A therapist offers an image of a garden recovering after a storm. The client pauses and says, “I don't know anything about gardens.” Nothing has gone wrong with the client's capacity to process. The therapist has simply chosen an unfamiliar language.
Adaptation begins before the metaphor. It asks how this person understands questions, communicates disagreement, and stays connected to the conversation. Age is relevant, but age alone does not tell us whether someone prefers a story, a concrete question, a drawing, written words, or no imagery at all. The task is to make the clinical invitation accessible without changing its purpose or taking away the client's voice.
These examples concern communication choices. They do not establish a pediatric protocol or authorize work beyond the clinician's training. Treatment recommendations differ across ages and conditions; an adult intervention cannot become a child intervention simply by adding a toy. NICE's PTSD guidance, for example, makes age-specific treatment recommendations and emphasizes developmental adaptation. [24]
Ask about communication before interpreting it
During preparation, ask, “When someone explains something important, what helps you take it in?” Offer possibilities without making them tests: hearing it, seeing a few written words, taking time, using an example, or having the question made more direct. Ask what makes conversations harder. A client may understand complex ideas easily but struggle to find words while distressed.
Learn how the person signals uncertainty and disagreement. “I don't know” can mean unfamiliarity, a need for more time, too many questions, uncertainty about your intention, or an actual lack of an answer. Silence may be useful processing. It may also mean the client did not hear you. Check rather than deciding from appearance.
Agree on an accessible way to pause. A raised hand, a spoken word, a communication device, or another agreed signal may fit. The signal must be usable under the conditions in which it will be needed. Consent is not established by a client appearing agreeable.
Children need more than smaller words
Work with children requires appropriate developmental and EMDR competencies, safeguarding knowledge, and attention to consent and assent. Clarify the roles of caregivers and who may receive information. Caregiver involvement must be assessed for safety; the presence of an adult does not make that adult a safe resource.
For a child who takes responsibility for an adult's anger, a clinician might explore an ordinary distinction: “Who was in charge of the grown-up's hands?” This is only a possible question, not a script to introduce into an unclear account. Establish the child's reported experience without supplying actions, people, or motives. Neither a child's drawing nor a play scene verifies an event.
Concrete objects may help some children communicate. If the child has already said, “It was too heavy,” they might choose objects to show what that means. Let the child assign the meaning. Do not announce that the largest object represents a parent or that hiding an object reveals a secret. Play materials can support expression without becoming evidence.
Check understanding in a way that does not resemble a school examination. “What did you think I meant?” is often more useful than “Do you understand?” If the child changes the story or prefers to talk directly, follow that information. A clever picture is not a reason to keep a child in a conversation they cannot use.
Adolescents and the risk of sounding rehearsed
An adolescent may value a familiar reference and still dislike an adult trying to sound like a peer. Do not assume that age predicts favorite games, social media, music, or slang. Ask what the person actually knows.
A young person says, “Everyone saw one clip, and now that's all I am.” In reflective work, the therapist might ask, “When you say one clip, what would the rest of the story include?” If this image later fits a genuine block, a much shorter opening may be enough: “Is that clip the whole of you?” The question should not minimize the real consequences of public humiliation or imply that changing perspective will remove harassment.
Privacy matters. Explain its limits plainly, especially when caregivers are involved. A metaphor about having a private room can feel hollow if the adolescent has just learned that every detail will be reported. Clinical language must fit the actual agreement.
Adults with different access needs
Do not equate fluent speech with understanding or limited speech with limited understanding. Ask about preferred language, sensory needs, reading comfort, fatigue, and the communication supports the person already uses. A supported conversation should still be directed to the client, not exclusively to a companion or interpreter.
Some people think concretely or find figurative language distracting. A direct version is a complete intervention, not an inferior substitute. Instead of “You were steering a boat in a storm,” ask, “What could you influence, and what could you not influence?” Instead of “The alarm is remembering the fire,” ask, “What is happening around you right now?” Use the latter only as part of an appropriate present-orientation assessment, not as proof of global safety.
Some clients do not readily form visual images. Do not insist that they see a scene. Words, concepts, sensations, or no metaphor may be more accessible. Avoid treating an inability to picture your example as avoidance. Similarly, autism, intellectual disability, brain injury, or a sensory disability does not specify one communication style. Assessment and relevant expertise are still needed.
Older adults without infantilizing
An older adult may have a lifetime of expertise that offers useful language: repairing machines, caring for relatives, teaching, organizing a household, making music. Ask rather than selecting a supposedly age-appropriate image. Do not assume traditional beliefs, technological discomfort, cognitive impairment, or dependence.
If hearing, vision, pain, medication effects, or fatigue affect the conversation, address those conditions directly. Repeating the same metaphor more loudly does not solve a language mismatch. A change in cognition, attention, or orientation requires assessment rather than an imaginative workaround.
An older client says, “I should have held the family together.” A therapist knows the client enjoyed sewing, but asks before borrowing that language. The client replies, “Please don't make this about stitching. I did enough mending for everybody.” That correction identifies a burden the proposed image would have repeated. The better question may be, “What were you expected to repair that you did not create?”
The same purpose in three forms
Consider a responsibility block involving information unavailable at the time. The clinical purpose is to distinguish what the person knew then from what became known later.
Direct: “What information did you have when you made that decision?”
Concrete comparison: “You were deciding before you had the later information. Which facts were missing then?”
Metaphorical: “If those pages had not reached you yet, what could you actually read?”
The versions are alternatives. Do not deliver all three to secure agreement. None should imply that missing information removes every responsibility or that the therapist knows what happened. Choose the version that fits the known situation and the client's language.
Adaptation follows the response
Watch for the difference between effort and mismatch. A client may need time to engage with a useful question. They may also be working hard to satisfy the therapist. Ask what the words meant to them and accept correction without defending the image.
Keep preparation conversations separate from active processing. Preparation may include exploring language at length. During appropriately paced reprocessing, a selected interweave is brief, responsive, and followed by attention to the client's experience within the clinician's training. Emotional intensity alone does not call for simpler words, a new metaphor, or an interruption.
The useful adaptation is the one that lets this person participate more fully. Sometimes it changes the image. Sometimes it removes the image. Either can preserve the work.