Setting Boundaries that Help Anxious Kids Thrive: Advice for Child Therapists from Compassionate Counseling St. Louis
As anxiety therapists in St. Louis, we know that children in counseling really benefit from boundaries.
Which is why our team has been working on our interview series.
This week, we talk once again with St. Louis therapist and Compassionate Counseling St. Louis founder, Kelsey Dunn, on how to set boundaries within the therapy office.
Why are boundaries so important for St. Louis kids who struggle with anxiety and anger?
When we give kids clear and measurable directions and expectations, it helps them to know what to expect, what's going on, and what is expected of them.
Giving kids boundaries helps them plan ahead and feel a sense of autonomy. They are able to make their own choices and decisions within the boundaries that have been set up for them, which is really empowering for kids.
How to Approach Challenging Kids with Compassion
Working with kids who feel anxious, angry, or overwhelmed can be deeply rewarding—but it can also be tough! As therapists, we know these kids aren’t bad. They’re trying to navigate big emotions that often come out in challenging ways. To support them, we need to bring a combination of empathy, clear boundaries, and a strong therapeutic structure to each session.
Here are some practical ways to show unconditional positive regard while helping kids feel safe, heard, and supported.
1. Lead with Empathy
Start by reminding yourself that every behavior communicates something. Kids who struggle with anxiety, especially when it shows up as anger, often feel misunderstood or labeled as "bad." It’s our job to counter that.
Feelings are not good or bad; focus on the changeable behaviors while normalizing the feeling.
You might say:
“It’s okay to feel angry or anxious. Let’s work together to figure out what your feelings are telling us.”
“I like you and want the best for you, even if I don’t like the behavior your body is choosing at this moment. What’s a better way to help this emotion feel less big?”
Normalize their emotions while holding space for safety:
“It’s not okay to throw things, but it’s totally okay to feel upset. Let’s work on a better way to show it.”
2. Using Structure to Help With In-Office Safety
Predictability can help kids feel more in control during sessions. When they know what to expect, their anxiety can take a backseat, making room for trust and progress.
Here’s an example of a simple session flow:
1. Parent check-in (5–10 minutes): A quick overview of the week.
2. Client check-in: Use tools like an outcomes rating scale (1–10) to talk about their week and identify focus areas.
3. Therapeutic work: Practice a skill, explore their emotions, or engage in an intervention (CBT, relaxation, etc.).
4. Rapport-building/free choice: End with a creative or fun activity they choose (games, art, sand tray, etc.).
5. Parent wrap-up (if needed): Share progress or skills to practice at home.
When kids know this structure, they feel grounded and ready to engage. For more anxious or dysregulated kids, consider using a visual schedule or whiteboard to outline the session.
3. Balance Boundaries and Flexibility
Kids with anxiety-driven anger often push boundaries—not because they want to cause trouble, but because they’re overwhelmed, or because they want to know what the expectations are. Setting clear expectations can help them feel secure.
Tips: Be specific and supportive:
- “Here’s what we’re going to do: first, we’ll talk about your week, then we’ll play a game you pick.”
- “If your body feels too wiggly or you’re upset, we’ll pause to try deep breathing or another relaxation skill.”
Allow choices within the limits:"
- “You can choose one toy to hold while we talk, and after that, we’ll move into today’s activity.”
- “Would you like to do sand tray or coloring today? Either way, let’s keep the sand in the box so we can both enjoy it.”
These small decisions give kids a sense of control while reinforcing safe, appropriate behaviors.
4. Prioritize the Relationship
Therapeutic rapport isn’t just important—it’s the most critical part of therapy. The relationship you build can transform how kids see themselves and their struggles.
Try to spend time on activities that show them you like and value them. Whether it’s playing a game, blowing bubbles, or building a sandcastle, these moments help them feel safe.
Always emphasize trust: “I’m here to help, and I’ll keep showing up for you, no matter what.”
When kids feel genuinely liked and respected, they’re more likely to open up and engage in the work.
5. Partner with Parents
Therapy doesn’t happen in a bubble—it’s part of a bigger picture that includes home and school. Helping parents adopt the same compassionate approach can be a game-changer.
We want to coach parents to focus on behaviors, not identifying their child as the problem, shifting them from language like, “You’re acting bad,” to “This behavior isn’t okay.”
As child therapists, we get this really wonderful opportunity to be an outside observer and help parents. We get to share strategies and progress, and a big tool is teaching parents relaxation skills along with the problem solving approaches you’ve practiced within the session.
When parents feel equipped and supported, they can reinforce therapy progress outside of the office.
6. Take Care of Yourself, Too!
Challenging cases can test your patience, but they’re also where we make the biggest impact. Remember, you’re not alone. Lean on your team, consult with colleagues, and take breaks when you need them. At the end of the day, your presence and approach matter more than anything. When kids leave your office feeling safe, respected, and valued, you’re already making a huge difference. Keep going—you’re doing great work!
Strategies to Support Your Clinical Work With Anxious, Angry Kids
Kelsey provides training for therapists on identifying and treating Anxiety-Driven Anger.
Curious to hear more? Compassionate Counseling St. Louis provides specialized anxiety and anger management therapy for kids, teens, and college students as well as parent coaching. We are located in Clayton, MO and provide anxiety counseling for kids, teens, and college students throughout St. Louis City, St. Louis County, Ladue, University City, Town and Country, Webster Groves, Creve Couer, Kirkwood, Richmond Heights, and Brentwood. We also provide online therapy to college students all over Missouri! You can set up your free phone consult right on our website.