Many aspects of traditional counselling and psychotherapy rely on language - words to explain, reflect, and make sense of inner experiences. But when we apply this model to children and adolescents, we often encounter blank stares, fidgeting, confusion, bumpiness, silence… perhaps a shrug, or one word answer. The truth is, many children simply aren't developmentally ready for the breadth and depth of verbal processing that traditional forms of therapy often depend on. Children aren't just "mini adults” - they think and understand the world in very different ways at different ages.

Cognitive Development in Childhood 

Although there are many theories about how children and adolescents develop cognitively, it’s the work of seminal psychologist Jean Piaget (1954) that I come back to most often as a therapist. Piaget asserted that (typically developing) children move through distinct stages of age-related cognitive development. First is the Sensorimotor Stage (birth to about 2 years), where babies learn about the world through their senses, actions and reactions - for example, a baby feeling soothed by cuddling a soft blanket or giggling when they hear their parent's voice. Next is the Preoperational Stage (around 2 to 7 years), when children use words, symbols and images to represent the world, but can often only see things from their own point of view. They also might get upset when they accidentally tear a drawing, thinking it’s hurt because they believe objects have feelings too.

Then comes the Concrete Operational Stage (about 7 to 11 years), where children start understanding logical rules about the real world - for example, realizing that even if their best friend moves to a new school, their friendship can still stay strong, even if they don’t see each other every day. Finally, in the Formal Operational Stage (12 years and up), teenagers develop the ability to think about abstract ideas, such as hypothetical situations or moral dilemmas - like wondering what a perfect society might look like, questioning fairness in the world or wrestling with big feelings about who they are and what they believe in. However, teenagers will still often have difficulty in expressing their emotions clearly. This is because their emotional brain - the limbic system - is developing faster than the parts of the brain responsible for self-regulation and language, like the prefrontal cortex (Arain et al., 2013). In other words, they feel things very strongly, but they may not yet have the tools to fully make sense of or explain those feelings.

The Struggle of Talking

Asking a child or teenager “How are you feeling?” may yield a shrug not because they’re unwilling, but because they lack the neurological wiring and emotional scaffolding to name and explain what’s going on inside. They may echo adult phrases, but not fully understand what they mean. In truth, children’s emotional vocabulary grows slowly. Research shows that between ages 4 and 11, kids roughly double their feeling words every two years, and this growth only levels off around age 12 - 16 (Grosse et al., 2021). Relying on words alone can sometimes bypass the complexity of their lived experience, especially when those words are borrowed from adults rather than formed from within. In my work, I’ve seen talk-based approaches fall short for children coping with issues such as grief, trauma, or anxiety. What they need isn’t necessarily a space to talk about feelings, but a space to experience and express those feelings safely - often through metaphor, image, or play. For a child to unpack what they are feeling often comes through imaginative, non-linear processes, not through adult logic and structured narrative. Child and adolescent therapy isn’t about simply turning down the volume on adult approaches. It’s about meeting children where they are - and speaking their language. So, if talking falls short, then what does connection look like in therapy?

The Language of Children

Creative Psychotherapy (or Expressive Arts Therapy, or Creative Arts Therapies) allow children and adolescents to project, explore, and process feelings symbolically. This type of therapy makes space for those aspects of the self that can be sensed and felt, yet not verbalized or articulated (Botton & Armstrong, 2013). Some of the most well-known modalities include Art Therapy, Dance/Movement Therapy, Dramatherapy and Music Therapy, as well as Play Therapy. As outlined by Malchiodi (2020), integrating arts-based expression in therapy encourages the senses to tell the story, offering children a vital alternative to traditional talk-based approaches. Many children, particularly those who have experienced trauma, may struggle to put their experiences into words. Their memories and emotions are often stored in sensory and somatic forms rather than in narrative, verbal memory (Belkofer & Nolan, 2016).

For example, a child may not be able to say, “I feel scared because my parents are fighting” but they might act out an argument between toys or bury figures under layers of sand. A teenager overwhelmed by the emotional intensity of puberty might not be able to say “I feel like I’m boiling inside and I can’t control it”, but they might create a chaotic collage of fragmented images, punch their fist into a slab of clay, or destroy an artwork they have created. In these moments, we see a depth of expression that language can’t reach. This sensory storytelling helps the child recover a sense of self-efficacy; by creating images, sounds, or movements, they can externalize and begin to organize overwhelming experiences that once felt chaotic or unmanageable (Bosgraaf et al., 2020).

The therapist’s role, then, is to gently support the child or adolescent in exploring the meaning behind what they have made, creating a safe and curious space for reflection. Rather than interpreting the work, the therapist might ask open-ended questions like, "Can you tell me about what’s happening here?" or "What do you think will happen next?" For example, if a child paints a burning house while coping with their parents' separation, the therapist might help the child connect the image to their feelings of fear, anger, or loss, allowing difficult emotions to be expressed symbolically. Through this process, the child is supported in making sense of their experience at their own pace.  

Conclusion

If we are to truly meet children in therapy, we must first step into their world - not expect them to step into ours. That means recognizing that talk therapy, while powerful for many, is not universally suitable - especially not for young minds still building the architecture of emotion and thought. Instead, we need to widen the frame of what counts as “therapy.” Play, image, rhythm, movement, and story are not just preparatory tools or icebreakers; they are central to how children understand, communicate, and heal. Therapists working with children must be fluent in these alternative languages - comfortable with silence, mess, metaphor, and mystery. Let us reimagine child therapy not as a scaled-down version of adult work, but as its own rich, playful, and profound discipline. 

References

Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R. & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric disease and treatment, 449-461. https://doi.org/10.2147/NDT.S39776

Belkofer, C. M., & Nolan, E. (2016). Practical applications of neuroscience in art therapy: A holistic approach to treating trauma in children. In Art Therapy, Trauma, and Neuroscience (pp. 157-172). Routledge.

Bosgraaf, L., Spreen, M., Pattiselanno, K., & Hooren, S. V. (2020). Art therapy for psychosocial problems in children and adolescents: A systematic narrative review on art therapeutic means and forms of expression, therapist behavior, and supposed mechanisms of change. Frontiers in psychology, 11, 584685. https://doi.org/10.3389/fpsyg.2020.584685 

Botton, A.D. & Armstrong, J. (2013). Art as Therapy. Phaidon Books.

Grosse, G., Streubel, B., Gunzenhauser, C., & Saalbach, H. (2021). Let’s talk about emotions: The development of children’s emotion vocabulary from 4 to 11 years of age. Affective Science, 2(2), 150-162. https://doi.org/10.1007/s42761-021-00040-2 

Malchiodi, C. (2020). Trauma and Expressive Arts Therapy. The Guilford Press.

Piaget, J. (1954). The construction of reality in the child. Basic Books.