When a Child Won’t Talk

01Apr

By Chantal, Psychodynamic Therapist

Understanding silence

Parents and carers often worry when a child becomes withdrawn, refuses to talk about their feelings, or seems overwhelmed by emotions they cannot explain. Silence can be confusing and even frightening for adults, especially when we sense that something is wrong but do not know how to help.

From a psychodynamic perspective, a child’s behaviour—including silence—can be understood as meaningful communication. Children may not yet have the words to describe their inner world, but their actions, emotions, and behaviours often express what they are experiencing internally.

Understanding what silence might mean and recognising signs that your child could benefit from therapy can help families access support early.

Why Some Children Don’t Talk About Their Feelings

Children and young people often struggle to put emotions into words. This can happen for many reasons:

  • They may feel overwhelmed or confused by strong emotions such as anger, shame, or sadness.
  • They may worry about getting into trouble or upsetting their parents.
  • They may lack the developmental language skills to describe their inner experiences.
  • They may have learned that difficult emotions are not safe to express.

In psychodynamic child therapy, behaviour is understood as an expression of underlying emotional
experiences. Some children communicate distress through behaviour rather than language because emotions feel too complex or threatening to speak about directly. Therapy can provide a safe space
where children can begin to explore these feelings through play, drawing, storytelling, and symbolic expression, which often precede verbal communication.

A Child’s Silence may be a Sign of Emotional Distress

Occasional quietness or reluctance to talk is developmentally normal. However, persistent silence or
emotional withdrawal may indicate that a child is struggling internally. Signs parents may notice include:

Sudden changes in behaviour

Children who are struggling emotionally may become unusually withdrawn, irritable, or angry.

Increased anxiety or sadness

Persistent worry, tearfulness, or low mood can indicate that a child is experiencing emotional distress.

Difficulties at school

This may include declining academic performance, school refusal, or social difficulties with peers.

Changes in sleep, appetite, or routines

Emotional distress in children can sometimes appear through physical symptoms such as sleep problems,
stomach aches, or loss of appetite.

Behaviour that feels “out of character”

For some children, distress is expressed through aggression, defiance, or risk taking behaviour. Children often experience emotional difficulties that they cannot clearly articulate. Psychotherapy can help them explore these feelings safely and develop healthier ways of expressing themselves.

What Happens When a Child Doesn’t Talk in Therapy?

It is common for children to be quiet during early therapy sessions. Building trust takes time. Research and clinical experience show that many children initially resist therapy because they feel embarrassed, anxious, or unsure about discussing difficult experiences. Once a positive therapeutic relationship develops, children often become more comfortable participating and expressing themselves.

Psychodynamic therapy recognises that silence itself can be meaningful. A child’s reluctance to speak may reflect:

○ Fear of being judged
○ Loyalty conflicts within the family
○ Difficulty trusting adults
○ Feelings that are too overwhelming to verbalise

Therapists work gently and at the child’s pace, often using play, creativity, and relational attunement to help children feel safe enough to express themselves.

Why Early Support Matters

Children rarely “grow out” of emotional distress without some form of support. When feelings remain
unspoken, they can sometimes emerge in other ways such as behavioural difficulties, anxiety, or challenges in relationships.

Early therapeutic support can help children:

  • Understand and regulate their emotions
  • Develop resilience and coping strategies
  • Improve relationships with parents, siblings, and peers
  • Build a stronger sense of self and emotional security

How Therapy Supports Children and Families

Psychodynamic child therapy focuses on understanding the child’s inner emotional world and the meaning behind behaviour.

Therapy may involve:

Play and creative expression
Talking with the child at their own pace
Supporting parents and caregivers
Exploring emotional patterns within family relationships

The aim is not simply to “fix behaviour” but to help children feel understood, emotionally safe, and better able to express themselves.

When to Consider Seeking Support

You may wish to seek professional support if:

Your child seems persistently withdrawn or unhappy
You notice ongoing behavioural or emotional changes
Your child struggles with relationships or school
Difficult experiences such as separation, loss, or trauma have occurred
Seeking support early can make a significant difference to a child’s emotional development and wellbeing.

References

Midgley, N., & Kennedy, E. (2011). Psychodynamic Psychotherapy for Children and Adolescents.
Fonagy, P., Target, M., Cottrell, D., Phillips, J., & Kurtz, Z. (2002). What Works for Whom? A Critical Review of Treatments for Children and Adolescents.
Target, M., & Fonagy, P. (1996). Playing with reality: Theory of mind and the normal development of psychic reality. International Journal of Psychoanalysis.

Anxiety and Worry: How CBT Helps You Regain Control

26Feb

By Shaun Hotchkiss, CBT Psychotherapist

Anxiety is a normal and adaptive human response. It evolved to help us detect and respond to threat. When functioning well, it sharpens attention, increases alertness and motivates preparation.

However, for many people anxiety becomes persistent, excessive, and difficult to control. Rather than responding to immediate danger, the mind begins anticipating potential future threats. This process is commonly experienced as worry.

While worry can sometimes feel protective or productive, chronic worry often maintains anxiety rather than resolving it. Cognitive Behavioural Therapy (CBT) offers a structured, evidence-based approach to understanding this cycle and learning how to respond differently.

What Is Worry?

Worry is typically defined as a chain of repetitive, negatively focused thoughts about uncertain future events (Borkovec, Robinson, Pruzinsky, & DePree, 1983). It often takes the form of “what if…” thinking:

  • What if I make a mistake?
  • What if something goes wrong?
  • What if I can’t cope?
  • What if this means something serious?

Research suggests that worry is primarily verbal in nature (rather than image-based) and functions as a cognitive attempt to problem-solve potential threats (Borkovec & Inz, 1990). However, unlike effective problem-solving, worry tends to be circular, abstract and difficult to resolve.

In Generalised Anxiety Disorder (GAD), excessive and uncontrollable worry is the central feature (American Psychiatric Association, 2013). But problematic worry also plays a role in health anxiety, social anxiety, panic disorder and obsessive-compulsive difficulties.

A CBT Understanding of Worry

From a CBT perspective, worry is not random. It is maintained by identifiable cognitive and behavioural processes.

The cognitive model of Generalised Anxiety Disorder (Dugas et al., 1998; Wells, 1997) highlights several key maintaining factors:

  • Intolerance of uncertainty – difficulty accepting that outcomes cannot be fully predicted.
  • Positive beliefs about worry – e.g. “Worrying helps me prepare”.
  • Negative beliefs about worry – e.g. “My worrying is uncontrollable”.
  • Cognitive avoidance – using worry to avoid more distressing mental imagery.

Worry often provides short-term relief. When a person engages in worry, they may temporarily feel more prepared or more in control. This short-term reduction in distress reinforces the behaviour, increasing the likelihood that worry will be used again in the future.

This creates a maintenance cycle:

  1. Trigger (internal or external).
  2. “What if…” thought.
  3. Anxiety increases.
  4. Worry escalates.
  5. Temporary sense of control.
  6. Anxiety returns.

CBT aims to interrupt this cycle by modifying both the thinking patterns and behavioural responses that maintain worry.

How CBT Helps with Anxiety and Worry

CBT does not aim to eliminate anxiety altogether. Anxiety is a normal emotional response and plays an important protective role. Instead, CBT focuses on helping individuals develop a different relationship with their thoughts and uncertainty.

Interventions may include:

  • Psychoeducation about anxiety and threat systems.
  • Identifying worry triggers and patterns.
  • Differentiating between productive and unproductive worry.
  • Behavioural experiments to test feared predictions.
  • Reducing reassurance-seeking and avoidance.
  • Developing tolerance of uncertainty.
  • Scheduled “worry time”.

One particularly effective and accessible strategy is the use of a worry diary, often combined with scheduled worry time.

The Worry Diary: Postponing Rather Than Suppressing

Attempting to suppress worry is generally ineffective. Research on thought suppression demonstrates that trying not to think about something can paradoxically increase its frequency (Wegner, 1994).

CBT therefore adopts a different strategy: postponement rather than suppression.

The principle is simple:

You may not be able to control which thoughts arise —
but you can influence when and how you engage with them.

A worry diary helps operationalise this.

How a Worry Diary Works

1. Notice the Worry

When a worry thought appears, it is briefly recorded.

For example:
“What if I embarrass myself in tomorrow’s meeting?”

This step builds awareness without engaging in prolonged rumination.

2. Postpone to Scheduled Worry Time

The individual designates a specific daily period (often 20–30 minutes, not close to bedtime) as “worry time.”

When the thought arises outside this period, they tell themselves:

“I will think about this properly during my worry time.”

This is not avoidance — it is structured postponement.

3. Redirect Attention

The individual gently redirects attention to the present activity. This may need to be repeated multiple times.

Over time, the brain begins to learn that worry does not require immediate action.

Why Worry Postponement Is Effective

There are several mechanisms involved:

Reduced Urgency

The brain learns that worry is not an emergency requiring immediate cognitive engagement.

Breaking Reinforcement

Immediate engagement with worry is reinforcing. Delaying it weakens this cycle.

Increased Tolerance of Uncertainty

Postponement strengthens the ability to sit with unanswered questions.

Cognitive Restructuring

Individuals experience that thoughts can be observed and scheduled, rather than cause automatic behaviours.

Research suggests that structured worry postponement can significantly reduce worry frequency and intensity (Borkovec et al., 1983; Dugas & Robichaud, 2007).

Interestingly, many people report that by the time scheduled worry time arrives, the earlier concerns feel less urgent or less believable.

Taking Back Control from Automatic Thoughts

A common experience in anxiety is the sense that thoughts are intrusive and uncontrollable. This can lead to secondary anxiety — worrying about worrying.

CBT reframes this:

While we cannot fully control the automatic emergence of thoughts, we can influence our response to them.

This shift — from reaction to response — is central to regaining a sense of agency.

Over time, individuals often notice:

  • Fewer spontaneous worry episodes
  • Reduced intensity of anxiety
  • Greater psychological flexibility
  • Increased confidence in coping

The goal is not to eliminate uncertainty or silence the mind. It is to respond in ways that reduce the long-term maintenance of anxiety.

Conclusion

Anxiety often persuades us that constant mental rehearsal will prevent bad outcomes. In reality, excessive worry rarely produces certainty. Instead, it sustains physiological arousal and cognitive distress.

CBT offers structured, evidence-based strategies to:

  • Understand the function of worry
  • Break maintenance cycles
  • Strengthen tolerance of uncertainty
  • Develop intentional responses to intrusive thoughts

A worry diary may appear simple, but its power lies in restoring choice.

Not every thought requires immediate attention.
And learning that distinction can be transformative.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21(1), 9–16.

Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder. Behaviour Research and Therapy, 28(2), 153–158.

Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226.

Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. Routledge.

Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101(1), 34–52.

Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Wiley.