Counselors who work with children and adolescents use innovative approaches
to enter into the world of young clients and to help them face myriad issues
By Lynne Shallcross
Originally published by Counseling Today Online
Norine Lyons remembers exactly what inspired her to specialize in working with children. After many years in corporate public relations, Lyons earned her master’s in counseling psychology and spent her practicum at a residential substance abuse treatment facility for adolescent boys.
“It was always amazing how some boys could come into treatment looking completely wretched and angry or just forlorn, and then, in a few months of regular meals and structure and chores and therapy and time away from family dysfunction or community distress, you could see someone start to emerge from all that pain and anguish. Not all the time, certainly. Far from it. But it was exciting when you could see the changes a boy could make, start to imagine a good life for him, and you could see that he could see that for himself,” says Lyons, who earned a certificate in child and adolescent psychotherapy from the Washington (D.C.) School of Psychiatry before starting her Alexandria, Va., practice in 2008.
Children and adolescents face many of the same issues as adults, says Lyons, who also sees clients at a private practice in Washington, performs pro bono work and spends one day a week at an agency that provides care to at‐risk children and their families. “They face everything their families face. Loss of a parent to death or illness or divorce or incarceration, those are the biggest and the deepest losses. There’s the loss of friends whose families move away. They worry about terrorism, war, bullying; about their parents losing their jobs; that their parents fight; that nobody likes them; that school is too hard; that they don’t look the right way; that parents and teachers expect too much from them; drugs, alcohol, pregnancy, gender identity issues, paying attention, depression, anxiety. Quite touchingly, children worry a lot about the happiness of the people they love.”
The way more “mature” topics are presented and shared today also affects the youngest among us, Lyons says. “I think the barrage of information that children are exposed to has to have changed things (for them). A fairly persistent 12‐year old a couple of generations ago could scare himself to bits by reading a newspaper, but at least you had some idea of what he was reading. The Internet has changed all that, as has the level of violence and other material that’s out in the ether now. Children aren’t wired to handle it, and it can create enormous distress and anxiety. Worse, they get used to it and accept it as normal.” Another issue Lyons believes is affecting children and adolescents is a loss of freedom. “I read about a study in England that looked at children’s ‘radius of activity’ ‐‐ the distance from home that kids could play unsupervised. It had declined by 90 percent since the 1970s,” says Lyons, who estimates that figures in the United States would look pretty similar. “Kids used to wander off on a summer morning with instructions to come home before dark. They invented their own games and went off on adventures and organized their own fun. No parent in his or her right mind would be OK with that today, and with good reason. But you have to wonder about the loss to children ‐‐ of flexibility, resilience, creativity, of fearlessness and feeling powerful. It’s hard to feel powerful on a play date.”
Counseling teaches practitioners to meet clients where they’re at, and that includes with young clients, Lyons says. “When you work with children, you meet them sitting on the floor. Kids need to play. It’s how they show you what their world is like, and it’s how they heal.” Having the right mix of toys is key to encouraging self‐expression, says Lyons, who believes the most valuable objects in her office are a sand tray and roughly 400 miniature figures, which range from animals and adult and child figures to wizards, kings, angry villagers, superheroes, tiny beer cans, wishing wells and a tiny Eiffel Tower.
“You show the child the miniatures and the sand tray and invite her to build a world in the sand,” Lyons says. “A boy that I worked with very briefly had a great deal of trouble with anger, and he had a lot to feel angry about. He would line up the horses tightly in one small corner of the tray and then put row after row of fences in front of them. It was all right there in the tray ‐‐ all the feelings he didn’t have words for. Another little girl who was missing her father would do these very elaborate trays where the king was always forgetting about the princess. For some children, using human figures is too threatening, too evocative, but they’ll play out stories and themes using animal families.”
Lyons also keeps a bowl of seashells in her office to help her young clients with relaxation. She invites children to pick a shell that they like and to carry it with them. She then teaches them to imagine the beach or some other place where they feel calm and peaceful as they hold the shell. “Older children are especially interested in the idea that they can do things to change the way they feel,” Lyons says. “It gives them a sense of control and mastery.” Another go‐to game in Lyons’ office is an adaptation of Jenga. Lyons took a Jenga set and labeled each of the wooden blocks with feeling words such as disappointed, furious, excited and surprised. As clients remove a block from the tower, they read the word and talk about a time when they experienced that feeling. “This is a good one to do with siblings,” Lyons says, “and it’s often interesting to see how they remember feelings for each other. ‘Furious ‐ that’s like how you were when we didn’t go to McDonald’s.'” The game is also helpful for teaching children words to express their feelings, she adds. “Some children have a real poverty of expression when it comes to emotions. They can’t get much beyond good and bad. The more you can enlarge children’s feelings vocabulary, the more you can help them make sense of their emotions instead of feeling overwhelmed by them.”
The parents and family always play a part in the counseling process when your clients are children and adolescents, Lyons says, but to what degree depends on the age of the child and the nature of the problem. Although many problems involve the parents, Lyons says it would be too harsh to say that parents are often the cause of their children’s problems. “For the most part, parents want to do well by their children and are usually very distressed when things go wrong,” she says. “Or they’re unaware of how their actions affect their kids. A parent may not realize that a child feels abandoned while mom or dad sits in front of the computer for hours or talks on the phone.”
In some situations, Lyons says, there’s simply a poor fit between parent and child, such as when a parent is loud and enthusiastic while the child is quiet and introverted. “The child can feel quite overwhelmed by the parent,” she says. “So you gently teach different ways for the parent to interact with and communicate with the child, dialing it back a bit to suit the child’s temperament.”
A bulk of the work is helping parents understand their child’s temperament and developmental level, Lyons says. “You’ll see a child who has frequent explosive behaviors and is labeled defiant or manipulative by the adults in his life. So you try to help (the parent) understand that it takes a lot of social skill and planning and patience to be manipulative ‐‐ this child isn’t capable of that. He isn’t having a meltdown to get his way. He just doesn’t know what else to do.” In this instance, the child’s social skills, planning abilities and communication skills need work so he doesn’t have to explode, says Lyons, who adds that Ross Greene and J. Stuart Ablon address the topic of the “explosive child” particularly well. “If you can help a parent to see a child in a different light, the parent is better able to empathize with the child’s struggle and more motivated to help,” Lyons says.
Lyons says she remains struck by the privilege of working with children and their families. “In everything, the goal is to strengthen the bond between parents and children. It takes great courage and compassion for a parent to bring a child to counseling, as well as a leap of faith. As a counselor, I always feel honored and humbled by that.”
Counseling Today asked ACA members Tiffany Craig, Scott Riviere, Norine Lyons, Katrina
Schurter and Michael Michnya for their best advice on working with children and adolescents.
Following are 20 tips to help counselors working in the field.
- DO respect the wisdom of your clients, regardless of age, Craig says. “A 2‐year‐old is not
less wise than a 92‐year‐old. They just have a different kind of wisdom. Tune into it!
- DO deal with your junk, Riviere says. Having the perfect childhood isn’t a requirement
for being a good counselor, but dealing with your baggage from childhood is.
- DO build strong collaborative alliances with parents, Lyons says. “Even if you’ve
developed great rapport with the 14‐year‐old client, he won’t be coming back if you’ve
alienated his mother or father.”
- DO relax, Craig says. “Don’t forget that kids are psychic and will read any insincerity or
anxiety in you in a heartbeat. You can’t fake it.”
- DO build on strengths, Craig says. “Human beings learn and genuinely grow by building
on what we do well.”
- DO be hopeful, Schurter says. “Even if you are not, convince yourself there is always
hope. If you are not, the client will pick up on it.”
- DO tell lots of therapeutic stories, Michnya says.
- DO be gentle and empathic with your recommendations, Lyons says. “Remember how
difficult it is for the parent to be in this situation and how wary he or she may feel about
being judged or seen as the reason for the child’s struggles.”
- DO give children and adolescents work to do outside of session, unless they are
extremely young, Schurter says. “This will help empower them and help them take
responsibility for their change.”
- DO separate the person from the behavior, Craig says. “Human beings are intrinsically
valuable, even children who act like hellions and grown people who harm children. Their
behavior is what is in question and needs care. We get much further toward lasting
healing when we honor this principle in our work.”
- DON’T ignore the family system, Michnya says.
- DON’T assume you are the expert, Schurter says. “Give parents and adolescents
empowerment by reminding them that they are the experts. They will be more willing
to do the work if they believe they are the reason for the change, not you.”
- DON’T underestimate the ability of a child, for good or ill, Craig says.
- DON’T try to lead until you have an excellent relationship, Michnya says.
- DON’T see a child without the full knowledge and consent of all legal parents and
guardians, Craig says.
- DON’T cast negative light on important people in a child’s life, even if those people are
harming the child, Craig says. “They need those powerful internal objects intact.”
- DON’T promise something you can’t deliver, Michnya says.
- DON’T work with children who have issues you are not trained to treat, Schurter says.
- DON’T keep secrets that have to be told, Michnya says. “The most common one that I’ve
encountered is when counselors know about an abusive or neglectful parenting situation and,
instead of reporting it to Child Protective Services, keep it to themselves.”
- DON’T get into kid therapy unless you are willing to sit on the floor, play by the creek,
get your clothes covered with paint, pick up a bug, deal with snotty noses and play for a
living, Craig says.