Children and Adolescents in Therapy: Understanding a Unique Therapeutic Journey
Children and adolescents represent a truly unique population in psychotherapy. In early developmental years, the line between psychological health and pathology is often far more elusive than in adults. Any therapeutic intervention—by its very nature—creates change and imbalance, and therefore demands particular sensitivity and caution from the therapist.
Unlike adults, children rarely seek therapy on their own. It is usually an adult—a parent, teacher, or caregiver—who defines the problem, determines its severity, and decides when to seek help. As a result, the child often enters therapy without a clear understanding of why they are there, or what “therapy” even means.
Children’s sense of time, space, and choice is markedly different from that of adults. Their frustration threshold is lower, and they often expect quick, concrete solutions to their problems. Discussing thoughts, feelings, or personal experiences with a stranger may feel confusing or even threatening. Many children struggle with the fear of “betraying” family privacy, expressing anger toward loved ones, or “gossiping” about relatives—all of which can make therapy initially uncomfortable.
Before entering therapy, most children have encountered adults who take charge—solving problems, setting boundaries, or offering direct help. Fewer have met adults whose role is to help them help themselves. The therapeutic relationship introduces a new kind of adult presence—one that does not instruct, grade, or bribe, but instead listens, observes, and engages.
A therapist’s stance is non-intrusive yet containing, marked by empathy, curiosity, and patience. The therapeutic space becomes a place where the child feels respected, supported, and accepted without judgment. This safe environment can gently awaken curiosity and trust, allowing the first cracks to appear in rigid defenses and fixed coping patterns. It is within these subtle openings that genuine growth and healing can begin.
Another important consideration in child therapy is the issue of labeling and diagnosis. The use of categorical diagnoses—such as those outlined in the DSM or ICD—can oversimplify the complexity of a young person’s experience. These labels, though sometimes useful, risk defining a child by their symptoms rather than their humanity. Moreover, such labels can persist across institutions—clinics, schools, and agencies—reinforcing a fixed identity that may no longer reflect the child’s evolving reality.
A truly comprehensive assessment integrates not only symptoms but also the relational context—the interaction between therapist and child, and the broader background of the child’s experiences. Just as a figure cannot exist without its background, a child’s difficulties cannot be fully understood apart from their environment, history, and relationships. Every young person’s psychological landscape is a unique configuration of elements that deserves to be explored with care and depth.
Ultimately, the therapeutic task with children is to offer presence rather than prescription—to foster awareness, resilience, and self-understanding in a space where the child learns, perhaps for the first time, that their feelings and experiences truly matter.
Reference:
Francesetti, G., Gecele, M., & Roubal, J. (Eds.). (2013). Gestalt Therapy in Clinical Practice: From Psychopathology to the Aesthetics of Contact. Istituto di Gestalt HCC.
