Crying in therapy

For many parents, family members and therapists, crying can be a big obstacle to overcome when teaching and working with a young child. While it may be difficult to manage this sort of behaviour, it is important to understand why a child is upset as well as the things you can do in order to see his way of thinking. In my opinion, the key to handling this issue is to try to figure out where the child is coming from and be willing to view things from his perspective. In doing so, you will be able to tell the difference between when he is simply protesting something new or if he is hurt and needs you to stop and assist him in his function.

Seeing from a child’s perspective

For this reason, it’s good to take a step back and observe your child. We often believe that since we are older and “wiser,” our primary goal is to teach a child the things that we know and understand. However, every child is different, and each has his own dreams, wishes and fears. In this respect our first response should be to learn as much from him as he learns from us. The ability to understand a child becomes really important especially when you are working with him to improve his function. In response to unfamiliar situations or tasks, a child will often cry because he does not want to do them. This makes it important to know the difference between crying as a response to new experiences or in response to actual injury. If he is really hurt, you will need to stop and find out what is happening. However, if this is not the case it is important to persist and continue with treatment.

Why is this the case, you may ask? If a child is only protesting, explaining things to him will be much more effective than stopping treatment every time he begins to cry. If you stop, he will automatically assume that crying will be the solution to stop you from making him do certain things. It is a self-defense mechanism, which is why you need to explain what, how and why he needs to do something in order for him to be able to understand. In this way, he will come to comprehend what is being taught and you will be able to continue with his treatment.

The effect of this approach

To demonstrate how effective approach this is, I’ll tell you about one of my experiences with a young girl that had cerebral palsy. As I worked with her, I made sure to explain every function and its purpose to her for each new activity we did together. During the girl’s treatment, her mother told me, “You are the first therapist that she didn’t cry with.” My question to her was: did anyone talk to the girl and explain what she was supposed to do? When the mom said no, it was easy to understand the differences she saw in her child’s learning and behaviour.

Whenever I encounter these situations, I ask myself: why do we have to assume things about a child and try to make him follow them, when we can simply ask a child what’s wrong and then explain what we are going to do? If a child is not willing to do the things which he should, then the approach to take is to explain, follow up, and repeat it again and again and again. This is how a child is able to learn and eventually follow. When we do everything for a child however, instead of simply assisting him as he learns to do things for himself, he starts to assume that everything can be done for him. If this were the case, then why should he have to follow instructions and strive to accomplish more? Without being given a reason for doing things, a child will continue to protest and cry whenever he comes across new situations.

So my final advice to parents, therapists and caregivers alike is this: communicate with your child. Explain why he has to perform certain functions and show him how to do them. It is important to be patient, persistent and understanding, for you are the one who will teach him what’s wrong, what’s right, what’s true and what’s false. As you help to introduce him to the world, remember: your child is bright, and it’s up to you to support and guide him as he continues along the path of development.

If you have any questions or comments, feel free to leave a comment down below or email me. Thanks everyone!

-Natan

Update: This article was featured by our friends over at Down Syndrome Centre, Special Education Advisor and Hope Magazine Online. Thanks guys!

Natan

About the author

Natan Gendelman has written 180 articles for Enabled Kids.

Natan Gendelman is licensed as a physical therapist in Russia and Israel. After moving to Canada, he was certified as a kinesiologist and osteopathy manual practitioner. Natan has more than 20 years of experience providing rehabilitation and treatment for conditions such as cerebral palsy, autism, Down syndrome, pediatric stroke and acquired brain injury. He is the founder and director of Health in Motion Rehabilitation, a Toronto-based clinic whose main objective is to teach their patients the independence necessary for success in their daily lives.

16 thoughts on “Crying in therapy

  1. Hi! I’m glad I found this website which tackles about child crying during OT sessions. I have a 3 year old boy diagnosed with gdd and is currently being monitored for persistent austism. He is undergoing an occupational therapy for two months now and I wonder (even his OT also wonders) why he is crying during his OT sessions to the point that he even vomits. During his first sessions, we were explained that there would really be tendencies of crying. His OT then said after a week that he cries with tendency of vomiting because of his manipulative behavior. After several weeks, my boy was ok and tends to enjoy the therapy. Recently, his acting stressed again during his OT session. He cries and vomits during the therapy. The therapist explained to me that my boy would really complete the task he was told to do even if he was crying while doin it. As a parent, I am also stressed of the situation. I try to explain to my little boy that therapy is fun and that he has just to enjoy, play and learn (He is not yet talking a lot).Its just different when he goes inside the therapy room. I hope you can enlighten me on this Nathan. Thanks. P.S. His crying began AGAIN the last time he saw a girl affected with cerebral palsy who was shouting with joy at the therapy room.He was really scared of the girl.

    • Wow! There are several children in the LIFE Program (http://www.healthinmotionrehab.com/life-program.php) who also cry a lot and sometimes vomit because it is their way of reacting. A lot of times they simply take time to get used to the therapy and stop crying after they are used to it. Sometimes it’s also a way they try to not do the therapy, but showing them that no matter how much they cry, they would be going through the therapy. All in all, it takes time.

      Best,
      The Health in Motion Rehabilitation Team

  2. P.C. My suggestion is to find another place for aqua therapy for your son or another more understanding patient therapist. It doesn’t sound like you’ve found a “good fit” for him yet. Your son may not always understand everything you’re saying to him right now, however, the tone of voice and the attitude does come across and that he can understand and react to. Children learn by touch who they can trust or not … even at this young of an age especially when they’re not yet verbally able to express themselves.

    I hope this helps.

    Dina, an adult with mild Spastic Diplegia CP

  3. This is wonderful to read. I understand the difficulties because crying in therapy happens with my little boy. One thing we have been trying at home is demonstrating what he might experience in therapy. At times I think he feels more comfortable because he has experienced it at home with his family.

    We even bought some therapy toys for him to have at home to he is familiar.

    We found an online source called Sensory Edge. They have wonderful products that children can use for therapy.

    Thank you for the wonderful article!

  4. I fully agree with you that we should explain the therapy to the child. Most of the time therapist will threaten the child that if you cry we will send the parent out of the therapy room. I have seen them shouting at a child for crying or insulting him to make it work. It may make the therapist feel they have done their work but in the long run it does not help the child. You may have streched him well at the joints but created a new behaviour problem.They will call the child stubborn not realising that this same quality of determination helps a child overcome The good ones always go the extra mile of engaging the child , gaining his trust and then make him do the exercises. may their tribe grow. Treat the child as you would treat any other person. Be reasonable , gentle and kind and then see how well the child performs. This is a good article hope more such are written and taught in the physiotherapy colleges.

    • Meeta,

      Thank you so much for your kind words. I wholeheartedly agree–understanding and respecting the child and treating him like anyone else, with kindness and patience, is so very important to his success. I’m glad that we are on the same wavelength. Let me know if there’s anything I can assist with, and feel free to email me if you need anything. I look forward to hearing from you again!

  5. Dear Natan,
    You did it again. Nailed it.
    It’s all so very basic. Who, What, Where, WHY?, When….
    I say to my boy, “Why son, because you need your independence. I will not be here forever. And I love you, that’s Why.” Now lets try again.. Take my hand.
    If you do not get your child to do it now, then when? When their twenty? When their thirty? Will you even make it to when their thirty???
    Is it hard, painfully hard. Does it hurt, all the time. I probably cry more then him!!
    But the more we guide them in functioning in our world, the easier it will be for us both in the future that is the fact.
    Ignoring is so easy, Dealing with it is so hard.
    Life wasn’t made to be easy or we all would be at the finish line.
    Here’s to when we cheer you & your loved one’s on when you cross your finish line!
    Peace, JCP

    • Thanks again John! Your words are great advice for any parent. All the best to you and your son!

  6. Natan,

    As a parent of a child with cerebal palsy, I really appreciate your ability to see things from all perspectives. We went through a tough time where our son cried hysterically when we headed in the direction of the clinic. We dropped those services when we were told that we just needed to let them MAKE him work. He didn’t cry for his in-home physical therapist so things just didn’t make sense. I think you hit the nail right on the head. There was no explanation to him or to me.

    The new OT, as well as his in-home PT and speech therapist, always explains and talks him through what is going on. His new OT corrects me for not explaining what I’m about to do before I start. We jokingly refer to her as the child whisperer because she very thoughtfully analyzes why he might be crying, though he rarely cries for her. He has such a high level of trust with his current therapists that they can do just about anything with him.

    There are often times that I have to confess that I’ve dropped the ball on doing the homework. He gets sick or seizures start and my whole routine goes out the window and I have to start all over. You are right in that sometimes we parents are just as afraid as the children.

    Your patients and their families are very blessed to have you!!!

    Anita

    • Anita,

      Thank you so much for your comment! I’m glad to hear that your son is doing well now. It really goes to show how much of a difference explanations and understanding can have for both the parent and child. You’re a wonderful mom, and both your son and his therapists are doing a great job. Let me know how things go, and if you have anything you’d like to ask I’d be more than happy to help.

      Thanks for sharing, all the best!!

  7. Great article – Many children cry for fear of the unknown. If explanations are offered – children feel safe. When children feel as though they are in a safe environment, they are more apt to develop trust in the therapist. Through that trust comes a willings to attempt safe challenges. You posed a question I have brought up within my own classroom and with other educators. When pressed with a behavioral issue did you assume you knew the cause or did you take time to ask the child why? Upon the childs response to why, did you tell the child the reason for your request? As mentioned, we learn as much from the child as they learn from us.

    Crying can be a conditioned response. Whenever I am presented with a challenging behavior I always subscribe to the theory that no behavior presents itself unless it has worked in the past. If a child crys and is constantly rescued this will become a learned behavior.

    As for assuming parents will not continue taking our advice on the homefront – here is food for thought. Perhaps – just as the child – parents will be more receptive to continuing theraputic techniques at home if they two are provided an explanation. They may be just as fearful as their children are.

    • Thank you for your comments everyone! As Marlaine said, communication is something that we show and teach children by interacting with them. Asking a child questions and getting him to understand the “why” goes a long way towards his success.

      Rhonda – I agree that there can be problems when there is a disruption between what a child learns in the therapy room and what he learns at home. In fact, that is one of the reasons why I started the LIFE Program for kids. I’ve experienced these issues myself, so I know where you’re coming from. Like you mentioned, parents play a big role in the success of their child’s treatment–so my philosophy is to take the time to show parents how to work with their child and continue his treatment at home. As Mari said, parents also need to know why they have to do certain things. Personally I do this by explaining and showing them what to do in terms of their child’s behaviour, mealtime, dressing, etc. and it goes a long way towards what their child can and cannot do.

      No one is perfect, and I know that both parents and therapists try and do the best they can. A child’s treatment is a learning process for everyone involved. I think that the most we can do is be supportive, understanding and assist when needed. Like Mari mentioned, parents may be just as fearful, if not more so than their child. We’re there to guide both them and their child to learn, grow and succeed in their everyday lives.

      Again, thank you everyone! I really appreciate your feedback. :-)

  8. Good points! The real problem for therapists come when they follow your suggestions but the parents do not do the same at home. When we only see a child once a week and the rest of the time parents give in to the crying and stop the activity, we can waste a whole session trying to stick to our guns and get nowhere at all. That is when it gets really frustrating for everyone involved.

  9. Great advice Natan! I remember reading an article when my daughters were young which said that when children are whining, they are actually angry. So I started asking them if they were angry about something when they whined rather than instructing them to stop. What a gift! Communication is a learned skill and children are newly learning. Respecting this fact and assisting them by asking questions restores pride and joy to the learning process for both Educators (parents and professionals) and children.

  10. I think that this is a good point for little kids but not really little. I struggle with my 22month old twins and therapy, they are to young and just don’t understand when things are explained to them. I’m trying not to form a habit out of stopping therapy when they cry but they are just babies what we tend to do is Mommy breaks when they just cant seem to handle it anymore (crying fussing etc) they come to me for some cuddles and then its back to work.

    though my son just started water therapy and we are having some real issues with him being scared of the therapist and of the water so our next step is for me to get in with them

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