A note about working with Children and young people in therapy


The clinical psychologist Daniel A. Hughes has spent most of his career working with therapists and professionals, as well as parents, who care for and support the most vulnerable children in society.


Hughes developed a therapeutic approach that he has called PACE, which offers four essential qualities of relationship that strengthen children’s sense of self, resilience, positivity and self-belief, and the ability to regulate emotions.


Playfulness:   Reciprocal enjoyment helps children to regulate positive affective states. Children who have experienced trauma, however small, or serious, can have difficulty managing emotional states, can plunge into despair, or have difficulty managing the arousal that accompanies fun and laughter. Taking turns, winning or losing in a game, in the safe and boundaried environment of the therapy room convey a sense of positivity, and hope for the future.


Acceptance:   Acceptance creates psychological safety. The focus is on acceptance of internal experience – the thoughts, wishes, beliefs, desires and hopes that we each carry inside ourselves. In accepting the internal experience of another we are communicating our understanding of this experience (or at least our desire to understand as best we can), that we are comfortable in knowing it and that we are not going to disregard or challenge it. We may not tolerate certain behaviours (and in the therapy room there are clear boundaries) but we will accept the experience underneath the behaviour. Behaviour is evaluated, the child is not.


Curiosity:   When we curiously explore within a relationship we express an interest in the other, and a desire to know them more deeply. Curiosity and acceptance are closely linked. When we direct non-judgemental curiosity towards the experience of a child, the child is likely to become responsive to understanding their own experience of self. The child experiences with another, rather than alone. This strengthens their sense of self.


Empathy:   Empathy communicates our acceptance and our curiosity. We try to "stand in the other’s shoes" and recognise and respond to their emotional experience. With the experience of empathy, a child is more able to experience an adult companion (therapist or parent) as being with them, as they explore current and past experiences – experiences which might be positive, or the more challenging experiences of trauma and shame.


I feel that these ideas (many of which can be explored further in ‘Creating Loving Attachments’, by Daniel A. Hughes, 2012) best describe the basis of how I work with children and young people.

© Elizabeth Greenan, 2021