In-Person Therapy for Kids

Both in in-person therapy and online therapy, play is an integral part of therapy for kids

Therapy for kids is grounded in play. We play with toys and dolls, act out scenes, listen to music, do art therapy, or simply act silly together. In in-person therapy for children, we also leave our Manhattan, New York office to visit the art closet, go on a walk, or draw on a chalkboard in the waiting room. These activities are not just frivolous fun; they are the stuff of kid psychotherapy. Unlike the adolescents and young adults we treat, young children rarely work through things or convey their mental health struggles through talk therapy alone. For those who can, play is especially important because it may suggest a need to get away from language and access feelings and connection in other ways for their well-being.

Play is the way kids show up and make sense of the world, which presents an incredible opportunity for psychotherapy (play also factors heavily into family therapy with kids and group therapy). Through play, we can see what feelings they’re working through and what experiences they’re struggling with, whether life transitions, behavioral problems, mood disorders, eating disorders, ADHD, self-esteem, OCD, or autism. A child who experienced a significant loss might show their therapist how they’re grieving through the symbolism of that play. Another child struggling with social anxiety and making friends may engage in play with the therapist in a way that provides insight into how they attempt to get along with peers. Yet another child struggling with perfectionism may, at first, embody characters that have honed this way of being. The clinician can, through the play, invite messier performance, and because it’s “play,” there is more room to explore and try on new ways of being for their behavioral health.

Play is an essential form of communication for children that is, without question, better in in-person therapy for kids

Children generally play quite easily. It’s a form of communication they usually haven’t learned to give up. It’s also a form of communication and intervention that is, without question, better in person in a space in which the therapist and child can be together in a fully embodied way.

On screens in telehealth, play is usually quite passive, both in and out of therapy, watching videos, engaging in video games, or talking to a relative. These are forms of play that are too familiar to many children. It can be hard to take them out of this default mode. Essentially, play therapy on a screen for a child is similar to handing them a screen on a playdate. Whatever joy in connecting with and truly playing with another is too easily put aside for the more immediate, familiar pleasure of getting lost in a screen.

The therapy office can be a separate place where big feelings live without concerns about parental monitoring

Therapy should feel special—a special relationship to hold a special set of conversations, feelings, and memories. In in-person therapy for kids, the office is a container for big feelings and a place where this important relationship happens related to their mental health. The therapy office is where fears and fantasies live, where the interventions take place, and where they talk about the hard stuff. 

Without that container, online therapy for kids presents more challenges, particularly with privacy concerns. In online therapy, we’re always thinking about both real and perceived privacy. If a child does therapy on their device, there’s an awareness of other (appropriate) contexts of parental controls and oversight that raises the thought of parental monitoring, as well as a contradictory idea of “who owns the iPad.” If they’re on a parent’s laptop, this can express itself in other ways within the therapy. Of course, there is also the question of physical distance: being alone in a room, especially in an NYC apartment, isn’t experienced as privacy, really. And in truth, parents are curious about therapy sessions about their child’s behavior and are inclined to snoop.

Children need to see their therapist as a whole person: A therapist’s office is a part of them

Kids also need to construct the idea of their child therapist as a whole person. Someone’s space is part of how children make sense of them—its smells, its colors, the toys, the pictures. In young children’s imagination, the therapist’s office is often seen as their home. Whether the office is understood as a home or is merely a place that belongs to and is occupied by the therapist when they’re not around, this helps construct the idea of the provider as a fully formed person with whom they have a real relationship.

The routine of going to the therapist’s office can be an important act of caring

The routine of coming to individual therapy in person can be just as important for kids’ wellness as it is for adults. Going to a different part of New York (even from New Jersey), a different building, and a special office all contain significance. Especially for kids, there is also a care and specialness in a caregiver accompanying them to therapy—private time with that parent, babysitter, and family members, an expression of effort, and the relationship between that parent and the therapist that’s seen (even if some of its content remains private). Though they may never have seen child psychologists or had psychiatry appointments before, kids have an experience of “going to the doctor” as a kind of early, coded experience of caring that often translates to the therapy office. While different from a doctor’s health care, that’s a point of reference in locating and making sense of “going to” the therapist’s office as an act of caring, by both the therapist and the person who takes them.