How I Support Children Through Anxiety, Depression, Trauma, and More in Play Therapy

One of the most common questions I get from parents and caregivers is: “How do you work with different challenges and symptoms in kids?”

While every child’s therapy journey is unique and tailored to their needs, goals, and strengths, below is a general look at what play therapy sessions might look like based on common challenges.

My approach is always neurodivergent-affirming, and I’m mindful of sensory needs and developmental appropriateness throughout our work.

How I Support Children & Teens with Anxiety in Therapy

What Anxiety Might Look Like in Children & Teens

Emotional & Cognitive Signs

• Excessive worrying about everyday things (school, friendships, safety)

• Constant “what if” thinking (fear of worst-case scenarios)

• Irritability or frequent mood swings (often mistaken for attitude)

• Trouble concentrating or mind going blank under stress

• Feeling overwhelmed by routine tasks

Physical (Somatic) Symptoms

• Frequent stomachaches or headaches with no clear medical cause

• Nausea, dizziness, or complaints of feeling sick before events (school, social activities)

• Rapid heartbeat, sweating, or shortness of breath

• Trouble sleeping (difficulty falling asleep, nightmares, or waking often)

• Fatigue despite adequate rest

Behavioral Signs

• Avoidance of situations (school refusal, skipping activities they used to enjoy)

• Clinginess (especially in younger kids) or reluctance to be away from parents

• Procrastination or inability to start tasks due to fear of failure

• Perfectionism and fear of making mistakes

• Seeking constant reassurance (“Are you sure I’ll be okay?”)

• Outbursts, crying, or shutting down when pressured

What Anxiety Therapy Looks Like for Kids & Teens

Anxiety is often rooted in the fight-or-flight response, a state of hyper-arousal in the nervous system. Many kids avoid situations that trigger these uncomfortable feelings, but this only reinforces the anxiety over time.

In sessions, we practice building a kid’s tolerance to acknowledge, discuss, and feel anxiety so it becomes less activating in the future.

In therapy, we work together to:

• Build a child’s window of tolerance for anxiety and big feelings through talk-based therapy, art, play, and/or sandtray therapy

• Explore and name body sensations tied to worry or panic

• Practice regulation strategies like movement, breath work, or using sensory tools

• Use nervous system education depending on age and learning style

• Identify and map personal triggers and coping strategies

Caregiver sessions include:

• Nervous system education

• Identification and discussion of individualized anxiety triggers and roots of anxiety

• Personalized strategies and visuals to use at home and school

• Support with co-regulation and daily routines

How I Support Children & Teens with Depression in Therapy

What Depression Might Look Like in Children & Teens

Emotional & Cognitive Signs

• Persistent sadness, emptiness, or “flat” mood

• Loss of interest in things they used to enjoy (sports, friends, hobbies)

• Hopeless or negative thinking (“Nothing matters,” “I’m a failure”)

• Low self-esteem or excessive guilt

• Difficulty concentrating or making decisions

• Lack of motivation

Physical Symptoms

• Changes in sleep (sleeping too much or insomnia)

• Appetite changes (eating much more or less)

• Low energy or constant fatigue

• Slowed movements or, sometimes, agitation

Behavioral Signs

• Withdrawal from family and friends

• Spending excessive time alone (room isolation)

• Decline in personal hygiene

• Less motivation to complete basic tasks

• Increased screen time as a form of escape

What Depression Therapy Looks Like for Kids & Teens

Depression often stems from hypo-arousal, or a shutdown response in the nervous system. Our first step is creating a felt sense of safety, allowing the child to begin feeling again.

In therapy, we focus on:

• Gently exploring emotional and body sensations

• Reconnecting with pleasure, motivation, and joy

• Building emotional tolerance without overwhelming the nervous system

• Processing difficult emotions through art, play, talking, and/or sandtray therapy

• Identifying what lights them up—interests, confidence boosters, and moments of strength

Caregiver sessions include:

• Nervous system education

• Personalized strategies and visuals to use at home and school

• Support with co-regulation and daily routines

How I Support Children & Teens Experiencing Suicidality and Self-Harm in Therapy

What Suicidality and Self-Harm Might Look Like in Children & Teens

Verbal & Emotional Warning Signs

• Talking about feeling like a burden or wanting to disappear

• Statements about death, even casually (“I wish I wasn’t here”)

• Sudden calmness after distress

• Intense shame, worthlessness, or emotional pain

• Intense feelings of hopelessness and helplessness

Behavioral Signs

• Self-harm behaviors (cutting, burning, scratching)

• Wearing long sleeves even in warm weather (to hide injuries)

• Searching for or talking about methods

• Increased isolation and withdrawal from others

What Therapy Looks Like for Kids & Teens Experiencing Suicidality and Self-Harm

This is a deeply sensitive and critical area of work. I integrate Synergetic Play Therapy with the Collaborative Assessment and Management of Suicidality (CAMS) model to:

• Understand the root cause of suicidal thoughts and self-harm

• Develop a collaborative safety plan

• Identify the function or “benefit” of self-harm (e.g., distraction, sensation, emotional release)

• Find non-harmful alternatives that offer similar regulation or relief

• Offer directive tools for emotional tracking and safety check-ins

Safety is always my number one priority, but I also want children and teens to have a safe space to process and discuss the feelings underneath the suicidality and self-harm.

Caregiver collaboration is essential here to ensure kids are supported across all environments. Caregiver sessions include:

• Nervous system education

• Personalized strategies and visuals to use at home and school

• Support with co-regulation, daily routines, and safety planning

How I Support Children & Teens Experiencing Trauma or Major Life Changes in Therapy

What Traumatic Stress Might Look in Children & Teens

Emotional & Cognitive Signs

• Heightened fear, vigilance, or being easily startled

• Emotional numbing or detachment

• Intrusive thoughts or distressing memories

• Confusion, guilt, or self-blame about events

• Changes around core beliefs about self, others, and the world

Behavioral Signs

• Regression (younger behaviors, such as clinginess or bedwetting)

• Avoidance of reminders (places, people, conversations)

• Increased irritability or aggression

• Reenacting traumatic events in play (younger kids)

• Perfectionism

• Increased academic or behavioral problems at school

Physical & Sleep Signs

• Nightmares or night terrors

• Difficulty sleeping or fear of sleeping alone

• Somatic complaints (headaches, stomachaches)

What Therapy Looks Like for Kids & Teens Experiencing Traumatic Stress

The foundation of trauma therapy is creating a strong therapeutic relationship, so sessions become a safe place to integrate past experiences, re-pattern the nervous system for regulation, and explore and slowly change core beliefs. This might look like:

• Using non-directive play to allow children to process and integrate in a natural, developmentally appropriate way

• Supporting narrative integration of trauma through art, parts work, or sandtray work

• Helping children name and manage intense feelings

• Improving interoception (the ability to feel and interpret internal body cues)

• Providing developmentally appropriate psychoeducation about trauma and the nervous system

Caregiver sessions include:

• Age-appropriate education on trauma and the nervous system

• Coaching for caregivers on how to talk about hard things

• Emotional regulation tools for everyday use

Final Thoughts

There is no one-size-fits-all in therapy. Whether a child is navigating anxiety, depression, trauma, or something else, our work together is about helping them feel safer in their bodies, more confident in who they are, and equipped with tools to manage life’s big feelings.

Want to explore how therapy might support your child?Click the button below to schedule a free 15-minute intro call.