Child psychotherapy, which sometimes is mistakenly called “play therapy,” has its historical roots in child and adult psychoanalysis. Like them, it offers an approach to mental life which offers empathic understanding, an opportunity to re-assess the usefulness of past solutions, and a chance to try some new ways of responding to the challenges which ordinary development brings our way.

I take issue with the phrase “play therapy” because it suggests that play is therapeutic. While play has a vitally important role in the mental life of every child, I don’t think that play per se is therapeutic. Play is a regular part of my work with young children, but it is there as a means of communication, not as an end in itself nor as a catharsis.

When meeting the children I see in my practice, I often introduce myself as a “Worry Doctor” – someone who knows something about worries and how to help with them. I tell them that I don’t give shots and I don’t ask children to take off their clothes for a physical examination. If they feel uncomfortable without a parent in my office, the parent stays in the room. It is my job to find out about the children’s worries; and it is their job to tell me about them, in whatever way they can.

Recently a child came to see me accompanied by a stuffed tiger that was larger than she was. Her first words to me, spoken as she bravely walked into my office, were “You’re not a cannibal.” She had managed to tell me, very quickly, how terrified she was that something awful might happen to her in my office. Such worries were a part of her everyday life, interfering with her ability to pay attention at school, to make friends with her age-mates, and even to settle down and get to sleep at night.

Of course, worries such as these have their own reasons and developmental histories. Child psychotherapy is a kind of work that allows the therapist to come to an understanding of the child’s view of the world. Once that is achieved, the therapist and child together are in a position from which they can attempt to amend that view of the world in ways that allow a return to normal development.

Child therapy usually involves meeting with the child (and sometimes a parent as well) once or twice each week. In my case the setting is a grown-up-style office that includes a small selection of toys, children’s books, and drawing materials. It is best if the time and place remain invariant since regularity in meeting is a big help in creating a sense of trust. I invite children to bring something of their own to their sessions if they wish; I also provide them with a private space in the office where they can keep things (e.g., Lego constructions, drawing, and so forth) safe from others.

Many young children find it easier to talk while they play . . . and their play is always a mode of communication, too. I encourage this because I have found that, given the chance to tell me their story, children will fairly quickly turn to the things that are bothering them. Often they do not speak directly about their worries; instead I may hear a story about another child, a friend, who has some worries. If the child can tolerate it, we talk about that other child’s worries in as much detail as possible, trying to understand what those worries must be like as well as what some solutions might be.

When children find that their thoughts, feelings, and fantasies are getting a respectful, careful hearing, they begin to tell more about themselves. Of course they repeatedly test the therapist to see how he or she will respond to the child’s inner life. Over time – usually measured in weeks or months – enough trust develops so that children can begin to approach topics that they previously had avoided. In some cases these might involve “family secrets” – for example, some ongoing parental conflict. The therapist then must meet with the parents to get their permission to “go ahead”; it is very rare for children to be able to proceed in treatment when their parents cannot tolerate the topics the children are raising.

To reiterate a point made elsewhere: the objective of child psychotherapy is to facilitate children’s return to normal developmental trajectories, not to create pseudo-adults who are able to provide detailed discussions of their innermost thoughts and feelings. In most cases, once developmental obstacles have been removed, the child therapist’s job is done.

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