Beyond Coloring and Card Games: Reflections on Therapy with Kids and Teens

By: Ashley Lanier-Pszczola, LMFT

Date: May 15th, 2024 

I remember starting my internship as a master’s student and feeling strongly that I did not want to work with kids and teens. This didn’t have anything to do with not liking kids – in fact, I have always loved kids (and I usually feel like a big kid myself). But as a new therapist, I was under the impression that working with kids was too simple, and that it wouldn’t challenge me professionally. To my surprise, I learned during my internship at a foster care agency that working with kids and teens is very challenging and takes a specialized therapeutic skill set. The reality is that kids and teens are experiencing feelings and issues just as complex as adults, and that these feelings aren’t watered down just because they are younger and have less life experience. Caregivers see concerning behaviors and therapists are tasked with figuring out what is going on beneath the surface, even when the kid or teen may not have the words to explain it. For the therapist, it is extra challenging to explain a skill or concept to a child client when it requires using concrete and accessible terms, staying away from the theoretical or abstract. Then there’s the therapeutic relationship – while the relationship between client and therapist is always important, it often takes much more time to build with kids and teens, especially if they aren’t thrilled about attending therapy in the first place. My experience has been that when working with teens, rushing through the relationship building part of therapy too quickly, can become a real barrier to positive treatment outcomes. On top of all of this, sessions need to be engaging – I constantly find myself sitting on the floor, or running around my office, or talking about a video game or TikTok trend. I personally find this challenge exhilarating – it keeps me alert and always learning and growing, and never bored. I’ve learned that meaningful work with kids isn’t just coloring and playing games, but discovering how to creatively use tools like these to implement evidence-based treatment, like Exposure and Response Prevention (ERP).

Convincing someone to face their fears is a difficult task, so I’m always assessing how I can meet kids and teens exactly where they are, and build on this to get them closer to confronting anxiety and tolerating uncertainty. Last but not least, there’s the added challenge of working with the family system and helping caregivers to learn how to reinforce the therapeutic work at home. I love that I have been able to use my family therapy expertise to bridge the gap between my client’s individual work and their family system. For me, a career focused on meaningful therapeutic work with kids and teens has felt like a homecoming and is always rewarding. It’s something I have always been called to, and a way to meld my natural love for kids with my drive for a professional challenge.

I am always trying to advance my skill set so I can best help my clients, including recently completing the Pediatric BTTI with IOCDF. I also love sharing my experience with other therapists, and my recent workshop “Intro to OCD in Children and Adolescents – What Therapists Need to Know” explores the unique challenges of working with kids and teens with OCD, and how family/parent involvement is the key to successful treatment outcomes. I enjoy exploring topics relevant to the treatment of kids, teens, and their family systems, and some of my past workshop presentations have included “It’s All Mom’s Fault: Mother-Blaming in Therapy” and “Gen-Z in Therapy: Competent Care for Teens and Tweens in 2023.”