4 Considerations For Working with Kids and Their Caregivers in Therapy
By Natalie Thomas
For most of my clinical career I’ve worked with children, adolescents, and families. Working with this population is rewarding, however can be challenging due to different family dynamics, lack or over involvement, and their perspective of what therapy should look like. I will admit my views, boundaries, and expectations have shifted over time. I will discuss my top four considerations to have when beginning to work with kids and their caregivers.
Children are starting therapy at a younger age than ever before. This is largely due to how much social media and external stressors are influencing daily life. Caregivers reach out to therapists when they don’t know what to do or how to help. It can be difficult to really know if something is going on if kids don’t flat out tell you. However, recognizing some signs of distress is important such as changes in eating or sleeping habits, extreme temper tantrums, isolation, and disruptive behavior are just a few to pay attention to.
Young children have difficulty expressing how they are feeling with words. Traditional talk therapy will not be the best form of therapy as they will not be able to sustain attention, words, or brain development at this stage of their life to process sessions. Therapists who specialize in play therapy are the most beneficial as children need to be able to use their “developmental language.” Therapists that work with children also understand age development and can help caregivers understand what are age and developmentally appropriate behaviors.
Understanding Therapist’s Role
Therapists’ roles you would think are similar, however they can shift depending on where you work and with which population. Something I have learned over the years is to have a conversation in the beginning stage of therapy with the child and caregivers on what your role is as a therapist. Over the years I’ve encountered hearing that my role is to gather information from the child and report back to the caregiver or to make a child attend therapy or be a behavioral authoritarian figure. All of these things needed to be discussed as I did not feel comfortable performing those roles as a therapist. Caregivers may have had their own therapy experience that crossed into these roles or may wish for you to assist them in these ways. Having an honest talk during the phone screener or intake can help distinguish between what you can support with and what is out of the therapeutic relationship that will be established.
This consideration is the highest on my priority list! We as therapists only get a glimpse into a child’s life with a weekly or bi-weekly session. If you’ve worked with kids like I have I’m sure you’ve had the ones who come into your office and when you ask how things are going give you a simple “fine” or “good.” However, then you receive an email from a caregiver with an entirely different story of what happened that week at home.
This is why I can not stress enough to involve caregivers in therapy. Based on age or presenting concern you may not need to have them present throughout the entire session, however, always check in at the beginning or end of the session. I teach a lot of coping and anxiety/stress relief skills. If I just teach the child and the caregiver doesn’t know what we discuss in session, how can they support at home when I’m not there? The greatest success I have seen is when caregivers are involved and can help support the skills that are being taught.
Individual vs. Family Sessions
This last consideration I feel is similar to caregiver involvement, however wanted to take it a bit further in explanation. I have experienced, like many therapists I’m sure, the what I call “dump and drop off” from caregivers. I call it this silly name because caregivers may come into your office and have “something” they want you to talk to the kid about…then run out of the office. In my early career I wouldn’t question this behavior and try to piece together what they threw at me. However, flash forward years later.
I now address the concern and remind them that we can absolutely discuss it in a family session. If a caregiver chooses not to stay or wants to discuss it in session, I remind them of my role and that I will not discuss anything that is not brought up by the kid. This tactic has helped me to weed out whether to continue just focusing on the kid or bringing in family if concerns are in fact arising. I hold my boundary of not being an investigator or taking sides so family sessions are the only way I will hear all perspectives.
Wrapping It Up
Hopefully this article provided some insights to consider when working with both kids and their caregivers. While the kid is technically your client, involving the caregiver from the very beginning with understanding your role, assisting with psychoeducation, and encouraging family sessions when needed is critical to achieve their therapeutic goal. Always seek out extra support and supervision if you feel you need guidance as a therapist navigating working with kids and caregivers.
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Natalie Thomas is a licensed clinical social worker (LCSW) and Clinical Supervisor for Firelight Supervision. She provides group and individual clinical supervision for provisionally licensed counselors and social workers, along with clinical consultation for independently licensed therapists. Natalie enjoys supporting therapists develop new skills and find their niche.