Child & Adolescent Therapy

When working with young children, we believe that talk therapy can be over-emphasized and limiting. We integrate expressive therapies such as art and sandplay in order to allow children ample strategies for communication, self-healing, and insight.

Therapy for kids and teens often looks different than it does for adults. Especially for young children, talk therapy alone can be limiting. Therefore other methods such as play and art therapy or mindfulness techniques are used to help kids and teens increase self awareness, self control, empathy, and attentiveness.

These creative methods of therapy are adapted to each child’s or family’s developmental level. It can help children communicate emotions and thoughts in ways they cannot put into words directly. Play therapy can make internal conflicts or negative thought patterns apparent and addressable.

Concerns Include: Therapy can help…
Increase Decrease
School Problems Social Skills Anxiety
Family Problems Emotional Resilience Depression
Behavioral Problems Self-Awareness Distraction
Disruptive Behavior Disorders Physical Development Fixation on Negative Emotions
Addressing difficult feelings Self-Regulation Behavioral Concerns
ADHD Self-Esteem Impulsivity
Depression Academic Skills ADHD
Anxiety Logical Reasoning PTSD
OCD Concentration/Focus Volatile Reactions
Eating disorders Language/Literature Comprehension Stress
Trauma Creativity Social Conflict
Mindfulness

Mindfulness is the skill of paying full attention and being intimately aware of the present moment. The premise sounds simple, but it is something that requires practice and application. It has been a part of human societies for thousands of years, as a part of meditation, yoga, and martial arts. There are many types of mindfulness, and it may look a little different for everyone. Practices include:

  • Attention to the present – Focusing on breathing and passing thoughts/feelings.
    • By consistently focusing on your breathing, the mind often tries to wander. By paying attention to the present you can draw your attention back to your breath while letting thoughts pass by observed, but not engaged. This increases focus and concentration, while decreasing anxiety and invasive thoughts.
  • Guided imagery – Creating and/or following a narrative often described by an external source (therapist, teacher, Youtube videos, etc.) which enhances concentration on details to promote relaxation.
    • Fully engaging in a mental scenario (like a walk through a quiet forest or on a beach) and creating/focusing on specific details helps to decrease stress and anxiety, improve sleep, increase relaxation.
    • It often uses all five senses to “build images in the mind that your body feels are as real as external events.” (Source)
  • Body Scan/Progressive Relaxation – Shifting focus to each part of the body to observe the sensations present.
    • Body scans helps to recognize pain or discomfort and assists with pain management. It also increases the mind-body connection by practicing being actively aware of physical sensations that often are dismissed or ignored in daily functioning.
    • Progressive relaxation allows you to acknowledge where pain and discomfort are felt and to consciously relax/release tension in those areas.
      • Ex. Anxiety and stress often cause tension and pain in the neck, shoulders, and upper back. By noticing this tension and practicing releasing it when it is noticed can help manage anxiety and stress symptoms when they occur.
  • And many more
Mindfulness Increases:
Academic performance
Adaptability
Creativity
Focus/concentration
Immune system
Pain management
Patience
Relaxation
Social skills
Stress management
Time management

Mindfulness Decreases:
Anxiety
Blood pressure
Chronic pain
Depression
Distraction
Fixation on negative emotions
Impulsivity
PTSD
Volatile reactions



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Imaginative Play

What is Imaginative Play?
In short, imaginative play is role play. It is open-ended make believe that allows children to act out scenarios, real or imagined. This kind of play is most common in children ages 2-6 and is highly beneficial in development.

Imaginative play teaches expression of both positive and negative feelings, helps children discover how to make choices (and the associated consequences), and experience the outcomes of multiple choices in a safe environment. It encourages intrinsic motivation and active engagement, as well as encouraging children to tune in to multiple perspectives and recognize others’ ideas and emotions.
Imaginative play can help:

  • Build social skills and increase social-emotional resilience
  • Develop bonds between parent and child
  • Develop communication and language skills
  • Balance emotions of the self with emotions of others
    • Increase sharing and negotiation skills
    • Increase respect of/toward others
    • Increase self-regulation skills
  • Improve stress management
  • Lower anxiety/anxiety symptoms
  • Improve academic skills, including:
    • Concentration and focus
    • Logical reasoning
    • Language/literature understanding
  • Decrease disruptive behaviors
  • Foster creativity
  • Improve physical development such as:
    • Hand-eye coordination
    • Fine motor skills

Imaginative play can be a solo or group activity. When playing with others, the child builds skills regarding communication and expectations:
– If the child wants someone to pick up a pretend phone call, they learn they need to explain this to the other person – “Ring, ring! It’s for you!”
– If the child wants to change situations, they have to communicate their idea to the other person too – “You’re a doggy now! Let’s go on a walk!”

By creating and designing their own make believe worlds, children develop social skills, implicate rules, and interact with multiple perspectives, goals, and feelings.


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Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) has been shown to be an effective method for improving mental health and quality of life for concerns ranging from generalized anxiety to depression to eating disorders and more serious concerns.

Unlike other forms of therapy, CBT focuses on the “right now,” rather than deep-diving into the cause of the problem. It helps clients to recognize their own unproductive thoughts and behaviors in the moment and provides methods to change them.

CBT allows for self-reflection and self-correction.

Core Principles

Psychological problems are, at least in part, due to:

  1. Unhelpful ways of thinking
  2. Unhelpful learned behaviors

Core Goals

  • Decrease and manage symptoms of presenting concern
  • Decrease and replace unhelpful ways of thinking
  • Decrease and replace unhelpful behaviors
  • Develop effective coping methods
  • Resolve relationship conflicts
  • Cope with grief/loss
  • And more…

Common Strategies

  • Learn to recognize perception distortions, and reevaluate in the context of reality
  • Understand behaviors and motivations of others
  • Develop confidence in self
  • Adapt problem-solving skills to difficult situations
  • Face fears
  • Utilize role playing to prepare for upcoming situations
  • Use techniques to calm mind and body

CBT has been supported in both psychological research and clinical practice, and has been found to be as or more helpful than comparable techniques and medications.

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Cognitive Behavioral Therapy Plus (CBT+)

Cognitive Behavioral Therapy Plus (CBT+) is an integration of multiple therapeutic techniques, specifically:

Cognitive Behavioral Therapy (CBT)
Acceptance and Commitment Therapy (ACT)
Compassion Focused Therapy (CFT)
Dialectical Behavior Therapy (DBT)

All of these therapies are evidence-based and emphasize approaching problems from different perspectives.

CBT+ allows for a broader view of the presenting concern, and incorporates real-world problems into the framework. For example, CBT+ integrates concerns such as poverty, racism, and marginalization into the approach to treatment.

CBT+ also adds a stronger emphasis to relationships and dives further into the history of the client.

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Trauma-Focused Cognitive Behavioral Therapy


Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based, modified form of CBT which is specifically designed to help children and their parents overcome the negative and often devastating effects of trauma, especially PTSD symptoms.

Taking a trauma-informed approach to child and adolescent therapy incorporates both the child and the parents.
Parents learn optimal ways to support their child and help them overcome the effects of trauma. This includes effective parenting skills associated with handling behaviors that accompany trauma. It can also help parents learn how to handle the emotional distress.
Children learn skills to help cope with and overcome trauma, including relaxation and self-regulation. Therapy also helps children create their own trauma narrative to be able to tell their own story. TF-CBT is adjusted to match the child’s developmental stage.
Improvements developed by TF-CBT have been shown to be long term – parental emotional distress, child’s anxiety, and related symptoms still showed improvement 1 and 2 years after completing therapy.

Trauma may be caused by:

Sexual or physical abuse
Traumatic loss of a loved one
Exposure to violence – domestic, school, community
Exposure to disaster – weather, terrorist attacks, war
Serious accidents
Serious medical procedures, operations, or hospitalizations
And more…

TF-CBT can help develop skills such as:

Stress management
Affect regulation
Problem solving
Safety
Communication
Self-esteem empowerment
Interpersonal trust

TF-CBT can address concerns including:

PTSD
Depressive symptoms
Behavioral concerns
Cognitive distortions
Guilt
Shame
Interpersonal conflict
Internalization of feelings

TF-CBT can be helpful for kids ages 3-18 and their families. This approach can also be used to help couples and individuals overcome trauma. TF-CBT is tailored to each child and family to be developmentally appropriate and conducive to each situation.


TF-CBT approach has three core stages of therapy, Stabilization, Trauma Narrative, and Integration/Consolidation. Each of these stages are broken down into individual steps. The acronym of these steps is PRACTICE.

Stabilization

P – Psycho-Education and Parenting Skills
The therapist helps the family learn about trauma, PTSD, common behavioral concerns associated with trauma, and validation of feelings.
R – Relaxation Skills
Learning relaxation skills helps reverse physiological effects caused by trauma, and includes a variety of techniques such as mindfulness, progressive muscle relaxation, and focused breathing.
A – Affective Regulation Skills
Affective regulation skills help each member of the family to recognize upsetting states and learn to manage their feelings. This includes developing problem-solving, anger management, and positive distraction skills. It’s also a time for the family to build trust and work toward emotional safety.
C – Cognitive Processing Skills
Cognitive processing skills help each individual connect thoughts, feelings, and behaviors and replace unhelpful thoughts and behaviors with beneficial ones (as in CBT). Cognitive processing poses two key questions: Is it accurate? Is it helpful?
This process allows each participant to create a “window of tolerance” for communicating about trauma. Once both feeling and thinking are within a tolerable range and the family members are present and trying, then trauma can begin to be processed.

2. Trauma Narrative

T – Trauma Narration and Processing
Creating a trauma narrative is a key component to processing a traumatic event, and it includes the telling of the individual’s story – the who, what, when, where and associated emotions with each component. Creating a comprehensive narrative is often difficult and deeply emotional, but is a core step in understanding where you have been and how to move forward. Once the trauma narrative is complete, each person can contribute their narrative and begin to understand how the trauma impacts their shared experience.

3. Integration and Consolidation

I – In Vivo Mastery of Trauma Reminders
In life trauma reminders often cause psychological and/or physiological responses. This step helps to recognize the stimuli that cause the trauma response, and learn how to overcome avoiding these reminders and cope with them as they emerge.
C – Conjoint Child-Caregiver Sessions
Sessions with the family help to develop communication about the trauma and moving forward. This step is a time to address topics such as safety plans and trauma responses.
E – Enhancing Safety
The final step is to apply the processing and coping skills and positive insights to current life and your life moving forward. It helps create a comprehensive toolbox of strategies and reminders to handle trauma, stress, and conflict moving forward including co-regulation of emotions and strategies for finding solutions based in emotional support and understanding.

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Co-Parenting

It is well documented that the most harm to children during and after a divorce is how parents handle themselves and their interactions with each other, not the divorce itself.

Co-parent therapy is designed to help divorced or separated parents work together to best meet the needs of the child(ren). Even when the parents aren’t together, kids still need love and support – this can become interrupted by emotions from the breakup and divorce process.

The relationship between co-parents can have a strong impact on the emotional and mental development and wellbeing of the children. Co-parenting therapy helps parents learn how to develop a new cordial, working relationship to best support the kids.

It helps both parents have an active role in child rearing, problem-solving, and decision-making, and can help eliminate dysfunctional, emotionally-charged interactions.

Co-Parenting therapy helps teach both parents how to:

  • Cooperate: Exchange information about the child(ren), support and respect the other as a parent, and divide the labor of childrearing.
  • Minimize conflict: Limit undermining, criticism, and blame toward the other parent, as well as minimizing arguments/fights about childrearing.
  • Triangulate: Develop the child(ren)’s relationship with each parent individually, while avoiding their involvement in parental conflicts. This includes avoiding:
    • Using the child(ren) as messengers to the other parent.
    • Venting to the child(ren) about the other parent.
    • Making the child(ren) feel like they have to choose between parents.
  • Communicate with a child-centered approach:
    • Separate the anger, resentment, and hurt from the relationship with the other parent in order to prioritize the child(ren).
    • Treat co-parenting as a business-like partnership. This allows conversations to be focused on what’s important whether in-person, on the phone, or through email/text.
    • Keep all conversations focused on the child(ren)’s needs, not yours or your ex-partner’s.
    • Make requests of the other parent, not demands.
    • Listen to the other parent. Listening is especially important in co-parenting in order to minimize conflict and prioritize the child(ren)’s wellbeing.

Documented Benefits of Co-Parenting for Children

Children of all ages with parents who have adopted co-parenting practices have been shown to have:

Significant improvements in:
-Internalization of symptoms – Ex. Being withdrawn, nervous, or irritable, feeling lonely, sad, unwanted, or unloved, etc.
-Externalization of symptoms – Ex. Acting out, lying, breaking rules/laws, showing disregard for others, defiance, and/or vindictiveness, etc.
-Social functioning skills
-Attachment
-Improvement in mental and emotional health
-Knowledge that they (the children) are more important than the conflict that ended the marriage
-Feelings of security
-Consistency between households leading to better adjustment
-Improved development of problem-solving and communication skills

Toddlers with co-parenting parents show increased compliance and decreased aggression compared to those who do not.

Low parental cooperation has been linked with passivity, problems with attention, and lower math grades of 3rd grade students.
Additionally, it has been shown to negatively impact the child’s relationship to each of their parents, and increase negative behavior toward each parent.
It also may be a factor in antisocial behavior in children.


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Please note that co-parenting therapy is relational and therefore will not be covered by insurance. For cash pay rates, please call the office.

Eating Psychology

Eating Psychology Coaching is an exciting and cutting edge approach developed by the Institute for the Psychology of Eating.

It effectively addresses concerns including:
Weight concerns
Binge eating
Emotional eating
Overeating
Body image challenges
Various nutrition related health concerns

Oftentimes, our eating challenges are connected to work, money, relationships, family, intimacy, life stress, and so much more.

According to the Institute for the Psychology of Eating – In America:

  • Nearly 70% of adults are classified as overweight or obese
  • ~90% of women are unhappy with their appearance
  • 81% of 10 year old girls experience a fear of being fat
  • 97% of women confess they have at least one “I hate my body moment” each day
  • ~75% of all diseases could be prevented with better nutrition
  • ~108 million individuals are on a diet
  • 99% of those who diet gain back the weight they lose within a year
  • Within a decade, 67% of the population is projected to have some form of diabetes

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Eating Psychology coaches are able to support you with both strategies and nutrition principles.

The strategies provided are doable, sustainable, and nourishing and, most importantly, yield results.

For eating psychology articles, look here.

Dialectical Behavior Therapy (DBT)

Please see our Dialectical Behavior Therapy (DBT) page here.

Parent Child Interaction Training

Please see our Parent-Child Interaction Training (PCIT) page here.

Pride Program and Resilience Group

Please see our Pride Program and Resilience Group page here.

Meet our Providers

Our staff is trained to provide a broad range of therapies such as couples therapy, family therapy, and individual therapy for children, teens and adults.

our providers
call: 253.460.7248
email: hello@integratedtherapynw.com
fax: 253.564.4409
3560 Bridgeport Way W
Suite 2-C
University Place, WA 98466