Psychotherapy with Children and Families: Promoting Connection, Competence, and Creativity

We are living in a time where therapy services for children and families are increasingly fragmented and children are increasingly treated through a lens of pathology and diagnostic disorders. The level of unhappy and anxious children and adolescents at all ages is growing, and parents feel increasingly overwhelmed, depleted, frustrated, and helpless. A typical parent might say “My child has ADHD or bi-polar disorder and needs therapy and an evaluation for medication.” Such a statement reflects a common view that the problem lies within the child, and the solution is to manage the symptom(s) through medication or other “interventions” that reside in the therapist’s expertise. 

The emphasis on seeing and labeling children in terms of a psychiatric or mental disorder has several pitfalls. Firstly, it encourages the inclination to objectify children, rather than to see the mystery and complexity in them as humans and understand their struggles in the context of family, culture and community. Secondly, it leads parents to rely too heavily on professionals as the “experts” on their own child(ren), which can inadvertently encourage them to disengage from their children and relinquish their parental influence and responsibilities. Thirdly, it diminishes a parent’s sense of confidence and competence in developing effective ways of understanding and helping their children navigate their emotional and developmental challenges. The mix of these elements intensifies children’s anxiety that there is something “wrong” with them, that they are not “good enough,” which in turn, leads to their expectation and worry that their parents will distance from them, leaving them alone and adrift to deal with their struggles on their own.

In our framework for understanding and working with children, we view children’s problems as indications of difficulties in negotiating developmental challenges and relational conflicts. Children thrive best in relationships where they feel appreciated, understood, and respected. Conversely, when they feel controlled, abandoned, or betrayed, they are more likely to lash out at others or themselves, sometimes in violent and self-destructive ways. It is in this disconnection and isolation that children’s symptoms tend to grow.

Despite how critical these relational dynamics are, a prominent trend in the mental health culture is to prescribe medication with the belief that one is thereby treating an underlying disorder. While medication can at times provide symptomatic relief, if prescribed without a holistic view of the child in their familial and community context, it can lead children to feel that there is something intrinsically wrong with them and can deter them from looking to their parents as resources in helping them navigate their struggles. It can also lead parents to disengage from their children and let go of their parental influence and responsibilities, which can intensify the child’s sense of disconnection in their family and increase the likelihood of symptomatic behavior. 

Here are some crucial guidelines for parents that are at the core of our framework:

• Speak simply and directly to your child 

• Set clear and age-appropriate expectations for behavior and enforce them consistently and unemotionally, rather than trying to manage or control your child’s behavior

• Listen quietly, closely and respectfully 

• Accept your child’s feelings unconditionally

• Play with your child and follow their lead

• Encourage their creativity and imagination 

• Slow down! Create space for uninterrupted interaction

• Be open to being surprised and delighted by your child 

• Risk being vulnerable with your child

John Brendler, MSW, LMFT is the founder of Building Bridges, where he has a private practice and works with families, individuals, couples and groups and conducts supervision groups with professionals working with couples and families.

Acknowledgements go to my Building Bridges colleagues for their collaboration on this article and, in particular, to Dr. Michael Silver’s contributions for the content and clarity he brought.