Psychotherapeutic approaches and work with high-sensitive children

High sensitivity, a term introduced in the specialty literature by the psychotherapist researcher Elaine Aron, represents an innate trait, encountered in 15-20% of the population and is characterized mainly by an increased ability to receive and elaborate processing of stimuli from the external and internal environment (Aron, 1999).

Since the characteristics of this trait influence all the personality traits of those who present it, it is important to identify it as early as possible, preferably from childhood. Early identification of the trait is also relevant in the context of the Differential Susceptibility Theory (Pluess & Belsky,  2010), a highly studied aspect of high sensitivity, which refers to the fact that highly sensitive people are highly influenced by the environment in which they grow and live.

Children who have this trait develop and benefit from the positive effects of a supportive and empathetic environment, with much lower probabilities of developing anxiety and depression (Aron, 2010). In contrast, in aversive environments, where there is aggression, lack of acceptance and lack of support or neglect of emotional needs, these children are more prone to affective and behavioral disorders, compared to the majority who do not have the high sensitivity trait (Aaron, 2010).

Steps in the therapeutic approach of highly sensitive children

Highly sensitive children can reach therapeutic contexts for a variety of reasons, from affective, behavioral and sleep disorders, to prevention to cope with transitions in situations that require novelty: school, class, housing, social group (Aron, 2010; Kibe, 2019).

Most of the time, the trait can be shaped by the fine details that appear in the manifestations of the child – low tolerance to sensory and emotional overstimulation, does not support certain noises, aromas, tastes, textures, complains about the labels of the clothes, quickly perceives the affective states of the others and reacts accordingly (from where it seems to absorb the states of the others), is affected by the high tone of the teacher, is sensitive to criticism, reacts strongly to injustice, has a high capacity for awareness that can manifest as an early maturity or wisdom (Aron, 2004).

First of all, therapeutic interventions should aim to provide a space of safety and tranquility, in which the child will feel heard, validated and seen.

Creative drawing techniques

For younger children, expressive-creative approaches are very appropriate. Expressive-creative methods and techniques can be successfully integrated into the evaluation/investigation procedure and psychological intervention in working with highly sensitive children, as complex therapeutic modalities of psychological intervention for various types of problems.

Representing an integrative diagnostic and therapeutic approach, expressive-creative methods use art and creative improvisation as symbolic provocative methods (Mitrofan, I., Petre, L., 2013).

Creative-expressive methods widely used: drawing, painting, modeling, collage, film and photography, manufacture of decorative objects, creative meditation, playing with sand, music, dance, metaphor theater, fairy tales, poetry.

Drawing techniques are among the most used methods of evaluation and therapeutic intervention, in the form of a projective test, of free or thematic drawing, or as a sequence within complex expressive techniques that may include other methods.

Another quality of these methods is related to their ability to facilitate the complex expression of the person, in ways that the word itself sometimes cannot achieve. They are a gateway to access to feelings, emotions, complexes, memories, profound affections, which are constituted as blockages in the path of growth and development of the person.

For older children and adolescents, it is important to validate the feeling of being “different” (Aron, 2004). The focus should be on supporting the acceptance of the particular style of functioning, discussing the difficulties that they face and pointing out the advantages or strengths, highlighting creativity, learning to manage emotions, respecting the need for more time for calm and relaxation (Aron, 2004).

The high receptivity and the intense mental processing, being structural capacities, cannot be modified, but only sustained, by alternating the necessary tasks, with pleasant activities such as hobbies, passions, favorite sports. The energy must be channeled for certain significant and interesting purposes to reduce or avoid overload.

Those around them need to understand that this is not an exaggerated sensitivity, but a very high capacity to retrieve and process information in many details, which overloads the nervous system and can amplify emotional reactions (Aron, 2004, 2010).

Objectives of using the graphic expression in the evaluation process:

  • Highlights some aspects regarding the child’s relationships;
  • Allows the capture of conflict zones, borders and alliances;
  • Symbolically revealed the means of communication and the relationships between family members;
  • Creates an image related to parental skills.

Child assessment using the drawing techniques

The Family Drawing Test is one of the most popular projective methods of evaluating the child and the family. It allows you to know how the child relates to his family members. The method has a complex interpretation protocol, with which it is possible to diagnose the nature of the problem the child faces. Elements such as the arrangement of the characters in the space, their size, their characteristics, facial expressions, clothing details, the colors used, the omissions allow a detailed analysis of the family organization and the real feelings and attitudes that the child has about the others, the possible indicative elements of a disorder, emotional blockages, attachment between family members, inhibitions or feelings of devaluation.

Objectives of using the graphic expression as a method of intervention:

  • create change;
  • to identify creative solutions to the problems highlighted by the evaluation;
  • to facilitate awareness and change;
  • create new ways of communication and interaction;
  • to modify problematic behaviors;
  • express emotions and feelings as a form of genuine contact.

Intervention method using drawing techniques

Graphic Family Sculpting (technique adapted from Virginia Satir / David Kantor and Fred Duhl) is a technique used to highlight the child’s perception of how the family is organized. The strategy used is to ask the child to imagine and draw on a sheet of paper what a family sculpture would look like, being allowed to represent its members in any position. It can be used to designate the present moment, or for him to imagine an ideal sculpture of his own family. The way the characters are placed (sometimes superimposed), the distance between them, the touchpoints, the body posture and the overall image of the sculpture allow an assessment of the family roles, borders, how they are perceived by the other members.

Collage. Evaluation and intervention

Collage is a method of creating a creation, using materials of various types (paper, textile, twine, photographs, various objects that can be glued), materials that glue on a sheet of paper, cardboard, representing a particular theme or a free creation. The collage method facilitates a series of elaborations aimed at self-awareness, self-exploration, border awareness, personal restructuring, creative problem solving. It is an easy to use technique both individually and in group work.

Objectives of using the collage in the evaluation process of the child:

  • facilitates the exposure of the problem – the vision on the problem;
  • highlights how the child identifies with certain representations;
  • facilitates the expression in constructive ways of psychic or relational conflicts;
  • offers access to the individual interior universe.

Assessment of the child using the collage

The Picture of the Problem involves making a collage of images, photographs and objects that, put together, symbolically reproduce an image of the problem the child is facing. Transposing the problem into an image can generate new angles of analysis, awareness or additional mechanisms to identify the causes for which a problem arises.

Objectives of using the collage in the intervention process:

  • allows the externalization of the problem and activates the role of observer;
  • facilitates creative identification of solutions to solve the problem;
  • allows to bring into action some unresolved traumas.

Intervention method using collage

The Restructuring Collage – creative problem solving – involves making a progressive collage, from the left side of the sheet of paper, where the problem is symbolized, to the right side of the sheet of paper, where it evolves, with the help of images, towards solving. The child can choose a fantastic way to solve it. In the analysis, he will give a concrete meaning to the chosen solutions (ex: “the good fairy” can find a correspondent in reality).

Involvement of parents in the therapeutic process

In the family context, it is necessary to take into account the peculiarities of the highly sensitive child, in order to support him to develop healthily. Parents can help by paying more attention to the signs of overcrowding of the child, not to expose it to crowds, noisy environments, programs loaded with many activities, surprise parties, conflicts, emotionally charged situations both negative and positive (Aron, 2004).

As a complex way of integrative approach to the family, expressive-creative methods and techniques can minimize or eliminate conscious blockages. These allow access to the unconscious contents and facilitate the in-depth analysis of the relationship between the members and the problems that arise in the family interaction.

Family intervention method using drawing techniques

The Rosebush is a technique organized in two stages. In the first stage, with the help of the guided imagery, the family members are asked to imagine themselves in the form of a rose bush and to represent themselves on a sheet of paper, with all the personal details they can imagine. The purpose of this stage is to help the family members to define and present themselves in their individuality, to get in touch with their limits, with their personal space and to bring to the surface, through the symbols – feelings, emotions, inner conflicts, their sensations. and their perceptions. The way each member represents and describes himself allows him to get in touch with himself and puts the other members of the family in contact with the identity of each one.

In the second stage, on a common sheet of paper, family members are invited to represent the family this time in the form of a rose bush, each representing a flower or bouquet in the respective bush. This makes the transition from individual to consensual, thus inviting members to allow each other space in a common context.

However, highly sensitive children do not have very special or very different needs from most children. For their healthy growth, it is essential to be seen, understood, accepted, validated, to respect their own rhythm, not to be pressured, and to feel emotionally secure in the immediate environment (family, classmate, friends).

Supporting and caring for a hypersensitive child can be a valuable process for you, from the role of parent, therapist, educator or teacher, because it primarily addresses you to yourself, to developing personal self-awareness and self-control.


Aron, E. (1999). The highly sensitive person’s workbook. New York: Broadway books

Aron, E. (2004). The highly sensitive child.

Aron, E. (2012). The highly sensitive person. Revised edition. New York: Citadel press

Aron, E. N. (2010). Psychotherapy and the highly sensitive person. New York: Routledge

Kibe, C. (2019). Environmental effects on highly sensitive children (HSC): Implications of differential susceptibility theory. Ochanomizu University Institute for Education and Human Development

Mitrofan, I., Petre, L.M. Artgenograma. Diagnoza și terapia unificatoare transgenerațională. Colecția Alma Mater, Editura Sper, București, 2013

Oaklander,V. Ferestre către copiii noștri. Editura Herald, București, 2013

Pluess, M., & Belsky, J. (2010). Differential susceptibility to parenting and quality child careDevelopmental Psychology46(2), 379-390. doi: 10.1037/a0015203

Satir, V. Arta de a făuri oameni. Editura Trei, București, 2010


Gabriela Dumitriu

Gabriela Dumitriu

Gabriela Dumitriu is a PhDs clinical psychologist and psychotherapist, having 8 years of experience working in the system of child protection. She has programs of parental education for parents and parents-to-be, workshops for emotional support and personal development for children, counseling programs for families that adopt children. As a clinical psychologist, she makes assessments and interventions for families in divorce. At Expert Psy Association she organizes trainings about psychological assessment, expertise and intervention in different dimensions for children and families.

Veronica Cristea

Veronica Cristea

Veronica Cristea is a clinical psychologist, psychoanalytic counselor and personal development counselor, Points of View coaching practitioner.

Alexandra Dudu

Alexandra Dudu

Alexandra Dudu is a clinical psychologist in supervision. She studies The Assessment, Counseling and Psychotherapy of the Child, the Couple and the Family, within the master's program.

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