Psychoeducation doesn’t have to be boring

Play is the perfect vehicle for explaining therapeutic concepts to children: we can tailor the information so it is appropriate to the age and stage of the child, and provide a way for them to engage with the idea, helping them to learn through doing. Understanding anxious processes remains important for children and their families throughout therapy, and we can deepen this as they progress through therapy.   

Understanding what is happening is often a key step to being able to do something differently and it can be amazing how powerful this can be. Indeed, developing an understanding is often an intervention in and of itself.  For example, helping a child understand the role that avoidance plays in their anxiety has often resulted in them coming into the next session to tell me that they 'just did' something that was causing them anxiety. Similarly, exploring the idea that anxiety might be 'catching' within a family has often resulted in parents being able to better notice and regulate their own worry, whether it be around bedtime or having their child take an important medication, and become better able to regulate themselves in these situations. In turn, this often results in the child's anxiety decreasing.

It is typically the adults in a child's life who initiate the therapy process and most children have little motivation to face their fears. The child's natural response has often been to avoid whatever triggers their anxiety and they frequently see new situations as threatening.  The idea of going to see someone who is going to help them do the very thing they fear most, whether that is going to school or getting in the water at their swim lesson, is often anxiety-provoking. Sometimes as therapists we inadvertently reinforce this anxiety by creating fear hierarchies in the first few sessions. One of our activities, the Worry Shrink Ray, enables children to try something out and notice whether doing it 'shrinks' their anxiety. Playing around with this helps to convey the idea that anxiety lessens when we do what makes us worried.   

Children learn best when we can engage them in hands on playful activities that scaffold their learning and allow them to make discoveries. Reflecting at each point about what a child and family might need to understand, and deepening their awareness through layers as we move through therapy, is important. A family might need to move, for example, from understanding how anxiety feels in our bodies, to learning that anxiety can be helpful at times, to knowing that avoidance increases anxiety, to learning that facing our fears can be worthwhile. 

Providing psychoeducation that works with the system around the child and is developmentally appropriate raises the question of whom it should be appropriate for. Children and parents both need to understand anxiety, but they need different explanations. Using play to explain concepts to children is a great starting point. Involving parents in the play, allowing them to experience a simpler explanation, and then allowing time for further discussion so that they can deepen their understanding as needed, works well.  

For example, in explaining anxiety to children I often use a game I call Flight, Fight, Freeze statues. It's a variation on the party game of musical statues, but rather than simply freezing when the music stops children can choose to pause in a running pose, assume a fighting pose, or freeze in whatever position they were in. As we play, we can talk about how we often have these responses when we are anxious. We explore times when we might have responded in this way and what our typical response might be. Parents can participate in this game and we can have further conversation about how their child tends to respond when anxious, and how they can best support them in this situation.      

Being playful with a child is a lovely way to build our relationship with them, which often has additional therapeutic benefits. Furthermore, play is intrinsically fun and the benefit of this should not be underestimated. Some of the children we see are struggling in many aspects of their lives and moments of fun are to be treasured. So why not embrace psychoeducation as an essential aspect of therapy? Use play as a vehicle for helping a child to learn about anxiety in a developmentally appropriate and meaningful way, and enjoy the fun this creates. 

-       Dr Fiona Zandt is a Clinical Psychologist. Her book with Dr Suzanne Barrett, Creative Ways to Help Children Manage Anxiety, is supported by a website with blog posts and free resources.