The Child Under the Table

A little boy once hid under the table every time I arrived.

He wouldn't make eye contact.

He wouldn't answer questions.

He wouldn't come out, no matter how much encouragement was offered.

At the time, there were many ways his behaviour could have been interpreted.

Uncooperative.

Avoidant.

Defiant.

Disengaged.

But after more than 30 years working in paediatrics, I have learned that the first explanation is rarely the most accurate one.

One of the challenges facing therapists today is that we are often expected to make sense of behaviour quickly.

Reports need writing.

Goals need setting.

Intervention plans need developing.

Yet some of the most important information cannot be gathered from a checklist or assessment tool.

It comes from observation.

Curiosity.

Patience.

And a willingness to look beyond what is immediately visible.

The longer I work in this field, the less interested I become in the behaviour itself and the more interested I become in the story behind it.

- What happened before this moment?

- What demands are being placed on the child?

- What strengths are being overlooked?

- What might we be missing?

Children rarely arrive in our sessions carrying signs that explain exactly why they are struggling.

Instead, they communicate in the ways available to them.

Sometimes through words.

Sometimes through play.

Sometimes through behaviour.

The challenge for therapists is not simply to respond to what we see.

It is to remain curious enough to ask what else might be contributing.

I often think some of the most valuable clinical skills are not found in textbooks.

- The ability to build trust.

- The ability to notice small changes.

- The ability to tolerate uncertainty while understanding develops.

- The ability to see possibility where others see problems.

These are the skills that shape our work every day.

The little boy who hid under the table eventually stopped hiding.

Not because anyone forced him to participate.

Not because we found a magic strategy.

But because, over time, something changed.

And that change began with understanding.

As therapists, we have the privilege of meeting children during some of their most challenging moments.

Perhaps our greatest responsibility is not to rush towards solutions.

Perhaps it is to stay curious long enough to truly understand the child sitting in front of us.

Because sometimes the most important question is not:

"What should I do next?"

But rather:

"What might I not be seeing yet?"

If you stuck, talk to your supervisor, a colleague or someone else who works with the child to gain more understanding.