‘Waiting, Waiting, Waiting’: Non-Verbal Communication in Child Therapy

Working as a child and adolescent psychotherapist in the NHS, I have always found it interesting that we are assigned the umbrella term ‘talking therapies’. Psychotherapy with young people transcends verbal communication, and in this blog post I want to think particularly about how we work with those who have experienced complex developmental trauma, or others who are unable to articulate their thoughts and feelings through words alone.

Children communicate volumes through their bodies. In complex trauma, their bodies have kept painful scores, but also hold stories that attest to resilience and strength. The concept of psychic trauma (explored by thinkers like Philip Bromberg and Rene Roussillon) highlights the profound impact of unbearable experiences that are borne alone, misrecognised and unattended. In therapy, we strive to create a safe relationship in which these muted frames can be gently witnessed, recognised, digested and acknowledged.

I believe our work as child and adolescent therapists, in this respect, is reminiscent of a translator who navigates the delicate space between following, feeling and understanding. Translating can be a perilous business, as it has to do with the existential risk of differentiating between life and death. In the brilliant psychoanalyst Victor Guerra’s work on the psychic life of infants, children will have their bodies and protosensoriality translated by their carers before they can engage in meaningful language.

Our role as therapists extends beyond interpretation. It also involves a deep engagement with the child’s emotional and psychological landscape, where our own experiences and mental dialysis contribute to understanding the child – and hopefully the creation of a shared verbal and non-verbal language through play.

I’m thinking here of a little girl who, unable to verbalise her experience of sexual abuse, showed the therapist ‘dangerous monsters at night’ through her play. This symbolic representation allowed her to express her fear and the reality of her trauma in a way that felt safe. But there are also times in working with young people when play can veer too close to the child’s lived reality, becoming overwhelming. If the child abruptly stops playing, or runs away from the room, this is in itself an important non-verbal communication.

Over time, and with consistent support, the child gradually becomes capable of processing more of their trauma through play. This reflects an increasing ability to regulate emotions, a deeper trust in the therapeutic relationship, and an enhanced capacity to use play as a means of exploration and understanding.

It is not uncommon during this time for the child to start speaking with grown-ups more and more about past events. At the same time, the child’s engagement in play becomes more complex and nuanced as they revisit themes with greater depth, often revealing new layers of their experience and emotion.

Psychotherapy with children and adolescents demands a unique blend of watchful observation, the ability to translate non-verbal communication into a language that can be understood and processed, and patience. As psychoanalyst and paediatrician Donald Winnicott put it, ‘I have had very good training in this matter of waiting, waiting and waiting’.