Even for seasoned therapists, child therapy can be challenging. Children often do not want to talk about difficult feelings, can be hesitant to open up, and may be in the role of the “identified patient.” Moreover, parents often present with their own desires and requests for the therapist and may not see their role in improving the psychological functioning of their child. In some cases, they may even refuse to be involved in treatment.
And while many therapeutic modalities target some component of the child’s needs — such as CBT appraisals to help them better manage their responses to distressing feelings — no approach is complete.
Better, says Kenneth Barish, to consider the emotional needs of the child and the painful, infectious family patterns that lead to poor psychological functioning for the family and the child.
In his new book, How to Be a Better Child Therapist: An Integrative Model for Therapeutic Change, Barish offers a clear, thoughtful way to understand the emotional and behavioral problems of childhood, a powerful overarching therapeutic goal, and ten effective and practical principles to help any therapist improve the way they treat children and their families.
“Even as we increasingly recognize the importance of emotion awareness and emotional regulation (or more broadly emotional intelligence) in child development, theories of child psychopathology and clinical interventions frequently fail to consider specific emotions and the causal role of emotions in determining children’s behavior,” writes Barish.
The search for positive emotions is a fundamental motivation for us all, and in children, this motivation emerges as what is known as the SEEKING system. As Barish explains, SEEKING is not a separate emotion but rather what underpins all emotional experience.
Citing neuropsychologist Douglas Watts, Barish explains that damage to this neural pathway not only results in diminished interest and curiosity, but a shutdown of emotional experience, and “virtually any motivated behavior disappears.”
An extreme example of this emotional pain is a core affective state, which Edwin Schneidman describes as “unbearable, intolerable, and unacceptable” and helps us understand suicide. For children, when the SEEKING system shuts down, the result is a shift in their expectations of what is possible.
Barish writes, “When bad feelings remain active, when children spend too much time feeling angry, discouraged, or alone, the consequences are widespread and profound. These children and adolescents anticipate criticism and misunderstanding instead of encouragement and support. Over time, the encouraging inner voice all children need to bounce back becomes eroded. They are therefore likely to withdraw or give up when presented with challenges, or make urgent and unreasonable demands, or find self-destructive way of coping with emotional pain.”
Bad feelings that do not go away not only are characteristic in depression but also lead to a central feeling of demoralization in children. These troubled children, Barish writes, “for complex reasons of temperament and life experience have become discouraged… They do not expect well.”
At the core of emotional health is positive expectations. In good health, children learn that bad feelings are a part of life and although they are painful, they do not last. Further, they can look to their parents to help them mitigate these bad feelings and find ways to cope with them.
Barish writes, “At every stage of life, we all need an encouraging and comforting inner voice, someone who appreciates our strengths, recognizes our potential, has confidence in us, and is proud of us.”
A fundamental component of successful child therapy then is to help children learn that bad feelings do not last forever and to help build and strengthen positive expectations for the future.
Successful child therapy also causes a shift in the functioning of the child’s family.
“Our most successful interventions then set in motion positive cycles of healthy emotional and interpersonal experiences: increased confidence and engagement in life and affirming interactions between parents and children,” write Barish.
How we turn vicious cycles into positive ones, Barish tells us, relies on the therapeutic principles of interest, empathy, repair, problem solving, emotional regulation, encouragement, play, sleep, helping others, and limits and discipline.
To help children effectively, therapists must also go beyond diagnosis. They must conceptualize the case in such a way that allows them to understand the child’s emotional needs, identify ongoing malignant patterns and pathogenic influences, and recognize and support the child’s strengths.
Showing interest helps to engage children in therapy and when performed by parents, helps to strengthen parent-child interactions.
Successful therapy, with a child or adult, is also not possible without empathy. Empathy is essential to mitigate suffering and is the lifeblood of social bonding.
“Each expression of a therapist’s empathy – in any form whether spoken or unspoken, consciously formulated or unconsciously enacted – arrests the spread of potentially malignant psychological events in the mind of the child,” writes Barish.
Play is also a critical component of children’s lives and one that, when done between parents and children, helps children improve both their emotional health and behavioral adjustment.
Through promoting frequent affirming interactions between parents and children, repairing moments of criticism, anger and misunderstanding, and engaging children in proactive solutions to family problems, therapists can play a pivotal role in changing the trajectory of children’s lives, and strengthening the family systems that nurture them.
Beginning with a conceptual understanding of children’s emotional needs, Barish integrates a wide range of therapeutic modalities into an approach that is clear, practical, and eminently useful. This book should be required reading for any therapist working with children.
How to Be a Better Child Therapist: An Integrative Model for Therapeutic Change
W.W. Norton & Company, August 2018
Hardcover, 218 pages