The Therapeutic Process with Children and Adolescents – Part One

By Violet Oaklander PhD

Part One


A process of therapy has emerged through analysis of the author’s work with children and adolescents over a span of nearly 40 years. This process fits organically with the philosophy, theory and practice of Gestalt Therapy, beginning with the prerequisite of the relationship between the client and therapist. The role of contact and its connection to resistance is examined as particularly applied to the specific characteristics of children. The author has found that the continuous strengthening of the child’s inner support structure in the course of therapy is fundamental to the child’s ability to work through deep-seated, blocked emotions. Therefore, enhancing the child’s sense of self is a crucial step toward healthy emotional expression and optimum growth and development. The focus on 
self-enhancement through specific experiences inherent in child development are an intrinsic part of psychotherapy with children and adolescents. Even the task of helping the child feel safe and comfortable with expressing feelings require its own sequence. The author discusses a 
method for helping the child become self-nurturing, an important component
 of the therapeutic process and one often neglected in Gestalt Therapy, yet 
particularly critical to the child who has suffered trauma. Finally, the
 therapeutic process concludes with termination, never actually a final step
 since children can only deal with specific issues in accordance with their
 particular development stage.


Nothing happens without at least a thread of relationship. The relationship
 is a tenuous thing which takes careful nurturing. It is the foundation of the
therapeutic process and can, in of itself, be powerfully therapeutic. This
 I/Thou relationship, based on the writings of Martin Bauber (1958). has
 certain fundamental principles that are highly significant in work with 
children. We meet each other as two separate individuals, one not more 
superior than the other. It is my responsibility to hold this stance. I am as 
authentic as I know how to be – I am myself. I don’t use a teacher voice or a patronising voice. I will not manipulate or judge. Although I 
am perpetually optimistic regarding the healthy potential of the child that I meet in my office, I will not place expectations upon her. I will accept her as she
 is; in whatever way she presents herself to me. I will respect her rhythm and
 in fact, attempt to join her in that rhythm; I will be present and contactful.
 In this way our relationship flourishes.

Transference generally enters into any relationship, however I do not
 encourage it. The child may react to me as a parent figure; however, I am not her parent. I have my own point of view, my own limits and boundaries,
 my own way of responding. In relating to my client as a separate being, I
 give her the opportunity to experience her own SELF, her own boundaries -
 to perhaps experience herself in a new way. I am not hopelessly enmeshed
 with her, as a parent might be. As I maintain my own integrity as a separate
 person, I give the client the opportunity to experience more of her own self, thus enhancing her sense of self and improving and strengthening her
 contact skills.

Further, I have a responsibility to be aware of any ‘buttons’ pressed in me
 that may not be genuine emotional responses to the contextual situation, and 
to explore these counter transference responses to eliminate their detriment 
to the client. I am true to myself as well. I am not afraid of my own feelings
 and responses, and I know my own limits. I honour what’s important to me.
We begin on time and end on time. I pace the session so that there is time 
for the child to help me clean up (except sand tray scenes). In this way
 closure is clearly evident.

Once the initial resistance is overcome, I can begin to feel that thread of 
relationship with most children. However, there are some children who 
cannot form a relationship, at least for some time. These are children who
 have been severely injured emotionally at a very early age, or perhaps at 
birth. Trust eludes them. For these children, the focus of the child’s 
resistance is vital, for it is the one way that the child has learned to protect 
herself. Finding creative, non-threatening ways to reach the child is the task
 of the therapist.


The next issue that I address in the therapeutic process is that of contact. Is 
the child able to make and sustain good contact? Or does he move in and
 out of contact, or have difficulty making contact at all? In every session
 together, contact is a vital, existential issue. Nothing much happens without
 some contact present. What happens outside the session may be similar or
 different, and I can only work with what we have together. Sometimes a 
child has so much difficulty sustaining contact with me that the focus of the 
therapy becomes one of helping the child feel comfortable with making and 
sustaining contact.

Contact Involves having the ability to be fully present in a particular 
situation with all of the aspects of the organism – senses, body, emotional 
expression, intellect – ready and available for use. Children who have 
troubles, who are worried and anxious, frightened, grieving or angry, will 
armour and restrict themselves, pull themselves in, cut parts of themselves
 off, inhibit healthful expression. When the senses and the body are restricted, emotional expression and a strong sense of self, will be 

Good contact also involves the ability to withdraw appropriately rather than
 to become rigidified in a supposedly contactful space. When this happens 
it is no longer contact, but a phony attempt to stay in contact. An example
 of this is the child who never stops talking, or who can never play alone and
 needs to be with people at all times.

We speak of contact skills – the how of contact. These skills involve 
touching, looking and seeing, listening and hearing, tasting, smelling, 
speaking, sound, gesture and language, moving in the environment.
 Sometimes in our therapeutic journey it is necessary to give children many 
experiences to open the pathways to contact. Children who have been
 abused particularly desensitise themselves, as do most children who have 
experienced some kind of trauma.

Sometimes I will notice that a child, who generally has the capacity to make 
good contact, will come into the session and appear to be distracted. I will 
know immediately that something amiss has happened prior to this time. I
 might casually ask the child to tell me something that has happened at
 school that he didn’t like, or something that happened on the way to my
 office. I need to assess the child’s contact level at each meeting.


Children evidence a variety of behavioural manifestations, often called 
resistances, as their way of attempting to cope and survive and make contact 
with the world as best they can. Sometimes it works, but more often
 children do not get what they need as they engage in these behaviours. They 
are considered inappropriate by others, and only make things worse. Since
 they have little awareness of cause and effect, they try harder, generally by 
accelerating the behaviours, but their efforts fail them, and life is far from 
satisfying. As they gain more self-support through a stronger sense of self, 
the unsuccessful behaviours drop away and are replaced by more satisfying, 
effective ways of contacting the world. Most every child will be resistant,
 self-protecting, to some degree. If there is no resistance whatsoever, I know
 that this child’s self is so fragile that she must do whatever she is told to do 
in order to feel that she can survive. I want to help this child strengthen 
herself so that she can feel some resistance, to have enough support to pause
 and consider.

Resistance is the child’s ally. It is the way she takes care of herself. I expect 
resistance and I respect the resistance. I am more often surprised when it is
 not there, than when it is. In some situations I articulate it for the child, ‘I know you probably don’t want to do this drawing, but I want you to do it 
anyway. Whatever you do, I don’t want you to do your best we just don’t
 have time for that.’ I want to help the child soften somewhat, and go through 
the resistance to some degree for a little while. The very fact that I will 
accept the child’s resistance often helps her take the risk to do something 

As the child begins to feel safe in our sessions, she will drop the resistance 
for a time. However, when she has experienced or divulged as much as she
 can handle, as much as she has inside support for, the resistance will come
 up again. In this way, resistance surfaces over and over again, and each time 
it must be honoured. We cannot force the child to go beyond her
 capabilities. Resistance is also a sign that beyond this place of defense, there
 is highly significant material to be explored and worked through. The child 
seems to know on some intuitive, visceral level when she can handle such 
material and I have learned to trust this process. As we work with sell-
expression and emotional expression activities, the issues emerge again and 
again. The therapeutic work with the child is accomplished in small 

I see resistance as a manifestation of energy as well as an indication of the
 contact level of the child. As the child engages with me or some activity or 
technique, there suddenly may be a perceivable drop in energy, and contact 
shifts away from me or the task in hand. I can often see this manifestation
 before the child’s own awareness, by observing his body responses at that
 moment. I may say, ‘Let’s stop this for now and play a game,’ to the great
 relief of the child (obvious through the body). He is back in contact with me.
 Some children show their resistance in passive ways; that is, they will 
ignore, act distracted, seemingly not hear what I say, or begin to, without 
response, do something other than what I have suggested. If that child
 finally comes to a place where she can say clearly ‘No. I don’t want to do
 that,’ I will quickly reinforce that direct, contactful statement by 
immediately honouring it.


To enhance tactile sensation I might encourage the child to fingerpaint or
 work with pottery clay, using lots of water. We might sit at the sand tray
 running our hands through the sand as we talk. I might bring in a variety
 of textures to touch and compare, or we might examine various textures 
right in the office. We might listen to sounds in and outside the office or the
 sounds of music or drums. We might look at flowers. colours, pictures, light, shadow, objects, each other. Books on early childhood education provide a
 wealth of ideas for activities to enhance the senses, and are effective with
 people of all ages.

In my book, Windows to Our Children (1978, 1988), I describe how I made 
use of the Orange Exercise to open and enhance the senses. I gave each 
child in a group an orange. Slowly we investigated every aspect of the
 orange, examining it, smelling it, weighing it, feeling its temperature and 
texture, licking it. We peeled off the skin and examined it very carefully,
 biting and tasting it. We peeled the fibrous layer and examined this. We
 marvelled at the shiny, protective layer over the orange, noting that it had no 
taste. We divided each orange into segments, took a segment and very 
carefully went through the examination procedure. We then traded segments
 with everyone in the group, discovering in amazement that each segment
 was different in taste and texture, though all delicious. One twelve year old
 girl remarked later, ‘I can never eat an orange, or any other fruit, the way I 
used to anymore. Now I really know it.’ This child was referring to her 
enhanced awareness and sharpened sensory capabilities.

When children feel safe in my office, they will often regress and allow 
themselves to have experiences that one may deem more appropriate for a
 younger child. When this happens, I celebrate inside myself. Children who 
live in dysfunctional families, or who have been traumatised in some way, 
tend to grow up too fast. They skip over many important development 
steps. Some children will pour lots of water on the clay, unconsciously 
replicating mud play. Others will use water in fairly creative ways. A twelve 
year old boy, after learning that he had to help me clean up, insisted on 
washing all the clay tools. I told him that I don’t usually wash them but he 
insisted. As I watched him at the sink, I was reminded of my three year old
 daughter standing on a stool at the sink washing her toy dishes. This boy did
 not need a stool but he was involved in the washing as much as my daughter 
had been. He was giving himself an experience that he needed; this was 
evident by his relaxed body and smiling face.

The Body

Our next focus is the body. Every emotion has a body connection. Notice 
how your body reacts the next time you feel angry or joyous. Notice the
 constriction of your head when you hold in your anger. Notice the
 tightening of the throat and chest as you fend off tears, the hunching of the
 shoulders when you feel anxious or frightened. Children develop body 
patterns at an early age, often creating at that time the defects in postures
 that we usually see more clearly in adolescents and adulthood.

Children who are troubled restrict their bodies and become disconnected 
from them. I want to help them unblock, loosen up, breathe deeply, know
 their own bodies, feel proud of that body, feel the power that lies within that
 body. Often we begin with breath. Children, and adults, when anxious or
 fearful, restrict the breath, thus cutting themselves off further from themselves. We invent games that involve breathing. We do breathing 
exercises. We blow up balloons and move through the air with our breath 
to see who can keep the balloon up the longest. We do relaxation, meditative 
exercises involving the breath. We blow cotton wool balls across a table to 
see whose will reach the end first. We play games involving making sounds,
 singing and screamimg. Adolescents in particular are fascinated by the
 power of the breath. Over and over again, they will tell me how they 
remembered to breath deeply, imagining the breath bathing the body and
 the brain, during school examinations and how helpful this was to them. The
 secondary gain of feeling over one’s life, rather than a victim of it, is 

We do many exercises involving the body. We might dance around the room,
 throw a ‘Nerf®’ ball, fall on pillows, have a ‘Bataca®’ fight, play a hand
 wrestling game. Hyperactive children particularly benefit from controlled 
body experiments such as yoga, or body movement games when they can 
experience body control with movement. Bed wetters benefit greatly from 
body work since they are generally quite disconnected from their bodies. 
Creative dramatics, particularly pantomime, is a tremendous aid for helping 
children know their bodies. Each movement must be exaggerated in order
 to get the idea across. We play many games involving mime.

We don’t necessarily spend a whole session doing sensory, breathing and 
body activities. If it appears indicated, I will suggest an activity which the 
child may or may not be willing to do. Much depends on my own 
enthusiasm and willingness to involve myself in these activities with the 
child, as well as my skill in presenting them. We may spend five minutes or 
a whole session with these activities. We may need to negotiate and 
compromise, spending part of the time with what the child wants to do, and
 part with what I suggest. Once the child allows himself to be involved in
 these experiences, he generally enjoys them greatly. Therapy with children 
is like a dance; sometimes I lead and sometimes the child leads.

Strengthening the self

Helping the child develop a strong sense of self is a major prerequisite in 
helping him express buried emotions. Further, the child begins to feel a
 sense of wellbeing as well as a positive feeling about himself. Let me 
remind you that these steps as outlined in this discussion of the therapeutic
 process are not at all consecutive. We go back and forth as needed. We may
be focusing on sensory work, and while the child is enjoying the tactile 
sensation of wet clay, for example, along with the kinesthetic experience inherent in working with pottery clay, he may feel an increased sense of self. This heightened feeling of self will often spontaneously evoke emotional

Strengthening the self involves, besides sensory and body experiences:

  • Defining the self
  • Experiencing some power and control
  • Making choices
  • Experiencing mastery
  • Owning projections
  • The setting of boundaries and limits
  • Having the ability to be playful and use the imagination
  • Contacting one’s own aggressive energy

Defining the self

To empower the self one must know the self. Many experiences are 
provided to help children make ‘self’ statements. The child is encouraged to 
talk about herself through drawing, collage, clay, puppets, creative
 dramatics, music, metaphor, dreams, in fact, any technique that will help the
 child focus on herself. ‘This is who I am’ and ‘This is who I am not’ is what 
the child is learning and integrating into her awareness.

I make lists that the child dictates to me, of foods she likes and foods she 
hates, things she doesn’t like about school and things she does like, if any. The child might draw a picture of all the things she wishes for, or what
 makes her happy or sad or angry or afraid, or all the things she likes to do. Or I might ask the child to make out of clay, figures or abstract shapes to 
represent herself when she feels good and when she feels bad.

Honouring the child’s thoughts, opinions, ideas and suggestions is an 
important aspect of strengthening the self. Sometimes, with adolescents, I
 will use an astrology book, or the manual after giving them a projective test. I will read various sentences pertaining to their birth sign, or the manual’s 
interpretation of the test and will then ask, ‘Does this fit for you?’ Each time 
the child can say, ‘Yes, this is how I am,’ or ‘No, I’m not like that,’ or even
 ‘Well, sometimes I’m like that and sometimes I’m not,’ she is establishing 
more of who she is. The more the child can be assisted to define herself, the 
stronger the self becomes and there is more opportunity for healthful 


Giving the child many opportunities to make choices is another way to 
provide inner strength. Many children are fearful of making even the most insignificant choices for fear of making a wrong one. So I will provide
 many non-threatening choices as I can; ‘Do you want to sit on the couch
 or at the table? Do you want markers or pastels?’ Later the choices become 
a bit more complicated; ‘Which size paper would you like? (three choices). What would you like to do today?’ A typical response may be ‘I don’t
 know.’ or I don’t care’, or ‘Whatever you want me to.’ I smile and patiently 
insist that they make a choice, unless, of course I see that it is just too 
painful to make such a decision at this time. I encourage parents to give their
 children the opportunity to make choices wherever possible.


Children who live in dysfunctional families or alcoholic families or who 
have been abused, neglected or molested often grow up too fast and skip
 over many important mastery experiences vital to healthy development. In
 some cases the parents may do too much for the child, thereby thwarting his
 need to struggle; other parents are so rigid they don’t allow the child to
 explore and experiment. Some parents believe that frustration improves
 staying power. Children never learn to accomplish tasks through frustration, 
and it is important to be sensitive to that point. The baby struggles to put the 
smaller box into the larger one, but when frustration sets in, he begins to cry.
 The older child loses energy – cuts off contact.

Mastery experiences come in many forms. Some are planned, as bringing in 
a new game and figuring it out together, building a structure out of ‘Lego’
or ‘Lincoln Logs’, or figuring out a puzzle. Some children, as they begin to 
feel safe with the therapist, create their own experiences, such as drowning
 the clay with water or intently washing clay tools. These kinds of
 experiences are closely related to regression. The child herself creates opportunities to relive the kinds of experiences she may have missed or
 needed more of. Sometimes mastery experiences present themselves 
spontaneously. An 11 year old boy, for example, attempted to make a model
 bird fly in a sand scene he was creating. He asked me for a stick and some
 string. I knew the string would not work, but wisely said nothing. He 
discovered, after many tries, that he couldn’t tie the bird to the top of the 
stick with string. His energy began to fade, his contact with the task was 
broken, and I knew that at any minute he would decide to stop working on
 his sand scene. Sensing the onset of his frustration, I said gently. ‘I have an 
idea that might work. Would you like to hear it?’ He nodded and I said, ‘Maybe wire would work or even something like masking tape. I don’t 
know – what do you think?’ The boy opted for some picture wire. It worked,
 and his energy and smile and big sigh indicated to me his mastery 
experience. I did not say, “Don’t forget, that was my idea”.

Of course, children who use many of the projective techniques experience
 mastery, not by my saying, ‘That’s a beautiful picture or a wonderful sand
scene,’ but by their own intrinsic satisfaction. I caution parents to avoid
 overblown, general statements such as, ‘That’s a beautiful drawing’ or ‘You
 are a musical genius.’ Children generally turn such statements into negative introjects. More effective are statements such as, ‘I like the colours of that
 picture,’ or I like the way you have cleaned your room,’ staying with the ‘I’ message.

Owning Projections

Many of the techniques we use are projective in nature. When a child makes a sand scene, draws a picture, or tells a story, he is tapping into his own 
individuality and experience. Often these expressions are metaphorical 
representations of his life. When he can own aspects of these projections, he 
is making a statement about himself and his process in life. His awareness
 of himself and his boundaries intensifies. When the child describes his safe-place drawing to me, he feels heard and respected as I listen carefully. When I ask him to give me a statement about his place that I can write on
 his picture, he feels further validated. When we connect his statement to his 
life today, he begins to feel his own significance in the world. From a 14
 year old’s safe place drawing of an ice cave, I write as he dictates ‘I am
 walking through my ice cave and I am thinking.’ I ask him what he is
thinking about. ‘I am thinking about everything – school, my life.’ I ask if
 anyone else is there. ‘No, no-one knows how to get here. I’m the only one 
who knows the way in and the way out.’ I ask how this place relates to the 
reality of his life. ‘I need a place like that. It’s hard for me to think about 
anything when my brother is around.’ (He is an identical twin.) He expands 
a bit about this situation and draws a picture representing how he feels when 
his brother is around – a tight mass of dark – coloured lines. He admits that
 he doesn’t know how to feel free without finding an ice cave in which to 
hide. We have come one step further toward helping this boy find and own 

Boundaries and Limits

Good parenting involves clear limit setting appropriate for the child’s age
 level so that the child can know, experiment and test her boundaries. When
a boundary is not available, the child tends to feel anxious and may flail
 around in search of this boundary. Her sense of self becomes amorphous. The parents need to know when it is appropriate to stretch the boundaries so
 that the child, at each developmental level, can find new areas of
 exploration. In our sessions, my limits and boundaries are clear. We begin on 
time; we end on time. I do not answer the phone, in fact, they notice that I generally turn it off. My desk is off limits, and we don’t flick paint around the room. At the end of each session the child helps me clean up (except for
 sand tray scenes). Closure of the session is made clear by this activity. I don’t articulate these ‘rules’, they are dealt with naturally as they come up. I believe that my respect for myself and my limits free children to become more acquainted with themselves. I am also aware of my own limits in another way, I know, or sometimes learn in the process, what I can or cannot do. If I am required in a game to jump 100 times, I inform the child when I reach my limit. I also respect the child’s need to limit herself.

Playfulness, Imagination and Humour.

Young children naturally have a flair for playfulness and imagination and
 love to laugh at funny things. They have not restricted or inhibited 
themselves as yet. Imaginative play is an integral part of child development.
 Often these natural resources are stifled in children who are traumatised in some way. Providing many opportunities for imaginative play is a necessary component of child therapy and serves to free and enhance the self. The therapist needs 
to know how to play with the child. If this quality of life is
 obscured or lost, the therapist herself must find a way to regain this joyful behaviour.
 Fortunately, I have never lost the capacity for play, and this attribute has served me well with my own children with whom I’ve worked. Because there is so little opportunity in life to experience playfulness and 
imagination as an adult, I am very fortunate to have found my own avenues 
for these expressions. Many parents have difficulty allowing themselves to
 play joyfully with their children. When I am aware of this, we spend some
 time in my office just playing. I can be a good model for this activity.

As children begin to trust me and feel at home in my office, they begin to 
take over sessions This step is one of the most exciting parts of the therapy 
for me. When I see this happen, I know that there is progress. The children
 I work with (and actually most children) have no power over their lives. They might fight for control, engaging in power struggles, but actually these
 children feel a terrible lack of power. The kind of control that happens in the 
sessions is not the same as a fighting for power, it is a contactful interaction, 
but one where the child, in the play (and the child always knows it’s play), 
has the experience of control. It is one of the most self-affirming actions 
that takes place in our sessions.

Here is an example with a little bit of the child’s story. (In child work it is essential for me to know the child’s ‘story’ – his history, the life he comes 
from, the life he is in now. Without this understanding of the child’s field, the experience lacks connection and substance.)

Joey was found in an abandoned car when he was about 5 years old. He was
 tied to the seat with ropes, and it was concluded that he had been tied often and not allowed to move much, since his body showed evidence of rope 
burns, and his muscles were quite atrophied. He was close to death when 
found. After a time in hospital and two foster homes, he was adopted. (His 
birth parents were never found.) His adoptive parents brought him to 
therapy when he was 10 years old because of his extremely hyperactive behaviour (in spite of medication), as well as severe bouts of explosive and
 destructive anger.

Joey spent the first four sessions running round the room, picking things up
 and throwing them down. In these sessions my focus was to establish a
 relationship and help Joey sustain contact with me or something in the 
room and so I attempted to join him by running round the room with him, 
picking up the object he threw down, making a brief comment about it, and
 chasing after him to the next item. I noticed at the second session he paused for a second as I made my comment, and by the fourth session he had 
slowed down considerably and was actually responding and interacting with 
me. The relationship flourished, and we participated together in a number
 of sensory, contact enhancing activities. The musical instruments were a 
great favourite with Joey, and we spent some time communicating without
 words through the drums and other percussion instruments. He spent one 
whole session looking through a kaleidoscope, finding interesting designs,
 inviting me to look at them, and then waiting for me to find something he 
could look at (contactful episode par excellence).

Suddenly, everything changed and he began to take control of the sessions 
in a new way. He spotted a set of handcuffs and set the stage for an 
enactment. ‘You are a robber and I am the policeman. You steal this wallet 
(an old one on the shelf) and I come after you and catch you.’ So we played 
this game with great gusto with various new directions from Joey. He was
 clearly in charge.

At the second session we played out the scenario, he said ‘I wish I had some 
rope so that I could tie you up.’ I brought in some rope at the next session,
 and he gleefully tied me up. Once or twice I came out of my role to tell him 
the rope was too tight for me, and he quickly loosened it. We enacted this
 scene, me grabbing the wallet, he chasing me and grabbing me, putting on 
the handcuffs and tying me up, for several sessions. Joey added various
 elements and new dialogue at each session. When he tired of this game, Joey 
decided to play ‘principal’s office.’ He surrounded himself with the staple 
machine, toy telephone and various office-like items. He directed me to be 
the therapist in my own office who called him for advice about various
 children in his school. Joey delighted in this game as well, and we played it 
many sessions. During this time his mother reported that he was a
 transformed child, happy, no longer destructive, and calm.

We began to work on various other aspects of the therapy process in 
between other play scenes Joey invented, engaging in self defining activities 
and focusing on emotional expression, particularly anger. He was quite 
responsive and, in fact, often advised me, when we played ‘principal’s 
office’, to tell my troubled child (usually a large teddy bear) to draw pictures of his angry feelings, as well as other activities he, himself, had attempted. I saw Joey weekly for about one and a half years, including his parents every few sessions. At our last session Joey brought in a music tape he liked, and at his request, we danced to it the whole session with much more abandon and laughter!

It is tempting to interpret Joey’s dramatic play, much of it is quite obvious. Interpretative words seem superficial in comparison with the depth of this experience. A final note about Joey; he asked his mother why he was seeing me. She replied, ‘When you were little, you never had a chance to play. Violet is giving you that chance now.’

This article is from a book in process by the author. The concluding part of this article will be published in the next issue of Inside Out.

Violet Oaklander PhD is the author of Windows to our children, A Gestalt Approach to Children and Adolescents (1978) New York; (1988) The Gestalt Journal Press and is the Director of the Violet Oaklander Institute in Santa Barbara, California, USA. She may be contacted at 3761 Gregory Way, ♯5, Santa Barbara, CA 93105 USA. or