Parents booking therapy for a six-year-old usually imagine a smaller version of adult therapy — the child sitting in a chair, describing feelings, gaining insight.
That is not what happens, and if it were, it would not work.
Why children do not talk their way through things
Young children lack the abstract language, the emotional vocabulary, and the developmental capacity for sustained self-reflection that adult therapy depends on. Asking a five-year-old why they have been hitting produces a shrug, and it is not evasion — they genuinely do not have access to that answer.
What children do have is play. Play is how they process experience, rehearse situations, and express what they cannot say. A child who cannot describe what happens when their parents argue will act it out with figures on a rug within ten minutes.
Play therapy uses that as the working medium. It is not a way of keeping the child occupied until real therapy starts. It is the treatment.
What a session actually looks like
A room with toys — figures, sand, art materials, dolls, blocks, puppets. A therapist who follows the child's lead rather than directing, and who watches for themes: what gets repeated, what gets destroyed, what gets rescued, what never gets mentioned.
Over weeks, patterns emerge. A child working through a frightening event will often replay it repeatedly, changing the ending, until the material loses its charge.
For older children, roughly eight and up, sessions shift toward a mix — some talking, some art, some games with a purpose, some structured skills work.
What we see children for
- Anxiety, including separation anxiety and school refusal
- Big feelings that do not fit the situation — meltdowns well past the age they should have settled
- Grief, after a death, a pet, or a family separation
- Divorce and family change
- Trauma, including things that happened before the child could talk about them
- Behavioral difficulty at school
- Sleep problems, nightmares, bedwetting after a period of dryness
- Social difficulty, or a child with no friends
- Selective mutism — speaking freely at home and not at all at school
- Sensory sensitivity and neurodivergence-affirming support
The signals worth acting on
Some behavior is developmental and passes. Get an assessment when you see:
- A change that has lasted more than a few weeks with no obvious cause
- Regression — a return to behaviors they had outgrown
- Physical complaints, frequently stomachaches or headaches, medically cleared
- A child who has stopped enjoying things they loved
- Anything the school has raised more than once
- Talk about not wanting to be alive, which does occur in young children and always warrants immediate attention
For that last one, 988 is answered any hour by call or text.
Parents are part of the treatment
This is the part that surprises people, and it is the part that determines outcomes.
Research on child therapy consistently finds that parent involvement substantially improves results. In practice, most of what changes a young child's world is what the adults around them do differently.
So expect to be involved: separate parent sessions, coaching on responding to specific behaviors, and periodic reviews of what is working. You will not be given a transcript of your child's sessions — children need their own space too — but you will not be left outside the process either.
You should also expect that some of the work will be about you. Not as blame. Because a dysregulated parent cannot regulate a dysregulated child, and the household's stress level is one of the most powerful variables available to change.
A note on video for younger children
Honest answer: in-person is generally better for children under about eight, because play-based work benefits from a room with materials in it. Video can work for younger kids with a parent facilitating and materials at home, and it works well for older children and teenagers.
Our offices are in Las Vegas. For families in Reno and northern Nevada, we provide video sessions statewide, which suits parent coaching, older children, and adolescents particularly well — and parent-focused work alone can produce substantial change in a young child's behavior.
If your child needs in-person play therapy specifically, we will say so and help you look locally rather than sell you something that fits us better than it fits them.
What insurance covers
We are in network with most major insurance plans. We do not accept Medicaid plans. Nevada Medicaid does cover children's behavioral health with broad entitlement under EPSDT — children under 21 on Medicaid are covered for medically necessary services, a stronger standard than adult coverage through participating providers.
Earlier is easier, and that is not a scare tactic
Children's difficulties respond faster than adults' do, because the patterns are less entrenched and the developing brain is more flexible. A problem addressed in first grade is a substantially smaller project than the same problem addressed in seventh.
If something has changed in your child and you cannot explain it, book an appointment.