Understanding the Major Types of Therapy Used With Kids
Discovering that your child might need more help than you can provide can feel both scary and overwhelming. You might even feel caught off guard when you realize that your child has a mental health issue. And while it can be tempting to blame yourself or wonder what you could have done differently, the truth is that no one is to blame.
Just as you would with any medical diagnosis, the key is to find the kind of therapy that will a make a difference your child’s quality of life. But with so many different types of therapy from which to choose, how do you know what is right for your child? Read on to discover why therapy is important, what types of therapy are available for kids and teens, and how you can find the right therapist for your child.
Why Therapy Is Important
When left untreated, mental, emotional, and behavioral disorders in childhood can cause long-term problems that affect the health and well-being of your child, so try not to delay when it comes to selecting a therapist. Finding treatment for their mental health issues will not only help improve their quality of life, but it also will make things easier at home, in school, and with friends.1
Therapy also helps build a healthy foundation of skills your child can use throughout their life. The first step is finding a therapist who not only provides the type of therapy you are looking for, but that also has training and experience in working with children your child’s age.
Typically, the therapist will choose the type of therapy or therapies that will be most appropriate for your child’s particular issue and goals, but you also can have a say in this decision as well. But first, it is important to familiarize yourself with the types of therapy most commonly used with kids as well as the benefits to each. Here are the most common types of therapy used with children and teens.
Applied Behavior Analysis
Applied behavior analysis involves thoroughly assessing the impact of a child’s behavior. Although this approach applies to many age groups and issues, it can be particularly useful during early interventions of kids with autism spectrum disorder.
“Generally, this type of therapy is used specifically with autism spectrum disorders,” explains Justin Schrieber, DO, MPH, FAAP, a pediatrician and child psychiatrist in Pittsburgh, Pennsylvania. “Applied behavior analysis works on an antecedent—that is something that leads to a behavior and then leads to a response.”
In other words, Dr. Schrieber says that if a child walks into a loud room and starts yelling and screaming because they are bothered by the level of noise, the therapist would find a better way to handle these antecedents and modify behavior. In this case the antecedent is the loud noise. One way to help is to set the child up for success by bringing along ear protection–like noise-canceling headphones. Another way is to teach them the behavior of requesting a break, then give verbal praise when they do so.
Kids receiving this type of therapy learn how to respond in real-life social situations. The therapist often offers strategies for communication, self-management, and cognition. When used with younger children, they learn how to communicate their needs.
“There is good evidence that this therapy is one of the best with helping with frustration intolerance [and] social communication,” Dr. Schrieber says. Applied behavior analysis can also help support self-care, play and leisure, motor skills, and learning and academic skills. However, it might not be the right treatment for every child so be sure to consult your provider.
With art therapy, the goal is to use creative expression to work through issues or challenges while engaging in self-expression. Throughout this type of therapy, therapists guide kids in using their art to gain personal insight and develop new coping skills.
Art therapy gives them an outlet for their feelings and helps them organize their thoughts and process their emotions.— BETH TYSON, MA
“Kids can have a difficult time verbalizing what they are thinking or feeling,” says Beth Tyson, MA, a psychotherapist and parenting coach. “Art therapy gives them an outlet for their feelings and helps them organize their thoughts and process their emotions.
With art therapy, the experience becomes more concrete, says Tyson. They also learn how to visualize something in their life and then modify their behavior in response.
“For instance, a bullied child might draw himself as a super hero,” says says. “He visualizes himself as a super hero, then rehearses it in his mind, and then acts out in real life by standing up to the bully.“
Because kids often do not have the communication skills to express themselves, therapists sometimes turn to art therapy to give them a voice. In addition to providing an emotional outlet for kids, art therapy also can help kids identify and name their feelings.
Cognitive Behavior Therapy (CBT)
This therapy type is one of the most common types of therapy for children, especially for those with anxiety or depression. During therapy, kids learn how to recognize and understand their thought patterns and how they contribute to their situation. More importantly, they learn how to change those patterns in order to create healthier thinking and behaviors.
We see really good evidence of CBT helping with depression, anxiety, and trauma.— JUSTIN SCHRIEBER, DO, MPH, FAAP
“CBT is effective in pretty much all situations,” says Tyson. “It is an evidence-based therapy that is more structured than talk therapy. Kids are given activities and assignments that they come back and talk about. This allows them to work through specific issues and determine what actions that they have to take.”
According to Dr. Schrieber, CBT is the gold standard in treating mental health issues. Plus, it is the most widely used form of therapy for children and has even been shown to be potentially effective in early elementary school-aged children.2
“We see really good evidence of CBT helping with depression, anxiety, and trauma,” says Dr. Schrieber. “CBT helps people develop a really good skill set so that they don’t get stuck—they really work on their thoughts. It helps kids develop great skills in general.”
Dialectical Behavior Therapy (DBT)
Originally developed to treat people with borderline personality disorder, DBT is also can be used to treat older teens who have chronic suicidal thoughts or feelings or engage in self-harming behaviors. It may even be used with kids and teens who struggle with eating disorders.
“DBT was originally created as a focus for borderline personality disorder, but we have found it is also a useful way to help people that have difficulty with mood instability,” says Dr. Schrieber. “DBT can be used in kids with depression, anxiety, PTSD, and eating disorders as well as with suicidal ideation and self-injury behavior.”
The focus behind DBT is that the child or teen learns to take responsibility for their problems while learning to recognize how they deal with stressful situations and negative emotions. To accomplish these goals, therapists using DBT may combine mindfulness with additional skills so that kids learn how to regulate their feelings and emotions.
According to Dr. Schrieber, DBT really helps kids learn how to manage distress tolerance. The therapist also helps kids and teens learn how to become better self-advocates. Because when they are feeling a lack of self-respect, they have trouble building healthy relationships.
“This is an effective and high-evidence-based therapy, and [there are a lot of] people with really great skills to practice this type of therapy but typically don’t take on a very large caseload,” he says.How Kids and Teens Can Benefit From Mindfulness
Exposure Response and Prevention (ERP)
This type of therapy is a form of CBT in which the child is gradually exposed to thoughts, experiences, objects, and situations that trigger anxiety and fear. While this type of therapy can be used in many different scenarios, it is frequently used with kids who have obsessive compulsive disorder (OCD).
“This type of therapy is often used specifically for OCD,” says Dr. Schrieber. “They learn how to tolerate the fear or the worry—they learn that they do not need to react to the compulsion.”
It also can be used for treating different types of anxiety, including social anxiety and phobias. For instance, a child with social anxiety might gradually be exposed to social situations. The therapist will guide your child through this experience so that it is therapeutic and not traumatic.
As the name implies, family therapy involves the entire family. Typically, this type of therapy is used to not only help the therapist learn more about the child from the family members, but also so that they family members can learn ways of supporting the child’s recovery.
Family therapy can be helpful when family members are not getting along, disagree, or argue a lot. It is also helpful when kids or teens are having behavior problems. Family therapy helps family members improve communication skills and learn problem-solving techniques.
Parent Child Interaction Therapy (PCIT)
With this type of therapy, parents are coached in real-time by the therapists. Throughout the session, parents interact with their child while the therapist guides them toward positive interactions. This type of therapy is often used when children struggle with behavior problems or have issues connecting with their parents or caregivers.
This therapy can be used when a child has experienced a trauma or has an extreme behavioral aggression, or an attachment disruption at some point in their life. “PCIT helps strengthen the bond and the attachment between the child and the adult in their life in order for them to feel safe and have a secure attachment to fall back on,” says Tyson.
Tyson says this type of therapy is often used in kinship care, adoption, foster care, or when a parent has been away from the child for an extended period of time. Oftentimes, the child and parent or caregiver are in a room alone during therapy and the therapist is behind a two-way mirror. The therapist observes the interactions and coaches the parent through an earpiece.
During play therapy, a therapist uses playtime to observe the child and gain insights into the issues or experiences they may be struggling with. The therapist also can help the child explore unresolved issues or trauma. This form of therapy is often used because children may not be able to process their emotions or articulate their concerns to their parents or the therapist.
“Play is the language of children,” says Tyson. “During play therapy, the therapist enters their world of play with them. When children play it is an expression of all the little dramas in their life and the therapist knows how to decode and interpret what they are doing.”
Through this type of therapy, kids learn new coping mechanisms. They also may learn how to redirect inappropriate behaviors and make sense of the things they are dealing with. According to Play Therapy International, up to 71% of children referred to play therapy experience positive change.3
“Once a trust is established, the child will start to verbalize more,” Tyson says. “They act out their emotional struggles and the therapist can intervene in that process and help them act out new behaviors.”
The goal of psychodynamic therapy is to understand the issues that motivate and influence a child’s behavior, thoughts, and feelings. By talking with the child, the therapist is able to identify a child’s typical behavior patterns and defenses. This type of therapy also can be used to help a child recognize their inner conflicts and struggles.
For instance, Dr. Schrieber says this type of therapy is about being able to use the experience a person has had to define how we approach new experiences. For instance, if a child feels like their parent does not listen to them, they may make an assumption that the teacher will not listen to them.
“Psychodynamic therapy is not really time-limited,” Dr. Schrieber says. “Meanwhile, with CBT, there is a set time and many times a child only needs about 8 to 12 weeks before they work through strategies and see results. CBT is more concrete and less abstract and much easier for kids to grasp because they are focused on learning new skills.”
This type of therapy may be used in conjunction with another therapy and usually involves things like deep breathing, mindfulness, muscle relaxation, guided imagery, and meditation. Kids also may learn TIPP skills, which stands for temperature, intense exercise, paced breathing, and paired muscle relaxation.
TIPP skills are used to help kids learn to regulate strong emotions and manage difficult situations. Kids are taught to use these skills when they are dealing with intense emotions. Using these skills to calm down allows them the space they need to then use their other coping strategies.
“Relaxation techniques can be helpful for anyone,” says Dr. Schrieber. “These are techniques that we encourage our pediatricians to use. They are effective for anxiety, stress, insomnia, trauma, ADHD, kids with anger or oppositionality and even for stress without a diagnosis.
With supportive therapy, treatment is designed to help improve or reinforce the child’s well-being, self-esteem, and self-reliance through supportive measures. To be successful, there needs to be a level of trust between the child and the therapist so that the therapist’s supportive behaviors like encouraging, validating, comforting, and reassuring. Most of the time, the therapist focuses on listening attentively and sympathetically.
“This therapy involves, positive support for the child and is used in conjunction with other therapies,” says Dr. Schrieber. “It is especially useful for kids who are depressed or anxious.
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