Personalized.
Flexible.
Empathic.
Intuitive.
Somatic.
Discreet.
Creative.
Evidence-Based.
Effective.
MA, LMFT
Therapy with Noelle
CONCIERGE THERAPY SERVICES
Kids!
Where do I even begin when it comes to working with children? I adore them, and I always have. Their infinite creativity, imagination, and play lights something up inside me. I have worked with small children since I was still technically a child myself. I wasn't quite Maria in the Sound of Music, but my summer job in college was as a live-in nanny for a family with five kids under 10 years old —a responsibility I took very seriously. In fact, I have always taken children seriously.
I know that, legally, anyone under 18 is considered a "child," however there is a marked difference between before and after adolescence. Most of my formative training was with notoriously challenging adolescent teens and their families in residential, PHP, IOP programs, so I can corroborate this from firsthand experience.
Young children’s brains are extraordinarily plastic. Their prefrontal cortex —the region responsible for executive functioning— is among the least developed areas of their brains. This makes impulse control, emotion regulation, planning, delayed gratification, perspective taking, evaluating potential consequences, and metacognition a struggle. To regulate these capacities, young children depend heavily on adults. In fact, at this stage of development, kids primarily rely on co-regulation from adults instead of “self-regulation.” Their hypothalamic-pituitary-adrenal axis calibrates through relationships, meaning: sensitive, attuned caregiving literally helps regulate kids’ cortisol levels (Gunnar & Quevedo, 2007).
Because of this, in my therapy practice, I require parents to be active participants. The focus is less on building children’s insight and more on helping parents become effective nervous-system regulators for their little ones through modeling, repetition, experiential learning, sensory integration, and parent coaching.
Neurobiologically, young children are dominated by their limbic systems. Emotions come first, and hit quickly —thinking comes way later. And, even then, kids often cannot explain why they feel something. Instead, they act it out, draw it, play it, even somaticize it (aka: tummy aches, phantom pains, etc.). “Toys are children’s words and play is their language” (Landreth, 2012).
Supportive caregiving and positive relationships for young children literally shapes their neural architecture. It has the potential to improve stress regulation, emotional regulation, resilience, and support healthy, secure attachment (National Scientific Council on the Developing Child, Harvard University).
According to Erikson, the primary psychosocial stage of development for young children is learning and building trust, autonomy, initiative, and industry. Their core questions are : “Am I safe?” “Can I trust adults?” “Am I loveable?” And, in therapy sessions, I love to meet kids (& teach parents to meet their kids) at their level through pretend play, storytelling, art, sensory experiences, and movement —NOT conversation. It’s just not the language that makes sense to their brain.
Young children communicate through other means, especially nonverbal ones. Body posture, movement, facial expressions, proximity, and play themes are invaluable to interpret with kiddos. As are co-regulation tools for adults like pacing, tone, rhythm, facial expression, and shared attention.
It is always my deepest honor to support families with young children and offer attuned, good-fit solutions aligned with yo.ur unique family's culture. And, if applicable, even help assess for outlier behaviors (ex: neurodivergence, developmental issues, etc) and offer supportive resources.
Evidence supports:
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Child-Centered Play Therapy
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Parent Child Interaction Therapy (PCIT)
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Child-Parent Psychotherapy (CPP)
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Traum-Focused CBT with caregiver involvement
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Parent coaching
What about online therapy with young children? Well, for PCIT and CBT, the evidence actually supports that, as long as parents are active participants and technology is sufficient to capture nuances, the results essentially the same as in-person (Comer et al., 2017; subsequent tele-PCIT studies). Play therapy is less researched in this area. And, in my professional experience, I feel most confident with initial at-home, in-person experiences with children and their parents so I can evaluate everyday environments and be better equipped to offer attuned, realistic support —even if we quickly transition to online sessions.
An example of how child-parent therapy might look:
I worked with a family of five who were mainly worried about their oldest child, in elementary school, who seemed “anxious” to them. After online parent consultations and questionnaires, I went to their house where I was able to meet every family member in person and assess for any other potential complications. Looking through their rooms (paying special attention to their personal spaces and “play areas," including games), seeing how their lives were set up, etc. gave me enough information to be creative about realistic interventions. Since both parents worked and all three kids had different schedules, we concluded that transitioning to online sessions would work best. And, because of the importance of pacing and consistency with young children, we focused on 90 minute sessions, where we were able to mix and match kids with parents, kids alone, parents alone —and had enough time for parents to vent, for kids to join later & not feel rushed..
We played games (inside and outside), made art, told stories, laughed, and learned new skills and tools, and —maybe more important—everyone had reparative experiences. It quickly became obvious that our initial “identified patient” was not the only one struggling in the family. But, the more Mom and Dad learned how to: manage their own nervous systems (especially their anxieties), develop a better-functioning & manageable family organization system, hold healthy parent-child boundaries, communicate in age-appropriate ways with age-appropriate expectations, and have “fun” as a family, the less the family needed me. And, their once “anxious child,” mellowed into a secure little person able to offer patience, grace, and compassion —for themselves, their friends, teammates, and their whole family.
American Psychological Association. (2023). Guidelines for the Practice of Telepsychology.
Comer, J. S., Furr, J. M., Cooper-Vince, C., et al. (2017). Rationale and considerations for the Internet-based delivery of Parent-Child Interaction Therapy. Cognitive and Behavioral Practice, 24(3), 302–316.
Eisenberger, N. I., Lieberman, M. D., & Williams, K. D. (2003). Does rejection hurt? An fMRI study of social exclusion. Science, 302(5643), 290–292. https://doi.org/10.1126/science.1089134
Gunnar, M. R., & Quevedo, K. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58, 145–173. https://doi.org/10.1146/annurev.psych.58.110405.085605
Landreth, G. L. (2012). Play Therapy: The Art of the Relationship (3rd ed.). Routledge.
Markowitz, J. C., Milrod, B., Heckman, T. G., et al. (2021). Psychotherapy at a distance. American Journal of Psychiatry, 178(3), 240–246. https://doi.org/10.1176/appi.ajp.2020.20050557
National Scientific Council on the Developing Child. (2020). Connecting the Brain to the Rest of the Body: Early Childhood Development and Lifelong Health Are Deeply Intertwined (Working Paper No. 15). Center on the Developing Child, Harvard University.
