For those of you who don't know, I'm a child psychologist. (See this post if you want to know the details of my education and training.) I have worked with kids of all ages, from infancy to late adolescence, but about ten years ago, while I was still in training, I began to specialize in early childhood. Most of my clients are under the age of six.
Kids are usually referred to me because of concerns about disruptive behavior (noncompliance, defiance, and aggression), anxiety (selective mutism, specific phobias, separation anxiety), and common behavioral problems such as sleep, toilet training, and feeding issues.
I think the most common question people have is: what exactly do I do behind that do not disturb sign hanging on my office door? Do I have some kind of magic touch with kids?
Can I fix them?
Well. The easy answer is no, but I also believe that question is the wrong one to ask.
Here's a simple description of how I work:
Through assessment and observation, I develop a sort of working model of what's causing problems for my client, and in collaboration with that client (or, usually, the client's parents), I construct a plan for intervention.
Here's an example of one of those working models. The reason five-year-old Johnny has been brought to see me is in the center circle.
A while back, Stephsco asked a related question: "Do you use art therapy in your work with children?"
The answer is no, not really. There are a few reasons why. The simplest is that I just wasn't trained that way. Sure, I use drawing and playdough and stuff like that to get to know a kid, build rapport, and observe things like cognitive organization, mood, imagination, activity level, attention span, and social reciprocity. But I don't ever read too much into what a kid creates apart from judging its developmental appropriateness/typicality in terms of content and theme. I'm not confident in the research evidence about more projective interpretations, or in my own ability to translate that into helpful information. I'll leave that to professionals who have that training.
But also, if you look at all those boxes up there, notice how many of them involve Johnny's parents? If I work individually with Johnny, it's going to be fun. Johnny will enjoy himself, and he'll want to come back to see me. I'm friendly, goofy, attentive, and I have an office FULL of toys. However ... I'm not sure that's going to make a big difference in Johnny's life, at least, not the kind of difference it would make if his mom and dad can get on the same page and create a home environment that makes it possible for a sensitive, intense, tricky-to-parent kid like Johnny to thrive.
So I keep my therapy sessions tightly focused on the items in the boxes. With this particular (imaginary) client, I would:
- Work with both parents on co-parenting and discuss whatever issues are getting in the way of that.
- Explore the parents' understanding of Johnny's behaviors, including what's appropriate for his age, but also WHY he's doing what he's doing.
- Help his parents reframe/re-interpret any thoughts they are having about Johnny (and his behavior) that are getting in the way of them being able to respond to him in ways that help him improve his behavior.
- Work intensely to help them repair and maintain loving emotional bonds with Johnny, including specific types of play and a focus on noticing when Johnny is obeying (and doing other great stuff)
- Work with them to set consistent behavioral rules, consistent consequences, and to follow through every single time (which isn't really humanly possible, but maybe we can get close)
- Work with them to respond to Johnny's anger as opportunities for closeness and teaching, in ways that validate his experience (while setting appropriate limits on behavior) and help him calm down more quickly
If I worked with older kids, I might do more individual stuff with them, but with the 0-6 crowd, most of my sessions are with either parent-child together or with only the parents. Because, once I make a map of what's causing the problem, that's the thing that usually makes the most sense (and note--I design my treatment plans for each unique client, so there are always exceptions and sometimes I do see kids individually ... it all depends on what's in those boxes).
Any questions for me?
Be sure to check out Lydia's Medical Monday post, as well as Laura's Mental Health Monday post!