Maggie McKay (Host): Welcome to The Parent-ish Podcast, where experts at Children's Mercy, Kansas City talk about the little everyday things parents experience with their babies, teens, and in-betweens. I'm your host, Maggie McKay. Joining us today is Dr. Haley Killian, pediatric psychologist, to discuss inside the therapy room, what really happens in a session with your kid. Thanks for being here today.

Haley Killian: Absolutely. I'm happy to be here, Maggie.

Host: Let's start at the beginning. What does a typical pediatric therapy session actually look like?

Haley Killian: Typically, a session usually has a combination of working with kids, doing a little bit of education about what—often times we're talking about emotions, but doing a little bit of education about that, and also utilizes some work with the parents and kind of giving them some tips and tricks on how to help support the kid when they go home.

So, a little bit of play and kind of getting to know you, especially in the beginning, but then also building some coping skills, and also kind of challenging kids to think a little bit different and answer some questions that they may never have been asked before.

Host: How do you help kids feel comfortable, especially if they're shy or anxious or unsure about coming to therapy?

Haley Killian: Comfort typically starts with connection, right? So, the first few sessions that I am working with at kiddo, I'm often focusing on building trust and learning what they like to do. It's not typically jump right in into therapy and what think of as therapy as parents and caregivers. But really, it's about learning to build connection with them and build on their interests, what they like to do. It really builds on the child's pace, what they're comfortable with.

You start to typically see kids open up a little bit more as they get more comfortable with anybody. And so, that works the same with a therapist that we're introducing essentially a stranger to a kid for the first time. And so, just like when you are meeting someone for the first-time, it's a lot of getting to know you and getting to know what we might have in common or what we can learn about each other. So, I like to both answer questions for kids if they have them, but also ask kids lots of questions, right? And that we are not challenging, especially those more anxious kids to feel pressured, and kind of shutting down by the end. So, that means lots of quiet activities. Maybe that means some really basic games before the kids are ready to engage in more of the therapeutic process.

Host: What are some common goals you work on with kids, and how do you decide what each child needs?

Haley Killian: Goals vary widely. I always say to parents that they really should know what the goals are, that their kids are working on in therapy. But they often fall into areas like emotion regulation, coping strategies—I feel like that's a really big one—behavior difficulties and confidence building, and deciding what kids need really involves a combination of getting to know what the parents' biggest concerns are, developmental history, what I observe as a therapy provider. And oftentimes, right, we're incorporating the child's voice and what they want to work on, because they are the experts of themselves. So, we kind of take all of those pieces together to help shape a plan that is helpful and kind of meaningful for the whole family.

Host: What's a misconception parents often have about therapy for children and what's the truth?

Haley Killian: A common misconception is that therapy is really only when things are going really wrong, right? Like, when we're really struggling, sometimes kids need a little bit of a supportive space that'll allow them to build skills, coping strategies being really big one, which I like to think of as anything that really helps a kiddo feel better or anybody feel better, right? But also understanding their feelings and navigating challenges.

And oftentimes, parents may even start to seek that support before the challenges become overwhelming. And also thinking, the other one that comes to mind for me is that, once the kid's in therapy, like first two, three sessions, right, like things should be getting better. And sometimes that's just not the case, because we see growth happen in small steps that build over time. Behavior change isn't easy for anyone. And so, I really like to emphasize that when I'm talking to parents and caregivers of what the process might look like and what the growth might look like.

Host: How involved are parents in the process?

Haley Killian: It's a great question and a question I often get, especially in the beginning. It really depends on the developmental age of the kiddo And what the goals that we're working on are, I would say like for our younger kids, oftentimes parents are very involved in what we're doing. When a kiddo is in a therapy room for one hour every week or every other week, that's only one hour of all of those hours within a week. And so, really recognizing that and saying, "Okay, so I can coach kids on building these skills." But really, the parents are helpful at home in supporting those behavior changes, those practicing of taking deep breaths or practicing taking breaks when they need them.

And so, some families participate directly in sessions. Others engage through more regular check-ins. I would say that would be like more of an early adolescence, teenager age range, and really working with the therapist on how that looks, because it might look a little different based on, again, what the presenting concerns are and what the goals are for therapy.

Host: Can you share what progress looks like and maybe also what slow progress looks like?

Haley Killian: Absolutely. Progress can show up in many different ways. I work with parents all the time who are like, "Hey, my child just took a break when I could see that they were getting upset or distressed." It might look like recovering from frustration more quickly. So, a tantrum that used to last a half an hour might last 10 minutes or 15 minutes, right? And so, it looks different depending again on the goal. But slow progress, I think, is where most of us get a little bit frustrated, right? Like, we want to see good behavior change happen, and good use of the skills that they're learning in therapy. So, it might look like they use the coping skill once, or they use the strategy once, anD it doesn't stick every single time. But really, if we think about it, does anyone really use everything every single time? No, probably not. But it could also look like a child needing more repetition and support before something really sticks for them. So, both using the coping skill and needing more repetition or more support before something sticks are really typical and really normal things that we see across the therapeutic process.

Host: For families who are considering therapy, but they're not sure if it's the right time, what signs should they be looking for?

Haley Killian: So typically, parents will seek out therapy, right? Or caregivers will seek out therapy when they notice patterns in their child behavior that feel really different or out of sync with what they have seen their child do in the past. So, signs that we might look for to really seek help might include ongoing worries, big emotional reactions; "hey, she used to be fine when we dropped her off at school, and now all of a sudden we're having meltdowns every day," for example; difficulty with transition, changes in sleep or appetite; challenges that are really starting to affect school or family life, I think that's a really big one because we don't want things to continue if they're getting in the way of life more broadly, right? We think about school, we think about family, but we also think about social interactions with other kids. And I think that, at any age, it's really important that we help support those connections. Because if we can start early, when we start to see those things come up, then we are helping our child be better prepared for the future and what that comes with.

Host: Well, this has been so helpful and informative. Thank you so much for sharing your expertise and giving us all this useful information.

Haley Killian: Absolutely. Happy to talk about these things.

Host: Again, that's Dr. Haley Killian. To find out more, visit childrensmercy.org/parent-ish. Thank you again. And that concludes this episode of The Parent-ish Podcast. Again. For more parenting tips and tricks, visit us at parentish.org where we help you celebrate the craziness and challenges of parenthood.