How to Be a Better Child Therapist

Positive Emotions. Children are always seeking good feelings. Therapists would do well to pay attention to a child's positive emotions.

Bad Feelings. Persistent emotional and behavioral problems in childhood are caused by painful emotions that remain active in the mind of the child. Most children in therapy have become discouraged, have come to believe that they will always have these bad feelings. The longer they remain in situations that evoke these bad feelings (e.g., schools in which they are failing), the more likely they are to seek relief in avoidant or self-destructive ways. Thus hope is an essential mechanism of therapeutic change.

Therapy often fails because the therapist cannot change the parents' perception and understanding of the child or a child's view of himself/herself.

The goal of therapy is to get children unstuck from bad feelings, from pessimistic expectations, and from pathogenic interactions.

Interest. As therapists (and as parents), our enthusiastic interest in a child's interests is the surest way to engage a child in meaningful dialogue or interaction and a first principle of strengthening family relationships. Question to ask parents during initial consultation: "What are your child's interests? What does he or she like to do?" This is how to begin a conversation with a child. Barish often spends almost all of the first session finding out about the child's interests.

Empathy. "Empathy is our therapeutic GPS. Empathy informs us when we have taken a wrong turn or subtly gone off course." Each expression of a therapist's empathy -- in any form -- arrests the spread of potentially malignant psychological events in the mind of the child. Empathy is a basic emotional need: "A child's confidence expectation of an empathic response -- that her feelings will be acknowledged and understood -- promotes a different orientation toward life and human relationships, an orientation characterized by openness and resilience." "Empathy helps make bad feelings tolerable. When children and adolescents feel heard and understood, they become, even if just for that moment, less absorbed in defiant thoughts and argument, and therefore more open to listening to us. Empathy allows a child to have her feelings without urgently needing to get rid of them, a core component of emotional regulation."

Children are able to regulate their emotions when they are confident that their feelings will be heard and understood, that problems can be solved, and that bad feelings, however painful, will not last forever. 

The best way to help children learn to regulate their emotions is to talk with them about their feelings. Parents should set aside time every day for emotional dialogue -- this is a time for listening, for accepting and validating a child's feelings. 

Play. Interactive play, beginning in infancy and continuing throughout childhood, is to children's social development what talking with children is to their vocabulary development and what exercise is to their physical development. All mammals play; it's a way to practice predatory skills, survival skills, social skills. Barish's work with children is usually a mixture of play and talk. "I offer all children an opportunity to play and then make an ongoing decision about how much play or how much talk will be a part of the therapy." 

Encouragement is essential. We must make not of every improvement, not every mistake. Working with children with problems: draw a large, blank rectangle; in the center of the rectangle, write the child's strengths; in the corner of the picture, draw her difficulties. 

Sleep. Important to ask about. 

Helping Others. Helping others is a source of meaning in life and of authentic self-esteem. 

Three principles to help families get unstuck: More frequent affirming interactions between parents and children; Repairing moments of criticism, anger, and misunderstanding; and Engaging children in proactive solutions to family problems.

• A first recommendation for strengthening family relationships is to set aside time every day to take a proactive interest in their children's interests and to play with their children.