What is Psychotherapy?

In my early professional years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?
— Carl R. Rogers

A consistent, trustworthy and reliable relationship between the child or adolescent and the therapist is the core element of every psychotherapy. Without this solid client-therapist relationship (alliance), psychotherapy is barely possible.

For this reason, I meet the child/adolescent with empathy, appreciation, openness and respect, so that the therapy room will become a safe space. This space will allow and enable them to express burdening and frightful fantasies, feelings and thoughts.

The therapy will invite them to show aspects of themselves that they might not be welcome or able to reveal in other situations. It requires trust for this to happen. A trustworthy relationship within a safe space offers room for change.

It is important to not only focus on the difficulties that the child is experiencing. Every child and every adolescent has resources: they all have their individual strengths, which need to be discovered and utilised. These resources will become their tools to master their fears, burdensome and traumatic experiences: in other words, their problems and symptoms.

In the therapeutic situation, the client expresses these problems, the burdensome and development obstructing experiences, consciously or unconsciously. This will enable the child/adolescent as well as me – the therapist – to experience and process them.

In addition, it can hold importance to explore the “purpose” of the disorder. For instance, what caused it? How does the child potentially benefit from having the symptoms? Or, does the adolescent choose to keep the disorder up and how?

As an example, they can gain attention and sympathy from their environment through the disease (secondary morbid gain). Alternatively, the patient is able to avoid even more uncomfortable challenges by developing an illness (for example, developing test anxiety to avoid making the test). Therefore, escaping into a disease produces positive internal motivation, because the medical condition can justify the inability to perform the task (primary morbid condition).

In order to continuously improve the quality of my work, I always keep my therapeutic work up to date with the latest professional standards through continual supervision and systematic further training.

Special Characteristics of Child and Adolescent Psychotherapy

The main purpose of child/adolescent psychotherapy is to enable them to re-discover and re-establish their psychological balance, which they are missing at that point in their lives.

There are several important differences between therapy for children/adolescents and therapy for adults.

The younger a child, the more important it is to speak the child’s “language”. For younger children, this is the child-like play. What is spoken language for adolescents and adults is play for children. Children communicate through play. They express current and past conflicts or present disappointments in a creative way, or they enact relationship constellations and experiences.

Alongside free play, children will be offered further creative methods to express themselves, such as drawing, kneading play dough or role play, sometimes with the help of miniatures, soft toys, hand puppets or action figures.

Often, the child provides insight into important topics by – for instance – always wanting to read the same book. Something in the story resonates with what is going on in their lives. Nevertheless, children also express themselves verbally.

The older the child is, the more space that is made for observing and thinking together, still alongside the playing that is an integral part of the therapy.

In contrast to children, adolescents express themselves mainly verbally, which means that access to their inner world is through conversation.

A further difference to therapy for adults is the role of their primary caretaker and other attachment figures. The younger the child, the more important the primary caregiver, which shows how vital it is to involve them in the therapeutic process. Usually, these are the parents, but sometimes these are third parties such as doctors, carers, teachers or family helpers.

If third parties are involved in the therapy of the child/adolescent, one has to pay particular attention to professional confidentiality. The therapy is meant to provide a safe space for “secrets” to be discussed. Sometimes, secrets have to stay just that, at least for a little while.

Cooperation with other institutions could sometimes be helpful, but may only be entered in agreement with the family. For this reason, as a therapist I will only contact these institutions upon request of the family.

However, there is one exception when it comes to professional confidentiality: if the patient poses a threat to themselves or others, the therapist has to act to protect the patient, to keep him/her safe. In this case, it is necessary to break the professional confidentiality.

The role and importance of the primary attachment figures change during adolescence. Parents play a less dominant role. Adolescents strive for autonomy and try to break away from the parental home. Peers become more important. This is why parents may be less involved in the therapy of an adolescent or not at all.

Another goal of psychotherapy for children or adolescents could be the reactivation of their normal development to enable the child or adolescent to deal with upcoming developmental challenges.

In this sense, developmental transitions can trigger disorders. This includes the transition from kindergarten to school, to puberty or breaking away from the parental home.

Sometimes, these symptoms are normal behaviours, albeit which the child displays in an amplified way or longer than he/she should. Therefore, the child carries a certain behaviour over into a developmental stage in which he/she should no longer be displaying it.