A couple weeks ago I went a few minutes over with an adult client, pushing back the start of my next session. The following week, this second client showed up a couple minutes late and when she sat on the couch, it seemed she couldn’t get comfortable, fidgeting and harrumphing. Of course, the reason for her lateness and her discomfort was that she was mad at me. By delaying her session the previous week, I had made her feel devalued and disregarded and now she brought these feelings into the room.

It turned out to be an important session: Instead of working to remember back to situations in her past that created these challenging emotions so that we could reprocess them, here were these emotions in the flesh, in the room, in the moment. We were able to process her feelings of betrayal, of being undervalued, in the context of our therapist/client relationship.

This is present processing and as well as it works in adult psychotherapy, I find that it works even ten times better with kids – rather than trying to talk about hypothetical situations and emotions, it lets you work with real emotion in the room. And by becoming aware of the potential for present processing, parents, teachers, doctors and nurses can help the young people in their lives work through their difficult emotions in this way, as well.

Kid Small Child Eye Watch Girl Toddler Facial

The key is to encourage a child to actually feel a difficult emotion so that you can help the child transform it, contain it, or otherwise work with it in a safe environment. Of course, one way to unmask challenging emotions is to bring up a child’s major worry – to bring up their health condition, or their upcoming treatment, or their parents’ separation. But this head-on approach can be brutal and if a child isn’t ready, can be too much or can create the opposite of what we hope for, namely the shutdown of an unfeeling mask.

Instead, it can be useful to see and name and process smaller dysregulations – for the child to become disorganized in the moment so that you can work together to reorganize. But when kids are one-on-one with an adult, kids tend to have fairly positive experiences. They may be regulated with you, but then when they leave, small challenges create problem behaviors – behaviors that we can’t “present process” because we don’t see them.

One strategy I use is to play challenging games: A frustrating puzzle, or a card/block tower that requires concentration but then tips over, or very simple toys that aren’t obviously entertaining, or a competitive game they could lose, or a game that requires deception. When these toys or games create anger, frustration, anxiety or more complex emotions like betrayal or mistrust, we have the opportunity to look into these emotions – we have the opportunity to process them in the present.  

Once a child feels emotion, your real work can begin – now you can work with the child to find safe strategies to deal with this emotion, strategies the child can apply outside the context of your relationship the next time he or she finds this emotion bubbling up in the real world of their everyday lives.

Kristi Pikiewicz

Dr. Pikiewicz earned her PhD in Clinical Psychology at Pacifica Graduate Institute in Carpinteria, CA. She completed pre-doctoral training at the Nan Tolbert Nurturing Center in Ojai, CA, and her post-doctoral internship at the Boulder Institute for Psychotherapy and Research. At both sites, Dr. Pikiewicz worked with a range of adult, adolescent and child clients in individual, couple, family and group settings. She also holds a B.S. in environmental science from Allegheny College and a teaching credential from Western Washington University.


Subscribe To Our Blog

Subscribe to our blog to receive weekly articles with the latest advice on supporting the emotional needs of sick children and teens.

You have Successfully Subscribed!

%d bloggers like this: