Hearing Between the Lines in Child Therapy

*For the sake of brevity, I will refer to all young individuals of minority age as “children” or “child” in this post.

I feel lucky in the fact that I have the privilege of working with several children on a long-term basis – and I mean it. As I have mentioned in my previous post, voluntary child clients can be hard to come by and even harder to retain in therapy. Therefore, I always felt lucky (and also slightly excited/nervous) whenever I have new children who come to me. Fortunately, most of my clients have all wanted to see me and were the ones who did the online research to find me, which made it easer for me to build rapport with them.

Most of my clients suffer from anxiety of some form. One of them is a precocious, solitary child who has been debilitated by their symptoms for the past two years to the point where I suspect their physical growth has been stunted not only due to their anxiety that reduced their physical activity but also due to poor eating behaviours associated with sensory hypersensitivity. Fortunately, over the past few months of working together, they have shown great improvements, of which they are proud.

In the initial stages of our work together, they had a lot of difficulty in producing spontaneous speech due to severe anxiety and agitation. Ordinary conversations, even ones about their daily lives, were a challenge to them because of a “brain-fog” that seems to plague them whenever someone asks a question. Recently, as a result of the improvements and increased relaxation in their body symptoms that had previously prevented them from engaging, they have become more open in sharing some of their deeper thoughts. One day, we were chatting about their school as part of our closing summary when they all of a sudden brought up their family. I had heard from the parents that they had an acrimonious divorce that could rival a soap opera’s. For ethical reasons such as to prevent bias towards the parents, I had asked each party to refrain from sharing too much about their side of the divorce and the stories, but from the pieces I gathered, the marital relationship appeared to have been highly contentious before leading to the bitter separation. It was therefore strange when I heard the child mentioning their parents’ separation so suddenly without warning. I became alerted when they mentioned witnessing the fights when their parents were still together. They told me that their younger sibling used to hide and cry in the bedroom out of fear.

“A kid shouldn’t have to see that,” they said.

“What about you? You were also a kid yourself, too!”

“Yeah, but I’m used to it,” they replied in an almost nonchalant manner, shrugging.

Hearing those words made my heart break for them and their younger sibling. I always knew that they were mature for their age, but no matter what, they are a child still. Yet, at the same time, I was glad to hear them share these thoughts with me, as it meant that our therapeutic alliance had deepened. As I continued the conversation with them, I slowly realized that it was their awkward/indirect way of asking me for help – not because they are at risk of domestic abuse, but to help them navigate their relationship with their parents and to advocate for them. They will soon be old enough to decide for themselves which parent they would like to live with, and being the kind-hearted individual they are who love both parents, it is a dilemma they do not want to confront. Be it ever so cliche, tears almost swelled up in my eyes when it hit me that this was the reason they brought up their parents’ divorce out of the blue. We ended the conversation with me promising that I’ll help advocate for them. They did not say anything but just shrugged – a usual body gesture from them when they do not know what to say.

It was not the first time I had to read between the lines when working with children. Most of them have a hard time identifying and expressing their emotions, much less regulating it, so it takes practice and time to acquire enough familiarity of their habits and idiosyncrasies before I can read their body language and understand what they are not saying verbally. If in person, wearing masks adds to the difficulty at times as children often do not meet eye contact but would gaze all over the room when they talk. Some of the strategies I have learned include the following:

1) Offering interpretations and letting them choose

2) Providing empathetic statements

3) Using self-disclosures and sharing other clients’ stories

4) Infusing jokes and humour – sometimes even self-deprecation as an “adult”

5) Being direct about the current situation

Finally, it is important to remember that most children find it challenging to share their true thoughts to adults as they have been used to getting shot down by the grownups around them, who, despite their good intentions can come across as discouraging and critical to their children. I have a young adult client whom I started seeing when they were still a child, and it is painful to see them being conditioned to giggle uncontrollably whenever they confront difficult emotions because no adults have ever believed and validated them.

Of course, everyone has their own unique traits and I continue to learn from my child clients as we grow together and as I discover new information about them. I do not dare to say that I have become any more of an expert to reading between the lines when it comes to a child, but I know that with each (rewarding) experience I have with them, I feel more grateful for the privilege of being able to practice this essential skill and, at times, even share them with their parents, which I have been doing more and more this past year; however, with the parents, it is another story that I will save for another time~

Interested in letting your child work with me? Feel free to contact me here! I look forward to working with you and your family 🙂

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