Why Children Don't Do Talk Therapy (And What Works Instead)
Why Talk Therapy Doesn't Work for Children
Play therapy is a developmentally appropriate mental health treatment for children ages 3 to 14. The most important piece to understanding play therapy is to understand children’s cognitive abilities, how they think. Understanding that guides the why and how play therapy is developmentally attuned for children. Children are concrete thinkers and their brains are developed to view situations in the context of the current moment. They lack the ability to think abstractly, meaning that they are unable to reason or rationalize their way through their problems. Let’s take that understanding and apply it to therapy. Most people picture therapy as traditional talk therapy. That is where one meets with a therapist and talks, reflects, rationalizes, and problem solves their issues. Since children lack the ability to think through their problems, it renders talk therapy as an incompatible method to treat children.
Play as the Path to Healing
With the understanding that children are not suited for talk therapy, a different approach to healing and processing their experiences is used. It is through a child's natural mode of navigating the world around them -- play. It is in the world of play where children are best suited and equipped to express, understand and overcome the challenges they face. Since play is the best suited place for children, that is where therapists must go.
The Plant Keeper Principle
Child-centered play therapy is based on the belief that children have an innate drive toward becoming the best versions of themselves, one that can only be realized when certain core conditions are provided to the child through a relationship. The process is similar to that of a devoted plant keeper and their house plant. For their house plant to reach its full potential, the keeper ensures that the plant receives adequate water, gets proper sun light, stays within a certain temperature range, gets fertilized periodically, is pruned, rotated now and again, and is even kept out of reach from a bored house cat, who is sure to knock it over should it be given a chance. Then, with the plant’s environmental conditions met and maintained, the plant keeper trusts that the plant will do the rest of the work. The keeper knows that there is no use in lecturing the plant on topics such as photosynthesis or in asking the plant to tell the keeper what it needs. The keeper trusts that the plant just needs the right conditions to do what it is innately driven to do.
Children are not plants, but the underlying principle holds true. The therapist is like the keeper, ensuring that core conditions are met to allow the child to do what they need to do to grow, just like the plant. The play therapist knows that there is no use in lecturing the child, nor does the play therapist expect the child to verbally communicate their emotional world. However, the play therapist does know that when a child is provided with the core conditions, CCPT skills and responses, the child is then able to do the therapeutic work that they need leading to greater positive longitudinal changes in the child’s life.
The Core Conditions
The core conditions the play therapist implements create a new environment where the child’s needs and experiences are acknowledged which then allows the child to fully dive in, work through, and process what they need to. The core conditions to the therapeutic relationship are genuineness, empathy, unconditional positive regard and permissiveness.
Let’s explore those starting with genuineness. A component of a healthy relationship is when both people are genuine with themselves and the other person. They are truthful in who they are, how they see the world around them, and what they believe. So, the play therapist is genuine with the child. They do not act as an expert, a teacher, or a parent. They are simply themselves, and they devote themselves to building a honest and trusting relationship with the child. If the child senses that the therapist is being inauthentic, distrust emerges which in turn hinders the child’s willingness to be vulnerable in ways that they need to be to heal.
In addition to genuineness, the therapist must be empathetic to the child’s behaviors, experiences, perspectives, and emotions. The play therapist does not try to fix or change how the child sees their world and instead allows the child to tell their story. The play therapist is curious about how the child sees their own world and does not pass judgement, criticize, blame, or pressure the child to see things any differently. The child feels free to share their experiences without feeling as though the therapist has an agenda or wants to change the child in any particular way.
Another core condition the therapist provides is unconditional positive regard, wherein the therapist conveys to the child that they are accepted, no matter what the child brings up in their play, what they say, or how they behave. This creates an openness for the child to fully express themselves without a fear of being rejected or unaccepted by the therapist. They can then work on the parts of themselves they may keep hidden from others, which will in turn help them to become more aligned with all parts of themselves.
Finally, the last core condition is permissiveness. The therapist does not enter the session with an agenda for how it should go and instead allows the child to lead and take charge. Many people do not believe that the child knows what it is that they need to work on, however, the play therapist believes and trusts that the child’s innate drive to thrive will guide the child exactly where they need to go. When the child is able to lead their therapeutic journey, they have more buy in through the process which leads to greater long-term gains.
What these core conditions do is create a relationship environment that is warm, consistent, and secure which allows the child to be vulnerable and engage in the emotional work that they need to do. It is the safety of the relationship built through the core conditions that allows the child to trust that the therapist can handle their deep emotional work and through that process, the therapist will always accept and try to understand the child without ever asking the child to be anything other than themselves. Much like how the plant keeper never tells the plant what it could be doing differently when its leaf tips have browned.
What the Play Therapist Actually Does
During sessions the role of the CCPT therapist is to adhere to the principles of the CCPT model including the use of a specific set of skills and responses. This creates consistency and predictability for children which allows them to have a greater internal capacity to work through and make sense of their world. It is the adherence to the model that creates a positive and trusting relationship between the child and play therapist which ultimately promotes the child’s progress. During sessions, the play therapist implements the CCPT principles, skills, and responses which act as a guardrail for the child as the child takes the lead navigating and processing their internal world and experiences.
In play therapy sessions, one of the roles of the play therapist is to reflect feelings. The play therapist reflects the feeling of the child at any given moment or reflects feelings that the child brings up within their play. When the play therapist reflects feelings it helps the child to better understand their own emotional experiences, offers validation that all emotions are part of the human experience, and it helps the child build an emotional vocabulary as it links the child’s internal feelings with the word the therapist reflected. This allows the child to gain awareness and insight into their feelings and the situations that elicit those feelings. The child will then begin to verbally express their feelings, wants, desires, and needs instead of communicating those internal feelings through their behaviors.
Another role of the play therapist is that of choice-giving. The play therapist finds opportunities for the child to make choices that are developmentally appropriate for the child. By providing the child opportunities to choose, the child gets practice in making decisions which helps the child gain a sense of power over themselves and their environment, leading to reduced power struggles with others. Choice-giving also makes it clear to both the child and the play therapist who is responsible for making the choice, resulting in the child learning to take responsibility for the choices they make inside and outside of the playroom. Choice giving also provides an opportunity for children to better understand themselves and their preferences and provides the child with an opportunity to gain power and control in their world, something children have very little of.
Limit setting is another role of the play therapist. It is natural for children to explore the boundaries of their behaviors. Children are not born with an innate understanding of acceptable behaviors, which means that adults must consistently set limits around unacceptable behaviors of the child. However, it is not enough to just set a limit for a child as they have needs that must be satisfied. The play therapist only sets limits when they are needed within the playroom which communicates to the child that permissiveness is allowed. When the play therapist sets a limit, they do so in a calm and neutral tone, starting by acknowledging the child’s feelings, wants or needs in that moment. Then the play therapist sets a clear boundary regarding the unacceptable behavior. The play therapist then provides the child with a choice between alternative behaviors that connect to the child's original feeling, want, or need. This communicates to the child an understanding and acceptance of the underlying feeling or drive behind the behavior, allowing the child to be more accepting of the limit. Once the limit is set, the child is then offered several alternative behaviors that they get to choose from. This helps the child learn a new way of responding to their feelings while allowing them to take agency of how to respond.
The final role of the therapist is to provide encouragement for the child’s efforts. Encouragement is the building blocks for a child’s self-esteem. As the play therapist encourages the child, the child learns to value their own efforts, final product and themselves. Additionally, it teaches the child that they are capable of overcoming difficult challenges. In contrast, children are often provided with praise from others, which is often someone’s evaluation of the child’s final product. Praise communicates to children that the opinions of others is what is most important and it often communicates a degree of acceptance or unacceptance. As the child receives encouragement from the play therapist, the child comes to believe that they are capable and worthy. Encouragement decreases anxiety, negative self-worth, dependency, lack of motivation and promotes confidence, an internal sense of worthiness, independence, and resilience.
Why Play Therapy Works
In conclusion, play therapy meets the developmental needs of children for them to effectively process their emotional world, allowing them to change and grow. For over a century, play therapy has been implemented and researched around the world. It is considered to be the most effective therapeutic approach for children. Child-centered play therapy also has a long and robust history of research that supports its effectiveness. Child-centered play therapy is suited to support a majority of concerns children face and is appropriate for most cultures. The therapist respects and understands the world of children, which is why the therapist enters the child’s world instead of asking the child to enter the world of adults. It’s like how the devoted plant keeper goes to the plant to take care of it. The keeper does not expect the plant to get up and go to the keeper’s world. Play therapy allows children to grow, resulting in the child leaving more regulated, more capable, resilient, and happy humans.
About the Author
Marti Bebo, LMHC, NCC is the founder of Cascading Roots Child Counseling in Everett, WA, where she specializes in child-centered play therapy for children ages 3 to 14. She is dedicated to providing children and families with a warm, evidence-based approach to mental health care.
