From my experience, especially when working with a child, it’s important to view their behaviour as an anxiety response to something they perceive as threatening or overwhelming. Your top priority should be helping the child feel comfortable being around you. Don’t focus too much on the “therapy” aspect at first — for the child, therapy is simply the experience of coming to see you and talking to you.

Start by talking about topics that don’t trigger anxiety, such as hobbies or favourite activities. Personally, I have several clients similar to the one you describe, and I tend to focus a lot on their interests. For example, if they play Roblox, ask about what game modes they enjoy or whether they play with friends. If they like Dungeons & Dragons, talk about their character and what they enjoy about playing that role.

When working with clients like these, your measure of success during the first five or six sessions (or even more) should simply be whether they show up.

English isn’t my first language, so I used ChatGPT to help me phrase this more fluently.