More than one colleague or client has asked me how I came to work with children. I used to work mostly with adults and when time, after time, these adults turned to me in session and said, "Steve, I wish someone had recognized the amount of emotional pain I was in when I was a child--then maybe I wouldn't be 40 years old and sitting in your office now!" When I reflected upon what those adults were saying to me, then I decided to do something about the emotional pain of children.
I like to think of my work with children as preventive medicine--i.e. treat the child before their emotional difficulties become a chronic condition. Some people are concerned about the meta-message being sent to children who are brought to counseling. I've been asked, "What does this do to their self-esteem--especially if siblings or peers find out?" In my experience is rarely a problem. I think the much bigger problem is what it does to a child's self-esteem to leave depression or anxiety or other disorders untreated. When a child has had difficulties for months or years and is brought to me, one of my first interventions is to counter their sense of worthlessness and guilt for having problems. The earlier the child is treated, the less their self-esteem is eroded.
Some researchers think that a large number of children with childhood disorders have a genetic predisposition to the disorder, then this predisposition is activated by environmental problems or other stressors. The following case illustrates this paradigm: A six year old was brought to me with feelings of sadness, isolation and withdrawal following the death of a loved one, continued for four months, and was accompanied by school and social problems. Both parents had a history of multiple losses and depression. After a month of psychotherapy the client's depression was greatly reduced and the client's grief was on track to being resolved. It appears that the stress of losing a loved one had triggered in the client a depression stemming from a biological predisposition toward depression that was inherited.
Children come to counseling with a need to be listened to and respond positively to attention, encouragement, empowerment, and assistance with their emotional and practical difficulties. Research shows that children have a high need for sharing personal experiences and feelings, which they do with relatively few reservations. I create a safe, friendly environment so the child feels free to express her/his stress and concerns. I find the child responds openly to suggestions for change when presented in a caring manner.
When providing counseling to children, I use imaginative play, games, books, puppets, various toys and art therapy to facilitate self-expressiveness and empathy to connect them to their inner feelings and to develop insight. After a therapeutic alliance is formed, even young children are quite capable of clearly talking about their thoughts and feelings. I find an easy give and take between play therapy and talk therapy facilitates the healing process.
The goals of counseling are to improve the child's immediate adaptation to her or his life situation, build ego strength and teach problem-solving skills. Sometimes what a child needs is more structure, discipline and attention from parents and that involves family therapy, but that is a topic for another article.
*Photo "India Whistling" by apdk
ABOUT THE AUTHOR: Mr. Knezek is a clinical social worker in private practice in New Haven, CT. His practice consists of 50% children/adolescents and 50% adults. In addition to his clinical work, Mr Knezek is a Practice Building Consultant who helps clinicians realize their dream of a thriving private practice, and a clinical supervisor. www.stephenknezek.com
