How Therapy with Kids Looks Different than Therapy with Adults

child therapy

Knowing the way therapy with kids looks different than therapy with adults can help you feel more relaxed in the process of bringing your child to therapy.  Once I point out the fact that there is a difference, it seems obvious.  

However, when you are concerned about something going on with your child, you want to see that the concern is being addressed directly, and that is totally understandable.  

Here’s the thing, taking a super direct approach doesn’t always get underneath what is causing the concern, at least with kids it doesn’t.  And we do want to get underneath it because you’ve probably done the things you can do to directly address the problem, and you are not seeing improvements, which is why you are bringing your child to therapy.

So let’s look at three ways therapy with kids is different.


Very often play or art is the work

The bulk of development and learning happen in early life through play and art; so in therapy this is where a lot of the work gets done.  Do you notice how your kid pays attention so much better when a game is involved?

“There’s a bit of a communication gap between children and adults. Depending on age and stage of development, children simply don’t have the language skills of adults. They may feel something, but in many cases, they either can’t express it to an adult or don’t have a trusted adult to express it to.” “Since the child can’t adequately express themselves in the adult world, the therapist joins the child in their world, on their level.” (Healthline.com | How Play Therapy Treats and Benefits Children and Some Adults | October 11, 2019 https://www.healthline.com/health/play-therapy#how-it-works)

Kids  learn about the world through playing, so it only makes sense that we would meet them in their world to understand and communicate effectively with them.  Engaging in play or art helps them relax and open up, allowing them to express themselves. 

The information we gather, as therapists,  is based on our ability to see into the metaphors your child presents and in what we observe about how they engage in therapy.  So we are looking at the content of what they bring up through art and play AND at the way they are playing, what emotions, behaviors, body language, ways of communicating come up. 


Kids don’t consciously develop the ability to conceptualize abstractly until around age 9

While your child might say deeply insightful things and share incredible wisdom, consider how those insights are always shared spontaneously.  They are powerful observers and have a way of getting to the heart of the matter, but not necessarily when you are trying to get an answer out of them.  

You have seen this when your child says something deep or insightful and then you try to ask follow up questions to find out more and they change the subject and bring up something random.

When we ask direct questions, that has the effect of engaging the logical mind and a child’s logical mind is very black and white in how it conceptualizes. This is why it may be hard for them to understand figurative language, humor or irony – because these are forms of communication that are not black and white and kids often just cannot grasp it.   

Kids are also keen on detecting if they are in trouble or if there is something “bad” about what they are doing, so you will often encounter defenses when asking direct questions.  

As adults, parents are used to talking to other adults and it’s normal, and usually effective, to ask direct questions.  It’s different with kids because they may not understand what they are feeling, therefore, can’t give you a direct answer. 

Questions that adults may be willing to answer and able to process and respond to very easily, could be met with hesitance when asked to a child; or they may simply refuse to respond because they do not understand.  It may come across as defiance but the lack of a response may be a coping mechanism. 

This all relates back to the cognitive development stage of  your child, which is characterized by concrete thinking.


When children try to explain emotion or behaviors, they can usually only tell you about it in a concrete way

Kids may be able to tell you if they are mad or sad, but they can’t always connect those feelings with the situations or experiences that caused them (unless it’s immediate, in the moment, like: “I’m mad because she hit me”).   If they cannot acknowledge or understand the relationship between their feelings and what caused them to surface, their ability to express it to you will be very limited and what they can tell you will be very basic.

This is where you get really extreme statements like “I hate you” or “I hate school” or “I hate my sister” and, of course, that is concerning as a parent.  It’s true that they might feel that way  in the moment; and in that moment, in their mind,  it’s almost like there are only  two options to express what they feel, either  “I like it” or “I hate it”. 

So many times parents worry about deep seated issues because their kids say really intense things.  Which is so understandable. 

But sometimes it isn’t deep seated trauma or major emotional issues, it’s just that they are emotional and don’t have the capacity (skills or cognitive development) to express or conceptualize what’s going on inside of them.  

This can be frustrating for you as a parent because you want to know what your child is feeling so you can help them, but before you pressure them to explain their feelings, think about how frustrating it can be for your child to have those feelings and not really be able to readily communicate them.

If your child is struggling with emotions and you are not able to help them move past them in a positive way, don’t blame them or yourself.  It may be time to look into therapy for them.  We discussed child therapy in a past blog post and you can read it HERE.


It’s important to meet your child where they are, tap into the places where the scaffolding is needed to support healthy development. 

That might mean that therapy sessions with your child look like they are just playing or doing art. There’s a lot happening underneath the surface. And, a good child therapist will communicate with you about what they are seeing, teaching some simple skills to both you and your child and getting feedback from you about what is happening in your child’s life (because kids are not great reporters) so that therapy can move with your child and their needs.  

We cover some other info about child therapy in this post – What to Expect When Your Child is in Therapy.
If you have questions about what therapy with kids looks like or how you can get started with your child, contact usWe are here to help!



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