Updated: Jun 15, 2021
I'm standing with a close friend in his kitchen, taking turns washing dishes as we watch his little girls play outside through the window.
"You have the benefits for it, right? You should really think about getting them into counselling. They have play and art therapy now, which I think the girls would really love."
"I don't know," he's saying doubtfully, "Maybe only M if anyone. The other girls seem fine."
The family's recently gone through a divorce. M, the middle child, is the most outspoken, affectionate, and emotionally aware of the bunch. She's been the most able to communicate her distress at the situation, sharing that she misses being together as a family, beginning to act younger than her age, and asking heart-wrenching questions about why "mom and dad don't love each other anymore."
Pondering my friend's statement, I think about the other girls: K is the oldest, but she almost never vocalizes distress. Her personality is very happy-go-lucky, laugh-it-off, make-others-happy: a pure little comedian with a quick wit and a thirst for justice. She has a hard time talking emotions and feelings though, even with the promptings of her doting therapist auntie. Sweet, shy N is the youngest and the shiest of the bunch, verging on selective mutism for many years. She still doesn't often say much, although she is coming out of her shell in ways that are beautiful to watch. I can't imagine either of the two girls would have an easy time sharing their distress verbally the way M does. I think of my own story, of why I became a therapist in the first place.
Still, I try not to press the issue too much.
"Besides," he says with finality, "they don't need that. There's nothing wrong with them."
My friend is far from alone on the subject. Many parents fear that having their child attend counselling might come with stigma, showing that something is wrong with them or their family. Others think therapy is only for those going through extreme trauma, for the "really bad" cases, or those with official diagnoses. Still more simply believe that children are too young to have own developed problems like adults that would warrant therapy.
As a psychotherapist by profession-and one who works often with children-I might be a little biased on the subject at hand. That's not the only reason for my bias, though. The second lies in my own journey with counselling. The first time I found myself in the therapy room I was 7 years old: and my only complaint is I wish I had been able to stay longer.
Skip here if you'd prefer not to have the mystique of your therapist's history revealed, for a summary of the academic literature.
My dad had suffered an accident when I was a baby, where he fell headfirst down a flight of stairs. While it had been a joyous miracle that he had survived at all, our entire family was still shaken irrevocably. Overnight, he became a chronic pain sufferer. A self-employed mobile locksmith by profession, with a brand new mortgage, a new baby, and a family to support, he had to keep working.
Every morning before my dad shuffled painfully out of bed, he had to grab a handful of morphine and other medication to ease the journey. He was miserable, feeling like his youth had been stolen, and was in terrible pain every day. Noise made the pain worse, so I had to be as quiet as possible while growing up. My mom was miserable and depressed too, feeling like she'd lost her husband and overwhelmed while playing multiple roles. While the burdens of the role of "mom" and "dad" are highlighted in my history due to burden of my family's accident, this is not a story uncommon to many Canadian families. Many partners feel overworked, overwhelmed by juggling multiple roles, exhausted and stressed from work and financial struggles, and these kinds of hurdles have ripple effects throughout an entire family.
Despite loving parents with the best of intentions, in many ways I was still the child "forgotten in the shuffle." On the outside, everything seemed perfect. My family won some settlement money and was able to afford a decent house in a middle-class neighborhood. My mom was involved and loving with me, orchestrating her entire life around my recitals and games. My dad had a successful business. The accident fell into the back of everyone's mind.
Years later, when my dad came to pick me up early from school, I witnessed him have a gran mal seizure. Shortly after, a kind and attentive teacher noticed I had begun drawing disturbing art in class, featuring the event pictured in dark black and reds. My first journey into therapy began at that time, and although it was exceedingly helpful, it didn't last long.
Throughout the course of my childhood and as I aged, many more traumatic and difficult events would transpire, both in my home life and at school. I suffered greatly especially towards the end of high school, when all the trauma and pain began finally surfacing in behaviours like self-harm. Without the help of therapy and a trained professional guiding me through processing events in real-time, I would be in my mid-20's before I began truly unpacking the deep trauma of my childhood and teenage years.
Interestingly, although I had been through significant traumatic experiences and there would be cause to suspect I might benefit from ongoing therapy, no one thought to seek help for me throughout my life other than one insightful and caring teacher. I came from a great family, with a loving mother and father. They just didn't understand that there was an easy way to help me fast-track with my mental health journey from a young age.
It's a familiar story I hear from adult clients all the time. They tell me about how their anxiety began with feeling nauseous everyday before middle school; or how they felt sad, different, and out of place amongst friends from a young age; or how although there were signs or clues that they were suffering, they had no words to ask for help; or how they didn't fully understand what they'd been going through and how it had impacted them emotionally until they were an adult. I often wonder how many clients could have been helped so much sooner, and what their lives would look like today if they'd had a jumpstart on understanding and processing their emotions in healthy ways.
You can have a traumatic childhood or a relatively normal one - can have the best, most well-intentioned parents in the world - and you can still really need and benefit from therapy. Myself and many others can testify to this fact.
The things I had to process, unpack, and learn painfully blow by blow as an adult could have been expedited projects I learned while young had I stayed in therapy. So if you ask me: do children need therapy? My answer would be a resounding "yes." The truth is that I chose this field of work to "become the person I needed when I was a child," a concept in line with the wounded healer concept coined by Jung.
Beyond my anecdotal musings, the research is resoundingly clear: children benefit from therapy.
Outcome researchers have found that psychotherapy "can be effective with both children and adolescents," with youth who participated in interventions scoring better on outcome measures than their peers who did not receive any intervention . Meta-analyses have shown that most children receiving psychotherapy treatment for depression using CBT and various other modalities have a positive treatment impact .
A review of the effectiveness of therapy with young people and children by the BACP revealed that CBT was effective for anxiety, behavioural and conduct problems in children, and found play therapy highly effective for a variety of presenting problems, particularly anxiety and behaviour/conduct problems . Researchers like Pattison and Harris (2006) conducted a review of psychotherapy conducted on children and young people, and found that cognitive-behavioural, psychoanalytic, humanistic, and creative therapies were all effective strategies used to treat childhood cases of behavioural problems and conduct disorders, emotional problems including anxiety, depression and post-traumatic stress, medical illness, school-related issues, self-harming practices and sexual abuse . Such studies show that children do in fact suffer from a wide range of mental health issues, and may simply present their symptoms differently than adults traditionally do . Research seems to point to the sad truth that children experience the full spectrum of human pain and difficulties, just with less experience and emotional vocabulary to help them cope and recruit help from others.
Play therapy is just one available treatment option that has proved to be highly effective for children aged 3-12.
"Play therapy is a structured, theoretically based approach to therapy that builds on the normal communicative and learning processes of children (Carmichael, 2006; Landreth, 2002; O'Connor & Schaefer, 1983). The curative powers inherent in play are used in many ways. Therapists strategically utilize play therapy to help children express what is troubling them when they do not have the verbal language to express their thoughts and feelings (Gil, 1991). Through play, therapists may help children learn more adaptive behaviors when there are emotional or social skills deficits (Pedro-Carroll & Reddy, 2005). The positive relationship that develops between therapist and child during play therapy sessions can provide a corrective emotional experience necessary for healing (Moustakas, 1997). Play therapy may also be used to promote cognitive development and provide insight about and resolution of inner conflicts or dysfunctional thinking in the child (O'Connor & Schaefer, 1983; Reddy, Files-Hall, & Schaefer, 2005)... Play therapy helps children:
Become more responsible for behaviors and develop more successful strategies.
Develop new and creative solutions to problems.
Develop respect and acceptance of self and others.
Learn to experience and express emotion.
Cultivate empathy and respect for thoughts and feelings of others.
Learn new social skills and relational skills with family.
Develop self-efficacy and thus a better assuredness about their abilities." .
Play therapy interventions have shown to improve academic, psychological, and social outcomes for the children treated . Child-centered, non-directive play therapy, which involves allowing a child to have control over how they will express themselves and with what in the play therapy room, has been shown to be effective at minimizing the challenging behaviours of kindergarten students in as few as 8 sessions . Non-directive play therapy has also been used to help young client's who were referred for aggression issues, and in school populations has proven to help improve self-concept and academic achievement .
Various research also "supports the effectiveness of play therapy with children experiencing a wide variety of social, emotional, behavioral, and learning problems, including: children whose problems are related to life stressors, such as divorce, death, relocation, hospitalization, chronic illness, assimilate stressful experiences, physical and sexual abuse, domestic violence, and natural disasters (Bratton, Ray, Rhine, & Jones, 2005; LeBlanc & Ritchie, 2001; Lin & Bratton, 2015; Ray, Armstrong, Balkin, & Jayne, 2015; Reddy, Files-Hall, & Schaefer, 2005)" .
Meta-analytic reviews of over 100 play therapy outcome studies (Bratton, Ray, Rhine, & Jones, 2005; LeBlanc & Ritchie, 2001; Lin & Bratton, 2015; Ray, Armstrong, Balkin, & Jayne, 2015) have found that the over-all treatment effect of play therapy ranges from moderate to high positive effects... Additionally, positive treatment effects were found to be greatest when there was a parent actively involved in the child's treatment." .
Art therapy is another technique that has been widely utilized with children due to it's ability to communicate without the need of words. It has been used to treat children who are depressed, anxious, traumatized, suffering from eating disorders, and to teach social skills to children on the autism spectrum in groups .
Used in conjunction with other therapy types, CBT and DBT, as well as narrative therapy, have also proved useful for separating and externalizing the source of the issue and teaching coping skills in children .
Altogether, the research seems to show great benefits for children and youth who are able to receive therapy, with reported effects like increased academic and life achievement, improved self-esteem and self-concept, as well as lowered aggression, stress, and anxiety, studies [5-10].
So, if find yourself wondering: does my child really need therapy? It may be helpful to consider it a question of benefit rather than need. That is to say, given the research, there is a lot for children to gain in the therapy room that they would otherwise potentially go without. It might be social stigma about therapy stopping you from accessing a valuable resource for yourself and your family - in which case looking at the literature can be reassuring and helpful.
That being said, I can understand having concerns when entering into something that is unfamiliar, unknown, and can feel so vulnerable and intimidating. Soon we'll be tackling the topic, "what to expect when my child comes for therapy" to help ease some of those fears.
1. Eder, K., & Whiston, S. (2006). Does Psychotherapy Help Some Students? An Overview of Psychotherapy Outcome Research. Professional School Counseling, 9(5), 337-343. Retrieved May 12, 2021, from http://www.jstor.org/stable/42732706
2. McCarty, C. A., & Weisz, J. R. (2007). Effects of psychotherapy for depression in children and adolescents: what we can (and can't) learn from meta-analysis and component profiling. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7), 879–886. https://doi.org/10.1097/chi.0b013e31805467b3
3. McLaughlin, C., Holliday, C., Clarke, B., & Ilie, S. (2013). Research on counselling and psychotherapy with children and young people: A systematic scoping review of the evidence for its effectiveness from 2003-2011. British Association for Counseling and Psychotherapy, 89.
4. Pattison, S., & Harris, B. (2006). Counselling children and young people: A review of the evidence for its effectiveness. Counselling and Psychotherapy Research, 6, 233-237.
5. Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The Efficacy of Play Therapy With
Children: A Meta-Analytic Review of Treatment Outcomes. Professional Psychology:
Research & Practice, 36(4), 376-390. doi: 10.1037/0735-7028.36.4.376
Landreth, G. L. (2002). Play therapy: The art of relationship (2nd ed.). New York, NY, US:
Routledge/Taylor & Francis Group.
Ray, D. C. (2011). Advanced play therapy: Essential conditions, knowledge, and skills for child practice. New York, NY, US: Routledge/Taylor & Francis Group.
6. Wixson, C. (2015). The Effectiveness Of Child-Centered Play Therapy On The Challenging Behaviors Of Early Elementary School Students. ScholarWorks @ Georgia State University Counseling and Psychological Services Dissertations.
7. Schumann, B. (2012). Effectiveness of Child-Centered Play Therapy for Children Referred for Aggression. Child-Centered Play Therapy Research, 193–208. https://doi.org/10.1002/9781118269626.ch11
Blanco, P. J. (2012). Impact of School-Based Child-Centered Play Therapy on Academic Achievement, Self-Concept, and Teacher-Child Relationships. Child-Centered Play Therapy Research, 125–144. https://doi.org/10.1002/9781118269626.ch7
9. Epp, K. M. (2008). Outcome-based evaluation of a social skills program using art therapy and group therapy for children on the autism spectrum. Children & Schools, 30(1), 27-36.
Eaton, L. G., Doherty, K. L., & Widrick, R. M. (2007). A review of research and methods used to establish art therapy as an effective treatment method for traumatized children. The Arts in Psychotherapy, 34(3), 256-262.
10. Butler, S., Guterman, J. T., & Rudes, J. (2009). Using puppets with children in narrative therapy to externalize the problem. Journal of Mental Health Counseling, 31(3).
Hetrick, S. E., Cox, G. R., Witt, K. G., Bir, J. J., & Merry, S. N. (2016). Cognitive behavioural therapy (CBT), third‐wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews, (8).
Perepletchikova, F., Axelrod, S. R., Kaufman, J., Rounsaville, B. J., Douglas‐Palumberi, H., & Miller, A. L. (2011). Adapting dialectical behaviour therapy for children: Towards a new research agenda for paediatric suicidal and non‐suicidal self‐injurious behaviours. Child and adolescent mental health, 16(2), 116-121.