Psychological and behavioural problems do not only occur in adulthood, but must also be taken into account at an early age, during childhood .

If left untreated, the consequences can be negative and the symptoms can become worse over time.

Interview with a child psychologist

Fortunately, it is possible to call on professionals in psychology who specialize in child therapy , who help children develop and build healthy self-esteem, improve communication and social skills, stimulate development and improve their emotional and relational intelligence.

Psychotherapy with children presents some differences from therapy with adults (for example, it involves the family in the therapeutic process and uses play as a key element), and that is why we wanted to talk to Mireia Garibaldi Giménez, psychologist and psychopedagogue at the Mensalus Institute, one of the most prestigious clinics in Spain, to help us understand what this form of therapy consists of.

If you want to know more about the Mensalus Institute, you can read this article: “Discover the Center of Mensalus Psychology with this photoreport”.

The characteristics of child psychology

Jonathan García-Allen: What do you think are the main differences between child therapy and therapy for adults?

Mireia Garibaldi: All psychotherapy, whether with children and adolescents or with adults, basically consists of 4 elements: the therapist, the patient, the therapeutic relationship and the therapeutic process. These are the 4 elements in which the two types of therapies are differentiated.

Starting with the first element, the child therapist must have different training from the adult therapist, with specific knowledge for this type of population and the ways to intervene in it. A good example is the need to know the stages and milestones of development (cognitive, social, emotional, etc.) in the different phases and ages.

As for the second element, the patient, it is clear that we are intervening in a very specific but at the same time very heterogeneous population, since it is not the same to treat a 5 year old child as a 10 or 15 year old one, so following the previous point, knowing well the evolutionary characteristics of each one is essential to practice. As far as the therapeutic relationship is concerned, it varies in its main elements: the frame, the asymmetry, and the alliance.

For example, in child therapy the alliance with the patient is not unique, that is, it is not established only with the child, but normally a multiple alliance must be carried out, since it must also be done with parents, teachers, etc.

Finally, the differences with respect to the process are closely related to the specificity of the assessment and intervention techniques, which are different from those used for adults, such as the use of drawing, for example.

Play-based therapy is often associated with child therapy. But what does it consist of? Are they the same?

Play-based therapy is a type of intervention in child therapy that uses different processes that for children are playful with a double objective: on the one hand, to evaluate and obtain information about the problem situation and, on the other hand, to intervene on it.

Since children’s cognitive, social and emotional characteristics are very different from those of adults, who are likely to come to consultation and express their problems more or less accurately, children need alternative routes to communication and to oral and direct language in order to work.

For example, if an adolescent can express in a direct way that he is concerned about the discussions in his home and expose him to the therapist, a child will need an indirect way such as symbolic play to do it, that is, through dolls that represent his significant people close to him (parents, siblings, etc.) he will be able to express and reproduce what happens in his environment or how he feels indirectly through them. The same will happen to work on different objectives of the intervention.

We can intervene by using symbolic play or other types of games for specific purposes, such as construction games to work on spatial awareness and fine motor skills in cases of learning difficulties such as dyslexia. However, it is important to note that in child therapy not only play is used, but play is a very important but not unique resource and child therapy and play are not synonymous.

Who does an attack of anger or a disproportionate response by a parent, a parent or a child hurt more?

Both will be affected very negatively by these kinds of responses, but in very different ways. Leaving aside the parents who are not aware of the harmfulness of this type of reaction, in consultation it is very common to find parents who are aware that their ways of handling some situations with their children are not the most appropriate and that sometimes their reactions are disproportionate, but they do not have alternative ways and tools to do it differently when they are overwhelmed.

It is very common to observe feelings of helplessness and even guilt when they talk about this kind of episodes, so it is important, within a process, to help them learn new ways to manage situations in which they may feel helpless. One thing is certain, and that is that both adults and children react in inappropriate ways when we do not have enough resources to manage the situations and problems of everyday life, so both will need help to do so.

And obviously, for children, angry and/or disproportionate responses from their parents on a regular basis lead to the creation of an unsafe type of attachment, which will affect their social and emotional development, their self-esteem, the way they behave, etc. and they may have difficulties in their future relationships as adolescents and adults. It is essential to remember that many behaviours are learned by imitating the references, which in childhood are the parents.

What are the most common disorders or problems that you usually treat in therapy sessions?

In my practice I usually attend to many children who come because of difficulties in academic performance or behavioral problems. Sometimes these are not problems in themselves, but expressions of an underlying problem. That is, it is true that there are specific learning disorders and behavioral disorders as such, which in themselves are what generates dysfunction in the life of the child and his environment, but at other times, a decline in school performance or inappropriate behavior are only symptoms of something that goes beyond, such as a case of bullying, problems in family relationships, etc.

When parents present me with a problem, I always give them the example of fever: someone may go to the doctor with a fever as a symptom, but it will not be the same as a fever from a severe urinary tract infection or a fever from a cold. The symptom is the same, but the basis and treatment will be very different. That’s why it’s important to properly explore those “symptoms” that children express, because the same behavior can have different origins.

Thus, apart from problems in school performance and behavioral problems in all its aspects (difficulties in impulse control, tantrums, disobedience towards authority figures, etc.), very common cases in consultation are: difficulties in social relationships, fears and phobias, interventions in processes of separation, divorce and / or family reunification or autism spectrum disorders.

What is the role that parents have when they go with their child to a child psychologist?

The parent’s role is essential in any intervention process that takes place with a child. It is important to state this point from the first moment that a therapy is started, in the setting or framing, so that the parents can adjust the expectations of the process.

Sometimes parents believe that by taking their child to a child psychologist, the psychologist will only work with the child, which is totally wrong. As mentioned above, a multiple alliance must be made with both the child and the parents and other people and/or institutions in which the child is involved (school, open centre, child and youth mental health centres, etc.) for the intervention to be as successful as possible.

Parents should be guided to work with their child outside of the consultation sessions, either by offering management guidelines or by teaching specific exercises and/or techniques to be applied in the child’s natural context. Without this intervention, supervised at all times by the therapist, it will be difficult for the changes that may be observed in the consultation to become generalised outside of it (although it is clear that each process is unique and will depend on each case).

What is the importance of the family in the development of the children’s self-esteem?

The role of the family is basic in all facets of child development (emotional, social, etc.) and among them, in self-esteem. This is the evaluation that a person makes of himself, according to thoughts, evaluations, beliefs, feelings and emotions about his way of being, acting, his physical appearance, etc.

Therefore, this evaluation is going to be closely related to the assessment made by significant people of their environment and, the main significant people for the children are their parents. During childhood, they are their referents, their main attachment figures, and therefore they have a very important influence on the creation of an adjusted and healthy self-esteem. Having low expectations about what a child is capable of doing or constantly making negative comments about him, will cause the child to perceive a low valuation of himself by his parents, which in the end will have repercussions on his own valuation of himself, devaluing him.

It is logical to think that if, for example, a parent constantly repeats to his or her child that he or she is a bum who doesn’t know how to do anything, the child may come to the following conclusion: “if my parents, who represent that they know and love me the most, think that way about me It is therefore essential to encourage the development of skills, to reinforce successes and to give children confidence in their abilities, so that they themselves can develop this confidence and respect for themselves, which are signs of good self-esteem.

Punishment is a controversial issue. Can punishment be used in the education of a child? What is the best way to apply it?

Punishment is a behavior modification technique based on the behavioral principles of operant conditioning, which aims to decrease or eliminate the occurrence of undesirable behavior.

There are mainly two types of punishment: positive punishment, which consists of applying an aversive stimulus in a contingent manner to a certain behaviour (for example, copying a sentence 100 times for a bad behaviour), and negative punishment, which consists of withdrawing a positive stimulus after the performance of a certain behaviour (for example, leaving a child without his play time).

Although it is true that punishment is sometimes effective in eliminating behavior quickly, I do not consider it the most suitable method to do so, apart from the fact that it is not applicable in all cases, I always consider it a last option (ahead we find the positive reinforcement). This is because in many cases the behaviours are reduced or eliminated in the short term because of the very fear of the threat of punishment and not because there is a real reflection on the inappropriate behaviour that makes the child advance and learn, so the changes are not usually maintained in the long term.

In addition, this fear can negatively affect the relationship between the person who applies it and the child, creating a threatening relationship based on fear, which can sometimes lead to even more defensive behavior or outbursts of anger, which will make the situation worse. This is in addition to the fact that if the child does not understand exactly why the punishment is taking place and how wrong it is, their self-esteem will be adversely affected.

What are the benefits of positive reinforcement and what consequences does it have on the character and emotional well-being of a child?

Positive reinforcement consists of applying a rewarding stimulus after the performance of an appropriate behavior so that it appears or increases. It is the main way to educate children in creating a healthy self-esteem, with a secure attachment based on trust and respect. It is important to differentiate between reward and positive reinforcement, because when we talk about positive reinforcement we are not always talking about a material reward, which can be a positive verbalization by the father (“I am very proud of what you have done”) or an act in which he is given attention (playing together).

For children, especially the youngest, there is no positive reinforcement greater than the attention of their parents. So it is important that when children do things right (for example, they are sitting down playing autonomously for a while in an appropriate way) we reward them with a time of shared play. It is usual that, before these moments, the parents take advantage of them to do other things, so in the end, the children learn that in order to have their parents’ attention they must perform less adequate behaviours.

It is also important to stress that we must reinforce the things that children do independently of each other, that is to say, if a child carries out two inappropriate behaviours and one correct one, we must continue to reinforce that correct behaviour so that it continues to appear, despite the fact that it has done other things incorrectly. For example, if a child picks up his glass but leaves his plate, it is more effective to congratulate him for having picked up the glass, than to scold him for having left the plate, otherwise he will feel that what he has done well has not been recognized, so he will stop doing it.

That is why reinforcement is so important, not only in the behaviors that children do, but in the formation of their character and self-esteem, providing them with emotional well-being.

According to the Spanish Association of Pediatrics and Primary Care, 15% of children present problems of disobedience. What can a parent do in this situation?

When faced with a problem of continued disobedience, it is important to go to a specialist, in this case the child psychologist, to evaluate the situation and determine if this is a normative behavior for the age and development of the child (for example, there is a child stage between 1 and 2 years in which it is common for children to maintain constant denial), whether it is part of the child’s personality or way of acting (for example, if the child has an inborn temperament) or whether there is a specific disorder or problem (such as a defiantly negative disorder).

Once the situation has been assessed, it is important to intervene with professional guidelines whatever the case, because depending on whether this disobedience has one origin or another, the orientation will vary (as in the example of fever).

The process of raising a child is very complex, but… could you give our readers (those who are parents) some basic tips for educating their children?

Based on my professional knowledge, but also on my experience with children and families, there are some basic guidelines for all parents that will encourage quality parenting and education:

  • Educate within basic, stable, consistent and agreed-upon limits and rules that provide a safe and protective environment for children to learn to distinguish right from wrong.
  • To be based on models of assertive communication in which one can express desires, points of view and opinions, as well as feelings and emotions, respecting oneself and others. Expressing and listening.
  • Preach by example. We can’t ask a child not to scream and tell him so by shouting.
  • Use a democratic educational style, neither too lax nor too authoritarian.

To promote the autonomy, personal capacity and worth of the child. Provide opportunities to learn, including making mistakes in this learning. If we do everything to him, he will never know how to do it alone and the message we will send him will be “I’m doing it to you because I don’t trust you to do it alone”, so we will undermine his self-esteem.