Before the First Session: Why Parent Consultations Matter in Treating Pediatric Chronic Pain

Working with children experiencing chronic pain or dizziness requires more than clinical expertise—it demands relational attunement and developmental knowledge. Before scheduling that first session with a child, a parent consultation can be one of the most pivotal steps in the therapeutic process.

A thoughtful consultation allows you, the clinician, to gauge the parent’s potential as a collaborative partner in the therapeutic process. It’s an opportunity to explore how they conceptualize their child’s symptoms and whether they’re familiar with current neuroscience insights around chronic pain, particularly neuroplastic pain and neural circuit dizziness.

If the parent appears engaged and open, it’s also the right time to introduce confidentiality. In California, for example, adolescents can consent to therapy starting at age twelve, meaning confidentiality applies unless safety is a concern. How a parent responds to this boundary can reveal a great deal about their ability to support their child's autonomy in treatment.

Assuming the consultation goes well, we suggest offering parents gentle language they can use to introduce therapy to their child: "Hey, you’ve been trying so many things to feel better. I spoke to a therapist with special

training. Nothing’s scheduled—you have the option to talk to her too. What do you think?" When meeting the child, speak with them, not at them. Invite their

perspective rather than instruct. Without this, therapy can easily slip into a

compliance-defiance loop.

Our workbook, The Chronic Pain Playbook: An Attachment and Play- Based Clinician’s Guide to Working with Children and Adolescents, offers practical, developmentally attuned tools to help you navigate these nuanced dynamics. From parent coaching scripts to symptom conceptualization and child-friendly interventions, the Playbook helps you build partnership from the very start with play-based rapport building exercises.

Written with clinicians in mind but filled with clear, jargon-free tools for

parents, this guide includes:

• Clear scripts for validating a child’s experience without reinforcing fear

• Games and metaphors that make neuroscience digestible

• Step-by-step guidance for graded exposure with parental involvement

• Reflections and exercises to explore emotional somatization through sensation-based language

Because when parents and therapists align, healing can begin. The Playbook helps therapists maintain this delicate balance by offering practical tools grounded in child development, attachment theory, and play-based engagement. It’s about fostering a shared understanding of pain as a protective signal that’s misfiring, and then teaching new ways to respond.

And that’s where the transformation begins.