Therapy for Children Who Show You What They Cannot Tell You

Approximately 1 in 5 children ages 3 to 17 in the United States has a diagnosable mental, emotional, or behavioral disorder (CDC, 2024). Among children ages 3 to 17, 11 percent have diagnosed anxiety, 11.4 percent have received an ADHD diagnosis, and 8 percent have a behavioral or conduct disorder. Yet nearly half of children with treatable mental health conditions do not receive adequate treatment. Early intervention matters. The patterns that form in childhood do not simply disappear. They become the foundation for how a person relates to the world as an adolescent and adult.

Why Play Is Therapy for Children

Play is how children organize their understanding of the world, rehearse social scenarios, express emotions they cannot name, and work through experiences that overwhelmed them. When a child builds a sandtray scene where a small figure is surrounded by larger figures, they are communicating something about how they experience their world. When a child draws the same image repeatedly, there is meaning in the repetition. When a child acts out a conflict between puppets, they are showing you something they do not yet have words for.

Play therapy is the systematic, therapeutic use of play to help children express feelings, develop coping skills, and resolve emotional or behavioral difficulties. A meta-analysis of 93 controlled outcome studies found that children who received play therapy functioned 0.80 standard deviations better than untreated children (Bratton et al., 2005). That is a large effect size, comparable to the effectiveness of well-established adult therapies. The research also found that involving parents in the therapeutic process produced the largest treatment effects, which is why parent involvement is built into everything we do.

Play therapy is effective across ages 3 to 12, across gender, and across presenting concerns including anxiety, behavioral difficulties, trauma, grief, social skills challenges, and self-regulation (Association for Play Therapy). A 2021 meta-analysis of child-centered play therapy for behavioral problems found moderate effect sizes with a median of just 6 sessions before meaningful improvement (Parker et al., International Journal of Play Therapy).

What Our Sessions Look Like

We use a combination of structured and unstructured approaches, chosen based on what your child needs.

Unstructured Play

Gives your child the freedom to lead. In a room with carefully selected toys, art materials, sandtray figures, and games, your child chooses what to engage with and how. The therapist observes, reflects, and responds in ways that help the child feel seen and understood. This is where children express what they cannot verbalize. It is not random play. It is guided by a trained therapist who understands the language of a child’s inner world.

Structured Activities

Build specific skills. The therapist introduces games, art projects, or exercises designed to practice particular skills: identifying and naming emotions, managing frustration, problem-solving social situations, building confidence in communication, or developing strategies for worry and anxiety. These activities are age-appropriate, engaging, and often feel like play to the child even as they are building real capabilities.

Art Therapy

Provides a nonverbal avenue for expression. Drawing, painting, sculpting, and collage allow children to externalize internal experiences. A child may not be able to tell you what makes them scared, but they can draw it. A child may not be able to explain how they feel about a family change, but they can create a scene that shows it.

Sandtray Therapy

Uses miniature figures and a tray of sand to create scenes that represent the child’s internal world or external experiences. It is particularly effective for children who have experienced trauma, because it allows them to approach difficult material at a safe symbolic distance. The therapist does not interpret the scene for the child. They help the child explore it at the child’s own pace.

What Brings Children to Therapy

Children come to therapy for many reasons. Sometimes the reason is a specific event. More often, it is a pattern that has been building and is now affecting the child’s ability to function at school, at home, or with peers.

Anxiety

Anxiety is the most commonly diagnosed mental health condition in children, affecting 11 percent of those ages 3 to 17 (CDC, 2022-2023). In children, anxiety often shows up as physical complaints (stomachaches, headaches), school avoidance, excessive clinginess, difficulty separating from caregivers, sleep difficulties, refusal to try new things, or meltdowns triggered by transitions or uncertainty. Our Anxiety Therapy page addresses anxiety in more detail.

Behavioral Concerns

Aggression, defiance, tantrums that are beyond what is developmentally typical, difficulty following rules, and explosive reactions. Eight percent of children ages 3 to 17 have a diagnosed behavioral or conduct disorder. These behaviors are almost always communicating something the child cannot express in words: frustration, fear, a sense of being overwhelmed, or unmet needs for connection and predictability.

ADHD and Attention Difficulties

Approximately 1 in 9 children (11.4 percent) in the United States has received an ADHD diagnosis, with nearly 78 percent of those children also having at least one co-occurring condition such as anxiety (39 percent), behavioral problems (44 percent), or a learning disability (37 percent). Therapy helps children with ADHD develop strategies for emotional regulation, impulse management, and social skills that go beyond what medication alone addresses.

Social Skills Challenges

Difficulty making or keeping friends, trouble reading social cues, withdrawal from peer interactions, being bullied or bullying others. For children who struggle socially, the therapy room becomes a practice space where they can learn and rehearse skills in a safe, low-stakes environment before applying them in the real world.

Family Changes

Divorce, separation, a new sibling, a parent’s remarriage, relocation, a parent’s deployment or incarceration. Children often do not have the cognitive maturity to understand what is happening or the emotional vocabulary to express how it affects them. What surfaces instead is behavioral change: regression, aggression, withdrawal, clinginess, sleep problems, or academic decline. Our Life Transitions Therapy and Grief and Loss Therapy pages address these dynamics.

Trauma

Children who have experienced or witnessed abuse, domestic violence, community violence, accidents, medical trauma, or other overwhelming events may show symptoms that look like anxiety, behavioral problems, or ADHD but are rooted in trauma responses. Philadelphia’s ACE Study found that nearly 70 percent of adults experienced at least one adverse childhood experience, with 40 percent experiencing four or more. Trauma-informed care is foundational to our practice. Our PTSD and Complex PTSD Therapy page goes deeper into trauma treatment.

Grief and Loss

The death of a family member, a pet, a friend. The loss of a home, a school, a neighborhood. Children grieve differently than adults, often in waves rather than sustained periods, and sometimes through play, regression, or behavioral changes rather than tears.

Depression and Sadness

Persistent sadness, loss of interest in activities, irritability, fatigue, changes in appetite or sleep, and statements of hopelessness or self-criticism. Depression affects approximately 4 percent of children ages 3 to 17, with rates increasing as children approach adolescence. Our Depression Therapy page addresses this.

Emotional Regulation

Big emotions that the child cannot manage: explosive anger, intense fear, overwhelming sadness, or rapid emotional shifts that disrupt daily functioning. Learning to identify, name, and regulate emotions is one of the core developmental tasks of childhood, and therapy accelerates this process.

Signs Your Child Might Benefit From Therapy

You know your child better than anyone. If something feels off, it probably is. Here are patterns worth paying attention to:

• Persistent changes in mood or behavior lasting more than a few weeks.
• Withdrawal from activities, friends, or family members they used to enjoy.
• Increased aggression, defiance, or emotional outbursts that are disproportionate to the situation.
• Difficulty at school, whether academic, social, or behavioral, that is not improving with school-based support.
• Sleep problems including nightmares, difficulty falling asleep, or refusal to sleep alone.
• Regression to earlier behaviors (bedwetting, baby talk, clinginess) in a child who had moved past them.
• Physical complaints with no medical explanation.
• Excessive worry or fear that limits what the child is willing to do.
• Difficulty making or keeping friends.
• Statements that reflect hopelessness, self-criticism, or a desire to hurt themselves.

If you are noticing several of these patterns, or even one that concerns you, that is reason enough to reach out.

How Parents and Caregivers Are Involved

Your child’s therapist works with your child. And your child’s therapist works with you. Both are essential.

Parent and caregiver involvement is built into the treatment from the beginning. You are not dropped off and shut out. You are a partner in this process. Caregiver sessions help you understand what your child is working through, how to respond to difficult behaviors with more confidence, how to support the skills your child is building in therapy, and how your own patterns and history might be showing up in the parent-child dynamic.

Children do not exist in isolation. A child can make progress in the therapy room, but if the environment at home does not shift to meet them, the gains are harder to sustain. Research consistently shows that involving parents in the therapeutic process produces the largest treatment effects in child therapy (Bratton et al., 2005). That is not a criticism of your parenting. It is a recognition that children are shaped by their relationships, and the most important relationships in a 5-to-12-year-old’s life are the ones at home.

What the First Session Looks Like

The first session typically includes both you and your child, along with the therapist. The therapist will want to understand what brings you in, what you have been noticing, and what your goals are. They will also want to get to know your child in a low-pressure way.

Your child is not expected to sit on a couch and talk about their feelings. The therapy room is set up for children: toys, art supplies, sandtray materials, games. The therapist will follow your child’s lead in how they engage with the space. Some children dive right in. Some are quiet and cautious. Both are completely normal.

After the initial session, the therapist will discuss a recommended approach with you, including how often sessions should happen (most children begin with weekly sessions), what the focus of therapy will be, and how caregiver sessions will be incorporated.