Implementing the Unique Techniques of ChilD Psychotherapy

Nathaniel Smith, LCSW-R, Psychotherapist

Nathaniel Smith, LCSW-R, Psychotherapist

Child and adolescent therapists have adapted techniques over time to meet the unique needs of children and adolescents in psychotherapy.  At my Westchester County therapy practice in Pleasantville, New York, I apply over 20 years of experience and advanced training in working effectively with children, teenagers and their families.  The treatment adaptations psychotherapists have made for youth are related to three primary differences in how children and teens function in the world:   

  • They may not yet possess the verbal skills to sufficiently communicate in words.

  • The vulnerabilities of their stage of psychological development can make it hard to use the verbal skills they have.

  • Their means of interacting with the world can be more action and play based.

While teenagers may have verbal ability, the emotional challenges that accompany the developmental stage of adolescence can make them anxious to fully utilize that language in therapy. Younger children are still building verbal skills and tend to spend less time in their life living through words as opposed to living through action and play. These factors and others call for the use of specialized techniques by the therapist to make the therapy office a comfortable and effective space for them.

*ADHD                 *Anxiety               *Social Problems               *Low Self-Esteem         

 AGES 4 to 8

Therapeutic toys and games such as sand play and puppets.

Therapeutic toys and games such as sand play and puppets.

The younger the child, the less likely they are to use words in psychotherapy sessions to help themselves.  The tools of play and activity are often used as a means of communication in session.   The therapist serves as the interpreter of the child's language.  My office is equipped with a wide variety of toys, games and activities, such as sand play, puppets, art supplies and pretend/action figures or dolls.  This offers the child the most options when searching for the right language for themselves at any given point in the treatment.  Some children bring in special toys that are uniquely important to them in telling their story.  Family sessions can also be helpful to this age group in helping the therapist understand the child's language, making the child more at ease during meetings or working through family based conflict.

*Bed Wetting                   *Eating Problems                   *Separation Anxiety           *Sleeping Problems


AGES 9 TO 12

Children in this age group often become more verbal in meetings or use slightly different forms of play, depending on their age and unique individual makeup.  More verbal children begin to engage in lengthier conversations with the therapist or their family in family meetings.  Younger and less verbal children start to have more short conversations interspersed with episodes of play.  The therapist can more often begin to use words to teach them coping skills or to help them understand their behavior and feelings.  At this age their play can tend more toward board game, puzzles or action based activity in the meetings such as ball play or darts.  The themes of competition, independence and problems solving, among others that emerge in play, are used by the therapist to address relevant concerns or build the therapeutic relationship.

*Oppositional Behavior        *Coping with Learning Disabilities       *Peer Conflict       *Autistic Spectrum Disorders


Psychotherapy office of Nathaniel Smith, LCSW-R

Psychotherapy office of Nathaniel Smith, LCSW-R

One of the unique challenges of adolescence is the amount of emotional vulnerability it entails.  The developmental realities of moving closer to young adulthood require the integration of multiple challenging emotional, cognitive and physical forces.  Grappling with increasing power in the world, integrating sexual realities and the increased importance of self-definition, among other factors, create significant turmoil.  All of this means that exploring this world with a therapist can threaten a very delicate balancing act.  Teens may talk but frequently shy away from direct talk of problems.  The therapist at times needs to use these seemingly off topic discussions to indirectly address important issues and themes and to build trust.  The therapist has to be alert to sudden shifts in the adolescent's readiness to directly explore sensitive topics.   Resistance to attending or participating in therapy

*Social Isolation                 *Substance Abuse                 *Sexual Orientation Issues         *High Risk Behavior           



The type and frequency of meetings at any given point in our work together is determined by a collaborative assessment between therapist and family.  A short or longer initial telephone or email communication between myself and the parent(s) generally determines the plan for the first meeting.  While at times I begin by meeting separately with a child or together with their family, at others it is most helpful to meet in person with parents before including the child or teenager.  I believe that the flexibility to integrate the many different possible needs for any given child or family at any give time in therapy is important.  Young people and families can very a great deal in terms of the child's need for independence or parental involvement, how a problem is perceived and how a child or family communicates or works best together.   Some situations call for coordination of care with a school or with another practitioner who prescribes psychiatric medication.  (I do not prescribe psychiatric medication but at times work in conjunction with those who do.)

*Bullying                      *Depression                   *Gender Identity Issues              *Trauma           


Family Therapy and PARENT MEETINGS

Family meetings can be useful in addressing certain issues that are best worked on together. They can also be the best way for some families in some situations to address all or some of the child or teen's difficulties. This could mean sessions with a child or adolescent and sibling(s), child and parent(s) or other combinations of family members. Family sessions can provide the opportunity for family members to heal relationship issues that can contribute or be fundamental to current problems.

The more that the therapist and the parent(s) can work as a team, the more effective the therapy can be.  Parent meetings can be a chance for parents to ask questions so as to better understand their child/adolescent, his or her difficulties or the process of psychotherapy. Parents can boost parenting skills, learn how to facilitate the progress of the therapy or provide updates to the therapist to aid the work.

*Family Conflict                 *  Anger Management                 * School Performance Problems              *Eating Problems      



Waiting area: WIFI available, convenient to the unique shops of Pleasantville.

Waiting area: WIFI available, convenient to the unique shops of Pleasantville.

  • Depression

  • Sexual Trauma

  • School Performance Problems

  • Anxiety

  • ADHD

  • Bullying

  • Post Traumatic Stress Disorder

  • Substance Abuse

  • Family Conflict

  • High Risk Behavior

  • Oppositional Behavior

  • Anger Management

  • Physical Abuse

  • Sexual Orientation Issues

  • Low Self Esteem

  • Gender Identity Issues

  • Eating Problems

  • Sleeping Problems

  • Bed Wetting

  • Peer Conflict

  • Social Isolation

These and most other conditions of childhood and adolescence are treated at my office.  Please contact me with any questions about addressing other concerns.

My psychotherapy practice is located in Pleasantville, Westchester County, New York, close to the Saw Mill and Taconic Parkways and one block from the Pleasantville train station.   It is convenient to reach from Hawthorne, Chappaqua, Valhalla, Tarrytown, Ossining, Croton, Briarcliff Manor, Thornwood, Sleepy Hollow, Armonk and Irvington among other locations.

In-Network Insurance Accepted(Please confirm current availability for the follwing on my Insurance Page): Blue Cross Blue ShieldMedicareCIGNAEmblem HealthGHIValue OptionsBeacon and The Empire Plan. *

Please contact Nathaniel Smith, LCSW-R to discuss out-of-pocket rates if you do not see your insurer listed here.  Contact your insurance company to verify if they provide reimbursement for "out-of-network" outpatient mental or behavioral health services.