What to Do When Your Child Refuses Therapy

You’ve noticed a change in your kid. She’s irritable all the time, she spends most of the day in her room, and you’re worried something deeper is going on. Maybe you have a good guess about what’s to blame, like a friendship with someone who isn’t a great influence or a particularly stressful school year. Or, maybe this seems to have come out of the blue, which can feel even scarier. Either way, no matter how delicately ask whether your child wants to talk to someone, you get the same answer.

”I’m fine!”

What do you do? I know so many parents who are trying to get their kids the help they wish they’d received when they were young. When a child refuses therapy, it can be confusing or even frustrating. Let’s talk about a few ways parents can start a genuine conversation with kids who say they don’t want help.

Clear Up Any Misconceptions About Therapy

I cannot tell you how many times I’ve had a kid sit on my couch for a first session and tell me that they have no idea what’s going on. They don’t know what to expect from therapy, and they may not even know why they’re in my office in the first place!

Young children may have heard the word “therapist” or “counselor” before, but may not know what it really means. They may imagine that a therapist is someone who administers tests, prescribes medications, or even gives out shots. I’ve had a few little kids arrive at therapy in tears because they remembered a recent vaccination appointment and worried they were in for more of the same.

Older kids and teens usually have a general idea of what to expect, but their vision of therapy may be vague or stereotypical based on what they’ve seen in the media. Because older kids have the maturity to think about cause and effect, teens often worry about confidentiality in therapy. What will happen if they share what’s really going on with a therapist? Will the therapist just turn around and tell everything to their parents? Could what they say in counseling get them or someone else into trouble?

For a younger child, explain what a counselor can do (play, talk about feelings) and cannot do (give shots or medicine). It might be helpful to explain what happens in a therapy room, including that therapists keep some things private. Older kids may benefit from learning the ins and outs of confidentiality: they need to feel confident that they’ll have some privacy if they’re going to consider counseling at all. You can also share any information you have about your prospective therapist’s personality or way of working with kids.

If you’re getting ready to explain therapy to your child, I’ve gone into what to say in more depth in an earlier blog post on having the “counseling talk”.

Don’t Make Therapy Sound Like a Punishment for Bad Behavior

If your child bristles whenever you bring up the word “therapy”, be mindful about when you’re mentioning it. Are you only talking about going to counseling on the heels of a big fight, or after a bad report from school? It’s understandable that bad stuff happening would remind you of the need for therapy, but if you’re bringing up the idea in the heat of the moment it might come off as sounding like a punishment.

When an adult goes to therapy, it’s usually a decision they’ve made for themselves. It may feel scary or vulnerable to get started, but it’s also empowering and a form of self-care. On the flip side, it isn’t always a child’s idea to seek out a counselor. Kids sometimes tell me they feel they were sent to therapy for being “bad” and that the goal of therapy is to make them “good.” Instead of feeling empowered, they feel ashamed and a bit like they’ve just been sent to the principal’s office. No wonder they don’t want to come.

An honest conversation held during a calm time can go a long way toward changing a child’s opinion about therapy. It can be really helpful for your child to hear that you are struggling, too. Shifting the focus away from the child and toward a “family problem” lets your child know that you are all in this together, rather than singling out your child as the sole person in the family in need of help.

Even if you’re 99% sure of the cause of your child’s distress (a mean friend, a recent breakup, upcoming state tests) it is sometimes helpful to stick to talking about what you can see. For some kids, having an adult speculate about the cause of their troubles feels like someone is putting words into their mouth. By sticking to the facts, you may help your child feel a little less defensive. For example, saying “I notice you’ve been spending a lot more time in your room” is likely to go over better than “Ever since you made that online friend, we never see you anymore.”

Consider Alternatives to In-Person Talk Therapy

Introverted kids in particular may not be thrilled about the idea of sitting in a room with a strange adult and pouring out their deepest, darkest emotions. Even though sitting on a couch and talking face-to-face is what we consider “traditional” talk therapy, it may not feel all that traditional to a child to be alone with an adult who isn’t a relative or a teacher.

If you suspect that solo, face-to-face therapy is intimidating to your child, consider other less “traditional” alternatives. Group therapy might help some kids feel a little less on the spot, and there’s good research to show that it is just as effective as individual therapy for many problems. For others, seeing a therapist online may feel safer and more comfortable than sitting six feet away in an office.

In my own practice, I’ve noticed that tweens and teens are sometimes able to open up about difficult subjects more easily online. Maybe it’s because communicating through tech feels more natural to them, or maybe the computer screen helps them feel a bit more anonymous. Either way, it’s an option to consider if your child is refusing therapy.

Depending on your child’s interest, you might even be able to find a hyper-specific group that plays to their passions and strengths. For example, my online D&D groups for middle and high schoolers can be a helpful first step into meeting peers, exploring emotions, and practicing social skills.

My Child Still Refuses to Go…Is It Ever Okay to Force a Child to Attend Therapy?

It’s possible that you’ll say and do everything you can to cast therapy in a positive, non-judgmental light, and it still won’t change your child’s mind. Some kids fell so sure that therapy won’t help—or so uneasy about going—that they’ll put their foot down, no matter what.

It’s really hard to “therapize” a person who doesn’t want to be in therapy. In an ideal world, a therapist and client are equal partners in the therapy room, with both people bringing in ideas and nobody acting like the boss of anyone else. If a child is forced to attend, it immediately puts them in a low-status position and makes the therapist the boss. That makes it hard to grow.

I will sometimes ask kids and teens who are unsure about therapy if they’d be willing to give it a try for a set number of sessions, like 3 or 4. If your child is on the fence, you may want to give this approach a try—you might be pleasantly surprised! However, if after those sessions your child wants to end therapy, hold up your end of the bargain.

If a child is forced to attend therapy long-term against their will, it may give them a negative perception of therapy and keep them from seeking help in the future. I’d rather give kids a sense of agency, and let them return to therapy on their own terms when they feel ready to do the work.

There’s one big exception to this rule: if a child is self-harming or feeling suicidal, they need to be in therapy no matter what. However, these kids may need more support or a more specialized approach than once-a-week therapy can provide. If you think your child is at risk of serious harm, speak to a guidance counselor or pediatrician or, in an emergency, dial 911.

How Do You Help a Child or Teen Who Doesn’t Want Help?

So, you’ve determined your child is not going to therapy. Maybe you tried a few sessions and it didn’t work out, or the therapist you found didn’t seem to be the right fit. Now what? How do you help a child who refuses help?

If a child is absolutely dead-set on going to therapy, and there are no safety worries like self harm or suicidal thoughts, forcing a child to go to therapy can do more harm than good. It reinforces the idea that therapy isn’t really for helping, it’s a punishment for bad behavior. It will make it even harder for your child to feel safe enough to give therapy a try in the future.

On the other hand, kids are growing and changing all the time. Many Gen Z and younger kids view therapy in a positive way, so it’s likely your child will learn more positive things about mental healthcare from peers as she grows. By respecting your child’s decision and continuing to check in about therapy as an option, it’s possible she’ll come around to the idea on her own.

In the meantime, your best option is to get yourself into therapy. I know it’s a suggestion that gets recommended a lot and it may not feel great to hear. However, therapy with a counselor who specializes in working with parents can equip you with the tools you need to help your child—whether they attend with you or not. Parents have so much influence over the lives of their children and the culture they choose to create in a home. When you take the time to care for yourself, it almost can’t help but rub off on your children, too.

In-Person and Online Therapy for Kids in Charlotte, NC

I love working with tweens and teens struggling with anxiety, and have some therapy options that go beyond the usual sit-on-the-couch-and-talk to meet kids where they feel most comfortable. Even super reluctant young children are often excited to attend play therapy, which uses kids’ natural creative instincts to work through feelings using actions instead of words. Older kids and teens may prefer online therapy, which feels a little less intrusive than being face-to-face.

If your child has a passion for games or geek culture, you may also want to consider my Dungeons and Dragons-based groups for tweens and teens. They’re an introvert-friendly space to meet new people and practice social skills in an online setting that still feels meaningful.

Interested in getting started? You’re always welcome to contact me here.

Navigating Transitions: How to Move from Elementary to Middle School (Without Losing Your Mind)

Need to help your child through the dreaded middle school transition? You’ve come to the right place.

Shifting from the safety of elementary school into the uncharted territory of middle school can be a bumpy ride for kids and parents alike. If you’re about to make this leap with your child and find yourself feeling anxious, you are not alone! So many kid clients in my practice start therapy around this transitional time, and even more opt to hold off on ending therapy until they feel settled into sixth grade. Even for kids without significant anxiety, beginning middle school can be a source of stress.

You don’t even have to take my word for it: we have reserarch to back up the idea that the middle school tranistion is hard on kids. A study from my home state of North Carolina found that sixth graders who move to a middle school building are more likely to be disciplined for behavior problems than their peers who remain in their elementary school for sixth grade. Other studies have found that students’ academic achievement drops between fifth and sixth grade, possibly due to the stress of tranisitioning to middle school. In both of these cases, the negative effects can be seen for years, even as the students enter 8th and 9th grade.

That data is a bummer, but the silver lining to all of this is that it’s not just you: the struggle for kids entering middle school is very real. In this guide, we'll explore why this transition is so nerve-wracking and share practical strategies to make the journey a little smoother.

What Makes the Shift to Middle School So Hard?

We know that the tranistion is hard, but why? For American kids, middle school is a nearly universal experience. If you’re a child of the 90s like me, you may have less-than-fond memories of your own junior high years, but ultimately, we all survived. Here are a few dynamics that make moving from elementary to middle school particularly challenging:

Small Fish in a Big Pond:

As a fifth grader, your child ruled the school. It was their home base for years—maybe as far back as Kindergarten—and they might not even remember life without it. By fifth grade, you know every nook and cranny of that school building, and it’s filled with familiar faces. Plus, your child enjoyed high status at the top of the social food chain. Fifth graders are the biggest, smartest, strongest, fastest kids in school. A Kindergartener practically looks like an infant in comparison! E ven if your child is not the competitive type, wielding this kind of power over your surroundings brings a sense of security.

Then you get to sixth grade and the whole ecosystem changes. You’re the youngest kid in the building, surrounded by teenagers who are way more physically and mentally developed than you. You’re no longer the big fish in a small pond: you’re a little fish, and the pond just got a whole lot bigger.

Unfamiliar Territory:

I’ve spoken to roughly a bajillion middle schoolers about their anxiety. Of all the fears I’ve heard about junior high, one reigns supreme: all kids worry about getting lost in their new building. In public school systems, multiple elementary schools typically feed into one middle school, so students tend to be dealing with a bigger school building.

What’s more, students face the new challenge of traveling from class to class between periods. Gone are the days of spending 7 hours in one cozy classroom: it’s not your job to get yourself to your teacher’s room on time. In most schools, you’ve got about 5 minutes between class periods, which goes by pretty quickly if you need to stop by your locker or the restroom. If I was racing against a timer 6-8 times a day, I’d be stressed out, too.

Students often worry that they’ll show up late for class and embarrass themselves in front of their new teacher and classmates. They imagine having to slink into class and sit down in their seat, humiliated, while everyone’s eyes are on them. And, honestly? Lots of kids will get turned around and end up late to a class, especially during the first week of school. It’s common, not a big deal, and definitely won’t ruin anyone’s social life. Whcih brings us to our next issue…

Fear of the Unknown

The process of starting middle school is shrouded in mystery. Most kids have not spent any meaningful time in the building. Their understanding of what middle school will be like is based on rumors passed down from older kids, as well as representations of middle school in the media. And let’s be honest, the media representations of middle school are not awesome.

With so little information to go on, kids are more likely to imagine worst case scenarios or cling to rumors that may not be rooted in fact. A child who hasn’t received their schedule yet may worry about being placed in classes without their friends or getting saddled with the teacher nobody likes. A student who hasn’t toured the building may worry about getting a locker in a bad location, or struggling to manage their combination lock. And virtually every student feels at least a little worried about the increased homework and friend drama they’ve heard comes along with life as a middle schooler.

In Middle School, School and Social Life Become More Complex

From more homework to cliques to passive aggressive bullying, there’s a lot for preteens to navigate starting aroudn sixth grade.

Middle school students are expected to do almost as much schoolwork as high schoolers, but with few of the perks. Most can expect nightly homework, more advanced subject matter, and more pressure in general to do well on tests and earn good grades.

Although they’re expected to behave like “big kids” academically, in most other respects they’re still receiving “little kid” treatment: no lunches away from campus, limited control over their class schedule, and micromanaged behavior. If I was given a heavy workload and then told by my boss that I was expected to sign out in order to use the bathroom, I’d quit immediately. Sadly, middle schoolers don’t have that option!

Things get trickier on the social front, too: friends become a primary source of support over these years. In middle school and beyond, friends are way more than just a companion on a play date: they’re confidantes, amateur therapists, and your family away from home. The older a tween or teen gets, the more central these friendships become in life.

As important as they are, we all know that navigating middle school friendships can also be fraught with drama. Everyone is figuring out their identity, and the influx of new classmates means that friend groups are frequently shaken up. Kids are dealing with issues like jealousy, gossiping, and cliques for the first time. It’s not surprising that so many kids make less-than-ideal social decisions that result in bullying or hanging out with the wrong crowd.

Create a Supportive Environment for Your Middle Schooler

Ideally, home and family life is a safe haven from the stresses we experience all day at work and school. But we don’t live in an ideal world! It’s easy for work and school stress to “bleed” into home life, or for resentment to build between parents and kids—especially during this increasingly hormonal and volatile age. Doing your best to create a supportive, consistent home environment is one of the best ways to help your middle schooler deal with the chaos of school.

Here are a few ways to emotionally support your middle schooler at home:

Take their perspective: Fumbling with a combination lock or arriving 2 minutes late to class may feel trivial to us as adults. But put yourself in your child’s shoes for a minute: in the microcosm of their middle school world, these are make-or-break issues. Keeping this in mind makes it easier to empathize with their worries, rather than brushing them off as insignificant.

Avoid toxic positivity: When a child comes to you with a worry, it’s so tempting to say something like “You’re going to have an awesome day!”, “Try to think positive,” or “You’re the best kid ever—who wouldn’t like you?!” While some kids appreciate this kind of pep talk, others find it makes them feel even more anxious, because it’s not acknowledging their concerns. Instead, try validating their fears while also focusing on their ability to overcome obstacles: “I can totally see why that would be embarrassing. I would be nervous too! But I’ve seen you handle so many awkward situations well, and I know you’d figure out this one, too.”

Normalize the struggle: Your middle schooler may feel as though they’re the only one who is having a hard time with this transition. As a parent, you can remind them that this is not the case! Let your child know that their worries are totally common and normal, and that they’re not alone.

Practice open-mindedness: If they haven’t started yet, the difficult parent-child conversations are just around the corner. You can set the stage for future conversations about hard subjects like drugs and dating by being mindful of your reactions now. Middle schoolers are highly aware of cause and effect, and if they see you’re flying off the handle about minor misbehaviors, they’ll be much less likely to approach you with the big stuff.

Avoid overscheduling: If your child is currently enrolled in 3 travel sports teams, now may be the time to consider cutting back. I’ve personally seen several anxious middle schoolers whose symptoms improved once they streamlined their after school activities. Prioritizing unstructured downtime can help ease the adjustment to the higher workload and demands of middle school.

Strategies for Middle School Anxiety Management

Anxiety about starting middle school is totally normal. There’s a lot you can do to help your kid cope.

In addition to creating a supportive home environment, there’s a lot you can do to proactively help your child navigate their middle school transition. Many of the same coping skills we use for other forms of anxiety work great for back to school anxiety, too—with a few tweaks.

Here’s how you can help your child manage their stress as they adjust to junior high life:

Be prepared: We talked earlier about how fear of the unknown can fuel worries about the middle school transition. Visiting the school, meeting teachers, exploring the school website, and speaking to rising seventh and eighth graders are all ways you can help your child prepare for their first day. This prep serves two purposes for your child: you’re helping make a strange environment feel more familiar, while also helping your child face their fears one little step at a time.

Question unhelpful assumptions: If you notice your child starting to get worked up over worst case scenarios, don’t let it slide—you can gently call out these thoughts and help your child adjust their thinking. We call this kind of worrying “catastrophizing”, and kids can expend a lot of time and energy thinking about horrible situations that are very unlikely to ever happen in real life (“I’ll arrive to class late, everyone will laugh, and the teacher will think I’m an idiot!”) You can ask your child questions like these to nudge them towards a more realistic perspective:

• Do you have any evidence this is going to happen?

• How likely do you think this is to happen?

• Can you think of some other ways that situation could go?

• Is this worry predicting something in the future that hasn’t happened yet?

• If your friend was worried about this, what would you tell them?

• Have you handled anything like this before in your life? If this happened, could you cope?

Support study skills: Executive functioning skills allow us to prioritize tasks, set and reach goals, folllow multi-step directions, and generally manage our impulses in order to get work done. It takes time to build these abilities, and a middle school workload asks a lot of kids from an executive functioning standpoint. If you suspect your child is struggling in this area, step in to support. Ask your school what they offer for kids needing study skills help, and check out the many resources available for parents of ADHDers on YouTube. Even if your child doesn’t have this diagnosis, you’ll find many helpful tips for strengthening executive functioning at home.

Don’t avoid: If your child is dreading getting to school every day, it can be tempting to let them stay home for a mental health day…and then another…and another. While everyone deserves the occasional day off, avoiding your anxiety trigger is an easy way to make anxiety grow. The more we avoid something that scares us, the bigger our fear will be when we try to return. In extreme cases, kids who frequently avoid school may become so anxious they’re unable to enter the building at all. I don’t want that for you or your kid!

It’s Not All Bad News: Make the Most of School Resources

Admittedly, this blog post has painted a pretty grim picture of middle school life so far. But it’s not all doom and gloom! I mentioned earlier that many of my preteen clients begin or continue therapy due to their nerves about starting middle school. However, once middle school actually starts, many of them return to tell me that it isn’t so bad after all.

As challenging as middle school can be, it has its upsides. Middle schoolers are some of the funniest people I know. Their imagination knows no bounds, and they’re independent enough to try out ideas on their own. This generation is so aware of social issues that, despite the usual peer drama, I find they tend to have a strong sense of morality. In short, they’re awesome.

Middle school kicks off a new developmental stage for kids. They’ve spent much of elementary school seeking praise from grownups in order to feel capable and confident. In the tween and teen years, kids are less reliant on that feedback from adults and more able to trust their own gut. Issues of identity come to the forefront: kids are figuring out who they are and what they stand for. They’re beginning to figure out what kind of adult they might like to be someday.

You can tap into this positive side of the middle school experience by making the most of what your school has to offer. Here are a few common resources that can support kids emotionally as they develop their sense of self:

• Extracurriculars: Many kids find their identity—and a group of kindred spirits—in after school clubs. Moving to middle school typically means gaining access to a much wider range of extracurriculars. Every kid needs a chance to shine and feel appreciated, and if their academics or social life are struggling, these groups can be a real safe haven.

• School counselors: These people know your particular school better than anyone! They’ve seen it all, heard it all, and probably tried it all. If you’re having a specific school-related issue, like anxiety at drop-off or loneliness at lunch time, they can likely offer strategies that have worked for others in the past. While most school counselors aren’t able to provide ongoing weekly therapy, they’re your best bet if an emergency comes up in the middle of a school day. Think of your counselor as a sort of Urgent Care for your mental health.

• Lunch Bunches and Social Skills Groups: Increasing numbers of schools offer extra support for kids looking to make friends. Lunch Bunches pull a small group of like-minded kids together during their break to get to know each other better in a structured environment, with support from a teacher. Your school’s guidance office may also run social skills groups for kids looking for more specific help. These services aren’t always widely advertised, so it doesn’t hurt to ask about them.

• Psychological and Learning Assessments: If your child is truly struggling emotionally or academically, you can request an evaluation from your school district at any time to see if they may qualify for a 504 or IEP plan. These two plans help kids with learning differences or disabilities get the support they need at school, either through changes to the learning environment or through special education. Your school district may not agree with your request, but if they do, your child can be screened for vision and hearing difficulties, autism and ADHD, learning and emotional difficulties, and sensory processing differences. These kinds of evaluations are pricy and hard to get from private psychologists, but are provided at no cost in schools.

When to Seek Extra Help

If you’ve tried to help your child through the middle school transition on your own, consider adding some extra help in the form of a counselor.

By fostering open communication, offering support, and being proactive in addressing anxiety, you can help your child navigate the transition to middle school without (we hope) losing your mind. Know that you’re not alone, and that the challenges of middle school can yield a lot of growth and personal development despite all the angst.

If you find that the stressors of middle school are becoming overwhelming for your child, or if you simply want extra guidance on supporting their emotional well-being during this time, consider reaching out to a professional therapist like me. My counseling practice specializes in helping tween clients learn effective coping skills to deal with anxiety and OCD.

For those who prefer to take a self-guided approach, I also offer an online coping skills course designed to equip middle schoolers with the tools they need to manage stress, anxiety, and the challenges of growing up.

Good luck out there, parents—I salute you.

What to Do if Your Child's Therapy Isn't Working

If you’re worried your child’s therapy isn’t working, don’t despair! There’s a lot you can do to get things back on track. Photo by SHVETS via Pexels.

Therapy can be a transformative experience for kids, helping them overcome challenges, devleop essential skills, and thrive in their daily lives. If you’ve reached this page, you’re probably a believer in the many benefits therapy can provide for children. So what do you do when…it just doesn’t seem to be working?

We all know that growth isn’t linear, change takes time, and all that good stuff. But it’s still disheartening when, after all hard work finding a therapist and attending sessions, things don’t appear to be improving for you and your child. Sometimes, despite everybody’s best efforts, progress in therapy can seem slow or nonexistent. The good news is there’s a lot you can do to get things back on track.

What Should You Realistically Expect From Therapy?

No matter what kind of therapy you choose for your child, you should expect that it will likely take some time before you see major results. In my counseling practice, the average length of a child’s therapy is about six months. Of course, some kids need a lot less time, and some need a lot more.

This lines up with what the big therapy organizations say about how long therapy takes. The Association for Play Therapy estimates that kids will need an average of 20 sessions to resolve the problems that brought them to therapy. According to the American Psychological Assocation, 50% of people in therapy will be ready to go after 15 to 20 sessions, and the rest will need more time. Even “short term” forms of therapy may take longer than you might expect: TF-CBT, a short-term trauma therapy, usually requires 18 to 24 sessions.

If you’re meeting once a week, that means you’re looking at 5 months or more of therapy before your child will be fully ready to move on. Given that estimate, I think it’s safe to start questioning whether a therapy approach is effective around the two month mark.

Here are some other points to keep in mind as you evaluate whether therapy is working out:

• Early therapy sessions focus on relationship building: your child might learn about their diagnosis and feel a lot more hopeful about therapy, but you probably won’t notice huge changes during the first few weeks.

• It’s not typical to notice big, positive changes after every session. Over time, though, you should see gradual improvement.

• Sometimes, symptoms may get worse before they get better, especially if your child is in anxiety or trauma therapy that involves exposure (facing feared situations).

• Pretty much every kind of child therapy requires some level of parent involvement. Even though kids need their privacy, you should expect to be kept in the loop by their therapist about their progress and how you can help.

If your child is new to therapy, it’s possible that you’re just too early in the process to see changes. On the other hand, if you’ve been in the therapy game for a while and progress has slowed or stopped, keep reading to learn what might be getting in the way.

What Are the Signs That Your Child’s Therapy Might Not be Working?

Stalled progress, difficulty using skills in real life, feeling uncomfortable in sessions, communication struggles, and worsening sypmtoms can all be signs of problems in therapy. Photo by Monstera via Pexels.

So, let’s say you have realistic expectations for therapy: you’ve been at it for 8 sessions or so, and you know change isn’t going to happen overnight. You’re still not seeing the differences you’d hoped for. How can you tell if you’re on the right track? Here are some indicators that something about your current therapy approach isn’t working for your child:

Lack of improvement over the long term

In therapy, progress tends to happen in fits and starts. You might have a big breakthrough one session, followed by a week or two that are relatively quiet. It’s even possible that symptoms will become more intense for a little bit, if your child is confronting tough stuff in therapy that they have avoided until now. If you zoom out and look at the big picture, though, you should notice an upward trend over time.

Skills aren’t translating into real life

Many forms of child therapy, like CBT, put an emphaisis on learning coping skills and other practical strategies a child can use to manage their feelings and handle tough situations. There’s a big difference, though, between learning these skills and putting them into action. If your child is consistently unable to use what they’re learning outside of therapy, it means something is getting in the way.

Your child feels uncomfortable in therapy

It’s pretty normal for kids to be reluctant to go to therapy some of the time. This is especially true if therapy is getting into difficult subjects, like facing anxiety fears or talking about trauma experiences. This can usually be figured out with your therapist. On the other hand, if a child consistently dreads therapy and really doesn’t want attend, this might indicate a bad fit or lack of trust in the relationship.

Communication isn’t clear

Does it feel like stuff is always getting lost in translation with your child’s therapist? Maybe it feels like your child is avoiding the big issues in sessions, and you never get a chance to meet with the counselor to bring up concerns. Or, maybe you’re not sure what’s being worked on and how you can help at home. Kids need some privacy in order to make therapy work, but as a parent you should always know what the current therapy goals are, and have a way to check in with the therapist.

Things are getting worse

Okay, this one may seem a little obvious, but it’s true! If you haven’t been warned that your child’s symptoms might flare as a part of the therapy process, and things are getting worse at home, its’s time for a talk with your child’s counselor. This is especially true if you’re noticing worsening depression, thoughts of self harm, or aggressive and destructive behavior.

It’s important to note that seeing one or more of these signs doesn’t necessarily mean you have a bad therapist or that you have completely wasted your time and money. It’s absolutely a sign, though, that you need to have a conversation with your child’s therapist and figure out how to make things better, so you don’t spend additional weeks or even months doing something that’s not working.

Please, Talk to Your Child’s Therapist!

If you are feeling frustrated and don’t think your child’s therapy is working, please don’t keep this to yourself! As awkward as it might feel, telling your therapist you are concerned is a really important part of turning things around. You aren’t going to hurt your therapist’s feelings if you tell them you’re not loving how things are going!

Speaking from experience, I always want to know when something I’m trying is not landing with a client. It’s a huge bummer to hear that something wasn’t working long after the fact. We could have changed approaches so much sooner if I’d known, and saved that kid a lot of unnecessary suffering!

Pretty much every therapist out there cares more about kids getting better than they do about their own ego. Your therapist wants to hear from you. In fact, hearing feedback from parents—the good, the bad, and the ugly—makes it much easier for us to do our jobs.

When you talk to your child’s therapist, try to be as specific as you can about what you’re seeing at home and what doesn’t seem to be improving. You can mention things like:

• How often your child is struggling, and how severe or long-lasting these episodes seem to be. For example, is your child having anxiety about school 4 out of 5 nights a week? Are tantrums lasting 30 minutes or more?

• What you’ve been trying in order to help your child at home: what strategies are you using? How are you implementing them? What doesn’t seem to work out when you do?

• Any concerns you feel haven’t been addressed yet in the therapy process

• Anything you’re confused about, like how a specific strategy works or what the current therapy goals are

One final note about having this talk with your child’s therapist: please set up a time to meet with the counselor when your child isn’t present. You want to be able to speak openly about behaviors you’re seeing at home or family dynamics that might be getting in the way of completing therapy goals at home. Kids tend to personalize these conversations and may believe that it’s their fault if therapy isn’t going well.

Common Therapy Problems, and How to Handle Them

Often, an honest conversation with your child’s therapist is enough to clear up issues that are keeping you from progressing. You may need to clarify treatment goals, rethink your child’s diagnosis, figure out what’s getting in the way of using skills at home, or consider switching approaches or therapists in order to get things working again. Photo by Cottonbro via Pexels.

Hopefully, you are able to bring these concerns to your child’s therapist, along with some specifics about what doesn’t seem to be going well. Together, you can figure out what the roadblock might be that’s preventing therapy from being effective. There are all kinds of reasons therapy might not work, but here are a few common ones to consider, along with ways you can help things improve:

Unclear Treatment Plan

I often hear from parents that they’re not sure what’s going on in their child’s therapy aside from “just playing.” This should never be the case! Start off your troubleshooting process by making sure you and your therapist are on the same page regarding your child’s therapy goals.

Every therapist is required to create and maintain a document called a treatment plan. This outlines what problems brought a child to therapy in the first place, and what goals have been set in order to make those problems better. If you’ve been in therapy a while, this document has likely been updated to show how much progress your child has made toward these goals.

If you aren’t clear on your child’s treatment plan, you can:

• Ask to meet with your child’s therapist to review the treatment plan together

• Let the therapist know that you’d like to get clear on what the current goals are, and be more direct in working toward them

• Get feedback from your therapist on what they’ve observed in sessions and how they feel your child is progressing

• Ask how you can support your child in achieving treatment plan goals at home

If your child’s therapist doesn’t have a treatment plan, can’t give clear answers about goals, or isn’t able to provide specific responses to your questions, you may not be a good fit for each other.

Treating the Wrong Problem

It’s also possible that your therapist has a clear, detailed treatment plan…and you’ve been focusing on the wrong problem. Sometimes, one mental health problem masquerades as another. Girls with autism, for example, have a harder time getting diagnosed and their symptoms might be mistaken for anxiety or another disorder at first. Trauma symptoms can look an awful lot like ADHD. Children who have OCD might take a while to get the right diagnosis, as well, because the behaviors can be hidden or hard to spot.

If you’ve been diligently working on your treatment plan, trying to follow through with things at home, and nothing seems to be moving the needle, it’s worth questioning if something else might be going on.

If you’re wondering if there’s another diagnosis at play, you can:

• Ask your child’s therapist if there are any other diagnoses (sometimes called “differential diagnoses”) they have considered for your child.

• Give a thorough review of any possible symptoms, behaviors, or difficulties you’re seeing at home,

• Reflect on your child’s history: have they lived through anything that might be considered a traumatic or highly stressful event? These are good for your therapist to know about, even if they seem unrelated to the problem at hand.

• Consider getting an evaluation from a psychologist to screen for ADHD, autism, or other developmental or learning conditions

Depending on what you learn, you may find that your goals in the therapy process need to change—or you may discover that your child is a better fit for another kind of therapy altogether.

Trouble Following Through

What happens outside the therapy room matters just as much as what goes on inside of it. This is especially true if you’re in a skills-based form of therapy, like CBT, or treating a problem like anxiety or behavior difficulties where a lot of the struggles occur at home.

Kids are still in the process of learning to regulate their emotions, and need an adult’s help to do this. Even if they’re learning skills perfectly in session, they won’t be much use if there isn’t a parent or caregiver helping with follow-through in real-world situations.

Of course, this is way easier said than done. Working on therapy skills can be time-consuming and emotionally draining. It can be really hard to find the time and emotional reserves to work on therapy when you’re managing a busy and stressful life. It’s also possible that a plan that sounded really good in the office falls apart when you get home: either your child is reluctant to do it, or you encounter some kind of issue that you can’t figure out how to navigate.

If you’re having a hard time following through on therapy goals at home, try the following:

• Be honest with your therapist about what’s going on. You aren’t getting graded, so there’s no need to lie about not doing your homework!

• Make sure you feel clear and confident about what your assignment is: you should know exaclty what you’re doing, and what to say when

• Sometimes, a plan sounds okay in the office but feels difficult, uncomfortable, or scary to a child when it’s time to follow through at home. If this is the case, you may need to adjust the goal or come up with a plan to support your child through it.

• Let your therapist know about any sticking points that you’re tripping up on when you try to practice at home

If you’re in the middle of a major life transition, experiencing trauma or loss, or feeling totally overextended by work and family obligations, you may just not have the reserves to fully participate in therapy right now. It may make more sense to focus on those life stressors first, and return to therapy once things have settled down a bit.

Child Needs Higher Level of SuPport

If you aren’t seeing improvement, and especially if things are getting worse, you may simply not be getting enough help. Some issues need more attention and support to resolve than a 50-minute sit down with a therapist once a week can provide. This is kind of the “bare minimum” of therapeutic support, and there are a lot of other options to consider when it isn’t enough.

Somtimes, families opt to try therapy on an every other week or even monthly basis. This may be due to financial concerns, time constraints, or limited availability from your therapist. While this can be a good option for kids with mild symptoms, kids who are really in the thick of it will have a hard time keeping momentum up if they’re only coming every other week.

If you feel like things are steadily worsening, and particularly if your child is struggling with suicidal thougths or self-harm, it’s worth talking to your therapist about ways to increase support. Here are some possibilities to consider:

• You child may need more frequent sessions: weekly if they’re coming every other week, or twice a week if they’ve attended weekly.

• Adding group therapy, like a DBT skills group, can add another layer of support for kids struggling with suicidal thoughts or self-harm.

• Consider meeting with a psychiatrist to see if medication could help your child make more progress in therapy: you can talk this over with your therapist and pediatrician.

• If finances make it hard to attend therapy more often, ask about a sliding scale or consider making a transition to a therapist who takes your insurance or can offer a lower rate.

• If your child is not safe at home, intensive outpatient therapy (meeting daily for part of the day) or an inpatient stay might be needed before your child is ready to “step down” to weekly therapy sessions.

It might be hard to think about adding more therapy when things are already not working: it means more time, more money, and more effort. While a higher level of care isn’t the right answer for every child, it can make a world of difference for kids who really need it.

Therapist is Not the Right Fit

Sometimes, it’s just not a good match. Maybe the style of therapy your counselor offers doesn’t work for your kid: a child who’s reluctant to attend therapy might not do well in an approach that requires a lot of self-motivation, for example. Or, maybe you’re feeling a lack of clarity about what the treatment plan is, and you can’t seem to get on the same page. If your child’s diagnosis or needs have changed over time, they may need a form of help your therapist no longer specializes in.

It’s also possible that your personalities just don’t mesh well: just like you’re not going to be friends with every person you meet, you’re not going to hit it off with every therapist you meet, either. Simply not feeling comfortable with your therapist—even if they’re a nice person—can be reason enough to make a change.

If you’re just not vibing with your child’s therapist, there are a few things you can do:

• As awkward as it may seem, you can still bring this up to your therapist, as long as you don’t have any big ethical concerns about their behavior. They may sense that it’s a poor fit, too!

• Try to get specific about what you need out of therapy that you’re not getting now. Would your child respond better to a therapist who is more animated and engaging? Do you need someone who specializes in a specific diagnosis, or does more parenting work?

• Ask yourself whether a difference in culture or background might be part of the problem. It may or may not be, but sometimes finding a therapist who shares your racial or cultural heritage can help.

• Search for therapists who meet your new criteria. You can even ask your current therapist for referrals, if you’d like!

Just like doctors have no problem with patients seeking a second opinion, most therapists genuinely just want our clients to feel better, whether that happens with us or someone else. I’m always happy when a family is able to find someone who is exactly the right fit for their situation.

Should You Switch to Another Therapist?

It’s always within your rights to switch to a new therapist, and sometimes that’s exactly what you’ll need to do if your current therapy plan isn’t working. If you’ve tried talking with your therapist and things still aren’t working out, it’s perfectly okay to transition your child to a new counselor. There are so many different styles of therapy out there that you might not find the right match on your very first try.

Just like you wouldn’t fire an employee over a minor offense, I don’t recommend leaving therapy the first time something goes wrong. In fact, you should expect that things will go wrong sometimes! Your therapist won’t always get it right. They may interpret something in a way that doesn’t sit right with you. Or, they may have a policy you don’t agree with, like charging a cancellation fee.

Minor missteps and frustrations can be worked through, and will often make your relationship with your therapist stronger. If you left therapy every time something like this happened, you’d be repeatedly starting from the begining and it would be hard to make any meaningful progress. On the other hand, unethical behavior—things like making racist or sexist comments, not protecting your private information, or saying something inappropriate in session—should never be tolerated. Get out of the situation immediately if this happens to you, and consider filing a complaint with your therapist’s board.

Most of the time, there won’t be a big, dramatic reason for ending therapy: it’ll just turn out not to be a good fit. In these situations, I strongly recommend being upfront with your therapist about what’s going on. Scheduling a final “goodbye” session for your child gives them a sense of closure before moving on.

Take Care of Yourself As a Parent

Your child’s therapy process isn’t going to look like anyone else’s, so resist the temptation to compare your child or family to others. You can’t help your child through therapy if you’re completely burned out! Photo by Albert Rafael via Pexels.

It’s easy to feel burned out when therapy isn’t working for your kid. Here you are, contributing all this time, money, and emotional energy in the hopes that things will get better…and then they don’t. You might blame yourself, worry that your child’s problem is unfixable, or start to question whether therapy will ever work.

We all know the adage about the oxygen mask in the airplane: there’s no use in bending over backwards to find help for your child if you’re feeling utterly fried by the whole process, and have no time to take care of yourself. Do whatever you need to do to prioritize your own mental health during this stressful time, even if it feels a little selfish.

Your kid’s process is not going to look like any other kid’s process: they’re a unique individual. There’s no reason to beat yourself up if so-and-so’s kid had a miraculous transformation in 3 sessions of therapy and your family is still struggling 6 weeks in. Just like kids hit their developmental milestones at their own pace, you and your child will figure this out on your own timeline, too.

When you’re really feeling stuck, it can be easy to overlook the small, everyday ways that things are getting better. It sometimes helps to refocus on those small victories. Did your child encounter a triggering situation today, but not melt down? Were they able to articulate their feelings to you this week? Have some aspects of your problem gotten better, even if other parts have stayed the same? This is all growth and progress to be celebrated.

Be patient, hang in there, and don’t neglect these little wins while you figure out how to get unstuck.

Begin Child Counseling in Charlotte, NC or Online

Finding a therapist who is the right fit for your child can make therapy more effective. If you’re looking for someone who specializes in tween anxiety and OCD, I’m available to work with children throughout NY, NC, and FL. Photo by Victoria Rain via Pexels.

If you’re still looking for the right fit for therapy for your child, I might be able to help! I can see kids in person at my Davidson, North Carolina office, or online anywhere in North Carolina, Florida, or New York.

I mainly work with tweens (rougly ages 8-13) who are struggling wtih anxiety due to OCD, difficult life circumstances, or just by virtue of having an anxious temperament. We’ll work together using practical, skills-based therapy along with a healthy portion of fun and play to learn new ways to deal with difficulties in life. I’m trained in three research-based forms of therapy: CBT (great for anxiety), TF-CBT (designed for trauma), and ERP (for OCD). I’m also a drama and play therapist, so we won’t just be learning dry skills from a book, but we won’t be playing Uno all day either :-).

If you think your child could benefit from this approach, feel free to reach out! You can also join my mailing list to get my free coping skills guide, as well as monthly information on how to help kids and tweens navigate life with anxiety.

Should Parents Be Involved In Their Child's Therapy?

Since becoming a parent myself, it’s dawned on me what a leap of faith it is to send your child to therapy. Whether you’re meeting in person or online, you’re sending your child into a room with a near-stranger without knowing exactly what’s happening behind that closed door. Does this person have your child’s best interests at heart? Do they know how to help? Are you missing out on important information? Are they just playing Uno in there?

Involving parents in a child’s therapy can be a tricky business. On one hand, kids need enough privacy to trust that they can safely share difficult thoughts and feelings. On the other, it’s fair for parents to want to be kept in the loop…and research shows therapy is more effective when they are.

Being a part of your child’s therapy process benefits everybody: you, your child, and your child’s therapist. But how you get involved will depend on your child’s age, maturity level, and the reason they’re coming to therapy.

You Are the Expert on Your Child’s Life

You know how, in documentaries, there’s always a “talking head” segment where an expert drops a bunch of knowledge and historical information about the subject of the movie? If there was a documentary about your child, you’d be that expert. You have insight about your child that your therapist doesn’t.

Child therapists have broad knowledge: they have data about a large number of kids. They know what anxiety, depression, and other mental health issues tend to look like in kids. They’ve studied child development and probably attended countless lectures and trainings on specific ways to help kids with different conditions. On top of that, they’ve met with hundreds of kids for therapy. Based on what’s helped all these other kids, your therapist can make a strong educated guess about what will be helpful for your child.

Parents have deep knowledge: you know your individual child better than anyone else. You’ve spent years learning to decode your child’s tiny facial expressions or tones of voice. You know their history and you’ve seen them at their most vulnerable. You’ve likely been with your child since the day they were born and seen them grow and change. You’re the family historian, and you can remember details about your child’s life that they cannot.

Your deep knowledge is really useful in therapy. It provides background and context. You can give your therapist feedback to help them tailor their skills to work for your specific child and family. And learning those skills alongside your child will help them to get the most out of therapy.

The Pros and Cons of Parent Involvement in Therapy

Participating in your child’s therapy is a bit of a balancing act. You want to be involved enough that you know what’s going on and how to support your child, but not so involved that your child feels like they don’t have any space to do their own thing.

There are definite benefits to parent involvement, but there are also some potential drawbacks to be aware of. Let’s take a look at both.

The Pros:

• We have a lot of research that shows that being involved in your child’s therapy is linked with better outcomes: kids do better when parents actively participate.

• Participating in therapy sends a message to your child that going to therapy isn’t a punishment for bad behavior: you’re committed to growing and changing, too.

• Coping skills are great, but kids will need help from an adult to put them into practice. You can reinforce what your child is learning at home.

• You can share important information with your child’s therapist about your family history, religion, culture, or anything else that might influence your child’s experiences.

• Children of all ages need help from their parents to handle their feelings. To create lasting change, both kids and their parents need to learn new ways of dealing with anxiety and behavior struggles.

The Cons:

• If everything a child says is immediately relayed back to the parent, it’s a betrayal of trust. Children will quickly figure this out, and stop sharing important information in therapy.

• Sometimes it’s easier for children to bring up difficult, embarassing, or scary subjects for the first time with someone who isn’t a family member: it helps to protect those important relationships. If parents are in the room all of the time, it’s hard to do this.

• Older children are more aware of cause and effect, and may worry about the consequences of sharing things in therapy as a result: if I say this to my therapist, will I get in trouble at home?

• As kids become teenagers, it’s normal and natural for parts of their lives to become more private from their parents. It’s no longer age-appropriate for them to share every detail of their personal lives.

A lot of these risks can be managed by setting clear boundaries in advance: everybody, including your child, should know what gets kept private and what doesn’t. You can talk with your therapist about the best way to participate, based on your child’s age and needs.

How Involved Should I Be in My Child’s Therapy?

There’s no “right” level of involvement in a child’s therapy. Every kid is different! Your child’s age is the biggest factor to consider when trying to figure out how to participate: the younger your child is, the more present you’ll need to be.

Your child’s reason for attending therapy matters, too. Children experiencing anxiety or OCD may need a little more privacy, safe space to begin talking about their fears. A teen having relationship struggles may not want or need to talk about all the details with a parent.

On the other hand, behavior concerns like fighting, tantrums, and not following rules usually need more parent involvement. An argument takes two people, so you really need both people to figure out how to respond differently.

Finally, the severity of your child’s symptoms might also dictate how involved you need to be. A child who is feeling stressed about homework may be able to learn ways to cope with her worries fairly independently. A child who is so anxious about their work that they’ve stopped going to school most days is going to need lots of support and guidance from parents to overcome their fears.

Participating in a Preschool Child’s Therapy

Sometimes people are surprised to hear that therapy options exist for toddlers and preschoolers. They absolutely do! If your very young child is struggling emotionally, you have options. Forms of therapy have been created specifically to help preschoolers cope with trauma, manage difficult behaviors, and explore feelings through play, rather than words. Kids in this age range need a lot of parent support in order to make therapy work.

As a parent, you’re the center of your preschooler’s universe. You’re their first playmate, their protector, and the person who sets the schedule for their day. Little children look to their parents to decide how to respond in stressful situations: they’re always checking what your reaction is. When feelings get too overwhelming, it’s hard for preschoolers to self-soothe: they need your help to do this. Because preschoolers rely on their parents for so much, you can expect to be highly involved in their therapy.

Depending on your child’s needs, parent involvement in a preschooler’s therapy could look like:

• Attending sessions alongside your child, so the therapist can guide you through play-based activities together.

• Getting coaching in real time from a therapist as you interact with your child, so the therapist can “translate” the possible meaning of your child’s behavior or offer suggestions on how you can respond.

• Learning coping skills together in session that you can help your child to practice at home.

• Meeting frequently for parent sessions with your child’s therapist to discuss their progress

• Learning parenting strategies that you can try at home to support your child and the work they’re doing in therapy

To summarize, if you have a child between the ages of 2 and 5, you should expect to be a very active participant in their therapy process. Younger preschoolers will need your support in the room for the entire session: and what you learn will be just as important as what they learn.

Older preschoolers might be able to meet alone for play therapy some of the time, but you’ll still need to be involved and open to trying new things in order for therapy to work well. If your child’s therapist meets with them alone for play therapy, you should expect (and ask!) to be included on a regular basis, either for part of each session or for regularly scheduled parent-only meetings.

Including Parents in Therapy for Elementary-Aged Kids

Elementary-aged kids have mastered the art of pretend play, which makes play therapy a wonderful option for this age group! Between the ages of 5 and 10, children are also working on their ability to verbalize their thoughts and feelings. Starting school opens up a whole new world for kids: there are new important people in their lives like teachers, coaches, and friends.

All these factors mean that unlike younger children, elementary school kids can often benefit from some alone time in the therapy room. Sometimes, practicing being apart from Mom or Dad can even be a helpful goal for kids with separation anxiety!

However, it’s not realistic to expect this age group to put what they’re learning into practice by themselves: they’re going to need help and support from you. You’re still your child’s biggest teacher, and the 50 minutes they spend in therapy once a week will never have as much impact as their time with you.

If you’re participating in your elementary schooler’s therapy, you might be asked to:

• Check in about how things are going at home at the start or end of each week’s session.

• Join your child for the last part of their appointment to learn a coping skill together—or have your child teach the skill to you!

• Help your child practice simple “homework” over the course of the week.

• Meet for parent sessions to discuss your child’s progress and talk about ways you can tweak things at home (like discipline or the way the family responds to anxiety) in order to best support your child.

In general, you can expect that a child between the ages of 5 and 10 will attend therapy sessions by themselves, but that you’ll still be needed as as major source of support. Whether it’s helping your child practice relaxation skills or encouraging them to gradually face their fears, your participation makes a huge difference in the therapy process.

How to Get Involved in Your Tween or Teen’s Therapy

It’s totally normal and age-appropriate for tweens and teens to want some privacy in therapy. They’re at an age where they no longer need to share every thought that passes through their head with their parents. As kids hit adolesence, friends become a huge source of support and a helpful sounding board…but they can also be a major source of drama. It can be a relief to talk to someone like a therapist, who isn’t a close friend or family member and who is removed from a teen’s day-to-day life.

Tweens and teens are also much more capable of considering cause and effect: what will happen to me if I share this information with my therapist? Will my parents find out? Will I get in trouble? Because of this, it’s really important for these older kids to be informed about how confidentiality works in therapy. Safety concerns (like thoughts of suicide) will always be shared with a parent, but issues that aren’t urgent or dangerous (like a fight with a sibling) might not be.

Despite all this added independence, parents still need to be kept in the loop. Teenagers still need guidance from their parents, even if it looks different now than it did when they were little. It can be stressful to raise a teenager, and parents could use some support during this time, too. Participating in your teen’s therapy also sends the message that you don’t simply see them as a “problem child”: you’re willing to put in the work to make things better, too.

Participating in your tween or teenaged child’s therapy could look like:

• Having an initial session with your child’s therapist before they meet to share your perspective and fill them in on your family’s history.

• Having an open conversation in your teen’s first therapy session about how confidentiality works and what will and won’t be shared.

• Meeting periodically with your child’s therapist to discuss the progress they’ve made toward their treatment goals—but not necessarily talking about their specific worries or problems.

• If your child is in a skills-focused form of therapy, like CBT or ERP, collaborating with your child and the therapist to come up with a plan to work on skills at home.

• Getting support for yourself and learning new ways to manage your tween or teen’s strong emotions.

Until your child turns 18, you can expect—and request—to be a part of your teenager’s therapy. Once your child turns 18, however, things change. Once your teen is a legal adult, they’re entitled to total privacy in therapy, even if they’re still living in your home and you’re the one paying for their sessions.

If your child is approaching this age, you should talk with both your teen and their therapist about how to prepare for this transition. Turning 18 doesn’t necessarily mean you can never participate in your child’s thearpy again—you’ll just need their permission to get involved.

What if I Can’t Attend My Child’s Sessions?

There are many reasons why it may not be possible for you to physically attend appointments with your child’s therapist. Maybe your child is in online therapy, and meets with their therapist while you’re still at work. Or, maybe your child’s other parent is typically the one who drives them to their sessions. Divorced parents may not live in the same town or state as their child’s therapist, which can also make it more difficult to stay in touch.

Research on children’s therapy has found there’s a difference between a parent who attends a child’s therapy sessions and a parent who participates actively in the sessions. Being physically present at the appointment is a great start, but it’s not going to be very helpful unless the parent is open to sharing, listening to feedback, and following through at home. Any parent can actively participate in therapy, whether they live 1 mile or 100 miles from the office.

If you want to be involved but you can’t make your child’s regularly scheduled appointment time, you have some options:

• Ask your therapist if it’s possible to schedule a monthly “parent only” appointment at a time that works better for you.

• Online therapy is common now, which is a great option for working or out-of-town parents. See if you can schedule periodic online check-ins to avoid a long commute.

• Many children’s therapists have much more flexibility to meet while children are in school. If you can meet remotely during your lunch break at work, this can be a good option to stay involved.

• Phone calls, emails and texts can be a good way to keep in touch when video calls aren’t possible. Your therapist can keep you updated on treatment plan goals and let you know how you can help reinforce these goals at home.

• If your child is under 18, you have a right to access their medical information. Consider asking for a copy of their treatment plan, if your therapist hasn’t shared it with you.

Regardless of how you keep in contact, your participation will have a positive effect on the therapy process. Being open to change and trying new things along with your child is a huge deal!

Therapy for Kids and Tweens in Davidson, North Carolina

Ready to get started in therapy? I’d love to help you take the next step. My child therapy office is located in Davidson, North Carolina, just north of Charlotte. I also offer online therapy for kids living anywhere in North Carolina, New York, or Florida. You can reach out to me here.

If you’re searching for a local therapist, or unsure if therapy is the right step, check out my anxiety coping skills course for kids and their parents. It can give you practical, actionable skills to try at home in the meantime to deal with overwhelming worries and panic. The course includes sections for both kids and parents, so you can support your child in learning more helpful ways to cope.

If you’re looking for more information on getting started with children’s therapy, check out my other blog posts on the subject:

What Questions Should I Ask My Child’s Therapist?
Should My Child See a Therapist, Psychologist, or Psychiatrist?
What Are the Different Types of Child Therapy?

If you’re ready to get started, email me here to inquire about therapy sessions.

How to Find a BIPOC or LGBTQ+ Therapist for Your Child or Family

It can be really challenging to find a therapist of color—and even harder to find one who specializes in working with children. I hear similar struggles from families looking for therapists who are part of the LGBTQ community: it is sometimes difficult to find affirming therapists for kids.

Usually, I write in this blog about issues that I can help kids with in my therapy office, either in-person or online. This post is a little different: I’m not a BIPOC or queer therapist, but if you need one I’d love to help you find one for your child.

Below, you’ll find a list of directories designed to help match you and your child with therapists and other helpers who understand where you’re coming from. Each of these directories has an option to search specifically for children’s therapists, and also to filter the search results for therapists who share a specific identity or background.

The Benefits of a Therapist Who Shares Your Culture

In order for therapy to be effective, your child needs to feel understood. Of course, this doesn’t mean your child has to have every life experience in common with their therapist: sometimes it can be helpful to work with someone of a different gender or background. But research shows that therapy works better when a therapist understands the client’s culture, and can tailor the therapy to line up with their client’s experiences and beliefs.

Some potential benefits of working with a therapist who shares your culture include:

• Spending less time in session having to explain yourself or your experiences

• The ability to have therapy sessions in your native language

• More informed care when dealing with issues related to racism or systemic oppression

• A stronger, more trusting relationship with your therapist

For kids, having a therapist who looks like them can also be a helpful role model or racial mirror, providing another example of a helpful, caring adult in their community who looks like them.

Directories for Finding BIPOC Therapists

The following directories were created to address the challenge of finding therapists of color. While not all directories cater to children, the ones on this list do have options to search specifically for therapists who help kids.

Therapy for Black Girls was founded by a psychologist to help Black women and girls improve their mental health. They have a large database of therapists, and their search function allows you to look for therapists who accept your insurane, as well as therapists who specifically work with children or teens.

Therapy for Black Men, according to their website, was “born from the idea that Black men and boys face unique challenges, and therefore need a dedicated space for seeking and finding mental health support.” You can find Black therapists here who specialize in helping boys, and search specifically for therapists trained to help toddlers and preschoolers, elementary-aged children, tweens, or teens.

Latinx Therapy is a bilingual database that helps people find therapists who understand the Latinx experience in the U.S., as well as Spanish-speaking therapists. Their database allows you to search specifically for help with many different problems that could bring a child or family to therapy, including some specific to the Latinx community. You can also filter your search results for therapists who work with specific ages of children, from toddlers through teens.

Asians for Mental Health is a directory for AAPI therapists. All therapists list their specific ethnic backgrounds in their profiles. You can search for issues specific to the AAPI community, including transracial adoption and immigration, as well as filter the results for therapists who speak a wide range of languages. You can also run an age-specific search to find therapists who work with specific age groups, including young children.

Llapanchik Hampinakuy is a new directory for indigenous and native healers of all kinds. Founded by two Quechua therapists, its name means “we heal each other mutually” in Quechua. Expect to find indigenous and native therapists listed here, as well as other kinds of healers who take more holistic views on health and wellness.

Directories for Queer-Affirming and Culturally Competent Therapists

While the directories above are all devoted to specific racial or ethnic groups, the ones in this section are more broadly committed to inclusivity and cultural awareness. You can find therapists who have deep knowledge of specific cultures, experiences, or religions, as well as therapists who identify as LGBTQ themselves.

Inclusive Therapists is a very large database that, according to their website, “offers a safer, simpler way to find a culturally responsive, LGBTQ+ affirming, social justice-oriented therapist.” You can search for therapists with expertise in a variety of religious beliefs, racial and cultural backgrounds, and social justice issues. You can also search for therapists who self-identify as part of the LGBTQ community or as part of a specific race, culture, or group. “Children and Tweens” and “Adolescents and Tweens” are included as searchable specialties in the database.

The LGBTQ+ Healthcare Directory can help you find therapists, doctors, and other healthcare providers who are LGBTQ-affirming and who specialize in helping members of the queer community. While not specifically focused on mental heatlh, the databse includes a good number of therapists. Therapists can also be filtered based on ethnic background, languages spoken, and whether they specialize in working with youth.

TherapyDen is another large database with an emphasis on inclusivity. It allows you to search for therapists not just by cost or location, but by gender, ethnicity, and many other factors. Their “specialized experience” drop-down menu allows you to select for therapists who have described themsevles as Queer-competent, Trans-competent, Neurodiversity-affirming, and working from a racial justice framework. You can also search fror therapists specializing in child, adolescent, or family therapy.

More Mental Health Help for Kids

If you’re looking for some support while you search for the right therapist, my online coping skills course for tweens is available to download right now. My book, A Parent’s Guide to Managing Childhood Grief, might also be a helpful resource for children and families who are recovering from a loss.

I provide counseling for kids and tweens with anxiety and OCD, both in-person in my Davidson, NC therapy office and online throughout the states of North Carolina, New York, and Florida. Want to learn more about therapy with me? Check out my FAQ or contact me with questions.

What Are the Different Types of Child Therapy?

“Play Therapy” is a catchall term to describe many different types of counseling that help children explore feelings using games, toys, and make-believe.

Considering therapy for your child but not sure where to start? This post is for you. Kids today have more options for therapy than ever before, which is definitely a good thing. However, it can also be an overwhelming thing when you turn to Google looking for a therapist only to discover a sea of jargon and acronyms. With so many types of therapy available, it can be tough to determine what’s right for your kid.

I love that families have so many different styles to choose from. No matter what your child’s concern is, there’s probably a therapy out there that’s been researched and proven to help. You can find therapists who teach practical, concrete coping skills, if that’s your thing. There are also therapists trained in forms of therapy that don’t require much language, for children who feel better expressing themselves in other ways.

There’s no one right way to do therapy, so this won’t be a ranked list. Instead, I’ll be doing a quick breakdown of 5 common types of child therapy you might encounter during your search. Even though there’s no such thing as “best’, hopefully you’ll come away with some ideas about what might be best for your child. All these types of therapy are valid, and they can all help kids and families change their lives.

Play Therapy: Exploring Feelings Without Words

Play therapy builds on a child’s natural tendency to learn about the world through play, so they can work through big feelings and difficult life changes without having to sit and talk for hours on end. Sitting on a couch across the room from a strange adult isn’t always the most natural thing for little kids. Play therapy is a wonderful way for younger children to feel safe and comfortable in the therapy room.

Play therapists like to say that “play is a child’s language, and toys are a child’s words.” With this in mind, you’ll see a wide variety of toys in a play therapists office that aim to give children a broad vocabulary to choose from. Expect to find nurturing toys, like dolls, aggressive toys, like punching bags, and creative toys, like art supplies. What you probably won’t find a lot of is electronic stuff: most play therapy toys are open-ended to encourage kids to play in avariety of ways.

So how is play in a therapy office different than play at home? Play therapists are trained to notice underlying themes that repeat themselves in a child’s play, and may give insight into how they’re thinking and feeling.

Within the umbrella of play therapy, you’ll find a variety of differen approaches. Some play therapists are child-centered, meaining they are trained to follow a child’s lead and let them set the pace for therapy. Others may incorporate education about feelings or coping strategies into play to help children learn new skills.

Cognitive Behavioral Therapy: Tools for the Here and Now

CBT differs from some other forms of therapy because it teaches children tools, like mindfulness, that they can use in the present—and continue to practice in the future.

Cognitive Behavioral Therapy, or CBT, is a form of counseling that focuses on helping people learn how to cope with strong emotions by changing their behavior or becoming more aware of their thinking patterns. It’s less focused on uncovering the past or figuring out why a problem evolved the way it did (although you might do some of this in CBT). Instead, the emphasis is on figuring out how to handle the problem now that it’s here, in the present.

One strength of CBT is that it’s an evidence-based treatment, meaning that there’s a lot of research to back it up and prove that it’s effective. Variations of CBT have been designed for pretty much every mental health concern. Exposure and Response Prevention is a specialized form of CBT for children and adults with obsessive compulsive disorder. TF-CBT, which you’ll read about below, is used for kids and teenagers who’ve survived a trauma. You’ll also see CBT used often with children dealing with anxiety, depression, or angry outbursts.

CBT gives children education to help them better understand their feelings and how they work. This can reduce fear and shame, and empower children to feel more in control of their emotions. They’ll also learn coping skills they can use during difficult moments to deal with their emotions in healthier ways. CBT skills require kids to be able to think abstractly—thinking about your own thinking is a complex skill! For this reason, it’s sometimes a better fit for older children.

TF-CBT and Trauma Therapy: Resilience and Storytelling

Children often need extra, more specialized support in order to recover from the after-effects of trauma. Highly stressful or dangerous experiences like accidents, illnesses, a death in the family, or exposure to abuse or violence can lead to long-lasting symptoms that don’t resolve on their own. You may notice a child having difficulty sleeping, experiencing big emotional outbursts, or regressing: going back to habits from earlier in childhood, such as thumb-sucking or bedwetting.

Children need to be able to share their feelings about what has happened to them in order to heal. However, traumatic memories can be very overwhelming. Trauma therapists understand how to help children gradually work through these memories in a safe way, so they don’t feel as confusing or hard to manage. This can happen through play, art, storytelling, or just by talking to a counselor.

Trauma therapy can also give kids and parents tools to deal with symptoms of PTSD, which can affect the whole family. One common form of trauma therapy for kids is Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT. This is a step-by-step approach that teaches children skills that build on each other, eventually helping a child to feel comfortable sharing their story with a parent or other supportive adult.

Parent-Child Interaction Therapy: Behavior Help for Kids and Parents

This is a special form of therapy designed for toddlers, preschoolers, and young children who are struggling with big behaviors and meltdowns. All little children tantrum, but sometimes these acting-out behaviors get so intense and difficult to manage that it puts a strain on the relationship between parent and child. This creates a vicious cycle of bad behavior, frustration, and disconnection.

Sometimes these behavior struggles are a response to trauma or stress, and other times it may just be due to temperament and sensitivity. Regardless of the reason, therapies like PCIT can help parents and children break the cycle of “bad” behavior, set appropriate limits, and enjoy more time spent together.

You can expect to spend a lot of time in the office with your child if you’re participating in PCIT. You’ll learn skills from your therapist to practice at home, and also get opportunities to use them in real time, with your therapist there to coach you through the process. The first part of PCIT is all about strengthening your relationship with your child through play and positive attention. The second is a set of discipline tools you can use to shape behavior without accidentally fueling the fire.

Expressive Arts Therapies: Use Mind and Body Together

Art materials give children a sensory experience that can help them stay grounded as they explore feelings in counseling.

Many kids (and adults) already know that the arts provide a mood boost. Mediums like dance, visual art, theater, and music can also be integrated into therapy to help children work through feelings and heal from trauma. We call this whole group of methods the expressive arts therapies, since they focus on creative expression.

Like play therapy, using art gives children a way to let out feelings they may not have words for, either because the feeling is too big or because they don’t yet have the vocabulary to do so. Music, dance, art, and drama are multi-sensory experiences, so they help kids engage their bodies and brains at the same time. This can be soothing, help children stay engaged, and even make it easier to process trauma.

Therapists can become specialists in any of the expressive arts, and use them as a way to connect with children in sessions. Your child doesn’t need to have any prior experience in a particular art form in order to do well in expressive arts therapy. All kids are creative thinkers, and therapy is focused on the process of artmaking rather than a finished product.

What’s the Next Step? Choosing the Right Type of Therapy for Your Child

Ultimately, the type of therapy you choose is going to be based on your family’s needs, and your child’s specific situation. As you’re weighing your options, you may want to ask yourself some questions, such as:

• Is my child still very interested in make-believe play?

• Are we the kind of family that does well with structure and direct advice?

• Does my child prefer to learn by doing or by talking?

• How is my child feeling about starting therapy? Are they self-motivated or a little unsure?

• Is there a specific event, like a trauma, that’s bringing us in to therapy?

• Is there a therapy option that’s tailored to my child’s specific concern?

• To what extent should I expect to be involved in this type of therapy, as a parent?

You may also want to check out my blog post on the differences between a therapist, psychologist, and psychiatrist to help you navigate those choices. Once you’ve got a list of potential helpers, this list of questions to ask your child’s therapist can help you interview them to find the right fit.

Options for Child Therapy in Davidson, North Carolina

Kids in North Carolina, New York, and Florida can participate in several forms of therapy in person or online through my Davidson, NC office.

If you’re located in the Lake Norman area of North Carolina, like I am, you may be interested in one of the different types of therapy I offer to kids in our region. At my child therapy office in Davidson, I help anxious kids and tweens through:

• Cognitive Behavioral Therapy for Anxiety

• Play Therapy

• TF-CBT

• …and one special form of expressive arts, Dungeons & Dragons Therapy

I also provide online therapy to children throughout the states of North Carolina, New York, and Florida. And if you’re further afield than that, you can check out my coping skills course, which covers my favorite strategies to help tweens with anxiety. It’s available on demand, wherever you live.

Signs of Depression in Children and Teens: Know When to Get Help

The pandemic hasn’t been easy for any of us, but teenagers have been hit particularly hard. From the loss of highly anticipated milestones like prom and homecoming to the social isolation of ongoing lockdowns, it’s been a straight-up bummer of a year. Middle and high school aren’t usually a walk in the park under normal circumstances, so it’s understandable that many tweens and teens have felt more down than usual under these exceptional circumstances.

It’s normal (and natural and human) for any of us to feel a little down this year—kids included. But if you are like many of the parents I know, you may be trying to figure out where the line is between normal sadness and clinical depression when it comes to your child. How can you recognize when a typical reaction to a stressful situation is becoming something more?

Any childhood mental health struggle is cause for concern, but depression can feel extra scary due to the highly publicized rise in suicide rates over the last decade for young people ages 10-24. Most children and teens with depression won’t experience the serious suicidal thoughts that put them at risk. However, it’s helpful to be familiar with the signs and symptoms of depression and take them seriously when they arise. Let’s take a look at some common signs of depression in kids and teens, so you’ll know when to get help if your child is ever in need.

What Causes Depression in Children and Teenagers?

You may have heard that a chemical imbalance is to blame for depression. Many of us have heard of serotonin, and how a lack of it might lead people of all ages to feel depressed. While serotonin and other chemicals in the brain are a part of the puzzle, the causes of depression are much more complicated. Many parts of the brain are involved in depression. In fact, researchers are still trying to figure out exactly what happens in our brains and nervous systems that makes some of us more vulnerable to feeling depressed.

Outside factors like stress and trauma play a major part in depression, too. Any of the following can contribute to a child or teen’s depression:

• Genetics: having a close relative with depression puts a child at increased risk

• Trauma or ongoing stress, especially if the trauma happened early in a child’s life

• Major life changes, like an unwanted move, a breakup, or a divorce or death in the family

• Chronic physical health problems

• Social isolation

• Poor sleep or nutrition

There isn’t usually a “smoking gun” that we can point to as a cause of a child’s depression. It’s more common that several factors have built on each other over the course of months or years and eventually led to a depressed mood. This is even true for kids during the pandemic: as stressful as it has been, the pandemic itself isn’t usually enough to trigger a major depressive episode. However, if your child was already vulnerable due to genetics, stress, or other life changes, they may be having a harder time with depressive symptoms now.

How is Depression Diagnosed in Kids and Teens?

A pediatrician can be a good first stop if you’re concerned about depression symptoms in your child or teen. However, they’ll probably point you in the direction of a mental health professional to make a definitive diagnosis. Pretty much any mental health worker—a counselor, social worker, psychologist, or psychiatrist—is capable of diagnosing common issues like depression.

Therapists use a manual called the DSM-5 to help them when determining whether a child (or adult) is suffering from depression. The DSM-5 gives specific guidelines about the type and number of symptoms a person needs to have in order to qualify as having depression. This gives therapists something concrete they can turn to, rather than just using their intuition or guessing.

According to the DSM, kids and teens need to have at least 5 of these 8 symptoms in order to be diagnosed with Major Depressive Disorder:

• Depressed or irritable mood most days (this one is mandatory!)

• Decreased interest or enjoyment of activities most days

• Unintentional changes in weight or appetite

• Noticeably slower thoughts, speech, or movement

• Feeling tired or low on energy

• Feelings of guilt or worthlessness

• Difficulty thinking, concentrating, or making decisions

• Repeated thoughts about death or suicide, or making a suicide attempt

In addition to having 5 of these, a child’s symptoms have to get in the way of daily life and cause emotional distress to qualify as Major Depressive Disorder. They also can’t be due to another cause, like drug use or a medical condition.

Just because a child doesn’t fully meet criteria for MDD doesn’t mean they aren’t depressed! There are several other forms of depression that may not be as severe or dramatic as MDD, but can still really get in the way of enjoying life.

Signs of Depression in Children

It can be hard to imagine a very young child being depressed: isn’t early childhood supposed to be the most carefree time of our lives? While not as common as anxiety, about 3.2% of U.S. kids ages 3-17 have been diagnosed with depression. Interestingly, young boys (10 and under) seem to be more at risk of depression than young girls.

Little kids may show symptoms of depression differently than older children. It can be harder for them to put their feelings into words, so you may notice that young children’s signs of depression show up more in their behavior. In addition to the symptoms above, here are some signs of depression more specific to younger children to look out for:

• Trouble concentrating at school

• Frequent physical symptoms, like headaches and stomach problems, that don’t respond to treatment

• Sleep problems: either having a hard time sleeping, or sleeping way too much

• Seeming “cranky”, overly sensitive, or quick to cry

• Difficulty handling rejection or criticism

• Low self-esteem

If you’ve noticed multiple signs of depression in your child that have persisted for more than a few weeks, it’s a good idea to have a conversation with your pediatrician or a mental health professional.

Symptoms of Depression in Teenagers

It’s common for depression to begin in the teen years. Teens have to grapple with body image, sexual identity, and social issues that are different from what any other age group experiences. What’s more, teens are navigating all these challenges in a rapidly changing body, while simultaneously trying to manage intense academic pressure on the way to college or a career. It’s no wonder so many teens feel isolated, misunderstood, or suffer from low self-esteem that may pave the way for depression.

Interestingly, while depression is more common in boys in the early years, the opposite is true among teens. By adolescence, girls are significantly more likely than boys to experience depression. Regardless of gender, depressed teens may not fit our stereotypical image of a withdrawn, quiet, sad-seeming person.

Teens experience their emotions intensely, and their depression can often look like outbursts of anger rather than outbursts of tears. They are also more likely than younger children to express their feelings in impulsive and potentially harmful ways, like substance use or self-harm.

Depression symptoms specific to teenagers include:

• Dropping grades at school, especially if the drop is fairly sudden and unusual for the teen

• Feeling hopeless or disinterested about the future due to a belief that things will never get better

• Frequently talking about death and dying

• Withdrawing from friends

• Dropping out of extracurricular activities they used to care about

• Abusing drugs or alcohol as a way to cope with feelings

• Cutting or other forms of self-harm

Speaking to your child’s school counselor or doctor can help you make a plan for your teenager if you notice any of the symptoms above. Any child who talks about suicide or self-harm should be taken seriously. If you worry your teen is at risk of making a suicide attempt, call 911 or your local crisis hotline for help right away.

Counseling for Teens and Tweens with Depression in Davidson, NC

Therapy can make a big difference in a child’s life. The teen years are tough for pretty much everyone, but learning coping skills at an early age can make them a little easier to get through. One of the reasons I love working with tweens and teens is that they’re old enough to learn many of the same skills adults learn in therapy, which means they have a leg up on their current challenges as well as the ones they’ll face in their twenties and beyond.

I use the roleplaying game Dungeons and Dragons as a form of group therapy for tweens with depression. I also provide more traditional talk therapy both in-person and online for tweens and teens. Group therapy can provide kids with the social support from their peers that is so critical to good self-esteem. Individual counseling allows us to take a closer look at the thought patterns that fuel a teen’s depression, and practice coping skills to manage negative thinking.

If your child’s sadness is caused by a recent loss, you can play a big part in giving your child the coping skills to manage grief in a healthy way. My activity book for caregivers and kids is designed to help children ages 5-11 get support and process feelings of grief through simple, play-based activities you can try at home.

If you’re looking for help in the Charlotte area, you’re welcome to request a session at my Davidson, NC teen therapy office. Not local to Charlotte? I also see kids for online therapy throughout North Carolina, Florida, and New York. For more information, contact me here.

How Do I Talk to My Child About Counseling?

You know your child better than anyone, and lately, things just don’t seem right. Maybe you have noticed your child seems to be more worried than other kids her age. Or, you’ve been waiting to see if your child’s tantrums were just a phase, but they’ve stuck around long past the toddler years. After consulting with friends, the pediatrician, or “Dr. Google”, you’ve decided that child counseling could help. How do you tell your child you’d like her to see a therapist? It’s not a conversation most families have every day, which can make it feel awkward. In this post, I’ll share some tips from my experience as a children’s therapist on how to introduce therapy to your child in a positive way.

Common Concerns When Discussing Counseling

The most common concern I hear from parents is that their child will think something is wrong with them if they see a counselor. Views on mental health are changing quickly, but there can still be a stigma attached to getting therapy. The last thing a child struggling with anxiety, depression, or low self-esteem needs is another reason to feel different or “bad”!

Parents of younger children often worry about separation anxiety during sessions, especially if this is one of the issues bringing a child to therapy in the first place. Will it be too frightening for their child to meet with a therapist alone? What be done to help soothe their child’s fears?

When the child is a preteen or teen, there’s sometimes a worry that kids will “shut down” or not be receptive to attending therapy if it wasn’t originally their idea. Any suggestions from Mom or Dad might be viewed with suspicion by a teen or tween. How can we explain therapy in a way that encourages kids to keep an open mind?

If any of these worries sound familiar to you, congratulations! Your concerns are totally normal and you’re in the right place. Keep reading for some tips on how to handle this important talk with your child.

Don’t Bring Up Therapy in the Middle of a Fight!

There isn’t one right way to bring up the subject of therapy. However, there are a few that are…not so great! This is one to avoid. As frustrating as arguments with your child can be—especially if this is your millionth meltdown this week—don’t let this be the way your child learns about therapy.

Telling your child you’re sending them to a therapist between screams or from behind a slammed door virtually guarantees they’ll view therapy as a punishment. It increases a child’s feelings of shame and embarrassment, which won’t help them get better. What’s more, it can turn children off to the whole idea of therapy. They enter their first therapy session feeling resentful and not trusting the therapist to be on their side. That is a hard place to start.

Instead, wait until everyone is feeling good to start a conversation about therapy. This way, your child won’t connect going to a therapist with bad behavior. Avoid times of the day when you know you or your child will be stressed, tired, or hungry. A quiet evening after dinner or snack time after a good day at school is a great time for this discussion.

Describe the Problem as Belonging to Everybody

It’s often easiest to start the “counseling talk” by identifying the problem at hand. Even if your child is showing the most symptoms, it helps to acknowledge that parents have a role to play in therapy, too. This way, the child doesn’t feel like she’s a problem that needs to be fixed: everyone is in this together.

Try to describe the problems you’re seeing in a matter-of-fact, non-judgmental way. It helps to empathize with the emotions your child is feeling, even if the behaviors may be tough. Avoid making assumptions about why the problem is happening, if you aren’t totally sure, and stick to the what instead. If you think a child’s struggles were set off by a particular event, you can always “wonder aloud” about the possible connection.

For example, if your child is having anxiety about going to school, you could try saying: “I have noticed you have had a lot of stomach aches and worries lately, and they usually happen right before it’s time to get on the bus for school. It must be terrible to feel so nervous every day! I wonder if starting in your new school has been scary. I don’t always know the best way to help you with your worries.”

Once you’ve outlined the problem and how it’s affecting your family, you can move on to talking about therapy itself.

Explain What a Counselor Is to Your Child

Children need to know that a counselor is someone who can help them—and you—deal with their big feelings. They need to know that therapy is common and not something to feel ashamed of. In fact, we could all use counseling at some point in our lives!

When I meet younger children, I often describe myself as a “feelings doctor” even though I don’t have a doctorate degree. Most little kids are very familiar with going to their pediatrician’s office, so it’s a good comparison to make. If you have a cold or hurt your arm, a doctor can help you feel better. If your worries, sadness, or anger are bothering you, a feelings doctor can do the same thing. It’s important to explain that feelings doctors can’t give shots!

I tell older children that a therapist is an adult whose job is to be there to listen to them. A therapist is different than a teacher or parent, because they can’t give out punishments or make the rules. They are also different from a friend, because you don’t have to worry about offending your therapist or giving them a turn to speak in conversation. Therapists also keep what you say private, which is helpful and reassuring for older kids to know.

Talk About How Child Counseling Works

When describing child therapy, it helps to keep things simple. Sometimes, over-describing the situation only adds to the anxiety. You might consider something like this: “When you see your therapist, you can talk or play about anything you want. She’ll help you with your strong feelings and will keep the things you say private. She’ll also meet with me to help me understand you better.”

You can also prepare your child for what the therapy session will look like. If you’ll be meeting the therapist in person, describe where the office is and how it looks. Young children are often excited to know that there will be a playroom filled with toys! Tell your child where you’ll be during their session, for example, that you’ll stay in the waiting room nearby.

If you’ll be meeting online, explain how that will work to your child. Most kids are intimately familiar with Zoom these days, but they may still have questions about how much privacy they’ll have or who exactly will be on the call with them. You can pick out a quiet, private location for video calls with your child, and practice logging into the therapy platform together. Younger children may want to pick out a few toys or art materials to “show” their therapist on the first day.

Looking for a Child Counselor in Davidson, NC?

I live and work in the Lake Norman area, just north of Charlotte, North Carolina. If you’re in my neck of the woods, I specialize in working with preteen anxiety and trauma at my Davidson child therapy office. If you aren’t local to Charlotte, I also work with kids throughout New York, North Carolina, and Florida using online CBT and play therapy. And no matter where you live, my coping skills courses are available to access and use at home.

Want to see if we might be a good fit? Feel free to drop me a line to ask questions about what to expect in therapy, or to schedule an intake appointment.

3 Signs Your Child is Ready for Social Media

Figuring out when to cave to your child’s pleas for a social media account is easier said than done. With more and more of life happening online, having Instagram or Snapchat can feel like a lifeline to kids. On the other hand, parents are right to be concerned about the (very real) dangers that children can be exposed to on social media, even if your child is only intending to talk to other kids. The stakes are really high!

Pretty much all the major social media apps set an age minimum of 13 for kids, but many experts agree that parents should base their decisions about social media on a child’s development and maturity, rather than just their numeric age. After checking in with some of the big organizations that speak out about children and social media, I’ve come up with a short list of signs that your child may have the maturity needed to stay safe online.

Readiness Sign #1: Your Child Can Think About Cause and Effect

As adults, we are painfully aware that anything we put on the internet is pretty much there forever. Even if we try to delete it, there’s no guarantee it’s been completely wiped from the record. When we interact with other people, we have a little running commentary in the back of our head that guides what we say and do. We’re aware that our actions have consequences. Embarrassing selfies or flame wars with strangers in a Facebook group doesn’t just exist in a vacuum: they could come back to haunt us in a job interview someday.

Adults are able to think abstractly and play out different possibilities in our heads. This helps us to make guesses about other people’s motivations and how they could affect us. It also (hopefully, at least most of the time) keeps us from saying or doing things online that we might really regret later on.

Kids are often concrete thinkers up until about age 11, but this can vary. Younger children tend to live in the here-and-now, and use the information they have in a given moment to make decisions. It is harder for them to play out hypothetical situations in their minds, especially when those things could occur far off in the future. It’s totally normal and healthy for kids to think this way, but it makes it harder to appreciate some of the risks of social media.

Some kids develop their abstract thinking abilities earlier than others. If your child is able to consider problems from different angles, plan ahead for different scenarios, and improvise solutions to problems, she’s likely reached this point in her development. If you are considering allowing your child to get on social media, check in about her ability to visualize different situations she might encounter online. If she’s able to understand cause and effect and anticipate possible issues, it will be easier to make safe choices.

Readiness Sign #2: Your Child Has Healthy Body Image

Honestly, even as I’m typing this I am asking myself how many tweens I know who fit this description. I can name maybe a small handful of tweens and early teens whose self-esteem about body shape, weight, and appearance seems pretty unshakeable. Many more kids share that they feel extremely vulnerable and open to criticism about the way that they look. While we may think of poor body image as a problem that mainly affects girls, boys can be impacted, too.

Researchers have started looking at possible links between social media use and poor body image and disordered eating in young girls. Although nothing has been proven for sure, studies suggest that photo-based social media apps, like Instagram, make girls feel worse about their bodies. Tweens on social media are inundated with images that are designed to look candid and casual—the “woke up like this” shots. In reality, though, these pictures have been heavily edited and posed by a team of professionals. The standard of beauty keeps getting more extreme and hard to attain as our ability to filter images becomes more commonplace.

In my own child and tween therapy office, young people tell me that they can’t help but compare themselves to others on social media. They scrutinize the likes their classmates have received, and question why they can’t look like the influencers they follow. I don’t think social media is solely to blame for the body image issues teens and tweens have to deal with, but it doesn’t make things any easier.

Before moving ahead with a social media account for your child, you might want to think about how you’ve seen your child respond to criticism or bullying from peers. Does she crumble when someone says something mean to her, or is she able to let it roll off her back? Does she celebrate the way she looks, or do you see her frequently comparing herself to others? How media literate is she—can she recognize an airbrushed or unrealistic photo when she sees one? If the answer to most of these questions is “yes”, she may be ready to brave the world of Instagram.

Readiness Sign #3: Your Lines of Communication Are Open

Chris McKenna at WaitUntil8th.com wisely points out that you should make sure you’ve had “the talk” and all other potentially awkward conversations with your child before letting them loose on social media. Even kids who are not looking for trouble are likely to stumble across explicit material on any of the major platforms. You want your child to be prepared when that happens, and not confused about what they have come across.

Being on social media also makes your child more vulnerable to sexual predators, which means you need to talk about safety and go beyond simple stranger danger. Your child should know how to recognize signs of grooming, and have a plan for what to do if someone makes them feel uncomfortable. You’ll also want to talk about what to do if that uncomfortable pressure is coming from someone your child knows—for example, a friend or classmate asking for inappropriate photos.

Social media opens up a new, private world for your child where they might encounter all kinds of uncomfortable stuff. It requires a certain level of mutual trust between parents and kids. As a parent, you’ll want to know that your child is responsible and makes good decisions. However, your child also needs to trust that they can come to you with problems, and you won’t immediately panic or ground them for the rest of time. If something inappropriate happens online, your child should feel safe coming to you for help. This will go a long way toward keeping them out of harm’s way.

More Help for Tweens and Teens

Tweens are stuck dealing with many of the pressures of teen life, like social media, demanding homework, and friend drama. But, they have to do it without enjoying a lot of the same freedoms that the older kids have. It doesn’t always seem fair, and it’s hard for both parents and kids to figure out.

In my Davidson, North Carolina therapy office, I help tweens learn skills to manage anxiety and recover after stressful or traumatic events. If you and your tween are having a hard time navigating this exciting, challenging, and sometimes awkward phase of life, counseling can help you both get through things a little more smoothly. Even the seemingly small stuff—like deciding when to get a social media account—can cause a lot of unnecessary stress, and it can be nice to have a neutral party around to help sort out everyone’s feelings.

If you’d like to get started in counseling, I’m available to help kids in North Carolina, New York, and Florida. You can learn more or schedule an initial appointment by phone or email.

Should My Child Have Social Media?

Depending on who you ask, social media is either the best or worst thing to ever happen to kids. Is it the way of the future, giving kids endless entertainment and a connection to peers all over the world? Or is it an unsupervised no-man’s-land that exposes children to danger and risks their mental health? I’m not here to tell you what to do—every kid and family is different. But, as a children’s counselor, I can go over the pros and cons of social media for children from an emotional perspective. Hopefully, this post gives you a more balanced perspective so you can make the right choice for your child.

What’s The Right Age to Get Instagram, TikTok, or Other Social Media?

If you ask pretty much any social media company, the answer is easy: 13. Instagram, TikTok, Discord, Snapchat, YouTube, and Facebook all require users to be 13 or older to join. This seems straightforward enough—end of blog post, right? If only life were so simple. Sure, Instagram says you have to be 13 to join, but Instagram doesn’t have a tween daughter begging for an account, claiming she’s the last person in her class who is without one.

As far as I can tell, the 13 year old age limit has very little to do with kids’ readiness to be on social media. Nobody consulted with a child psychologist or child development expert to come up with this magic number. Instead, it has more to do with big media companies not being allowed to collect data on little kids. One of the reasons social media apps remain free is because they’re collecting data on us all the time, so that they can target advertisements to us. I guess that, somehow, it’s deemed okay to do this once a child turns 13.

What does this mean for parents? I think we should all be taking this age guideline with a grain of salt, because it’s a little bit arbitrary. Depending on their maturity level, some kids may be ready for social media at 13. Many others may need to hold off until they are older, or have a lot of parental supervision to make sure they stay safe. Personally, I would not feel comfortable with any child age 13 or under having an unsupervised social media account of any kind.

How Social Media Hurts Kids’ Mental Health

Have you seen The Social Dilemma yet? If not, go watch it and come back…I’ll wait. It does a much better job than I could possibly do of explaining how social media puts children at risk of developing anxiety and depression. Imagine your 13-year-old past self for a moment. Think about how important your friends’ approval was to you. Remember how awful it felt when someone made a snarky comment about you? Multiply that by ten, one hundred, even a thousand, and that’s what tweens and teens are exposed to on social media.

Our brains were not designed to deal with social acceptance or rejection on such a large scale. Getting “likes” activates the pleasure centers of the brain and can become addictive. Kids on social media aren’t just comparing themselves to other students at school, but to professionally styled, heavily filtered influencers on TikTok and Instagram. This can really do a number on a child’s self-esteem. Research shows that depression, anxiety, and suicidal thoughts are all more common among teens who frequently use social media.

The Safety Risks of Social Media for Children

We have all heard horror stories about internet predators at this point. Fear-mongering news stories aside, it’s absolutely true that there are people out there who try to victimize kids online. Even if you’re in a “child-friendly” corner of the internet, or talking to someone who appears to be a fellow teen, you never really know who you’re dealing with.

Even though most kids are very aware of “stranger danger”, predators know what to say and do to earn trust. This is called “grooming”, and it lowers a child’s defenses and makes them more vulnerable to being financially or sexually exploited. Because being online feels so anonymous, it’s really easy to accidentally overshare personal information. Younger children tend to be impulsive, and they have a hard time considering the long-term consequences of their decisions. This can (incorrectly) make it feel less dangerous to send photos through apps like Snapchat, where they’re seemingly only available for a short period of time.

Are There Any Benefits to Social Media For Kids? (Actually, Yes)

Okay, so this all sounds pretty grim. Even though it’s super common, it’s undeniably risky for kids’ mental health and safety to have unrestricted social media access. But here I am, the children’s therapist, writing this blog post with Instagram pulled up on my phone and Facebook in the next tab on my browser. You may be surprised to learn that I think social media—when used in moderation—can be beneficial to kids’ mental health.

Social Media Is a Child-Friendly Creative Outlet

Social media can be an amazing creative outlet for kids. Many of my child clients primarily use social media to share fanfiction and fan art that they’ve created based on their favorite TV shows. Aspiring makeup artists, photographers, and fashion designers can also find an outlet for their passion online. I could write a whole blog post on the possible mental health benefits of this kind of creative expression. It’s meaningful, positive social interaction that helps kids build real-life skills. Especially during times when kids are stuck at home, positive and creative experiences like these can reduce their risk of depression.

Social Media Encourages Diversity

I also think social media can open a child’s eyes to a bigger, more diverse world. If you live in an area where everybody looks the same, this is an opportunity to provide racial windows for your child that give her a peek into another culture or way of life. Did you know there’s a big Indigenous and Native American community on TikTok performing dances and teaching about their culture? I didn’t until this year, and now I love watching their content.

I also think social media is a godsend for anyone living with a disability or chronic illness. A child who lives with a medical condition may be the only person at their school with that diagnosis. However, social media can connect him to tons of other people who get exactly what he’s going through. It can be a source of moral support, positive role models, and even advice. Being different can be isolating, and social media can make a child feel less alone.

Need More Help? Try These Resources for Tweens and Teens

It’s tough to figure out how to navigate the internet when you have young children. Unless you are planning to move off the grid, internet access is a necessary evil for today’s kids. My age-by-age guide to internet safety can help you figure out what activities are appropriate for kids from preschool through late elementary school.

If you have older children, my guide on internet and phone safety for preteens and teens may help. It talks about the specific risks older kids face online. You’ll also find advice to consider if you’re deciding whether your tween is ready for their own phone.

As you may have gleaned from this post, I’m a children’s counselor in Davidson, North Carolina. I especially love working with preteens who are dealing with anxiety and trauma symptoms. I’m able to work with families in North Carolina, New York, and Florida thanks to online counseling. If you’re in one of those states and would like to learn more about starting therapy, you can reach out to me here.

Signs of Separation Anxiety in Older Kids and Teens

The term “separation anxiety” might conjure up images of a toddler crying in the window as you pull out of the driveway. While it’s true that separation anxiety is super common in preschool kids, older children and even teenagers can be affected by it, too. As I’m writing this post, we are (still) in the middle of the COVID pandemic, which has kept kids of all ages at home with their parents for most of each day. I’ve noticed more older kids and teens coming into my virtual office these days with separation anxiety struggles. In this post, I’ll share some signs to look out for if you suspect that Separation Anxiety Disorder is the cause of your older child’s worries.

How Common is Separation Anxiety in Kids and Teens?

Separation anxiety is so common in young children that it’s considered a normal part of child development. In fact, it can be seen as a positive sign: it means that a child feels attached to his caregiver, which is always a good thing.

Historically, little children have needed to stay in close proximity to their parents in order to survive. Feeling anxious about being far away from a parent makes sense! This is why we often talk about separation anxiety in little kids, but don’t usually start referring to it as Separation Anxiety Disorder until about age 6.

Separation Anxiety Disorder is pretty common among older children. It affects roughly 4-5% of American kids between the ages of 7 and 11. If your tween child is struggling to leave home and do things away from the family, she’s not alone.

The older kids get, the less common Separation Anxiety Disorder seems to be. About 3.9% of young teenagers (12-14) are dealing with separation anxiety symptoms. The numbers go down even further for older teenagers, to about 1.3% for teenagers ages 14-16. Although it used to be considered a children’s condition, some research suggests that a small percentage of adults continue to struggle with Separation Anxiety Disorder into adulthood.

What Causes Separation Anxiety In Older Kids?

There’s no single cause for separation anxiety in older kids. As is the case with many mental health problems, a combination of genetics and life events seem to make some children more vulnerable to it than others.

Some children may simply be born with more anxious temperaments than others, kids can inherit these anxious traits from their parents. Kids with Separation Anxiety Disorder are more likely to have other types of anxiety disorders as well, like Obsessive Compulsive Disorder, Agoraphobia, and panic attacks. IF a child is naturally worry-prone because of their biology, they’ll be more predisposed to all these forms of anxiety.

Children who have been through stressful situations are also more likely to develop separation anxiety. Trauma experiences—especially ones that involved a child being separated or removed from a parent—can make it much harder for a child to be away from parents in the future. The loss of a loved one can also prompt children to cling more closely to surviving family members. Sometimes, less serious changes can also trigger separation anxiety, such as a big move or switch to a new school.

Both genetics and environment are usually to blame for separation anxiety. If your child has a naturally anxious temperament, they may be able to cope just fine as long as life remains calm. However, a big disruption can really activate their anxiety, and sensitive kids may have a harder time bouncing back. These kids may try to cope with their overwhelming anxiety by staying close to a parent, which can sometimes get in the way of day-to-day life.

What Are the Symptoms of Teen Separation Anxiety?

We all know that the major symptom of separation anxiety is fear of being away from a parent, and this is true for all kids from toddler age through the teens. However, all kids are different, and separation anxiety can manifest in various ways based on age.

Older children and teens may be less likely to voice their worries about being away from parents. This might be due to embarrassment or shame about struggling with something seen as babyish. Parents may need to look to their child’s behavior for clues that Separation Anxiety Disorder is behind their teen’s struggles.

Here are the symptoms that therapists use to diagnose Separation Anxiety Disorder in kids and teens:

• Anxiety about being away from an important caregiver that is excessive and not typical for the child’s age. This can lead kids or teens to avoid separating from parents altogether.

• The anxiety or avoidance is persistent and lasts at least 4 weeks.

• The child or teen suffers negative consequences due to their anxiety, and it may interfere with school, work, or friends.

• The problems aren’t better explained by another reason or another form of anxiety.

Now that we know the symptoms to look for, let’s see how these problems might look in teenagers or older kids.

Signs of Separation Anxiety to Look Out For

Here are a few signs of teen separation anxiety to look out for:

• Refusing to go to school: this is a big one. Plenty of teenagers are reluctant to go to school for all kinds of reasons. If your child’s dread about school looks more like anxiety or sheer panic, without a clear reason, social anxiety could be an underlying cause.

• Worrying about the health or safety of family members: many kids with separation anxiety fear that something terrible will happen to their caregivers if they let them out of their sight. This can be true for teens, as well. Teens are more able to imagine worst-case scenarios than younger children. They may be especially prone to these worries if they’ve survived a trauma or experienced the serious illness or injury of a family member.

• Fears about kidnapping or getting lost: teens are very aware of stranger danger and other safety risks. If their anxiety levels are high, they may be overly worried about their safety when they are away from home. The fear is out of proportion to the situation, and might hold them back from going on outings alone.

• Body symptoms: for some people, anxiety mainly shows up as physical illness rather than emotional upset. If that’s the case for your teen, you’ll likely notice that the symptoms start shortly before a separation and resolve once the threat of being away from parents has passed. Of course, it’s always a good idea to rule out medical causes before assuming this is a sign of anxiety.

• Avoiding outings with friends: difficulty being away from home might lead teens to turn down social invites they would otherwise be interested in. It may be too anxiety-provoking to participate in activities if you aren’t there, too. This can negatively impact a teen’s social life.

• Meltdowns: you may notice your teen having meltdowns when it’s time to leave the house. They may seem unexpected for your child’s age, and even resemble the tantrum of a younger child. It’s a sign your child is so overwhelmed with anxiety that she’s moved past her ability to cope.

Begin Counseling For Teens With Separation Anxiety in North Carolina

Whether it’s due to an anxious temperament, life stress, or the pandemic, counseling can help anxious kids and teens get back on track. It’s really satisfying to watch teens master their separation anxiety through cognitive behavioral therapy. Sometimes, the process is surprisingly quick once teens feel empowered and they have the right tools!

If you are looking for therapy for a preteen or young teenager, I may be able to help at my Davidson, North Carolina counseling office. If your family lives anywhere else in North Carolina, New York, or Florida, we can meet virtually in my secure telehealth platform. If you’d like to learn more, contact me here. I’m always happy to answer questions!

Helping a Teenage Girl With Anxiety: What to Say, and How to Say It

Did you know that teen girls struggle with anxiety at higher rates than teen boys? During the elementary school years, about 5% of girls and boys will be diagnosed with depression. As puberty approaches, those numbers shift: by the teen years, as many as 20% of teen girls have symptoms of an anxiety disorder. If your teenage daughter is struggling with anxiety, she isn’t alone.

It can be easy as an adult to look back at the high school years through rose-colored glasses. As exciting as the teen years can be, they also come with a lot of stress. Teenage girls have to tolerate all kinds of uncertainty: a changing body due to puberty, shifting friendships and social groups, and unknowns about life after graduation. Social media pushes an impossible standard of beauty on teen girls. Meanwhile, standardized testing and resume-building activities are putting more pressure on today’s teens at school than ever before. It’s no wonder so many young women are feeling stressed.

Some of this stress is inevitable, but parents and caregivers can do a lot to make life easier for teen girls. Here are a few ways you can help your anxious teen to cope with stress in a healthy way.

Don’t Try to Solve Your Teen’s Problem—Validate It

If someone is venting to you, it’s tempting to start offering advice right away. This is especially true with teenagers, who are going through problems that might sound all too familiar to us from our own teen years. I struggle with this same advice-giving impulse sometimes in my therapy office: therapists were teenagers once, too! Unless you’re directly asked to give advice by your teen, it might be more wise to validate their feelings rather than jumping straight to a solution.

When a teen vents her worries or frustrations, she’s not necessarily asking you to “fix” anything. She’s looking to connect with you and feel heard. That may be all the comfort she needs to self-soothe and figure out the solution to her issue on her own. You can let your teen know that you empathize with her and that what she’s feeling is totally normal and understandable. If you’re feeling the pull to give advice, consider a short, sweet validating statement instead:

• “Ugh, that sounds awful.”

• “That would upset me, too.”

• “I can see why this is so important to you.”

• “What a rough day.”

Highlight Your Teen Girl’s Strengths, Rather Than Her Anxiety

Sometimes, talking about anxiety actually makes it worse. While some venting and validating can help (see above!), continuing to rehash the same information tends to intensify anxious feelings. Have you ever found yourself in a conversation where you’re hitting the same points over and over again, and it kind of feels like you’re circling the drain? You keep analyzing and re-analyzing, but there’s no resolution.

This kind of circular thinking pattern is called ruminating, and it’s common in both teens and adults who struggle with anxiety. Just like water circling a drain speeds up and gets faster, ruminating tends to amplify our worries. Rather than falling into the trap of ruminating, redirect your conversation to focus on your teen girl’s strengths. After you validate her feelings, you can show her you’re confident that she can overcome whatever situation she’s facing. Consider saying something like:

• “This sounds so hard, but I know you can handle it.”

• “You are so brave.”

• “You’ve done this before, and you can do it again.”

• “You’ve got this!”

Practice Coping Skills to Relax and Manage Worries

We all know we need to relax when anxious, but it’s easier said than done. Well-meaning friends might suggest that we “just breathe” or “just relax”, which might work fine for someone who has a lot of practice using coping skills. For many teens, though, this advice isn’t specific enough. They need to learn what relaxation feels like, and find the coping skills that work best for them.

Learning how to take deep belly breaths, rather than shallow breaths, can help teens learn how to use the breath to soothe anxiety. For some teens, body-based techniques like progressive muscle relaxation work better than breathing. Mental health apps designed for teens, like What’sUp?, give teens portable tools to stay grounded during panic attacks. I also have an online course, Worry-Free Tweens, that teaches my favorite coping skills for anxiety to both kids and their parents.

Although teen girls are more likely to struggle with anxiety than younger children, they also have more options when it comes to dealing with their worries. Teens have the advanced verbal and cognitive skills needed to start noticing their own thoughts. Rather than accepting their worries at face value, teen girls can double-check to see if they are worth listening to. Cognitive Behavioral Therapy can teach teens and young adults how to “think about thinking” and manage worries more easily.

Cognitive Behavioral Therapy for Teen Girls With Anxiety

If supportive conversations and coping skills don’t seem to be enough, counseling can help teens girls overcome anxiety. You don’t need to be in a full-in crisis situation in order to benefit from therapy. Normal life transitions like starting at a new school, managing homework stress, or dealing with friend drama are common and valid reasons to seek out a counselor. Sometimes, it’s just nice to have an unbiased person to work through all this stuff with who isn’t a friend or a parent.

In particular, Cognitive Behavioral Therapy can be a great option for teen girls with anxiety. It goes beyond just talking about worries—teens walk out the door with tools they can use right away to start coping with life stress. It’s really empowering to get a handle on strong feelings like anxiety. Teens can take the newly learned self-confidence and coping skills they learn in CBT with them into young adulthood.

If you’re in North Carolina, New York, or Florida and looking for a CBT therapist for your teen girl, I’d love to help! I’m local to the Davidson, North Carolina area, but I can see teens from all three of these states online. You can learn more about me and my approach, or shoot me an email if you’d like to set up a first appointment.

Is Your Child a Highly Sensitive Person?

Have you noticed that your child is deeply affected by things that don’t seem to faze other kids? Maybe your son is ultra-sensitive to the way clothing fits, and absolutely can’t stand seams in his socks. Or, your daughter always seems to melt down after spending a day in a loud or crowded place. Many of the children I work with in my child counseling practice fit this description: they’re very perceptive, emotional, and respond strongly to changes or sensory input. They might be Highly Sensitive People, a term used by some therapists and parenting experts to describe kids who have big responses and strong feelings.

What Is a Highly Sensitive Person?

“Highly Sensitive Person” is a term coined by the psychologist Dr. Elaine Aron in the 1990s. According to Dr. Aron, Highly Sensitive People (or HSPs) are neurologically wired in a way that makes them more sensitive to the world around them. This means they respond more strongly to sensory stimuli, like loud sounds, strong smells, and bright lights. They also react with bigger, stronger emotions as a result. HSPs tend to feel things very deeply, and may need a longer time to emotionally recover when upset.

Being “Highly Sensitive” Is Not a Diagnosis

Being highly sensitive isn’t a disorder or mental health problem, it’s just a personality trait. It’s also more common than you might think! Dr. Aron estimates that around 15-20% of people qualify as highly sensitive. In fact, she considers herself to be a Highly Sensitive Person. Just like a person might be introverted or extroverted, they can also be more or less sensitive.

A therapist can diagnose a child with anxiety or depression, but they can’t diagnose a child as being an HSP. There is no in-depth test that can “prove” how sensitive a person is. What’s more, being highly sensitive isn’t a problem to be solved. Just like any personality style, it has its pros and cons. On one hand, the strong reactions and emotions HSPs experience can be hard to manage. On the other, they tend to be incredibly empathetic, creative, and perceptive.

Ultimately, calling someone (or yourself) a “Highly Sensitive Person” can help put a name to experiences that otherwise might feel lonely or “weird”. It can be helpful shorthand to describe your child, and might help you find coping strategies to help with strong feelings. On the other hand, it’s just a label. You only have to use it if it’s helpful to you.

Signs Your Child May Be Highly Sensitive

Wondering if your child might be a Highly Sensitive Person? Here are a few of the most common signs of high sensitivity that I see in my child therapy office:

• Difficulty With Change: Pretty much every child struggles with transitions sometimes, but HSPs are really affected when their routines are thrown off. This can look like an inconsolable tantrum if a playdate is canceled, anxiety about going on an unexpected errand, or discomfort with their room being rearranged at home.

• Empathy and Intuition: Because highly sensitive kids are so attuned to subtle changes, they’re great at spotting other people’s emotions. These kids are often the ones who can read their parents like a book and pick up on everyone’s nonverbal cues. They can easily feel what others are feeling, which often makes them compassionate young people.

• Easily Overwhelmed: Sensory input that wouldn’t bother other people can overwhelm a sensitive kid. They may not be able to tolerate loud parties or music as well as other children. Certain textures or foods might bother them. Busy places can be visually overstimulating and lead to fatigue or a grouchy mood. I also often hear about HSP kids being particular about their clothing having the right fit or texture.

• Strong Emotions: These kids might get labeled as “dramatic” or “fussy” by others. They feel things deeply, and their emotions tend to be bigger and last longer than you might expect. Being highly emotional often means HSPs are creative and funny. However, without adequate coping skills they can be overwhelmed by their feelings.

No formal test exists that can “diagnose” someone as being a Highly Sensitive Person. However, if you’re curious, you can take this self-test on Dr. Aron’s website to see if your child fits many of the HSP traits.

How to Help a Highly Sensitive Child

It can be tough growing up as a highly sensitive kid. Adults may not always understand why a child feels things so deeply. Meanwhile, a child may have a hard time putting her big feelings into words. If your child is struggling with sensory overload or emotional overwhelm, there are things you can do to help.

• Remember the Positives: If you’ve been dealing with the harder parts of this personality style, it can be easy to forget that being highly sensitive is a gift. I’d be willing to bet that many artists and people in creative professions are HSPs. You can’t have all that empathy and intuition without also having the sensitivity and anxiety—they’re two sides of the same coin. You can help your child to reframe her way of seeing the world as a strength, rather than a weakness.

• Practice Coping Skills: A highly sensitive child’s powerful emotions can easily lead to overwhelm. These kids need to learn healthy ways to channel their strong feelings, so they don’t turn into panic or tantrums. You can support your child by practicing mindfulness or relaxation skills at home to soothe anxiety. Physical activity, art, and journaling are other helpful outlets for strong emotions.

• Provide Structure: Many sensitive kids fare better when they have a predictable schedule. Children feel safe when they know what’s coming next, so a set routine can calm your sensitive child’s nerves. Consistent boundaries can also help children with strong feelings to better regulate their feelings. This doesn’t mean you have to be harsh or strict—just that you generally stick to your word. Just like a predictable routine, predictable rules help children feel more secure.

Considering Child Counseling in North Carolina?

Sometimes, despite everyone’s best efforts, kids need a little extra help. I tell families that a child doesn’t need to have a serious problem in order to benefit from counseling. There’s probably a time in every person’s life when having somebody to talk to can make a difficult phase pass by a little more easily.

If your sensitive kiddo could use some strategies for dealing with strong emotions, check out my online coping skills courses for kids. They’re available at-home, on demand, wherever you live. Worry-Free Tweens, my course for kids ages 8-12, could be a good bet if your child’s sensitivity leads to anxiety.

A child counselor can help your child better understand her strong feelings. In therapy, highly sensitive kids can learn how to cope with the day-to-day situations that lead to stress. They can also learn ways to self-soothe and deal with overpowering feelings when they happen. My hope is that kids and parents leave my office recognizing how cool it is to have strong feelings.

I love working with highly sensitive kids and preteens in my Lake Norman counseling office. If you aren’t nearby, I also see children for online therapy throughout North Carolina, New York, and Florida. Ready to get started? You can get more information or request an appointment here.

5 Things Your Child Learns When You Play Together

“Mom! Dad! Play with me!” If you are the parent of a young child, you’re familiar with this plea. Kids crave individual playtime with a parent more than pretty much anything else on the planet. We all know that “quality time” is important for families. And, if you’ve ever visited a children’s counselor, you’ve probably heard all about the importance of parent-child playtime from them, too. What exactly makes this play so special? When you play together with your child, you’re teaching them important lessons about themselves and the world.

Children Learn Through Play

Have you ever watched your child repeat an activity over and over again? Maybe your preschooler watched the same movie every day, or loved to repeat the same game for what seemed like forever. Kids repeat things in their play because they are using play to figure out something new. Play is one of the main ways the children learn. Even when it looks like they’re just goofing off and having fun, they’re also doing serious work that helps them grow and develop.

Social skills, fine and gross motor skills, and creative problem-solving are all learned or practiced through play. You are nurturing life skills when you play with your child, but you’re also nurturing your relationship. Play can help you and your child to bond. It can also teach your child important lessons about herself, and how you see her.

Play Lesson #1: “I Am Important”

Some parents are surprised to learn that setting aside time for individual play is so helpful to kids. After all, many children are with at least one parent all day long! Sometimes, it can even feel like there’s a little too much togetherness when everyone is cooped up at home.

Even if you and your child are together a lot, much of that time is spent multitasking. We have all “uh-huh-ed” our way through a conversation with a child while replying to a text, or half-watched a movie while trying to finish some work. That’s life! Nobody is perfect.

During playtime, however, all of your focus is on your child. You are totally present. Ideally, this means no phones or screens. When you do this, you are letting your child know that they matter to you. Their interests and feelings are important, and worthy of your undivided attention. This kind of attention strengthens your child’s self-esteem. It may also make it easier to handle not being the center of attention at other times of day.

Play Lesson #2: “My Parents Listen to Me”

As a play therapist, I help parents learn how to play with their kids as part of my work. Sometimes parents tell me they aren’t sure what to say while playing. How do you respond when your child is telling you about an elaborate Star Wars Lego adventure or dollhouse family saga?

When in doubt, you can always reflect what your child says back to them. When you paraphrase or repeat back what your child just said, it shows you are listening. Kids love to feel heard, and they don’t always feel like grown-ups pay attention to what they say. It is empowering to know that what you say is important enough to be listened to, even if the topic is Star Wars Legos.

Children learn social skills through play. When you listen to your child, you are teaching them to be a good listener by example. Over time, it can help them to be a better listener when you’re speaking, too.

Play Lesson #3: “This is What Good Behavior Feels Like”

Kids are usually on their best behavior when playing. And why wouldn’t they be? It’s fun, it helps burn off energy, and it gives children a chance to feel like they’re in charge for a little while. Whining, tantrums, and other forms of negative attention-seeking often seem to melt away. This is especially true when a parent is following the child’s lead during play.

Children are more likely to repeat behaviors that we pay attention to. All too often, good behavior gets ignored due to the business of everyday life. We might only stop to reprimand a child for negative behavior, and take advantage of quiet “good behavior” times to get other work done. This can mistakenly lead a child to believe that the only way to get our attention is by acting out.

Playing with your child gives you the chance to point out good behavior and reward it with a heaping helping of positive attention. Your smiles, praise, and focus lets your child know that you like what they are doing. That feels great! Kids can then mentally “flag” that behavior as something that got a positive reaction from you. This means they’ll be more likely to show that good behavior again in the future.

Play Lesson #4: “I Can Be Mindful”

Another trick I teach parents in my office is to verbally track what their child is doing during play. This is something that play therapists do all the time. “Tracking” means simply describing the actions you see your child doing. If you imagine a sports commentator talking about a game, it’s a similar idea.

Children are still learning to be self-aware. A lot of the time, they’re acting on their impulses and are not really conscious of what they’re doing, or why they are doing it. This can make it hard to be “well behaved”—after all, how can you change your behavior if you’re not aware that it’s happening?

Describing your child’s play increases their self-awareness, and helps them to be more mindful of their actions. We know that mindfulness is an important skill for helping children (and adults) to manage strong feelings without becoming overwhelmed. Being more mindful during play also helps active or distractible children to focus on an activity. You may notice your child sticks with an activity longer if you are narrating while they play.

Play Lesson #5: “I Am Loved”

The activity you choose for playtime doesn’t really matter. The warmth exchanged between you and your child is what’s most important. A lot of nonverbal communication happens during play: smiles, laughter, hugs, or pats on the back are common. Play makes it easy to feel and show affection, which brings up warm, fuzzy feelings for kids and parents alike.

Playing together strengthens your parent-child bond. It helps children to feel safe in their knowledge that you love them unconditionally. Feeling loved increases a child’s emotional resilience. It can make it easier for them to cope during periods of stress.

All this bonding has a benefit for parents, too. If your child has been challenging you with difficult behavior, it might be hard to summon up those warm, fuzzy feelings all the time. During stressful times, positive experiences with a child can feel few and far between. Setting aside time to play makes sure that those positive experiences keep happening even during hard times. Playtime can help you feel closer to your child, and make parenting feel more rewarding.

Are You Considering Play Therapy in North Carolina?

Individual playtime with a parent can work wonders for children. It can improve relationships, increase resilience during times of stress, and even improve tough behaviors. Sometimes, though, children need more help. A specially trained play therapist can work with you and your child to help you get through stressful times more easily.

Play therapy is a great fit for younger kids, because they still do most of their learning through actions rather than words. It can help kids with anxiety, trauma, and general life stress. If you’re looking for a play therapist and you live in North Carolina, New York, or Florida, I may be able to help. My play therapy office is located in the Charlotte area, and I also provide online counseling to kids in all three of these states.

You are always welcome to call or email me to learn more about how play therapy can help your child. If you’d like to go ahead and request an appointment, you can do that too!

What Age Can A Child Start Therapy?

How young is too young to see a counselor? Every week, I talk to parents on the phone who are trying to figure this out. Starting therapy can feel like a big step, and nobody wants to jump the gun. On one hand, a child may be passing through a phase that will resolve on its own. On the other, behavior struggles are tough for the whole family even if it is “just a phase.” In this post, I’ll unpack how old a child needs to be to benefit from therapy. I’ll also share tips on what to expect in counseling according to age, and signs that you should consider getting help.

The Younger the Child, The More Involved You’ll Be in Therapy

When you imagine what therapy looks like, you probably envision the patient sitting alone in a room with their counselor. Individual therapy is the most common form of therapy in the U.S., especially for adults. Things look a little different for kids in therapy. Depending on their age and developmental level, kids don’t always get the most benefit from working 1-on-1 with their therapist. As a rule of thumb, the younger your child is, the more time you can expect to spend in the room with your child’s counselor.

Parents are the center of a young child’s life. Little kids look to their caregivers to decide how they should think, feel, and act. Their connection with their parent is what helps them feel safe. Because your young child takes so many cues from you, it’s hard to create any lasting change in therapy if you aren’t kept in the loop.

Can Really Little Kids Benefit From Counseling?

You might be surprised to learn that special forms of therapy exist to help babies and toddlers with emotional problems. This type of therapy always includes the parent and child together, and helps the parent learn new ways to soothe their baby and deal with hard behavior. This can be especially helpful for young children who have survived trauma.

When I see preschoolers in therapy, I try to have parents join for about half the session. That way, we have a chance to learn coping skills together and problem-solve anything new that’s come up during the week. Most preschoolers are able to meet alone for part of their therapy session. However, they’ll need their parents’ help to practice the new things they’re learning in therapy at home.

For elementary-aged kids, it’s still helpful to have a quick check-in at the beginning of the therapy hour. Kids this age usually meet alone most of the time, but will still need reminders and support from parents in between sessions. I like to meet with parents periodically to talk about our progress in therapy, and discuss skills they can use to at home to help their child.

When Can Children Go to Therapy By Themselves?

Many preschoolers can benefit from individual play therapy. In my therapy office, I usually meet with 3-, 4-, and 5-year-old kids alone for half of each session. Preschoolers make sense of their world through play, and can’t always put their feelings into words. This makes play therapy a fantastic option for this age group, since it builds on a young child’s natural strengths.

I usually start seeing children for therapy by themselves around ages 7-9. By this age, kids have gotten used to separating from their parents each day for school. They are more independent, and much more able to verbalize their thoughts and feelings. Elementary school kids are also starting to develop more advanced thinking skills. This makes them a great fit for cognitive behavioral therapy, or CBT, which helps kids learn how to deal with overly negative thoughts and feelings. Parents of elementary school kids should still plan on meeting with their child’s therapist on at least an occasional basis.

By middle and high school, most kids are able to manage therapy almost entirely by themselves. Tweens and teens crave independence and have started forming an identity away from the family unit. Having an unbiased listener to vent feelings to in confidence can be really helpful at this age. While I still work closely with parents of tweens and teens, they don’t usually need to meet with me as frequently.

How to Tell if Your Child Is Old Enough for Therapy

Age isn’t the only thing to consider when deciding whether your child is ready for therapy. Every child is unique and develops at their own pace, so there’s no one-size-fits-all answer. Keep an eye out for these signs to decide whether your child will benefit from one-on-one time with a therapist:

• Your child has started make-believe play: for example, they can use an object to represent something else while playing.

• Your child can communicate her needs to other people if you aren’t around.

• With help, your child can focus on an activity for more than a few minutes.

• Your child has started verbalizing thoughts and feelings.

Every child’s situation is different. If your child is meeting milestones at a different pace due to a health condition or developmental delay, they can still benefit from counseling. Look for a therapist who has training in helping children with special needs to make sure you have the best possible fit.

Signs That Therapy Could Help Your Child

It’s totally normal for young children to throw tantrums, fear monsters under the bed, or enjoy using the word “No” whenever possible. So how do you figure out when a problem has gotten big enough to consider therapy? In my experience, the fact that a parent is considering therapy at all is usually a sign that things have gotten too hard to manage.

You don’t have to wait for a crisis to call a therapist. In fact, sometimes it’s nice to get an outside perspective on the typical, every day problems of growing up. Even if you can muddle through a situation on your own, a therapist can help make things easier and less painful for everyone involved.

Here are a few indicators that therapy could help your child:

• Your child is struggling with her feelings more than other kids her age

• The problems are getting in the way of daily activities like eating, sleeping, play dates, or school

• Your child is having difficulty making or keeping friends, or getting along with siblings

• The problems started after a stressful event

• You’ve noticed that things are getting worse, not better

After you have thought about your child, take a minute to check in with yourself, too. How is your stress level about this issue? Are you feeling so overwhelmed by your child’s emotions that you’re not sure how to help her manage them anymore? Feeling pushed beyond your own limits as a parent is a totally valid reason to look into counseling.

Begin Child Therapy in Charlotte, North Carolina

If you are looking for a child therapist in the Charlotte area, I can help. I’m a children’s counselor and Registered Play Therapist who loves working with kids from preschool through the preteen years. You can meet me for individual or parent-child therapy at my office in Davidson, or join me online from anywhere in North Carolina, New York, or Florida.

Not in one of those states? I can’t provide counseling, but you may be interested in my coping skills class for tweens. It’s an online video course that includes step-by-step help for both kids and parents to better manage anxiety at home.

Have questions about getting started? Learn more about me here, or reach out by phone or email.

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.

Help! My Child Won't Stop Interrupting Conversations!

It's normal for young kids to blurt things out sometimes, but parents can help make it easier to hold that thought.

Remember “BBC Dad”? The guy who was giving an interview with the BBC about South Korea when his 4-year-old toddled through the door behind him on camera, followed shortly by his adorable baby in a bouncer? I’ve been thinking a lot about poor, flustered BBC Dad lately in this age of Zoom calls, and how tough can be when kids continuously interrupt conversations, whether they are virtual or face-to-face. In this post I’ll be unpacking a few reasons why kids may struggle with interrupting, and what parents can do to help.

Why Does My Child Interrupt?

It’s normal, common, and even developmentally appropriate for young kids to interrupt conversations sometimes. From roughly age 2 to age 7, children are naturally egocentric, meaning that it’s hard for them to think about points of view different from their own, or to separate their thoughts and feelings from other people’s. Kids this age tend to assume that everyone is thinking and feeling the same way that they are. This can make it hard for young children to realize that other people have important thoughts to share, too, and may not be ready to hear what a child has to say.

Here are a few other factors that can contribute to frequent interrupting behavior in kids:

• Difficulty with impulse control

• Boredom

• Trouble with social skills, such as recognizing natural give-and-take in conversations

• Desire for attention from a parent or other adult

• Stalling to avoid an unwanted activity

Has Zoom Made Kids’ Interrupting Worse?

I accidentally interrupt people on Zoom calls all the time. The few seconds of lag time between when someone speaks and when you hear their voice makes it easy to assume someone is done talking when they really aren’t. It’s pretty easy for adults to navigate this with minimal awkwardness, but for kids, it might be much harder to do.

In addition to the slight sound delay, there are fewer opportunities to pick up on nonverbal communication in video conferencing calls, especially if there are many participants. We can’t really read body language when we’re only seeing people from the shoulders up, and people’s faces are pretty tiny when the whole class is on the call together! This could make it even harder for kids to know when it’s a good time to talk.

Finally, I know that some kids feel quite anxious about online school. While Zoom calls are a big relief for many children with social anxiety, for others, it can be overstimulating. Kids who are feeling a little uneasy about being on camera or who worry they may be overlooked by their teacher due to the large number of kids on the call will be much more likely to interrupt.

Give Visual and Physical Cues To Let Your Child Know You’ve Heard Them

Kids who interrupt are trying to connect with people around them, which is awesome! They may just need a gentle acknowledgement that we’ve seen their request to speak and haven’t forgotten about them. A hand gesture can let your child know you’ve seen them and will be with them shortly, without you having to break the flow of your current conversation.

Ariadne Brill from Positive Parenting Connection describes how she used to gently hold her child’s hand when he interrupted her on the phone, to let him know that they were still connected and he’d have her attention soon. For older kids, try holding up 2 or 5 fingers to let them know how many minutes you need, or coming up with a funny secret code together that you can use to gently make them aware of their interrupting when it happens.

Boost 1-on-1 Time Together

When kids are craving attention, they’re more likely to rely on difficult behaviors like interrupting to try to get their needs met. If your child has been going through a particularly stressful time, she may need a little more attention than normal to feel secure. Similarly, kids who have had to share a parent’s attention with a sibling may be feeling a little lacking in individual support.

Setting aside a few minutes a day of individual, focused playtime with your child can help them get their need for attention met in a more positive way. Kids who get this 1-on-1 time often feel more secure in their connection with their parent, which can make it easier to tolerate time apart. This can help cut down on interrupting in the long run.

Practice Social Skills at Home to Interrupt Politely

Some kids may just need the right language to interrupt politely. You can teach your child to say “excuse me” or “may I please interrupt” when they have something important to say, and praise them when you hear these words. It’s also helpful for kids to learn the times when it is good to interrupt, such as in an emergency or when someone has been injured.

The picture book “My Mouth Is a Volcano!” is a children’s therapy go-to for young kids who are struggling with interrupting. The story, told from the point of view of an elementary school-aged boy, can be validating for kids who interrupt. It highlights the positive intentions that sometimes motivate kids to interrupt: for example, being really eager to share information that feels important with your friends and family. At the end of the story, children learn a simple coping skill to help them self-soothe and hold on to important thoughts until there’s an appropriate time to share them.

Model the Behavior You’d Like to See

Kids learn how they should behave from the adults in their lives, so any time a child is struggling with a behavioral issue, it really helps them to see the grownups around them practicing what they preach. Do you come from an outspoken family where people tend to talk over each other? Have you been a little lax in your own manners when you need to interrupt your child in conversation? I know this is something I could be more mindful of in therapy sessions, myself!

Nobody is perfect, but really accentuating the behaviors you’d like to see more of can help your child pick up on them, too. Make a point of saying “excuse me” or apologizing to your child for interrupting when it’s really necessary to do so. When you notice your child using good manners, heap on the praise! Children tend to repeat the behaviors that we pay a lot of positive attention to, so showing your enthusiasm for their newfound manners is a good way to encourage a repeat performance.

More Ways to Help a Child Who Constantly Interrupts

I’ve written a few other blog posts that might be of interest if you’re struggling with a tiny interrupter. If your child is really struggling to stay on task during online school, these tips to help combat Zoom fatigue may help improve his focus and comfort during class.

Online social groups are an excellent resource for kids looking to brush up on their social skills while still practicing social distancing. I’ve rounded up a few suggestions for online groups here, as well as outlined the benefits of these kinds of group activities for kids.

If your child is having a hard time picking up on social cues and collaborating with others, counseling that incorporates drama therapy might be a fun, low-pressure way to practice teamwork, nonverbal communication, and the other “soft skills” that help children communicate effectively and make friends.

I run an online group that helps middle schoolers brush up on social skills through game play—if that sounds appealing for your preteen, you can read more about my Dungeons & Dragons Social Support Group here.

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.

Why Do So Many Kids and Teens Have Depression During the Pandemic?

In normal times, I don’t see many kids or teens with depression coming to my office for help. It’s much more common for me to meet children who are struggling with anxiety, or who have been impacted by a recent trauma. I figured that the coronavirus pandemic would bring more of the same: lots of kids feeling super anxious about the virus, or who were experiencing the pandemic and quarantine as a traumatic event.

At first, this was true: I did see lots of anxious kids in March, April, and May. But things have changed recently. Suddenly, it seems like almost every child I meet has symptoms that warrant a diagnosis of depression. Given these new struggles, I thought it would be helpful to talk about childhood depression today: what causes it, how to spot it, and how to know when to get help.

What Causes Depression in Children and Teens?

When you imagine depression, you might picture it as the result of bad things happening in a child’s life: for example, a divorce, a serious illness, or bullying at school. Kids who experience these kinds of events can absolutely feel depressed, but for many kids, depression happens without a clear cause.

Sometimes, it isn’t negative experiences, but a lack of positive ones that leads to depression. Many psychologists believe that depression happens when we lose our ability to socialize with others, and participate in activities that are fun or rewarding. A child who is feeling isolated may begin to feel depressed, and this can set off a vicious cycle: kids who feel depressed lose interest in activities they used to enjoy, which leads to more social isolation. This can make it really hard to beat depression, and symptoms tend to get worse over time.

For other children, genetics and biology might play a part in depression. Scientists have identified at least one gene that may be linked to depression, and people who have an immediate family member with depression are up to 3 times more likely to experience depression themselves. An imbalance of chemicals in the brain, such as serotonin, might also contribute to depression for some kids.

How Quarantine Increases Depression Risks for Kids

As the pandemic wears on, many children seem to be developing depression symptoms who didn’t struggle with depression before. Even if a child doesn’t know anyone who has fallen ill, they may still notice changes in mood. Kids and teens who haven’t been directly affected by the coronavirus are still finding themselves feeling down, crying more easily and often, and losing interest in the activities that used to excite them.

When you think about depression as coming from a lack of positive experiences, rather than an excess of negative experiences, this starts to make a lot of sense. Most children have remained physically safe and unharmed during quarantine, but they’ve lost many of the activities that add joy to life. Social distancing is critically important, but it has some side effects that increase the odds of depression for kids and teens. For example:

• Many clubs, classes, and extracurriculars have been canceled or postponed.

• Online school is very structured, and kids miss out on the casual chats with friends in the halls, cafeteria, etc. that help to build friendships.

• Most children are going on fewer face-to-face hangouts and playdates with friends, and may have limited options for outings.

• Kids who have recently moved or changed schools have very few ways to meet new people.

Which Kids Are Most Affected by Pandemic Depression?

Quarantine may be especially hard on preteen and teen-aged kids, because being away from other young adults makes it harder to develop and grow. Friends play an increasingly important role during the preteen and teen years. Older children are expanding their horizons, becoming more independent, and developing their own identity, and they need their peers to accomplish these tasks.

Children of any age who already struggled with social anxiety or feeling isolated may also be at increased risk of depression. Kids who had a strong social network before the pandemic tend to be faring better right now, because it’s fairly easy for kids to maintain close friendships online. On the other hand, kids who were already lonely feel even more so right now, and they have few opportunities to meet new people or turn acquaintances into closer friends.

Signs of Depression in Children and Teens

Let’s be honest: a lot of us are feeling a little down right now, and that’s normal and okay. It can be hard to differentiate between everyday quarantine malaise and symptoms of depression that might require extra support. This can be especially true when we’re dealing with kids. Here are a few signs and symptoms of depression to keep eye out for if you are concerned about your child:

• Ongoing, prolonged feelings of sadness and hopelessness

• Pulling away from friends and activities that used to be fun

• Sleeping too much or too little

• Being irritable or extremely sensitive to criticism or rejection

• Fatigue, low energy, or low motivation

• Headaches, stomach aches, or other physical symptoms that don’t have a medical cause

• Decrease in self-esteem

• Thoughts about death or a wish to be dead

When (And How) to Get Emergency Help

Most children and teens who are depressed do not have thoughts about suicide. However, it’s important for parents who suspect their child may be depressed to be on the lookout for warning signs that could indicate a child is thinking about or seriously considering suicide:

• Isolating from family and friends

• Writing, drawing, or talking about death in a preoccupied way

• A sudden, major shift in personality

• Increasingly aggressive or risky behavior

• Giving away important belongings

• Threatening suicide

Any time a child threatens suicide, it has to be taken extremely seriously. Parents who worry their child could be at risk of seriously hurting themselves should head to the nearest emergency room, where a child can get help right away.

If your child is struggling with suicidal thoughts, there are resources to help. Parents or children can call the Suicide Prevention Lifeline for help at 1-800-273-8255. Teens can also text “home” to 741-741 to contact the Crisis Help Line, where they’ll be put in touch with a crisis counselor who is trained to work with young people. Both these services are free, and available 24/7.

Help for Kids and Teens With Depression During Quarantine

Social support systems are our best weapon to fight depression, especially during quarantine. You can help your child by encouraging her to find new ways to stay in touch with friends. I find that online socializing feels less awkward and more “real” when there is some structure to it: for example, playing a game, cooking a recipe, or even watching a movie together. Small groups or one-on-one Zoom hangouts also tend to feel more natural and less intimidating than large group calls.

Any activities that are new, different, or give a sense of accomplishment can help. You can gently encourage your child to accompany you on grocery store runs, walks, or other outings for a change of scenery. Kids with depression may be incredibly reluctant to get out of the house, but the more they do it, the easier it will become.

If you’re noticing big changes in your child’s mood, counseling can help get your child back on the right track. Cognitive behavioral therapy can help young people notice the overly negative thought patterns that fuel depression and keep them feeling down. It can also help them to learn coping skills to deal with intense sadness, and discover activities they can enjoy even in the midst of the pandemic.

Online therapy for kids is available in many communities, and some counselors have begun offering online social groups for kids, like my Dungeons and Dragons gaming group for girls. If you’d like to learn more about the group or my approach working with kids online, you can contact me here.

How Do I Know if My Child Has Sensory Issues or Emotional Problems?

“It is a daily struggle to get my son to brush his teeth.”

”My daughter has a huge meltdown any time we go to a crowded place.”

”My child plays too rough with other kids, and can’t seem to get out of their personal space.”

”We spend forever trying to find clothes my child is willing to wear, because nothing feels ‘right’ to him.”

Do any of these sound familiar to you? Concerns like these bring many families to a child counselor’s office, because they can really get in the way of a child’s life and cause stress for the whole family. But how can you know if your child’s behavior are caused by emotional struggles like anxiety, or by sensory issues? In this post, I’ll be talking about common signs of sensory processing difficulties that might show up as behavioral or emotional problems.

What Are Sensory Processing Issues, Exactly?

“Sensory processing” describes the way that our brain and nervous system deals with the information we receive through our senses. We take in sensory information all day long through our eyes, ears, noses, mouths and hands, and special receptors pass along this information to the brain, which interprets the information and decides how important it is. For most of us, this all happens pretty easily: our brains can manage the amount of sensory information they’re receiving, and know just how to handle the information when it arrives.

For some people, though, this process isn’t quite so easy. They may be easily overwhelmed by the sensory information they’re receiving, which is called hypersensitivity. They may crave more sensory information and not be getting enough, called hyposensitivity. Or, they may have a hard time organizing information from different senses and keeping it all in sync, a process called sensory integration. This kind of trouble with sensory information is more common than you might think: it likely affects between 5 and 15% of kids.

How do Sensory Processing Issues Affect Kids?

Sensory processing issues can affect any of the 5 senses we are all familiar with—sight, hearing, sound, taste, and smell—but it can also have an impact on 3 additional senses you may not have heard of before. These senses are:

Proprioception: Our sense of where our body is in space, and what our body is doing.
Vestibular: Our sense of balance and movement, which is controlled by the inner ear.
Interoception: Our awareness of sensations inside our bodies, like heartbeat and hunger.

We may not always be totally aware of these senses: for example, proprioception helps us to move around easily while we focus on other things, and our vestibular system keeps us balanced as we go about our day. When one of these senses is not being processed well, it can cause problems for a child.

When Sensory Hypersensitivity Looks Like Emotional Problems

Children who are hypersensitive are more easily affected by information from at least one of the senses. This means they can get easily overwhelmed by sensory experiences that might not seem like a big deal to others, which can lead to outbursts, meltdowns, or avoidance of certain tasks that might look a lot like anxiety or behavior problems. Here are a few ways hypersensitivity commonly shows up that might look like an emotional issue:

• Extremely picky eating

• Tantrums and meltdowns that seem to come out of nowhere, but mainly happen in loud or overstimulating places

• Abruptly running away from caregivers, which can be a safety risk

• Being very sensitive to the fit and texture of clothing, for example, refusing to wear anything with a tag or anything that feels “wrong”

• Refusing to brush their teeth or hair, or avoiding other activities that involve the senses, like haircuts

• Not enjoying cuddles or touch, especially when it’s unexpected

• Fear of swings, slides, or other activities that involve movement

When Sensory Hyposensitivity Looks Like Behavioral Problems

Kids who are hyposensitive react less strongly to sensory input than other people, meaning they often feel understimulated and crave more sensory input. These children often engage in “sensory seeking” behavior, meaning they deliberately try to get more of the sensory experiences they lack. Sensory seeking can look a lot like aggression or hyperactivity, and it may be hard to figure out the root cause of a child’s behavior at first glance. Here are a few examples of hyposensitivity that might resemble emotional symptoms:

• Speaking too loudly, or craving loud music or TV

• Not giving people enough personal space

• Seemingly in constant motion, with difficulty sitting still

• Lack of awareness of their own strength, which leads to being too rough with others

• Touching people (hugging, holding hands, sitting in laps) even when it isn’t socially appropriate

• Very drawn to rough-and-tumble play, like crashing into furniture and jumping off things

• Doesn’t appear sensitive to pain

• Frequent chewing on objects, thumb-sucking, or nail-biting

How to Get Help for a Child with Sensory Issues

If you suspect your child has issues with sensory processing, it’s worth bringing up with your child’s pediatrician and school. Often, schools can help children to get evaluated for sensory processing issues for free. Teachers might also have good insight into your child’s behavior at school, and your pediatrician may recommend skills to try at home before reaching out to another professional for help.

If you do decide to get professional help for sensory issues, an occupational therapist can help. Occupational therapists use an activity-based approach to help children better process sensory information and practice life skills. Kids often participate in occupational therapy in a “sensory gym”, and the process is a bit like play therapy in that it non-invasive and often fun for children. Through OT, kids learn exercises they can practice at home to get used to different sensory experiences.

Sometimes children with sensory difficulties benefit from counseling, as well. Many (but not all) kids with sensory processing difficulties also have anxiety, ADHD, or fall somewhere on the autism spectrum. You can learn more about my online therapy with children by contacting me here.