Child therapists are known for being patient, playful, compassionate, and endlessly creative. We spend our days helping children navigate big feelings, supporting families through difficult seasons, and celebrating small but meaningful victories. Contrary to popular belief, most of us are not particularly bothered by spilled paint, noisy playrooms, messy sand trays, or children having emotional meltdowns. Those things come with the territory.

What tends to frustrate child therapists is not children's behavior. It is the barriers, misunderstandings, and systems that make it harder for children to thrive. After decades of working with children and families, there are certain themes I have found that consistently evoke strong feelings among child therapists because they directly impact the well-being of the children we serve.

Here are ten things that child therapists often find particularly difficult to witness:

1. When children's emotional pain is minimized.
   Statements like "they'll get over it" or "they're too young to understand" often overlook the very real impact experiences can have on a child's developing brain and sense of safety.

2. When play is dismissed as "just playing."
   Play is a child's primary language. Child therapists know that some of the most clinically significant work happens on the floor, in the sandbox, or through imaginative play.

3. When children are expected to manage adult-sized problems.
   Parentification, chronic exposure to conflict, and being placed in the middle of adult issues can create burdens children were never meant to carry.

4. When systems prioritize convenience over children's needs.
   Policies, schedules, productivity metrics and the like can sometimes make life easier for organizations while making care harder for children.

5. When children are punished for skills they have not yet developed.
   Emotional regulation, impulse control, perspective-taking, and frustration tolerance are developmental skills, not character traits.

6. When trauma responses are mistaken for defiance.
   Many behaviors that look oppositional on the surface are actually rooted in fear, overwhelm, stress, grief, or unmet needs.

7. When adults expect instant results.
   Healing, attachment repair, trust-building, and skill development take time. Children are not projects to be completed on a deadline.

8. When access to quality mental health care is limited.
   Long waitlists, provider shortages, transportation barriers, and insurance obstacles can prevent children from receiving help when they need it most.

9. When children's voices are ignored.
   Children may not always express themselves in adult ways, but their experiences, feelings, and perspectives deserve to be heard and taken seriously.

10. When developmental expectations are unrealistic.
    Child therapists spend a great deal of time helping adults understand what is actually age-appropriate and what may be asking too much of a developing child.

And a Bonus Issue...

11. Moral Injury.

    Moral injury in child therapy (and related professions) occurs when clinicians are unable to uphold their ethical responsibility to protect and serve children because systemic, organizational, or administrative forces interfere with clinically appropriate care, resulting in profound distress, loss of trust, anger, grief, and injury to the therapist's professional integrity.  When systems make demands or issue unethical directives to child-serving clinicians, moral distress and moral injury can occur. This is a serious concern that has far-reaching consequences, and is gaining more traction as clinicians talk more about it.

Have you experienced moral distress/moral injury? We'd be interested in hearing about it!

If you've experienced moral distress or moral injury, or have been in environments where it has occurred, I'd love to hear more about it. You can see the questions, and participate, if you'd like, by clicking the image above or GOING HERE. There, you'll see the full disclaimer, the purpose for the survey and how the responses will be used. All data gathered will be anonymous and further information awaits on the actual survey.

I hope to see you there!

References

American Academy of Child and Adolescent Psychiatry. (2023). Behavioral health care workforce shortages: Policy statement. Journal of the American Academy of Child & Adolescent Psychiatry, 62(5), 567–570.

Bartlett, J. D. (2021). Trauma-informed practices in early childhood education. ZERO TO THREE Journal, 41(4), 8–15.

First Focus on Children. (2024). Congress should prioritize development of the pediatric mental health workforce. Washington, DC: Author.

Forkey, H., Szilagyi, M., Kelly, E. T., Duffee, J., & Council on Foster Care, Adoption, and Kinship Care. (2021). Trauma-informed care. Pediatrics, 148(2), e2021052580.

Hill, E. K., Bond, L., Weisz, J. R., & Patel, V. (2025). Addressing the adolescent mental health care gap in the United States. Journal of Adolescent Health, 76(2), 123–131.

Mahmood, A., Smith, R., Johnson, K., & Williams, T. (2024). Disparities in access to mental health services among children and adolescents: A review of current evidence. Journal of Pediatric Health Care, 38(3), 245–254.

Meng, J. F., Cummings, J. R., Wen, H., Druss, B. G., & Chen, J. (2024). Factors associated with not receiving mental health services among children with mental disorders. Preventing Chronic Disease, 21, E72.

National Academy for State Health Policy. (2022). States enhance children's mental health services through workforce supports. Portland, ME: Author.

National Association for the Education of Young Children. (2025). Developmentally appropriate practice in early childhood programs serving children from birth through age 8 (Position statement). Washington, DC: Author.

Rushton, C. H. (2023). Responding to burnout and moral injury among clinicians. The Commonwealth Fund.

Sun, Y., & Stewart-Tufescu, A. (2023). Trauma-informed interventions in early childhood education and care: A scoping review. Children, 10(11), 1770.

Until next time,

Wendy Young, LMSW, BCD, is  the founder of Kidlutions and co-author of BLOOM: 50 Things to Say, Think and Do with Anxious, Angry and Over-the-Top Kids, co-creator of BLOOM Brainsmarts and creator of The Joyful Parent. She is the author of numerous workbooks and resources to help from the preschool through the teen years. 

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