a second and imagine an intruder. What do you think of? Someone who busts down the door, unannounced, without being invited. What a scary scenario! It’s safe to assume that most of us would be pretty freaked out to discover an intruder in our home. We’d probably dread having it happen again, and try everything we could to make sure our house was secure in the future.

Intrusive thoughts are the brain equivalent of an unwanted guest. They show up to ruin the party. Intrusive thoughts tend to:

• Pop up out of the blue

• Come back repeatedly

• Feel unlike the thoughts a child usually has

• Be upsetting to the child

Intrusive thoughts are ego dystonic. This is therapy jargon that means a person doesn’t agree with the thoughts, and it may not even feel like the thoughts really belong to them. Intrusive thoughts include imagery that is violent, sexual, or feels “wrong” to a child. Other times, worries about worst-case scenarios might come up again and again. They aren’t things that kids would choose to think about, and they’re often the opposite of what a child would do or hope for.

Kids with intrusive thoughts may feel distressed, anxious, or ashamed. They may not understand why the thoughts are happening, but can guess that not everyone is bothered by their thinking in this way. Because the thoughts feel out of control, children may dread having more and try to avoid them.

At What Age Do Kids Get Intrusive Thoughts?

There is no set age at which intrusive thoughts start. However, they may be more common or noticeable in tweens and teens. Intrusive thoughts are sometimes a symptom of OCD, which can show up as early as age 7 or 8 and as late as the teens or early twenties.

In my child therapy office, it’s usually middle or high school kids who are able to put the weird experience of having unwanted thoughts into words. They are old enough to think about their own thinking and notice their thoughts as they pass by, so they know that something doesn’t feel right.

Although they may not talk about it as much, younger kids can be bothered by these thoughts, too. Because they don’t have the vocabulary to talk about what’s going on, you might see changes in their actions, instead. For example, they may ask for reassurance about the same subject again and again.

Why Do Children Have Intrusive Thoughts?

Now that we have spent the past several paragraphs talking about how difficult and upsetting intrusive thoughts can be, you’re probably wondering why kids get them in the first place. The answer may surprise you! Many people experience intrusive thoughts, and it doesn’t necessarily mean something is wrong. They may happen when a person is going through a lot of stress, or they may just happen randomly.

Having an intrusive thought every once in a while isn’t a sign of mental illness. They can be totally normal, like the brain version of a hiccup. A child with occasional intrusive thoughts can usually brush them off without taking them too seriously.

What Mental Health Problems Cause Intrusive Thoughts?

Children who are struggling with repeated, ongoing intrusive thoughts can’t brush them off so easily. In these cases, a child may be dealing with a mental health problem that needs attention. OCD and PTSD are two common mental health conditions that can cause children to have intrusive thoughts.

Kids with OCD deal with repeated thoughts, worries, or mental pictures that upset or scare them. Kids are bothered by these worries, and feel pushed to do something to make the worry go away or prevent something bad from happening. This creates a cycle of repeated worries and repeated behaviors, called obsessions and compulsions, that take up a lot of time and add even more stress.

Children who have survived extremely frightening or dangerous events may have lingering problems after the fact. While some kids will bounce back, others may be diagnosed with PTSD. Kids with PTSD will re-experience parts of their trauma in some way, often through intrusive thoughts or flashbacks. Flashbacks are vivid memories that pop up suddenly and intensely, almost as if a child is living through the event again.

What Are Some Examples of Intrusive Thoughts in Children?

Most of the intrusive thoughts children have fall into one of three broad categories: worries, flashbacks, and “inappropriate” thoughts. If you think your child may be having intrusive thoughts, keep reading to take a closer look at each category. I’ll share some examples of each intrusive thought type. It can be helpful for both kids and parents to discover that they’re not alone, and many kids (and adults) deal with these kinds of thoughts.

Worries: Children with anxiety or OCD may have repeated, unwanted worries that they cant seem to shake. These are often “what if” worries that focus on something bad that could happen in the future. Other times, these “what if” thoughts could be about something naughty a child worries they could have done. Some children with OCD may also get a nagging sense that if they don’t do something exactly right, they could cause something bad to happen. These thoughts may not always be logical, which can make them even more confusing and bothersome for kids. Here are some examples:

• “What if I throw up in public?”

• “What if I accidentally lied to the teacher?”

• “I have to step on all the sidewalk cracks or I won’t be safe.”

Flashbacks: These are most common in kids with PTSD. Flashbacks may feel like they come out of nowhere, or they can be triggered by something that reminds a child of their trauma in some way. They can include any of the 5 senses, and often activate a child’s fight-or-flight system as if the dangerous event was happening again. Examples of flashbacks include:

• Feeling as though you’re back in the place where a trauma happened

• Having an image of the trauma pop into mind

• Hearing or smelling something you associate with the trauma

“Inappropriate” Thoughts: I put inappropriate thoughts in quotes here because there’s a big difference between thinking something and acting on it. We all have weird thoughts from time to time about things we probably wouldn’t be proud to share. Sometimes, intrusive thoughts are about the exact subjects we try to push away or not think about in our day-to-day lives: things like sex, violence, and criminal behavior. These kinds of thoughts can cause a lot of shame, guilt, and distress for children, who worry these thoughts mean they are bad or naughty. They may have thoughts like:

• Imagining hurting someone else

• Picturing themselves stealing something

• Noticing other people’s bodies or imagining them naked

Are Intrusive Thoughts Normal?

The short answer: yes. Intrusive thoughts can be weird, annoying, or disturbing, but they are totally normal. In fact, most of us will probably have intrusive thoughts at some point in our lives. One recent study found that 94% of people have them, which is a surprisingly huge number.

That number is particularly surprising when you consider that most kids with intrusive thoughts feel like the odd one out. They may worry they’re the only ones who have ever had thoughts like this, and that it means they’re bad or weird. Most adults with intrusive thoughts don’t talk about them with other people, either because they quickly disregard them or because it would feel odd to mention in casual conversation. No wonder kids feel so alone.

So, intrusive thoughts are normal—but we know that they can still cause problems for kids. Those issues aren’t caused by the thoughts themselves. Problems arise when the thoughts are very frequent or intense, or when kids have a hard time dismissing them.

Children with OCD have a tougher time disregarding stray thoughts that the rest of us would shrug off. They may take these thoughts more seriously or begin to fixate on them, which causes the thought to pop up more often. Trauma-related thoughts and flashbacks may be so upsetting that they quickly overwhelm a child.

Help for Kids with Intrusive Thoughts in Charlotte, NC

If your child is complaining of an occasional intrusive thought, a little reassurance and education may be all she needs to feel better. It’s helpful for kids to hear that their thoughts are normal, and can’t hurt them or others. Armed with that knowledge, it may be easier for kids to let intrusive thoughts pass by without taking them too seriously. This reduces anxiety which, over time, can also reduce how often the thoughts happen.

On the other hand, you may be on this page because your child’s thoughts are causing larger problems. Maybe you recognized your child in the descriptions of OCD or trauma. If these thoughts have been happening for a long time, are disrupting your daily life, or are combined with other symptoms, therapy can help.

Cognitive behavioral therapy helps anxious kids learn how to catch themselves when their thoughts aren’t doing them any favors. Being able to put a name to your worries helps you to gently shift your mindset. In CBT kids learn that they have control over their thinking, and what thoughts they choose to listen to. A specialized form of CBT called Exposure and Response Prevention helps kids with OCD break the cycle of obsessive thinking and repetitive behavior.

Play therapy helps younger children work through their complicated feelings after trauma. Kids naturally make sense of the world around them through play, and this gentle, child-led approach lets kids handle scary topics in the way that feels safest to them. For kids who are ready to tell their story more directly, TF-CBT gives children a step-by-step path toward managing strong feelings, talking about their experiences, and coping with reminders of trauma.

If you are looking for therapy in North Carolina, New York, or Florida, I’d love to help. We can meet online or in-person in my counseling and play therapy offices just North of Charlotte, North Carolina. If you’ve got questions or would like to schedule an appointment, contact me here.

Online Trauma Therapy: How TF-CBT Helps Kids Heal At Home

2020 has been a weird year. The pandemic has been a trauma event for the whole world: we are all going through it together. As Covid continues on and case counts rise and fall, regular life carries on, too. Kids are experiencing traumas like accidents, illnesses, and violence just like they were before the pandemic began. How do you get your child the trauma therapy they need while staying at home? In this post, I want to talk about online TF-CBT, and why it’s a great option for kids’ trauma therapy both now and in the future.

Why Consider Online Trauma Therapy?

Families may consider online trauma therapy for a variety of reasons, some of which are not unique to 2020. Depending on where you live, it might be hard to find a counselor who knows how to treat childhood PTSD. Other life circumstances can make it hard to find time to drive to a counselor’s office in the middle of a 9-5 work day. Health conditions might also prevent a child or parent from easily being able to travel. Here are a few situations where online trauma therapy can help:

• You really connect with a therapist who lives in your state, but not your town

• You live in a rural area where it’s hard to find a trauma specialist

• You or your child is living with a chronic illness or disability

• You and your ex-spouse have joint custody, so your child travels between two far-apart homes

• Your child’s schedule is extremely busy, and it’s hard to squeeze in another appointment

Doing therapy online means you can see therapists all over your state. You have way more options! If you’re looking for someone who specializes with a specific age group or a particular problem, online therapy broadens your horizons.

What is TF-CBT?

TF-CBT stands for Trauma-Focused Cognitive Behavioral Therapy. It’s a form of therapy that was created to help kids with PTSD symptoms following a trauma. If you imagine a stereotypical therapy session, what comes to mind? Do you picture going into a room and talking about your earliest childhood memories while a therapist nods and says “How does that make you feel?” If so, that’s not what happens in online TF-CBT.

This style of therapy is skill-based, meaning kids learn coping tools they can use in the here-and-now to get some relief quickly. It is also fairly short-term, meaning that children will usually attend therapy for a matter of months. TF-CBT is designed for children from age 3 to age 18. Any child who can put their trauma experience into words is likely to be a good fit for this therapy approach.

How Does TF-CBT Work Online?

TF-CBT is divided into three parts. Here’s how each of them works online:

In the first phase of TF-CBT, kids learn about trauma symptoms and practice coping skills to manage them. Children learn that many other kids have gone through similar experiences, and felt the same way they do now. They rediscover how to soothe their body and mind when trauma symptoms send them into high alert. A TF-CBT counselor can model how to practice relaxation skills on video chat, email handouts to families to practice at home, and share educational books and videos online.

In the second phase of TF-CBT, children gradually begin to face their fears. Many children are bothered by upsetting memories or flashbacks after a trauma. They may also be fearful of situations or people that remind them in some way of what happened. In this middle part of the therapy process, the therapist helps the child gradually expose themselves to scary situations or memories in a careful way. Children can use their new coping skills to manage strong feelings as they arise.

An important way children face their fears is by creating a trauma narrative: a story about their trauma experience from their own point of view. This can be done online using a shared Google Doc for older kids, or by using online comic strip or art programs for younger children. Either way, the therapist is there at all times to make sure the child isn’t overwhelmed.

Finally, children and parents meet together. Kids have an opportunity to share their story with their parents. Meanwhile, parents have the change to show children that nothing they think or feel is too scary to be mentioned. This helps children and parents strengthen their bond after trauma, and paves the way for the child to graduate from therapy. I really enjoy seeing families curled up together on the couch to read their child’s story: it’s much more comfortable than being in my office!

The Benefits Of At-Home Therapy for Trauma

While I love seeing children for face-to-face therapy, online counseling has a few distinct benefits to offer. Until I started practicing online, I’d never considered its hidden perks! Here are a few advantages to consider if you’re considering at-home trauma therapy for your child:

• Online therapy can feel less overwhelming than being face-to-face. This can be especially helpful for shy children who are nervous about talking to a strange adult. When kids are in my office, they’re very aware that I’m close by and looking at them. Online, though, I seem a bit more removed. This makes it easier for some children to open up.

• Being at home means being close to comfort objects. If a child gets overwhelmed during a home session, they are already in a place that likely feels safe and comfortable to them. Pets, stuffed animals, siblings, and photos of loved ones can all be brought into sessions for emotional support.

• As a therapist, I’m able to watch children write and create their stories in real-time. A shared Google Document allows me to observe a child’s thought process as they’re writing, without having to awkwardly peek over anyone’s shoulder. This can be really helpful when children are sharing memories of trauma, because I can spot important details quickly.

Looking for an Online Child Trauma Therapist in North Carolina, New York, or Florida?

I’m a Davidson-based children’s counselor who specializes in childhood trauma and anxiety treatment. I’m also a big proponent of online therapy for kids! I love online counseling because it gets rid of many barriers that make it hard for kids to get good quality therapy. If you’re not local to the Charlotte area, I offer online TF-CBT throughout North Carolina, New York, and Florida.

If you’re looking for an online trauma counselor for your child, you can learn more about me or reach out to schedule an appointment. I’m always happy to chat and answer questions before scheduling.

You can also learn more about TF-CBT and trauma here or by checking out my blog posts on the subject.

How Often Should a Child See a Therapist?

For most kinds of healthcare, we don’t have to worry about when or how often to show up. We go for an annual check-up or drop by the doctor’s office if we feel sick. Dentists send reminders for six month cleanings, and pediatricians have a set schedule of appointments to keep babies and children healthy. Therapy is a little different: we need to attend on a regular basis in order to see results, but what “regular basis” really means isn’t always clear. This can be especially true for kids in therapy. In this post, let’s unpack how often children should be seeing a therapist in order to see positive changes in their mental health.

Kids Need to Attend Therapy Regularly to See Change

Children thrive on predictability and repetition. They need time to absorb new ideas and put them into action. The fact that therapy happens on a regular, predictable basis is part of what makes it so effective. Kids know they can count on their counselor to be at the office each week for their scheduled appointment, and that they have a special time set aside to work through their feelings. This helps to reduce anxiety about the therapy process, and builds trust in the therapist-client relationship.

The positive changes that happen in therapy don’t happen all at once: they are usually gradual and incremental. Each session builds upon the next one. This is why it’s extremely difficult for kids who only attend therapy occasionally to make any meaningful progress. With these kids, so much time has to be spent reviewing old skills and getting caught up on current events that there isn’t much time left for “deeper” work. It’s also hard to establish trust and feel comfortable with your therapist when you only see them once in a blue moon.

Weekly Therapy Sessions Work Best for Most Children

In my own child counseling practice, I recommend that nearly all kids start therapy with weekly appointments. This how often most experts recommend that you see a therapist, and for good reason. Making therapy part of a child’s weekly routine helps them to mentally plan ahead and look forward to appointments. It means that kids and parents are setting aside time for regular self-care, just like they set aside time for piano lessons, sports practice, or any other activity in a child’s life.

I use cognitive behavioral therapy with children, and meeting weekly gives kids a chance to practice coping skills between appointments, without forgetting what we talked about last session. This gives us plenty to talk about the following week! For most kids, weekly CBT is a good balance between feeling supported and having enough free time to participate in the extracurriculars that keep life fun.

Younger Children Need More Frequent Therapy

Meeting weekly is especially important for younger kids. Preschoolers and early elementary-aged children can’t retain information over long periods of time the same way that older kids can, so repetition is key. This is especially true for young children who have separation anxiety about leaving Mom or Dad in the waiting room when they come to therapy. Getting regular opportunities to practice separating makes it much easier, and it’s common for young children to feel a bit nervous about coming to therapy if they have been away for a while.

In general, I still think most little kids do just fine with weekly appointments, and it’s rare they need to meet more often. However, if you’re having a parent session with the therapist one week, consider scheduling an additional appointment for your child in order to keep the momentum going.

Older Kids Can Sometimes Be Seen Less Often

Every once in a while, I will suggest that a kid who is 12 years or older can start therapy on an every-other-week basis. As kids approach the teen years, their ability to retain information and practice skills independently increases. Kids in this age range also face more demands on their time from school, sports, and other extracurriculars, which can make it a little more difficult (and stressful) to schedule regular therapy sessions.

While it’s still usually best (and fastest) to meet weekly, every-other-week sessions can sometimes be a good compromise for busy kids. However, there are a few times when this might not be a good idea. Kids who are experiencing severe symptoms of anxiety or depression really need more consistent therapy in order to feel better. This is also the case for children who have survived a trauma or stressful event. Finally, preteens or teens who have thoughts of suicide or self-harm absolutely need to be seen more frequently until they’re in a safer, more stable place.

Do Kids Ever Need Therapy More Than Once a Week?

There are some situations where kids really need to be seen two or more times a week for therapy sessions. Often, this is a short-term plan designed to help kids get through an extremely difficult time. The goal is always to help children strengthen their coping skills enough that they can function independently for longer, and come to therapy less often.

Here are a few circumstances that could affect how often a child needs to be seen, and require more visits:

• A child has just experienced a new trauma or loss, such as a death in the family

• Severe anxiety or depression prevents a child from doing important daily activities, like attending school

• A child or teenager has expressed serious thoughts of suicide, or has made a suicide attempt

• A child is “stepping down” from more intensive therapy, like inpatient therapy at a hospital

Going More Often Might Mean Fewer Sessions Overall

This is purely based on my own experience as a child therapist, although I’m sure there’s research out there to back me up. I have noticed that my clients who come to therapy on a weekly basis usually end up needing fewer sessions than those who come less often. Weird, but true!

Sometimes, parents request every-other-week or even monthly therapy sessions due to financial concerns. I totally get it—therapy can be a big investment of both time and money. However, I’ve noticed that kids who come to therapy every other week often need to stay in therapy much longer, because we have to spend more time playing catch-up. In the long run, this makes therapy more expensive: more sessions are needed to achieve the same result.

Are You Considering Child Therapy in Charlotte, NC?

Now that you know how often you can expect your child to go to therapy, maybe you’re thinking about next steps. If your child is struggling with anxiety, my online course can help her learn coping skills as you consider your options. You can check out Worry-Free Tweens here.

If you live in the Charlotte, NC area and have a child struggling with anxiety or stress, I’d love to help at my Lake Norman office. You can learn more general information about child counseling here, learn more about me, or contact me to book an appointment. I can also see kids for online therapy throughout the states of New York, North Carolina, and Florida.

What are the Symptoms of PTSD in Children?

Kids are incredibly resilient. One of the things I love about being a children’s therapist is that children are growing and developing every day—they can’t help but grow! This often means that they can progress through therapy at a surprisingly quick pace. Sometimes, however, children can have an experience that is so stressful that it overwhelms their capacity to cope. Parents of children who have endured a trauma often ask whether their child has been seriously affected, or if they may be suffering from PTSD. Keep reading to learn about the signs and symptoms of PTSD, and how these symptoms commonly show up in children.

Categories of PTSD Symptoms

In order to receive a diagnosis of PTSD, a child must have witnessed or directly experienced something that put themselves or a loved one at risk of serious harm. They must also have a number of symptoms in each of 4 identified categories: intrusion, avoidance, negative changes in mood or cognition (thoughts), and changes in arousal or reactivity. These categories are the same for kids as they are for adults, but children often express their symptoms a little differently than their older counterparts.

Intrusive Symptoms in Children

Intrusive symptoms are negative thoughts, memories, or feelings that pop up uncontrollably even though they are not wanted. Many people know that flashbacks can be a part of PTSD, and these are a common intrusive symptom. A child who is experiencing intrusive symptoms may feel like they are right back at the scene of their trauma, and living through it again. These symptoms aren’t under the child’s control, and they may be triggered by people, places, or situations that remind the child in some way of their trauma experience.

Flashbacks, recurring dreams, and strong physical or emotional reactions when reminded of a trauma are all examples of intrusive symptoms. Here’s a few ways they can manifest in children:

• Frequent, recurring nightmares which may or may not resemble some part of the trauma experience: even if your child’s dreams are about something seemingly unrelated, they may be a symptom of trauma if they’re new and/or unusual for your child

• Meltdowns, fear, or anger when your child encounters something reminiscent of the trauma

• Repeatedly acting out scenes through play that are similar in some way to the trauma: this type of play is often very rigid, repetitive, and it may be hard for the child to shift focus to another activity once the play has started

• “Spacing out” when something stressful happens

Avoidance Symptoms in Children

As you can imagine, it feels terrible to have intrusive symptoms that show up when you don’t want them. Children with PTSD begin to avoid people, places, or situations that remind them of their trauma as a way to protect themselves from distressing and overwhelming feelings. They may do this by avoiding external reminders (people and places), internal reminders (their own memories), or both.

In children, avoidance symptoms may look like:

• Refusing to talk about the trauma, or insisting that they are not bothered by it

• Avoiding people who resemble their abuser in some way

• Reluctance to go near the place where the traumatic event occurred

Sometimes, the things a child avoids become more generalized over time: for example, a child whose mother had a heart attack may be afraid of driving by the emergency room where her mother was treated, but may also begin to avoid any doctor’s office.

Negative Changes in Mood or Thoughts in Children

Traumatic events can color a child’s entire worldview. People with PTSD experience changes in the way that they think, feel, and remember things. PTSD can make it very hard to trust other people, especially if your trauma was deliberately caused by another person. Many people with PTSD feel depressed, and they may unfairly blame themselves for what has happened. Some people find they can’t remember parts of their trauma experience.

Adults with PTSD are often able to put these negative beliefs into words: for example, “The world is a dangerous place” or “I’m just waiting for the rug to be pulled out from under me again.” For kids with PTSD, however, these feelings are harder to verbalize. Here are a few ways you might see negative changes in thinking and mood show up in children:

• Low self-esteem

• Lack of interest in seeing friends, or doing things they used to enjoy

• Difficulty with attachment or bonding

• A belief that they caused the trauma, or it was somehow their fault

Increased Arousal and Reactivity in Children

When a person is in danger, the brain and body go into fight-or-flight mode: a surge of adrenaline is triggered in the body, giving the person the energy they’ll need to either physically defend themselves or run to safety. For children with PTSD, their fight-or-flight response may have been activated so much that it now remains “switched on” a lot of the time. Increased arousal, also called hyperarousal, means that the brain is on high alert at times that it doesn’t really need to be, causing that surge of energy and adrenaline in the body. Reactivity means that a person with PTSD has very strong, fast emotional and physical responses to stressful situations.

Hyperarousal and reactivity can look a lot like ADHD in children. I have met a good number of kids who were diagnosed with ADHD before the adults in their lives became aware of their trauma history. Of course, it is possible for kids to have both ADHD and PTSD, but if a child’s symptoms came on very suddenly, it is worth ruling out any possible trauma. Here are a few other ways these symptoms can show up for kids:

• Difficulty concentrating or learning

• Sudden, severe tantrums that seem to escalate from “zero to sixty” very quickly

• Being very sensitive to sounds or small movements

• An exaggerated startle response

• Having trouble falling or staying asleep

• Aggression towards others, risky behavior, or self-harming behavior

How Long Do a Child’s Symptoms Have to Last to Be Considered PTSD?

It is normal and common for many children to experience at least a few of these symptoms in the days and weeks immediately following a trauma. It’s also common for a child to be in a state of shock, and have a hard time processing their feelings about what has happened at first. If your child’s trauma is very recent and they are struggling, it doesn’t necessarily mean they will go on to develop PTSD.

A child’s symptoms need to be happening for over a month in order for PTSD to be considered as a possibility. It’s also good to know that trauma symptoms may not show up right away: a child may not start showing signs of PTSD for weeks or months after a trauma.

Does Every Kid Who Experiences Trauma Develop All These Symptoms?

Not every child who survives a trauma event will develop PTSD. As many as 43% of American boys and girls experience at least one trauma event every year, and many of these resilient kids will be able to “bounce back” from the experience without developing PTSD. Nobody knows exactly why some children develop PTSD while other’s don’t, but we do know that children are more likely to be affected if their abuse happened as a result of violence or abuse, or if they have had repeated trauma experiences throughout their lives.

It’s also possible for children to experience a few of the symptoms listed above, without fully meeting the criteria for PTSD. PTSD is a label that can help us give a name to a child’s experiences and figure out what treatments will work best for them, but many kids have trauma-related symptoms that don’t exactly fit this mold. Trauma-focused therapy can be helpful for these children, as well, if they are bothered by their symptoms but don’t fully meet the criteria for PTSD.

I Think My Child May Have PTSD. How Do I Get Help?

If you suspect your child may have been abused, contacting a Child Advocacy Center near you is a good first step. Your local Child Advocacy Center can give you advice on what to do next, and they have trained professionals who can help determine whether a child has been abused in a way that minimizes a child’s stress and protects their emotions. The CAC may also be able to refer you to local therapists in your area who are trained in PTSD.

If you are looking for a children’s therapist for a child with trauma symptoms, I’d recommend seeking out someone with specialized training in a form of trauma-focused therapy, such as TF-CBT for older children, CPP for toddlers, or TBRI for children who survived long-term abuse or neglect.

Sometimes, grieving children can suffer trauma symptoms due to the nature of their loss. If you’re wondering what’s “typical” for grief and what might be a sign of something more serious, my book for grieving kids and caregivers might be a good place to start. Inside, you’ll find over 100 activities for caregivers and kids to do together to manage grief symptoms.

If you’re looking for more information on childhood trauma, check out my Help for Trauma page for more information and resources.

All About PCIT: How Parent Child Counseling Helps Strong-Willed Kids

Imagine this: your kids are sitting quietly on the couch, watching a show together. It’s seemingly the first time all day that they haven’t been bugging each other about something. You breathe a sigh of relief: you can finally finish the coffee that’s been sitting on the counter all morning. You sneak off wordlessly to the kitchen to finish your cold coffee and scroll through Instagram. You’ve only been gone a few minutes when you hear a yell, and you have to drag yourself back to the living room for yet another 15-mintue lecture to your oldest about not hitting her sister.

Those lectures are not fun for anybody, and it seems like they never work. Your child may smile and nod, but in a half hour the whole cycle is going to repeat itself again. PCIT, or Parent-Child Interaction Therapy, is a therapy for kids and parents designed to break this cycle. Read on to learn more about how this parent child counseling approach can help strong-willed kids to get attention from good behavior, rather than bad behavior.

How Parent Child Counseling Breaks the Bad Behavior Cycle

Many parent child counseling strategies are based on the idea that children will repeat the behaviors we pay attention to. It’s a simple concept, but it can be really difficult to put in to practice, especially when you consider that both positive and negative attention can make a behavior more likely to happen again. PCIT helps parents to “feed” the good behaviors they want to see more of by heaping on positive attention and praise, while “starving” unhelpful behaviors by depriving them of attention.

Often, we ignore kids when they are doing the right thing. Think of the scenario above with the siblings sitting quietly on the couch: it’s only natural to want to slip away unnoticed for a few minutes, especially if your kids have been bickering all day. But by ignoring this good behavior and only coming back into the room when the children start fighting, the parent has accidentally heaped a big dose of attention onto that bad behavior. The child who hit has learned that nobody notices when she’s being good, but that hitting her sister is a great way to get mom’s attention.

What Is Parent-Child Interaction Therapy?

Parent-Child Interaction Therapy, or PCIT, is a form of counseling for young kids who have problems with acting out. It’s an evidence-based treatment, meaning that it’s been heavily researched to make sure it’s as effective as possible for the largest number of families. In PCIT, a counselor acts like a coach for parents, giving them new discipline tools to try with their child and helping them to implement them successfully.

The goal of PCIT isn’t to simply punish a child for being “bad”: it also helps a family create more fun experiences together that provide a child with opportunities to do the right thing. Often, by the time a family tries PCIT, parents may feel exhausted and exasperated by their child’s behavior, which makes it hard to enjoy time spent together. Children may sense their parents pulling back, which can lead them to act out even more in order to keep their parents close.

The Two Phases of Parent-Child Interaction Therapy

PCIT is divided into 2 stages: in Phase 1, parents learn play therapy skills that they can use at home with their child on a daily basis. By setting aside a small amount of time each day for “special playtime”, parents give kids the focused, individual attention they are craving so intensely at a time when they’re behaving well. This helps kids to see that they can get more (and better) attention from parents by doing the right thing, and can help parents to reconnect with their kids and enjoy time spent together.

In Phase 2, parents learn a set of simple discipline strategies to help change difficult behaviors. Consistent, effective, and non-physical discipline helps put parents back in the driver’s seat and gives kids the consistent boundaries they need to feel secure. Over time, kids learn that their old acting-out behaviors like negotiating, tantrums, and whining don’t work anymore: the rules are the rules, and they don’t change. Once that happens, negative behaviors tend to fade away.

What Kids Benefit from Parent Child Counseling Like PCIT?

PCIT was designed to be used with kids ages 2-7 who have disruptive behaviors at home, school, or with others. It’s been used with children who are very strong-willed and have a hard time following rules, as well as children whose behavior problems stem from traumatic experiences. Because PCIT strategies are gentle and based on common sense and logic, I have found these skills can be modified to work well with older kids, too.

Here are a few signs your young child could benefit from parent child counseling such as PCIT:

• Frequent tantrums that are longer and more intense than other children her age

• Deliberately annoying behavior, like whining, pouting, stomping feet, or calling people names

• Breaking things on purpose when angry

• Difficulty following directions or being told “no”

• Negotiating, stalling, or ignoring you when you give an important instruction

How to Find a Parent Child Counselor

PCIT uses a “bug in the ear” approach in counseling sessions: your therapist teaches you the skills, and then observes you playing with your child and gives you real-time feedback through a microphone device in your ear. This unique setup means that “pure” PCIT usually occurs in a big therapy office or agency that has equipment like a two-way mirror or a special observation room.

Here’s a list of therapists who are certified to practice PCIT in the US as well as worldwide. I have completed a certificate course in PCIT from UC Davis, and although I don’t practice “pure” PCIT, I borrow many of the skills in my work with children and preteens. You can learn more about my therapy practice here.

Looking to get started in therapy? Reach out to me to learn more about my approach, and how to help break the cycle of bad behavior with strong-willed kids.

Choosing a Child Therapist, Psychologist, or Psychiatrist

Once you have made the decision to get outside help for your child’s mental health, you’re faced with an array of choices to navigate. There are all sorts of other mental health professionals standing by to help your child manage anxiety, depression, or other big feelings. How can you sort through these different labels to find the professional who can best help your child? Today, I’ll be focusing on the differences between therapists, psychiatrists, and psychologists, and the different problems that they can help children and families to overcome. By the end of this post, I hope you’ll feel more confident choosing a therapist, psychiatrist, or psychologist for your child and family.

How Can I Tell If My Child Needs Therapy?

As a parent, it can be tough to decide when exactly it’s time to reach out for help for your child. Other people might reassure you that your child’s problems are just a phase, or you may worry that seeing a therapist might make your child feel singled-out or different. I wish there were a magic checklist I could give to parents to help them decide when to contact a therapist, but it’s really a personal decision.

I believe that most of us could use someone to talk to about our problems at some point in life. Even if a problem is just temporary or a phase, therapy can help make a really difficult time in life easier and less painful to deal with—for both kids and their parents.

Here are a few general things to consider that can help you decide if and when your child could benefit from therapy:

• Your child is dealing with a stressful situation in life, such as bullying, a health problem, divorce, a new sibling, or a move to a new city or school.

• Your child’s problems seem to be getting worse with age, instead of better.

• Tantrums last longer than you’d expect, or your child gets destructive or hits people when angry.

• The emotional problems started after a trauma in the family, such as a death, accident, or abuse.

• You notice big personality changes in your child: for example, your child spends most of the day in her room and has dropped out of school activities.

• Your child’s anxiety seems bigger and different than other kids his own age, and it is interfering with activities like school, homework, meals, or bedtime.

• It is harder for your child to make and keep friends.

• Your child’s grades are dropping, or she is frequently having trouble with her behavior or paying attention in class.

If any of these things are true for your child, and your gut is telling you that a therapist could help, it’s worth making a call or sending an email to a children’s therapist. Keep reading to see what kind of mental health professional might be the best fit for your child’s needs.

When to See a Child Therapist

“Therapist” is an umbrella term for several types of mental health professionals. Most often, people who refer to themselves as children’s therapists have a Master’s degree in a mental health field like social work, marriage and family therapy, or mental health counseling. These therapists have attended a specialized 2 or 3 year graduate school program after college, as well as some time (usually 2 years) being supervised by another professional before they are allowed to practice therapy on their own.

A therapist can help a child to work through difficult situations, learn coping skills to manage strong feelings like anxiety and depression, and help families to communicate and get along better. Most therapists work directly with clients in an office setting, and they are less likely to be researchers or teachers. Therapists usually have an approach that is more practical and focused on problem-solving.

While a therapist can diagnose you and help you treat emotional or mental health problems, they can’t prescribe medication. They may also not be the best bet if you need a diagnosis for an IEP or other school accommodations: often, schools prefer to hear from a psychologist for this.

Your child might benefit from seeing a therapist if:

• They need emotional support and someone to talk to about their feelings

• They’re struggling with anxiety, depression, anger, or big life changes

• You’d like help figuring out how to get along better with your child, and improve tough behavior

• You’d like to meet with someone on a regular basis, and you’re not looking for help with medication

When to See a Child Psychologist

A child psychologist has a doctoral degree, which means they have spent about 5-6 years studying different aspects of psychology. Most psychologists also have to work under another doctor’s supervision for about a year before working on their own. Psychologists learn about human behavior, how to help clients in therapy, and also conduct research as part of their training. Because their training is more broad, psychologists can work as researchers, professors, or teachers in addition to seeing clients in an office for therapy.

If a child needs emotional support, a listening ear, and help managing big feelings, a therapist or psychologist might be equally good choices. Both therapists and psychologists have similar training in how to provide this kind of counseling.

However, psychologists are able to conduct many tests that therapists can’t, in order to help diagnose mental health and learning problems such as ADHD, autism, and learning disabilities. This can make them extremely helpful when you need more information about the source of a child’s difficulties, or if your child needs accommodations to succeed at school. Psychologists are not medical doctors, which means that they can’t prescribe medication for your child.

Your child might benefit from seeing a psychologist if:

• You think your child might have a condition that affects his learning or neurology, such as ADHD, a learning disorder, or autism spectrum disorder.

• Your child needs support to manage emotional or behavior problems.

• You would like a more detailed diagnosis for your child, and a full picture of all the factors that might influence your child’s mental health.

• One of your goals for therapy is to determine what changes your school can make to better support your child.

When to See a Child Psychiatrist

Psychiatrists are mental health providers who have a medical degree. Like other medical doctors, they attend school for 7 or more years, where they are trained in biology and chemistry as well as psychology in order to understand how different medications affect the brain. After graduation, they participate in a residency, where they work under supervision for several more years before becoming fully licensed.

Psychiatrists are the only mental health professionals who can prescribe medication. In some situations, a nurse practitioner or family doctor may be able to write prescriptions for your child, but usually, this is a child psychiatrist’s job. Because so much training is required in order to safely prescribe medication, psychiatrists—and especially child psychiatrists—are in very high demand. Child psychiatrists can see patients to help them manage medication, and they can also sometimes work as researchers or professors.

These days, most child psychiatrists see children on an occasional basis, and only manage the medication portion of a child’s treatment. While some psychiatrists also provide therapy, this is less common. Usually, a child will need to see a different professional, like a therapist or psychologist, for weekly therapy in addition to their visits with a psychiatrist.

Your child might benefit from seeing a psychiatrist if:

• Your child has been in therapy for a while and is still struggling to manage their symptoms, and you wonder if medication could help them make more progress.

• You need someone to help you select the right medication and dosage for your child, and keep an eye out for side effects.

• Your child’s pediatrician, therapist, or another professional in your child’s life has suggested that medication might be helpful.

• You aren’t sure if medication is right for your child, and you’d like to talk about your options with someone knowledgeable.

Therapists, Psychologists, and Psychiatrists:The Bottom Line

Finding someone who you and your child like, trust, and feel comfortable with is the most important part of looking for a mental health worker. The relationship you create with your therapist, psychologist, or psychiatrist is more powerful than any degree or label, and it’s the biggest factor in whether or not therapy will be helpful to your child.

One you’ve decided what type or types of professional might be a good fit for your family, look for clinicians who specialize in the difficulties your child is going through. Someone who really knows your child’s struggles inside and out is more likely to understand what your child needs in order to feel better. Trust your gut, and find a professional who helps you and your child feel comfortable, safe, and free from judgment.

If you’re looking for next steps to take, you can read more about child counseling here, or reach out to me if you’re interested in scheduling an appointment with a therapist for child counseling. Not ready for therapy? My educational course, Worry Free Tweens, can help your child learn coping skills to manage anxiety at home.

Pros and Cons of Online Therapy for Kids

While many people may not have considered online therapy as an option until quarantine forced us to take a lot of our lives online, it’s been around for years. Large companies like Talkspace and BetterHelp have mostly appealed to millennials who are comfortable with technology and may not have much time during a 9-5 day to make it to a brick-and-mortar therapy office. In addition, plenty of private practice therapists have used online therapy to help reach people who may not otherwise be able to access therapy, such as those in rural areas or people living with chronic illness. Until recently, though, most online therapy services were for adults, not kids.

Because I didn’t see many online children’s therapists out in the world, I was skeptical about whether kids could benefit from this kind of help. Since I want to help my community flatten the curve, when quarantine hit I decided it was time to find out for myself! While I am looking forward to the day when I can go back to my playroom, I have made so many exciting discoveries about online therapy that I would never have realized if quarantine hadn’t pushed me to give it a try. In this post I’ll be sharing some of the most surprising “pros” I have discovered about online therapy for kids, as well as the “cons” to be aware of, since no form of therapy is the perfect fit for every child.

What Kids Are a Good Fit for Online Therapy?

Online therapy, or teletherapy, may not be the best fit for everyone. However, in the past few weeks I have seen some children and families benefit more from online sessions than they have from in-person therapy. Here are a two scenarios where I’ve found online therapy has an edge over face-to-face counseling:

Children whose behavior problems only occur at home. I can’t tell you how many times I’ve had parents tell me that their child’s behavior at home and in my office is a night and day difference. Some parents have even asked if they should film their child’s behavior, because they’re afraid I won’t believe how tough things can really get behind closed doors.

While I don’t recommend filming your child, online therapy gives me a better chance at seeing behavior problems firsthand. Since kids are participating in therapy from home, in a familiar place, they often behave more naturally than they would in my office. Since I’m present on the screen but not physically in the room, it’s more likely that kids will fall back into familiar patterns with the parent as if I’m not there. This gives us the opportunity to work through the problem together, as it’s happening, in real time.

Kids who have a hard time opening up about tough subjects. While many kids enjoy and appreciate individual time spent with a counselor, I have found that some kids feel too exposed or overwhelmed in face-to-face sessions to get vulnerable about painful experiences. Play therapy and art therapy techniques can help give kids the feeling of “safe remove” from an issue that they need to open up, but so can online therapy.

Some kids may feel a little bit less “under the microscope” when they’re talking through a screen or typing, which can make it easier for them to speak their mind. I’m finding that many of my clients who are recovering from grief or trauma are able to speak more directly about their experiences than they were in my office.

The Pros of Online Therapy for Kids

Online counseling isn’t better or worse than face-to-face therapy—just different. Here are a few of the potential benefits that online therapy can offer for kids with anxiety, trauma symptoms, or behavior problems.

• Online therapy can feel more confidential, which can make it easier to open up about difficult subjects.

• Video and text chatting mimics the way that children are most comfortable communicating with friends.

• Kids can design their own “safe space” for therapy sessions that includes all their favorite comfort items: loveys, dogs, and favorite snacks allowed!

• For parents with demanding work schedules or non-traditional hours, online sessions can be easier to manage than in-person therapy, because there is no commute required.

• Home-based sessions can help kids and therapists work through tough behaviors at “the scene of the crime,” which can make it easier to practice new skills. Some kids enjoy doing roleplays of difficult situations using their own toys as props to find better ways to resolve conflicts with siblings or friends.
  
  
  

The Cons of Online Therapy for Kids

For some kids, individual virtual counseling may not be the best option. While some of these issues can be problem-solved in session, other kids might benefit more from another form of therapy, such as family counseling, parenting skills coaching, or face-to-face sessions, when available. Here are a few factors that I have observed can make individual online therapy more difficult for kids:

• Preschool children have a harder time paying attention to a screen for a full therapy hour, and seeing a familiar face onscreen instead of in real life can be a little confusing. For very young kids, shorter “check-ins” with a therapist paired with parenting support sessions might be a better bet.

• Some kids with ADHD may have a tough time with online therapy, since it might require them to sit still for longer. This is especially true for younger children. Adding in extra movement to sessions can help, but individual online therapy may not be the best fit.

• It’s a little harder to pick up on nonverbal information in online therapy, like subtle facial expressions, body language, and small changes in tone of voice. This is true for both the therapist and the client. If a child already has a hard time picking up on these social cues, online therapy can make it more challenging.

• Online therapy sessions rely mainly on sight and sound, and so the sensory experience is not as rich as in-person play therapy for kids with sensory processing needs. Adding sensory play materials like play-doh and scented markers at home can help to address this.

Learning about the pros and cons of online therapy for kids has inspired me to keep offering it as a service even in our post-quarantine world. I have a feeling that for many kids, combining face-to-face visits with occasional online sessions could give them the best of both worlds and make therapy more accessible for many families. If you’d like to chat more about online therapy, or set up an appointment for your child, I’m located in the Davidson, NC area and happy to help. You can contact me here.

3 Common Fears Kids Have About Coronavirus (And How to Help)

I don’t know about you, but I’m feeling pretty saturated with news about the coronavirus pandemic right about now. If you’re like me, you are getting coverage 24/7 from all sides: the news, social media, friends…it can be a lot to take in. While we adults are busy processing all of the sound bites we’re getting from various media sources, kids are listening in, too.

The urgent tone of the news coverage of coronavirus can be alarming for children, and increase their worries. The good news is that there is helpful, age-appropriate information we can be giving to children right now to ease their anxiety. Today I’m sharing 3 of the most common fears I’m hearing children mention this week, as well as what we as adults can say and do to help.

#1. Fear of Getting Sick, or Fear of a Family Member Getting Sick

“Am I safe?”

This is often the first question kids have in moments of change, crisis, or transition. It’s totally normal for kids (and adults, too!) to worry about their personal safety above all else. Because children are so dependent on their parents, children often worry about their parents’ safety, too. Many kids may worry about what will happen to them if a parent is ill or otherwise unable to take care of them during a crisis.

I’m hearing many children voice concerns right now that they might become seriously ill, as well as worries about parents, grandparents, and relatives who may be elderly or have preexisting health problems. If your child has similar fears, you can help by making sure your child understands that the coronavirus usually causes very mild symptoms in children, and sometimes no symptoms at all. You can explain that children have strong bodies that can fight off coronavirus germs easily, but they can still carry these germs to other people who might get sick. This is why school and other group activities have been canceled: not because lots of kids are in danger, but to avoid accidentally spreading germs that might make others ill.

It’s also useful to remind children about all the steps that you and other important adults in their lives are taking to stay healthy: for example, washing your hands, practicing social distancing, and eating healthy foods. You can remind your child of the big network of caring adults in their lives, which may include close friends, extended family, and neighbors. Your child may feel more secure in knowing that these people will be available to take care of them, too, if you were ever feeling sick.

#2. Fear About How the Virus is Transmitted

We are still learning details about how the coronavirus spreads between people, but we have a pretty good understanding of how the illness is spread from person to person: through respiratory droplets, or by touching a contaminated surface. However, the fact that we can’t see the coronavirus can make it feel extra scary: we’re not sure where it is and isn’t, which means everyone is taking extra precautions. I’m finding that many children aren’t totally sure how the virus is transmitted, and may have incorrect ideas about how it is spread that lead to more anxiety.

Kids don’t need to know every detail about the current pandemic, but giving some age-appropriate information about what the virus does and how it is spread can alleviate worries. For example, I’ve heard many children have concerns that they might catch the virus through an open window, or that it might come into their home in the air without a sick person being nearby. By helping children understand exactly how a person gets coronavirus, we can allow them to feel more empowered about preventing the spread.

You can explain to children that usually the virus needs help to get into our bodies, and it can hitch a ride on our hands if they have germs on them when we touch our eyes, nose, or mouth. By washing our hands and avoiding touching our faces with dirty hands, we can help to keep the virus outside of our bodies.

#3. Fear of the Unknown

Personally, it is easier for me to cope with a situation when I know the end date. Wouldn’t it be easier to self-quarantine if we all knew for sure when the outbreak would resolve? I think many kids feel this way, too. It is hard for them to not know when school will be back in session, or if they will be able to celebrate their spring birthday with friends, or even if their summer vacation will happen as planned. This uncertainty can lead to more anxiety.

Right now, kids may have questions that we don’t have answers for yet. If your child asks you a question you don’t know the answer to, it’s perfectly fine to tell them you’re not sure. We can reassure children that we do know that the outbreak won’t last forever, and that things will eventually go back to normal. It might also be helpful for children to know that when we practice social distancing, we’re helping doctors and nurses to fight the virus so that the pandemic won’t last as long as it might otherwise.

Although a lot of routines are changing in children’s lives, some things remain constant. Help your child to recognize the parts of life that have stayed the same during the pandemic: maybe your whole family still has dinner together each night, or they still get to talk to their grandparents on FaceTime every Saturday afternoon. By maintaining family traditions and routines and highlighting them for children, you can make the world more secure and predictable for kids.

How to Help Children with Coronavirus Fears

Children are looking to the adults in their lives right now to determine how they should think and feel about the pandemic. By talking to our children honestly, but calmly, we can help them to take the outbreak seriously without adding unnecessary worry. When children don’t get enough information about the coronavirus, they tend to “fill in the blanks” with ideas or assumptions that might not be correct, leading to more fear. Providing age-appropriate facts can empower kids and reduce this anxiety.

You can also support your child by making sure they get a little bit of individual playtime with you each day, since children use their creative play to process their feelings about the world. This is also an important time to practice your own self-care, so that you can share your own feelings of calm with your children. If your child’s anxiety symptoms are increasing during the pandemic and you think they might benefit from some extra support, you may want to consider online therapy. If you’re in the Davidson, NC area, I’m happy to help!

Is Online Therapy for Kids Legit?

A lot has happened in the world since my last post! If you’re in North Carolina, today marks the beginning of a 21-day shelter-in-place order to help prevent further outbreak of COVID-19 and, hopefully, flatten the curve. This is a big deal for kids and families, who may suddenly be adjusting to a “new normal” that involves a lot more togetherness, unstructured time, and canceled plans. Part of my own new normal has been diving headfirst into the world of online therapy for children, and in this post I’ll be telling you all about what I’ve learned so far.

Are You Skeptical About Virtual Therapy? It’s OK—I Was, Too

I wish I could tell you that I’ve been 100% enthusiastically on board with online therapy for years and years, but that just isn’t true. Like many therapists, I have clung to the belief that in-person is always better. To my mind, online therapy was a “second place” option at best. After all, therapy is all about the healing relationship and connecting with the kids in my office: how can that work as well over a computer screen? How would play therapy work without a playroom?

When the new coronavirus started circulating in my area, there was no doubt in my mind about switching over to online sessions. I didn’t want to risk spreading germs to my immunocompromised families, or send a child to visit with Grandma and Grandpa not knowing if they might have picked up the virus in my playroom. “Second place” therapy in this situation, I figured, was better than no therapy at all.

Then I started actually doing online sessions, and I quickly realized what online therapists have been saying for years: online therapy is different, but equal to in-office counseling. In fact, sometimes it has an edge over face-to-face therapy when it comes to helping kids and families.

What Online Counseling Looks Like With Kids

Online counseling—also called Teletherapy, or distance therapy, uses video conferencing so that clients and therapists can see and hear each other in real time. If your child is familiar with FaceTime, Skype, or even Snapchat, they’ll probably have an intuitive understanding of how to use an online therapy platform. Most video chatting platforms used in therapy are designed to look and feel a lot like Skype or Zoom, but with more protections in place to prevent hacking and safeguard sensitive health information.

In my practice, I ask that children participating in online therapy have access to a computer with high speed internet in a room with a door that closes, in order to protect their privacy. It’s also helpful for kids to have paper, pencils, and markers available to use in session, just like they’d have if they were in my office. That’s likely all that older kids will need to have a successful virtual counseling session, but younger kids often enjoy having a few of their own toys on hand, as well. I’ve been introduced to lots of loveys and other special childhood toys this month!

Today’s Children Have Grown Up Using Technology to Connect

I often try to remember how I felt or reacted to things when I was the same age as my kid clients. This is helpful a lot of the time, but it held me back when I started considering online therapy. I tried to picture how I would have felt at 7, 8, 9, or 10 years old, talking to a counselor on our big family computer in the living room. It felt foreign and weird to think about, and I imagined it as a cold and clinical experience. At that time in my life, computers were still new, and the technology felt like it was separate from my day-to-day life.

However, my kid clients didn’t grow up like I did—and they probably didn’t grow up like you did, either. They’ve been FaceTiming aunts and grandparents since before they could talk. Many of them log many hours a week chatting with friends while playing Roblox or other multiplayer games with friends online. Communicating through technology doesn’t feel cold and detached to these kids: for many of them, it feels more familiar and “safe” than sitting on a couch and talking to an adult in real life.

There is Research to Support Teletherapy for Kids

When I’m trying to decide if a therapy treatment is legit, I turn to the research. It’s important to me that the techniques I use with kids have evidence to back them up, which is one reason why I love cognitive behavioral therapy. Luckily, there’s a growing body of research on teletherapy, and it comes to the same conclusion I’ve reached watching my clients in online sessions: online therapy can be just as effective (and sometimes more effective) as face-to-face counseling, even for kids.

Several peer-reviewed studies have found that people with anxiety and depression can get relief from online therapy, and that their improved mood continues after treatment is over. Researchers have also studied how kids respond to computer-based therapy, and found that it can be helpful for both depression and anxiety. According to the study, kids spend so much time on their phones and other devices that this form of therapy may come more naturally to them.

My Verdict On Online Therapy for Kids: It Is, in Fact, Legit

While some play therapy activities can’t be done online (I miss my sandbox!) there are plenty of reasons to consider online therapy as a different but equal way to get mental health help. Your child might be surprised to find they feel more comfortable chatting with their counselor from home, surrounded by their toys and pets. It may not be what we’re used to, but it’s legit.

Still looking for a therapist, but need some online help? My self-help course for kids teaches coping skills from an educational perspective, rather than a counseling one. Worry-Free Tweens was designed to help anxious kids ages 8-12 feel more in control of anxiety.

Still wondering about whether teletherapy could work for your child? Reach out to me here to learn more about online therapy for kids in the Lake Norman area.

4 Coping Skills to Help Children with Depression

If your child is experiencing severe depression symptoms or is feeling suicidal, please contact 911, the National Suicide Hotline, or the Crisis Text Line.

As anyone who has experienced anxiety symptoms knows, anxiety and depression often go hand-in-hand. People who have survived a trauma also often have symptoms of depression, including hopelessness, numbness, or lack of interest in activities. Because of this, I often see children struggling with depression in my therapy office, even though I specialize in PTSD and anxiety disorders.

There are lots of coping skills for anxiety that can offer some quick relief, either by distracting a child from worries or by helping the body to relax. I think it’s a little trickier to find skills that provide “quick wins” for kids with depression. Maybe this is because anxiety often has a more sudden, intense onset, and depression tends to be a consistent feeling for a longer period of time. In this post, I’ve compiled a few simple ways to help a child cope with depression that are supported by research. While some of these may not be as simple or quick as a breathing exercise, building these habits over time can help boost a child’s mood and encourage positive thinking.

Depression Coping Skill #1: Schedule Positive Activities (Even if They Don’t Sound Fun)

Many people assume that depression is caused by a negative event in life: for kids, maybe this is a move, a divorce, or an experience being bullied. While it’s true that tough life situations can trigger depression, researchers who studied depression found that a lack of positive experiences can also lead to low mood. Kids struggling from depression often withdraw: an elementary schooler might prefer staying home to going on play dates, or a preteen might drop out of her extracurriculars. This can create a vicious cycle where the lack of positive, rewarding activities in a child’s life make the depression worse, which in turn makes it harder to get out of the house.

You can help your child by encouraging activities that are social, fun, or provide a sense of accomplishment. Therapists call this technique behavioral activation, and it’s a treatment for depression in adults, as well as kids. Even if a child is reluctant, scheduling these kinds of activities and sticking to them can have a positive snowball effect. Think of it like going to the gym: you might really dread going the first time, but once you try it, you’ll realize it wasn’t so bad. In fact, you might feel so energized that you get motivated to go back the next day. The same thing can happen for children: the first outing might be really hard, but they may surprise themselves, and have more fun than they expected, which can make the next activity easier and more fun.

Here are a few positive, rewarding activities to consider:

• Making a meal or a snack together

• Trying an art class, or another class related to a child’s interests

• Taking the dog for a walk

• Re-arranging a child’s bedroom

• A movie night with a friend
  

Depression Coping Skill #2: Talk Back to Negative Thoughts

Kids with depression are prone to ruminating: mulling over their negative thoughts over and over again, which makes their sad feelings more intense. Depression often exaggerates and distorts our thinking, making our thoughts too negative to be true. Kids can stop the cycle of ruminating by spotting these overly-negative thoughts, questioning them, and coming up with a more helpful and realistic alternative. This is called cognitive restructuring and it’s an important part of cognitive-behavioral therapy, an approach that helps people learn how their thoughts and behavior influence their feelings.

This skill is best for kids who are elementary-aged or older. Sometimes it is hard for kids to learn this skill on their own, because it requires them to think about thinking, which is an abstract concept. A child counselor can teach children how to master this idea and practice “talking back” to negative thoughts. I often use the picture book Tiger Tiger, Is It True? to help kids understand how changing their thoughts can change their feelings.

You can help your child catch himself when he’s thinking something too negative to be true, and encourage him to ask himself questions like:

• Do I have any proof this is true?

• What would I tell a friend who had this thought?

• Is there another way of looking at this?

• OK, it if really is true, would it be the end of the world?

If your child benefits from this form of thinking, CBT might be a great option to help them cope with feelings of depression, and learn to change the thinking patterns that can trigger sadness and low mood.

Depression Coping Skill #3: Add More Sunshine

Many people notice that their depression is worse in the winter, when there is less access to sunlight. Seasonal Affective Disorder, a form of depression that often starts in the fall and ends in the spring, can occur in kids as well as adults. There is a theory that sunlight might encourage the body to produce serotonin, a chemical that influences many processes in the body including our sleep, digestion, and mood.

For kids, outdoor play is a great way to improve mood and cope with depression. Children who play outdoors get more sunlight, but this kind of play offers all kinds of other benefits, too. A study by the American Medical Association found that “children will be smarter, better able to get along with others, healthier and happier, when they have regular opportunities for free and unstructured play in the outdoors.” Being more connected to nature can also be a mood booster for both children and adults. Interestingly, spending more time in nature has been shown to help kids with ADHD feel more relaxed and focused, as well.

You don’t have to go on a big camping trip or expensive vacation to get the benefits of playing outdoors: a trip to the park, playing catch in the backyard, or a walk on a local nature trail can be just as helpful.

Depression Coping Skill #4: Practice Good Sleep Hygiene

Therapists like to say that sleep, exercise, and nutrition are all important for treating and preventing depression. If your child is feeling down, it’s worth looking into all 3. I have personally noticed that many of the children I meet who are feeling depressed are also really struggling with their sleeping patterns. Often, these children are staying up late, having a hard time falling asleep, and as a result have really shifted their sleep cycle to start and end later than is typical. These kids often have to operate at school on very few hours of sleep, or end up sleeping all day and missing out on the daylight hours they could be spending with friends.

Insomnia is a common symptom of depression, so it’s totally understandable that depressed children often have such a hard time falling asleep. What makes this situation so tricky is that sleep deprivation can also make people more vulnerable to anxiety an depression, so disturbed sleep can create a vicious cycle that ultimately makes depressed feelings more intense. In addition, if a child is losing a lot of their daytime hours to sleep, it cuts back on their opportunities to socialize or get involved in other positive activities that can reduce and prevent depression.

Sleep hygiene is a term to describe many habits that can encourage people to fall asleep and stay asleep, leading to a better night of rest. These habits on their own may not be enough to completely resolve sleep problems for a child, especially if she is also struggling with bedtime anxiety, but they’re a great place to start. Here are a few things to consider if you think your child’s sleep patterns might contribute to depression:

• Stop using any electronics (phones, computers, TV) for at least 30 minutes to an hour before bedtime.

• Finish any soda or other caffeinated drinks 4-6 hours before it’s time to sleep.

• If your child is struggling to fall asleep, encourage him to read a book or try another quiet activity for a few minutes. This can help kids feel tired faster, whereas tossing and turning in bed can make children more angry or anxious, and less likely to sleep.

• Create a routine for your child that is consistent each night and can help her unwind, such as reading a book together and practicing a relaxation technique.

• Checking the time repeatedly at night can lead to more worry and less sleep. If this is the case for your child, put the clock or phone in a position in the bedroom where she can hear the alarm but can’t see the face or screen.

• Make sure your child gets enough physical activity during the day, so that they are ready to relax by bedtime.

Begin Therapy for Kids with Depression in Davidson, North Carolina

Depression is tough, but kids can and do bounce back from their low moods. Trying these coping skills at home can be a great first step in fighting back against depressive symptoms. Looking for a way to go deeper with coping skills? Check out my online courses, which teach coping skills to kids and tweens in a self-study format. You and your child will learn specific skills you can start using right away, and get tips on how to practice them effectively.

If your child is dealing with depression after a loss, my activity book for bereaved children helps caregivers support children as they work through their grieving process. It’s available on Amazon, Barnes & Noble, and at local bookshops near you.

If you try these techniques and find your child is still struggling, a counselor can provide in-depth help and support. If you live in the Davidson, NC area and would like to learn more about how therapy can benefit children with depression, anxiety, and trauma, contact me here.

TF-CBT for Preschoolers: Therapy for Early Childhood Trauma

TF-CBT is designed to help preschool children as young as 3 and 4 years old after a trauma.

Preschool Trauma is Common

Trauma is one of the leading causes of mental health problems in children, and TF-CBT for preschoolers can help support the many young children who find themselves affected by trauma each year. Learning that a preschooler has experienced a trauma is terrible news for any parent. As caregivers for children, we do everything possible to shield the young people in our lives from danger. Despite our best efforts, sometimes life happens in ways we didn’t expect or hope for: accidents, violent situations, grief, and loss are not always preventable, and can affect people of any age—including preschool children. Statistically, 26% of kids in the United States will witness or experience a trauma before the age of 4.

Some common causes of childhood trauma among preschoolers are:

• Prolonged separation from a parent due to illness, incarceration, or foster care placement

• A severe accident or illness, such as a car accident or cancer

• Physical, verbal, or sexual abuse

• Witnessing physical or verbally abusive arguments between parents

It’s important to know that preschoolers can be just as affected by witnessing a parent’s trauma as they would be if the trauma happened to them directly. Very young children are so connected to their parents that their own sense of self and safety is wrapped up with their parents’ well-being. Seeing a parent in trouble can be intensely frightening and painful for a preschool-aged child, and can be just as likely to result in trauma symptoms.

How PTSD Affects Preschoolers

While some preschool children will “bounce back” fairly easily from their trauma experience, others might show lingering problems long after the initial event has passed. Trauma symptoms can impact any child’s life, but younger children may especially vulnerable to developing symptoms. Other factors that make trauma symptoms more likely include having special needs or sensory sensitivities, experiencing other life stresses, and having a previous history of trauma or loss.

How can you tell if a preschooler in your life has trauma-related symptoms? Very young kids may not be able to tell us in words what they are going through, but will communicate their trauma through tantrums or crying, difficulty sleeping, frequent nightmares, or problems paying attention or following directions. Parents often observe that their child seems to “regress” to an earlier developmental stage after a trauma, and may suddenly struggle with problems they had previously grown out of, such as potty training or sleeping through the night.

Lots of research has been done on the subject of early childhood trauma. We’re learning that even the youngest children can be just as deeply affected by trauma as older children and adults. Fortunately, we’ve also discovered that preschool-aged children can benefit greatly from age-appropriate trauma therapy tailored to their developmental level. One of the best-researched forms of therapy for preschool survivors of trauma is Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT.

What is TF-CBT, and How Can it Help Preschool Children?

TF-CBT is a form of therapy designed specifically to help children ages 3-18 following a traumatic event, and it can be an especially big help for children in the preschool and early elementary age range. It is an evidence-based form of therapy, meaning that it has been proven effective by research to help children with these symptoms. Through TF-CBT, preschoolers and their parents learn skills to cope with trauma symptoms, helping the child to alleviate anxiety, manage worries, and cope with strong feelings. The parent and therapist gradually assist the child in expressing their thoughts and feelings about the traumatic event and make sense of what happened, so that it no longer feels like an overwhelming experience.

TF-CBT tailored for preschoolers puts a strong emphasis on educating both children and parents about how trauma can cause problems problems with their bodies as well as their feelings. This can be extremely helpful for young children, who may feel quite confused by their symptoms and alone in their experience. Educating children about trauma in an age-appropriate way helps children understand that they are not alone—many other young children have walked in their shoes, and have recovered from trauma to live happy and fulfilling lives.

How does TF-CBT for Preschoolers Work?

During treatment with TF-CBT, preschoolers are taught how to use relaxation and mindfulness techniques to reduce anxiety and mood swings during the day and promote restful sleep at night. While these relaxation skills are used initially to reduce symptoms of trauma, they are also a great life skill that can grow with the child, helping them to manage other stressful situations as they arise.

Since younger children may have more difficulty putting feelings into words and making connections between past and present experiences, TF-CBT for preschoolers relies more on art and play-based activities to help children identify important feelings and develop a better understanding of their experiences. Through art and play activities facilitated by a therapist, the child can work through any misconceptions about their trauma experience, alleviate feelings of guilt or self-blame, and find a sense of closure.

Helping Preschoolers Move Beyond Trauma with TF-CBT

While therapy cannot make a young child forget what has happened to him, it can take some of the power away from a traumatic experience. It can help a child move past this difficult time in their lives and toward other, more hopeful chapters. Many parents and children find that after working through a traumatic event in therapy, children develop more resilience and empathy for others. Children and parents complete the TF-CBT process together by reviewing the child’s growth and learning strategies to help the child stay safe and avoid dangerous situations in the future.

If you’d like to learn more about how to support your preschooler with trauma through TF-CBT, my door is always open. You can also learn more by visiting the official website for TF-CBT.

Drama Therapy for Children: Express Yourself Through Theater

Drama Therapy uses storytelling and make-believe to help children work through feelings

This is the second blog post in my series on drama therapy. Click here to read part one!

Drama therapy is a form of mental healthcare that uses theater techniques to improve the mind-body connection, encourage emotional growth, and provide symptom relief. When drama therapy is used with kids, storytelling, imaginative play, props such as dolls and puppets, as well as theater techniques like improvisation and performance help children to explore their feelings, connect with others, and problem-solve difficult situations.

Drama therapy can be used in both group and individual therapy sessions. Because it helps participants express themselves nonverbally, it works well for people of all ages and abilities, as well as across cultures or when there may be a language barrier within a group. Today, I’d like to talk about how Drama Therapy can be an especially powerful tool for kids in counseling.

Drama Therapy for Children: No Theater Experience Required

Parents might wonder if their child has to have a flair for the dramatic in order to benefit from Drama therapy. Is this a form of counseling just for "theater kids?" Not at all! Kids who are natural performers or have theater experience are a great fit for a drama therapy group, since they’ll be building on their strengths and connecting with other children who may share their interests.

However, I believe that more introverted kids can benefit just as much—if not more—from therapy that uses theater techniques. There’s a lot more to Drama therapy than just performing on stage, and the skills can be modified to meet any child’s needs and comfort level with performing.

Why Drama Therapy is a Natural Fit for Children

If you have a young child in your life, you have probably seen her pretend to be a superhero, or act out scenes from a favorite movie or story using her friends or toys. Children are natural storytellers, and they love to take on the roles of their favorite characters and heroes. This type of play is the foundation of drama therapy!

Kids are naturally inclined to work out their feelings and learn through play. Child therapists like to say that "play is the child's language,” and research has shown that imaginative, make-believe play is a critical part of healthy child development. Even when children are exploring pretend scenarios in play, they are learning important lessons about real life. Drama therapy builds on this natural capacity for imaginative play to help children work through feelings and events that might be too big to describe with words. 

What Kinds of Children Benefit from Drama Therapy?

Drama Therapy has been used to help children with a wide variety of problems. Some of these include:

• Children having problems with relationships, or who need to practice social skills

• Children on the autism spectrum

• Children who are acting out behaviorally

• Children who are recovering from a serious injury or illness

• Children who have experienced trauma or loss

In general, drama therapy can be an asset for any child who has a hard time verbalizing his feelings. Even bright and talkative kids often have a hard time articulating deep, underlying worries or emotions. Even if they can verbalize them, many kids are hesitant to share these deep-down feelings out of a fear that they may become too overwhelming for themselves or others to handle. For these kids, traditional talk therapy alone may not be the most helpful option. Drama Therapy can help children begin to access and explore their emotions in a less threatening, more playful environment.

Benefits of Drama Therapy for Kids

Drama therapy has some unique benefits for children when compared to other forms of therapy. Here are a few of the common positive outcomes for children who participate in drama therapy:

Reduced Social Isolation: Drama Therapy is a community-building activity that helps children build empathy and social skills. Young people have the opportunity to walk in another person’s shoes and may discover that their peers not only understand their worries and problems, but share them.

Increased Self-esteem: Children can experience the confidence that comes from learning a new skill, whether performing for a full house, a group of peers, or an audience of one. Theater performance celebrates the uniqueness of each individual and can help young people to identify their own strengths.

Practicing New Skills: Roleplaying allows kids to try out new coping and social skills in a safe, low-risk environment. The role-player is free to experiment and make mistakes, and discover how different approaches to a problem have different outcomes.

Creative Problem-Solving: Drama therapy increases children’s creativity and spontaneity, encouraging young people to trust their instincts and come up with new, out-of-the-box ways to approach life's challenges.

Improved Emotional Expression: Drama therapy is a great way to more deeply explore feelings that may not be accessible with verbal therapy alone. It can also be a safe way to explore feelings that are too big or scary to talk about directly.

Learn More about Drama Therapy for Children

Drama Therapists are increasingly employed in settings that work with children, such as schools, early intervention programs, recreational facilities, and hospitals. Drama therapy for kids can also sometimes be found in therapy practices specializing in children, such as my own.

To find out more about how Drama therapy can benefit young children, check out the North American Drama Therapy Association’s website here.

If you’re in the Davidson area, I’m a Registered Drama Therapist and would be happy to talk more with you about this unique form of child therapy. You can contact me here.

What's a Registered Play Therapist?

An RPT is a therapist who specializes in play therapy with children.

If your younger child is struggling but has a hard time talking about her feelings, keep reading: this post is for you.

Any parent who has searched for a child counselor is probably familiar with the string of letters that follow every therapist’s name. This “alphabet soup” of acronyms demonstrate that a therapist has specialized training to help with a particular problem.

More specialties are becoming avialable all the time, which is a great thing! No matter your concern or your stage in life, there is likely a therapist in your area who has been specially trained to be the best help to you. But if you’re not familiar with every acronym, it can be hard to tell exactly what you’re looking at.

There’s one set of letters that’s particularly important to know if you’re searching for a counselor for a young child: RPT. Today, we’re going to talk about Registered Play Therapists—also called RPTs—and learn why this special type of therapy can be so helpful for kids.

What is a Registered Play Therapist?

A Registered Play Therapist, or RPT, is a counselor, psychologist, or other mental health professional who has received additional training in helping people heal through play. RPTs use play activities in a strategic way to help young people express feelings, work through problems, and practice new ways of interacting with others.

More traditional talk therapy techniques often work great for adults, but they’re not always so effective for children. Kids are much more likely to show their feelings, rather than tell about them. They don’t process their experiences through language as easily as adults do.

A Registered Play Therapist uses familliar toys like dolls, stuffed animals, art supplies, and even slime to help kids learn, discover, and process information in the way that’s most comfortable to them. You may find that your child can make more progress and express deeper feelings in play therapy, because they’re in a more age-appropriate environment.

Who Should See a Registered Play Therapist?

Preschool and elementary-aged kids who still use imaginative play to learn and express themselves are great candidates for play therapy with a Registered Play Therapist.

People of all ages benefit from play, but most participants in play therapy are children or teens. The majority of children in play therapy in are between 2 and 12 years of age. If a child has an interest in toys, make-believe, and imaginative play, it’s a good indicator that they could benefit from (and enjoy!) play therapy.

Some of the concerns that bring children to a play therapist’s office include:

• Anxiety and phobias

• Tantrums or behavior problems

• Grief and loss

• Trauma

• Social skills difficulties

• Problems in family relationships

• Coping with big life changes, like divorce or a recent move

Play therapy can be especially helpful for children who are working through experiences that are too big to easily put into words. The birth of a new sibling, overwhelming fear or anger, or experiences with trauma and loss can all be difficult to talk about. Play offers kids another way to express their feelings that isn’t as intimidating. A play therapist can guide a child as they work through their feelings and deepen their understanding of what happened.

How Are RPTs Different Than Other Therapists?

While many therapists may incorporate toys into their therapy sessions to help children feel more at ease and facilitate conversation, Registered Play Therapists are trained to work with children through play at a deeper level. Using the metaphors of play and storytelling, an RPT can help a child to communicate and explore feelings and subjects that she may not be able to put into words. An RPT’s work with children is rooted in play therapy theory, as well as knowledge of child development.

This means that when your child meets with a play therapist, they’re doing more than “just playing” with toys, the way they might at home. The therapist is responding and guiding the play with a plan in mind to help your child work toward the goals you’ve set. This might mean helping a child express their feelings about a situation, safely express anger, use coping skills, or strengthen self-esteem through play.

What Training Do You Need to Become a Registered Play Therapist?

All Registered Play Therapists hold a Master’s degree or higher in a field of mental health, like counseling, psychology, or social work. They also have to pass an exam to be licensed to practice therapy in their state, just like other therapists. But RPTs complete additional coursework during or after graduation to deepen their knowledge of children, development, and play therapy.

To become a Registered Play Therapist, you must complete a minimum of 150 hours of additional training on different subjects related to play therapy. During this time, you also consult with a more senior therapist who is an expert in play therapy, so they can give you feedback on your work and help you become a stronger therapist.

By the time an RPT starts conducting play therapy sessions with kids, they’ve received additional training in child development that goes beyond what most therapists were taught in their grad school programs. They’ve also learned how play can help children with specific problems, including behavioral difficulties, grief and loss, ADHD, social skills difficulties, anxiety, and depression.

This helps play therapists use toys and games intentionally when they meet with kids, keeping their specific needs and goals in mind.

Find a Registered Play Therapist in Davidson, North Carolina

I’m a Registered Play Therapist based in Davidson, North Carolina. I’m avialable to meet with families both in the Charlotte area and throughout New York, North Carolina, and Florida.

The Association for Play Therapy maintains a database of all Registered Play Therapists, both in the U.S. and globally. Families looking for a play therapist can run a search for therapists working near their zip code who have completed formal play therapy training.

Are you in the Charlotte area? I am a Davidson-based Registered Play Therapist who specializes in helping tweens (ages 8 to 13) through anxiety, OCD, and trauma. Keeping sessions playful makes it a lot easier for kids to learn coping skills and face their fears. I also love using games (like Dungeons & Dragons!) to help kids socialize and meet like-minded peers.

My Davidson, NC play therapy office is accessible to Charlotte and Lake Norman-area families. If that commute doesn’t work for you, fear not! If you’re anywhere in North Carolina, New York, or Florida, we can also meet online. Reach out here to learn more, and see if we might be a good fit.

Therapy for Toddlers with PTSD: Child-Parent Psychotherapy

A Special Therapy for Toddlers with Trauma Symptoms

Can Toddlers Have PTSD?

Trauma has become a buzzword among people who care for children. In the past, the word “trauma” was usually reserved for experiences most common among adults, like war and violent crime. Now, mental health professionals understand that many other frightening experiences, such as abuse, medical emergencies, and witnessing accidents or violent arguments can lead to trauma in people of all ages. In this post, I’ll be discussing how therapy can help toddlers with trauma symptoms and PTSD following one of these experiences.

Doctors, teachers, counselors, and parents are becoming increasingly aware of the ways that traumatic experiences like these can affect children's physical and emotional health. Even children's television programs like Sesame Street have recognized the impact of trauma on young children, and have started to address difficult experiences like grief, foster care, and incarceration in episodes. As hard as it might be to imagine, trauma and PTSD can affect even very young children—including toddlers.

How Trauma Affects Toddlers

Studies have shown that exposure to extremely frightening or violent events impacts a child's ability to learn, form close relationships with family and friends, and can even make kids more susceptible to chronic illnesses later in life. Separation from a parent, even when it isn’t due to a violent or scary cause, can also have similar effects on a child. We also know now that these effects last for a long time: even if a toddler is too young to remember the traumatic event, he may suffer from trauma symptoms like tantrums, anxiety, difficulty bonding with parents, or problems with sleep for years to come if he does not receive the help he needs to move forward.

Therapy for Toddlers with PTSD

While there are quite a few forms of therapy to help older children cope after a trauma, it can be hard to find therapy that is a good fit for very young children. Toddlers often have a hard time putting their feelings into words, and need specialized therapy that incorporates play and nonverbal techniques to help make sense of traumatic experiences, as well as coping skills to manage strong emotions. Child-Parent Psychotherapy is one of the only forms of therapy specially designed for the youngest kids--children under the age of five--who have survived a trauma or loss.

Child-Parent Psychotherapy, or CPP, is a form of play and talk therapy for children ages 0-5 and a parent or caregiver. It is a dyadic therapy, which means that typically the child and parent participate together with support from a therapist. CPP aims to strengthen the bond between parent and child after a frightening event. Because parents are so central to young children's lives, they are especially equipped to help a child return to healthy growth and development.

How Child-Parent Psychotherapy Works

Through CPP, toddlers with PTSD symptoms rediscover how to feel safe and protected after a trauma, and make sense of what has happened to them in an age-appropriate way. Learning coping skills to help the child relax and manage emotional outbursts is another important goal of CPP. Parents can also get support for themselves through caregiver coaching sessions, where they have the opportunity to cope with their own feelings about what happened and receive tips from the therapist on how to handle behavior problems related to trauma.

CPP is an evidence-based therapy, which means that it has been proven effective by scientific research. While not every form of therapy works for every person, CPP has been used successfully with kids from many different cultural backgrounds, and to help with a variety of traumatic events including domestic violence, grief, abuse or neglect, parental separation, and serious accidents. It can be a helpful therapy for children with biological, foster, or adoptive parents, and even a caring relative can serve as a support system in CPP sessions.

Therapy for Young Children After Trauma in Davidson, NC

Coping with a trauma or loss can be an extremely challenging situation for people of any age, but parents with toddlers don't have to struggle with this alone. If you think your young child might benefit from therapy for toddlers with trauma symptoms, please don't hesitate to reach out to me and learn more about this approach. You can also learn more about the impact of trauma on children and how therapy can help here.

All About Drama Therapy (and Why It’s Not Just for Extroverts)

Find out how drama therapy might help your child, even if she’s not a “theater kid”

When you hear the words “drama therapy”, what do you think of? Maybe you imagine standing on stage, performing a play in front of an audience. If you’re super extroverted (like me!) this might appeal to you, but if you are someone who is not so jazzed about public speaking, this might sound like a nightmare. How could performing a play be therapeutic?

I had some of these same thoughts before I became a Registered Drama Therapist. I knew that I loved theater, and I knew that creating and performing art was an inherently healing activity, but I wasn’t entirely sure how theater could be used to help heal mental health problems. Here’s a little bit of what I have learned about the field of drama therapy, and why it might be a great fit for you or your child…even if you aren’t an extrovert.

Therapy That Uses Theater

While some drama therapists do help their clients to perform plays, there are many other ways to practice drama therapy that don’t involve getting up on a stage in front of lots of people. Most Drama Therapists incorporate theater techniques, like improvisation, roleplay, and storytelling, into group or individual therapy sessions where there is a greater sense of privacy. Sometimes, Drama Therapy is a standalone form of therapy treatment, but it can also be blended with other, more familiar forms of therapy that a client may already be using, such as CBT, trauma-focused therapy, or play therapy.

The North American Drama Therapy Association defines drama therapy as "the intentional use of theater techniques to achieve symptom relief, emotional growth, and mind-body integration." It’s an experiential form of therapy, which means participants learn by doing, rather than simply sitting and talking about their feelings and problems. This full-body approach can be a great fit for clients who have a hard time feeling grounded and focused in traditional therapy, or who need to access bigger, deeper feelings that are difficult to put into words.

What Are the Benefits of Drama Therapy?

Although acting is a form of make-believe, drama therapy explores real-life issues. Through an imagined character or an improvised scenario, we get the opportunity to try out new ways of interacting with other people, and can come up with more creative solutions to problems than we might think of in our everyday lives. Because Drama Therapy is based in play, it’s often a less intimidating, more enjoyable way to explore heavy subjects. The safe remove of make-believe can also make it easier to share experiences or feelings that might be too overwhelming to talk about right away in traditional talk therapy.

Theater is one of the oldest art forms on earth, and it can be found in cultures all over the world. By participating in a Drama Therapy group, people can develop a sense of community, create new friendships, boost empathy, and strengthen self-esteem. For people who have experienced trauma, Drama Therapy can be especially helpful because it engages the entire body, which helps to fully process traumatic memory and relieves trauma-related symptoms, like flashbacks. Drama Therapy is also an excellent option for people interested in improving their social skills, because it emphasizes nonverbal communication and team-building.

Finding a Registered Drama Therapist

Many Drama Therapists enter the field after professional careers in theater, where they may have noticed the healing effect that drama can have on both the audience and the performers. Therapists who are certified in Drama Therapy are called Registered Drama Therapists. This is a specialized, Master’s-level credential that requires the same coursework as a mental health counselor, as well as extensive training in several forms of Drama Therapy, professional theater, and completion of a supervised internship that is equivalent to a second Master’s degree. Like other mental health professionals, Drama Therapists are board certified and adhere to a code of ethics.

Because it doesn’t rely solely on verbal communication, drama therapy has been used across many cultures, and adapted to meet the needs of people of all ages, abilities, and needs. Drama Therapists can be found working in a wide variety of settings, including inpatient and outpatient mental health facilities, schools, shelters, Early Intervention programs, wellness centers, and in private practice. If you’d like to learn more about Drama Therapy, please feel free to reach out to me (I’m a Registered Drama Therapist myself!), or check out the North American Drama Therapy Association’s website.

Help! My Child Won’t Sleep Through the Night!

It’s 9pm. The homework is done, the dishes are washed, and your kiddo is bathed and tucked into bed. Stories have been read! Cuddles have been given! You’ve made it to the end of the day! Time for a celebratory Netflix episode, or a chapter in that book you keep telling yourself you’re going to finish…and then you hear the pitter patter of little feet in the hallway, and your door creaks open.

Does this sound familiar to you? If so, you are not alone! In this post, I’ll be sharing suggestions to help a child who can’t sleep through the night.

When Your Child Can’t Sleep Alone, Bedtime Becomes a Problem

Insomnia is one of the most common concerns I hear about in my child therapy office. This can mean a child is having trouble going to bed, falling asleep, or staying asleep. Sometimes, a child is able to fall asleep with no problem—as long as a parent stays in the room all night long.

Insomnia is a frequent complaint for both kids and adults, but children’s sleep problems can be especially tough on a family. When a child isn’t sleeping well, it weighs on everybody in the household. Not only is the child not getting enough sleep to function, but parents and siblings may also be getting their rest interrupted by the child’s frequent waking,. This maked things harder for everyone the following morning.

The Insomnia Vicious Cycle

Many of us will have trouble sleeping at some point in life, especially when we’re stressed. Sometimes, a child’s sleepless nights resolve by themselves once the stress is gone. For other children, sleep problems are not so easily solved. The insomnia can go on for weeks, months, or longer.

Sleep is important to a child’s emotional well-being, children who have trouble sleeping for prolonged periods often enter a vicious cycle. The lack of sleep leads to increased anxiety and difficulty concentrating, which in turn makes it even harder to sleep the following night. With help from parents, and sometimes with extra support from a child counselor, children and families can break this cycle, and help everyone to get a better night’s sleep.

Sleeping Through The Night Helps Children’s Physical and Mental Growth

Good quality sleep is especially important children who are still growing. It has a direct impact on their ability to grow physically, mentally and emotionally. During sleep, kids release growth hormones that they need to develop and mature. Sleep is also critical for learning. It helps children to retain and store information they’ve learned, and makes them more able to focus and learn at school the next day.

Sleep is really important for kids’ emotional health, too. Sleep problems can contribute to anxiety, depression, and ADHD. In fact, poor sleep can even trigger emotional problems, and make it more difficult for people to cope. Studies have shown that disturbed sleep can lead to symptoms of depression, and that depressed people who aren’t sleeping well are less likely to respond to treatment than those who are getting a good night’s rest.

How Much Sleep Do Kids Need Each Night?

More than you might think! No two kids are exactly alike, and different kids may be able to get by with different amounts of sleep. The National Sleep Foundation has set guidelines to help make sure your child’s sleep time is in the right ballpark.

For toddlers between ages 1 and 2, the Foundation recommends 11-14 hours of sleep per day, which usually includes a daytime nap. Preschoolers (age 3 to 5) generally need 10-13 hours a day, and may still nap.

By elementary and middle school (age 6 to 13), it is recommended that children sleep between 9 and 11 hours a night. You know your child’s rhythms best. Helping him to establish a healthy sleep schedule within these guidelines will ensure that he’s getting the rest he needs to grow, both physically and emotionally.

What Causes Childhood Insomnia and Sleep Problems?

Many children have difficulty falling or staying asleep at some time in their lives—this is a really typical problem! Here are a few common reasons children can’t (or won’t) sleep through the night:

Anxiety: Many children appear nervous or downright fearful as bedtime approaches. Separation anxiety, a fear of being away from parents or loved ones, is common in younger children. It can sometimes manifest as reluctance to go to bed, a fear of being alone, or a fear that something bad will happen if the child is out of sight of the parent.

Other forms of anxiety, like generalized anxiety and OCD, can also make it harder for children to sleep. If a child seems nervous or afraid at bedtime, is bothered by lots of worries at night, or needs to complete a long or elaborate bedtime ritual in order to feel comfortable going to bed, anxiety might the source of their difficulties.

Media: Kids often have vivid imaginations, which is a great strength. Sometimes, though, a very active imagination can make children more prone to sleep problems. For children with rich fantasy lives, the lines between reality and pretend are easily blurred. These kids may be more sensitive to the effects of scary movies, violent video games, and stories shared by children at school. Their fears of scary characters may last long after the movie ends, and often intensify at bedtime.

Behavioral Causes: Sometimes, without meaning to, children and parents fall into a nightly routine that has to be repeated in order for the child to feel ready to sleep. For example, a child whose mother lies in bed each night until she falls asleep may start to link mom’s presence in bed to the idea of sleep, and soon this becomes a requirement for bedtime every night. Once the child has unconsciously connected this behavior with falling asleep, she won’t be able to drift off until it’s been done.

Physical Causes: Just like adults, some kids are naturally night owls while others are morning people, and this can impact sleep habits. According to this article from Today’s Parent, a small minority of children with sleep problems may have an underlying medical reason, such as sleep apnea or restless leg syndrome. If sleep problems persist for a long time, or you notice any physical symptoms such as difficulty breathing, it’s a good idea to schedule a checkup with your pediatrician to rule these conditions out.

Trauma: Rarely, a traumatic event can be the cause of disturbed sleep. Children who have experienced a trauma often become fearful at bedtime, have trouble falling asleep, and are bothered by night terrors or other bad dreams that may or may not have anything to do with what they’ve experienced. If the sleep problems are accompanied by other symptoms, such as bedwetting, tantrums, or anxiety, trauma should be ruled out as a possible cause. You can read more about the impact of trauma on children here.

How Can I Help My Child Sleep Better at Night?

Sleep problems take time to develop, and so they also take some time and patience to resolve. Anxious children benefit from a bedtime routine that is consistent, predictable, and includes opportunities to soothe and relax before bed. Creating a visual chart of the bedtime routine can also be a good way to help kids shift gears and get ready for sleep.

For imaginative children with fears about monsters or other “bad guys”, it can be a big help to talk about the difference between “real” and “pretend” and offer reassurance that scary events from TV will not happen in real life. Some children are also very motivated by reward charts. Children may “buy in” to the idea of sleeping alone more readily if they are able to set a goal for themselves to sleep independently for a certain number of nights in order to earn a prize.

If you have tried these tips and your child still can’t unwind at bedtime, she may need more effective coping skills. My coping skills course for kids helps kids and tweens learn how to relax their body, manage panic attacks, and learn how to deal with unrealistic worries that aren’t likely to ever happen (like that monster showing up in the night).

Begin Therapy for Kids With Insomnia in Davidson, North Carolina

Sleep problems can be exhausting for all involved, but patience and persistence can often turn even the most nocturnal of night owls into a more peaceful sleeper. However, some kids need more than a few coping skills and a consistent routine to resolve long-standing sleep issues. If you’ve been trying tips like the ones in this post for a while with no luck, counseling can help.

Therapy can help your child work through any underlying worries, and increase her sense of felt safety so she can sleep more soundly. I use cognitive behavioral therapy to help kids with bedtime anxiety at my Davidson, North Carolina child therapy office. If you aren’t local, I see kids online throughout North Carolina, as well as in New York and Florida. I also have an educational class called Worry Free Tweens, which can teach coping skills to kids regardless of where you live.

Interested in therapy? You can contact me to request an appointment or get more information.