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Are young kids too young for therapy if they don’t really understand mental health?
pencils

I didn’t see Jenny’s eyes for three weeks.

We saw kids four and up, many of them victims of abuse and neglect, long term. Other kids came as part of family therapy, and still others had various issues that concerned their parents or professionals.

Jenny was six, and tiny for her age. She always looked at the floor. No eye contact at all for the first three weeks.
Jenny wasn’t interested in my toys, or puppets, or stuffed animals, or drawing. She wouldn’t look at anything. It was like she was terrified of doing something wrong.
Good reason, her mom’s boyfriend Boris expected perfect compliance with his screamed commands. He didn’t often hit her, but he made menacing gestures all the time, almost smacking her face or punching her nose. Boris had given her a black eye or two, but preferred to hit her mom. He loudly complained that he had to take care of “this little shit” because mom was drunk or stoned. Jenny was terrified and spent her waking hours trying to be “good.”
I gave Jenny lots of emotional and physical space, careful not to be too warm — just safe. Mostly I told her stories about butterflies and puppies and trips to the zoo, watching for the cues I could pick up without seeing her eyes, and adjusting the story accordingly. Soon after, we started collaborating on the stories, with her creating the characters, and often a basic plot, frequently about families, like her new foster family. She started to make eye contact, and to tell the kind of stories kids tell when they are feeling better.
Still, Jenny was standoffish, and very careful about making “mistakes.”

I have a water pitcher and small paper cups in the office. Jenny liked me to pour a cup for her, and always asked for it. One day she dropped her almost full cup on the carpet. Her eyes got wide and she jumped back with a gasp.

I said “Oh, that looks like fun!” I stood up, dramatically raise my own paper cup, and dropped it on the floor by Jenny’s and laughed. Her eyes grew even bigger and she laughed too. “Can we do it again?” “Yes, please, but can we drop in the waste basket so we don’t have to clean it up?” We emptied the whole pitcher, eventually, and it was the funniest thing either of us had ever done.

Kid therapists have lots of approaches to build trust and connect, and we have to make some of it up as we go along, in play therapy.

I called this the Jenny Drop a Cup of Water on the Floor to Increase Spontaneity and Trust Therapy, and it’s the only time I ever used it. And this is the first time I’ve talked about it, for that matter.
After that day we got into some of the more typical play therapy, and there were lots of pictures of big mean giants with huge mouths being vanquished by smaller good people or dragons, I don’t remember. I’m sure the puppets and stuffed animals got into the act too.
  • David McPhee, PhD
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