Peter Carnochan, Ph.D.

Child and Family Psychotherapy

Growing up takes time and practice. It’s ordinary that in the movement from infancy to adulthood there are times when the maturation process becomes rocky. Children can become worried and struggle with the new demands they meet at home and at school. Parents can find themselves taxed by the dual demands of parenthood and work. In many cases these bumps in the road are transitory and families find a way on their own to help their children negotiate the challenges of getting older.

Sometimes, however, children and families can use help to to navigate the turbulent waters of growing up. When children have challenging temperaments or learning differences, when there is significant stress in the family, then psychotherapy can be an important part of transforming these obstacles into opportunities for further growth. Families and children who have committed to the process of psychotherapy, often report that by the end of the work, they have gained a resiliency and maturity for which they are grateful. In this way, therapy can be more than merely dealing with difficulties. It can provide an opportunity for children to develop emotional and relational skills that will serve them for the rest of their lives. For parents it is a chance to expand their parenting capacity and rework patterns from their own childhood.

When families call for help, I begin by meeting with the parents to talk about the situation. This gives parents a chance to see me in person and to get a sense whether I may be of service. During these initial meetings I talk with parents about their concerns and begin to evaluate whether it makes sense for the child to try a session with me. If together we feel that further work would help, I will meet with the child for several sessions so I can get a better sense of his or her strengths and weaknesses. After the evaluation period I then meet again with the parents to talk over what I have seen and to discuss treatment recommendations.

Therapy with Children

It is rare for children to refer themselves to therapy. Their difficulties tend to show themselves more in action than in words. Asking a young child to come into therapy and talk about their troubles, then, offers limited possibilities for change. With children, it is play that offers a language to express their worries and conflicts.

When children come for therapy they are often unsure of what to expect. During my first meeting with children I tell them that I am a doctor who helps children with their worries and troubles. After telling them something about what I have learned about their situation, I invite them to explore my collection of toys. Over time games emerge that express key themes in the child’s emotional life. To give a better sense of how this works I want to describe the play of a boy who was having a great deal of anxiety around learning to read and write at school. In one sequence of play he would hide under my couch while I tried to find him. I would then see him under the couch and resolve not to lose sight of him. Inevitably, though, he would play some trick on me. He would tempt me with pictures of candy or scary pictures of a ghost. I would pretend to become so preoccupied with these images that I could no longer think. At that moment he would sneak out from under the couch and pounce on me catching me by surprise. Through this game he found an imaginative way to depict the anxieties that were making it hard for him to concentrate at school. By taking on the role of the character who couldn’t think, I was able to put into word what I understood about his troubles. Over time this kind of play helped the boy become more at ease and better able to focus. Part of the art of play therapy is creating a space where each child is able to invent his or her own way of playing and expressing hopes and fears. To see further examples of how play can become a medium for personal expression and change, I invite you to read my professional articles on working with children.