Many times when a new family enters my office for a first appointment, parents and kids are often wondering what therapy is going to look like. I’ve often been asked the questions “Is he going to lie on the couch when you talk?” and “How do you expect my child to just sit still and talk for an hour?” While there is definitely talking (while sitting up!) involved, CBT with kids is often full of crafts, play, acting, and other fun activities. Here are some examples of how I’ve utilized specific CBT techniques with kids:
1. Worry Monsters, Calm Down Bottles, and Stress Balls, oh My: Arts and crafts regularly become a part of my practice as a child psychologist. Sometimes I find tangible items are more helpful in assisting children master skills to help them calm down in times of worry or stress. It’s not surprising to see children walk out of my office with a sparkly bottle of water to help them calm down when they are angry and worried, a stress ball made out of balloons and flour to squeeze in troublesome times, or a picture of a monster that symbolizes what their worry would like if they drew it as a creature. These art projects are often utilized to break the ice and get children comfortable talking about what it is that they are presenting to treatment for.
2. Leaky Tire Contests: Diaphragmatic breathing is a skill that’s helpful in calming one’s body down when they feel nervous in anxiety provoking situations. While I’m teaching belly breathing to a child I often tell them to breathe in through their nose like they are trying to put the air into a balloon in their belly. Once they’ve mastered belly breathing, we turn it into a game. We take a deep breath in through our noses and then have a contest where we hiss the air out of our mouths like leaky tires. Whoever hisses the longest wins the game. I’ve found that this not only helps the child’s body calm down in times of stress or anxiety, but it also is an excellent distraction away from whatever negative feelings and thoughts they were currently having. Kids often get very excited when they beat me in the contest as well!
3. Robots Vs. Ragdolls: Progressive Muscle Relaxation (PMR) can be a helpful tool to teach a child the way their bodies feel when they are stressed or tense versus how they feel when they are relaxed. It’s also helpful in the moments where an individual needs to calm their bodies down. I often teach PMR mimes to help kids get the concepts and use them in practice. Whether I’m teaching children the difference between being robots (tense) versus ragdolls (relaxed) or we are “squeezing lemons” or “squishing their feet into the ocean sand,” they are learning an important skill that can help them out when things get rough.
4. Searching for Clues as Thought Detectives: Challenging one’s negative thoughts can be an abstract concept. With kids, I tell them we are going to be like detectives and find clues to see if their negative thoughts are true. For example, when a child has a negative thought about being lost from a parent, we examine the evidence and see how possible it is for that to actually happen. Sometimes, I even hide clues around my office and practice, to help challenge these thoughts. As children spend time finding the clues (usually hidden in Easter eggs), we are also challenging their unhelpful thoughts and coming up with positive coping statements.
5. Let’s Rock and Roleplay: For kids who are anxious, sometimes exposing themselves to the things that make them the most anxious can be next to impossible at first. One way I get them used to practicing facing those fears is by using toys or masks to act out these exposures first. It’s not uncommon for my client and I to use Lego men, hand made masks, or even stretchy toy lizards to act out different scenarios that make the child feel frightened. Sometimes this is the first step to get getting a child to face their fears on their own.
These are just a few of the many ways I try to make CBT fun and exciting for kids. I’ve found that the more hands on I can be with a child in treatment; the better they respond and can generalize the skills I teach to the areas in their lives that are causing them difficulty. Hopefully, this helps clear up some of the misconceptions that we’re just lying down on the job during psychotherapy.