What are the major differences between
therapy for adults and children?

    I delayed answering this one because it has been several years since I treated children and I wanted some input from a colleague who is currently treating children to assist me in reviewing my answer.  My contact pointed out several key differences.

    First, children have difficulty implementing "home work" type counseling, such as  cognitive therapy, partly because of a shorter attention span than adults, and partly because they do not have fully developed mental skills such as virtual self observance.  That is, they have difficulty mentally standing outside themselves and objectively viewing their behavior, especially real time behavior.   Due to the child's inability to understand and hold onto all of the therapeutic elements, the parents should meet with the counselor to be educated as to how to help their child carry out the therapy "home work" assignments moment by moment.

    Children also tend to be less rational and more emotional than adults.  Thus, their emotions need to be understood and contained by an adult.  Children often do not know, and/or cannot verbalize, the reason why they are upset.  Lacking this ability, children are handicapped when implementing cognitive "home work."  They are less able to invent alternative thought patterns than adults, a skill often employed in therapy.  With the parents help, children can be coached to think of alternative thoughts or conclusions which they might not be able to do on their own.

    Because children have far less control over their environment than adults, they are less able to move out of a specific situation long enough to implement a cognitive strategy even if they did remember when and how to do it.  They are far more impressionable and affected by their environment than is typically the case with adults.  Thus, children will have great difficulty unless their environment is supportive of cognitive retraining.

    That last issue is why I ceased treating children in  early 1998, and instead, insisted that the parents come in.  I observed that children's behavior was, more often than not, an indication of something going on at the parental level.  The child was watching and hearing, on an ongoing basis, dysfunctional thinking and behavior patterns in the parents and then mirroring the parents' problem, rather than having a problem of his or her own.  Until the parents got their own act together, they would not be in a position to help their child who was trapped in that environment. I concluded that there was little chance that seeing the child alone for one therapy session per week would ever counter the influence the parents had during the remaining 167 hours.