An Interview with Next Steps Psychology on Stepping into Meaningful Therapeutic Alliance with Children & Adolescents

At TherapyWalks, therapy is understood as a relational process, one that adapts to the individual rather than forcing the individual to adapt to the process. This philosophy is complementary to the work of Stephanie Miodus, PhD, a licensed psychologist and founder of Next Steps Psychology, whose practice also focuses on helping children, adolescents, and families build meaningful engagement in therapy grounded in emotional safety, readiness, and evidence-based care.

Dr. Miodus specializes in child and adolescent therapy, parent coaching, and psychological evaluation, supporting families navigating anxiety, trauma, neurodevelopmental differences, and emotional regulation challenges. Her work centers on a core belief shared by both practices: progress happens when clients feel understood, respected, and met where they are rather than when they are pressured to perform or comply.

In this conversation, Dr. Miodus reframes motivation and clarifies what meaningful engagement looks like in effective therapy for children and adolescents, while helping parents, caregivers, and clinicians better understand the early stages of change.

Dialogue with Dr. Stephanie Miodus, Licensed Psychologist, Next Steps Psychology

1. Parents sometimes worry when a child does not seem actively engaged in therapy. From a psychological perspective, how do you assess emotional readiness and safety rather than assuming a child is unmotivated?

When a child appears disengaged, my first question is not, “Why are they not trying?” but rather, “Do they feel safe enough to participate?” Engagement depends heavily on a child’s nervous system, prior experiences, and sense of trust. Especially for children impacted by trauma or chronic stress, participation comes after safety, not before it. Therapy often begins with observing how a child communicates comfort or discomfort, even if that communication is subtle or nonverbal, and building rapport and trust.

2. You emphasize that motivation is not the same as compliance. What is the difference, and why does that distinction matter in child and adolescent therapy?

Compliance is about doing what is asked; motivation is about internal readiness. A child can comply without feeling understood or invested. Motivation develops when individuals feel respected, when their autonomy is honored, and when therapy feels relevant to their lived experience. This is especially important pacing for adolescents who are typically on the brink of claiming increasing independence. For clinicians and parents alike, this distinction matters because real progress depends on engagement and not just outward cooperation.

3. From an evidence-based perspective, what conditions need to be in place before children and adolescents can meaningfully engage in therapeutic work?

Research consistently shows that the therapeutic relationship is a primary driver of outcomes. Emotional safety, predictability, and collaboration are foundational. Children also need interventions matched to their developmental level and cognitive profile. Evidence-based care involves selecting treatments with demonstrated efficacy while thoughtfully adapting delivery to match the child's developmental level, cognitive profile, and cultural context.

4. How do neurodevelopmental differences and trauma-informed considerations shape the way psychologists understand engagement and motivation?

Neurodivergent children and trauma-impacted youth often communicate needs in ways that do not align with traditional expectations of “participation.” Engagement might look like movement, silence, humor, or side-by-side interaction rather than direct conversation. A neuro-affirming, trauma-informed lens recognizes these expressions as meaningful rather than problematic and adapts the therapeutic approach accordingly.

5. What role does parent coaching play in supporting engagement and helping therapy translate into everyday life for children and adolescents?

Parent coaching is essential. Children do not exist in isolation, and therapy is most effective when caregivers understand the “why” behind the work. Coaching helps parents and caregivers support regulation, reinforce skills, and respond in ways that align with therapy goals. This collaboration often accelerates progress and reduces frustration for everyone involved. 

6. You focus on diagnosis-informed symptom change in your work, while often prioritizing relationship and emotional safety first. How does a strong clinical understanding of a child’s profile help you sequence therapy and set realistic expectations for early progress?

Diagnosis and evaluation provide valuable context as they help us understand how a child processes emotions, stress, and expectations. That understanding guides the pacing of therapy. Symptom change is absolutely a goal, but for children and adolescents, especially those with anxiety, trauma histories, or neurodevelopmental differences, the therapeutic relationship comes first. Increased comfort, trust, or emotional awareness and expression are other markers of progress. Helping parents and caregivers recognize these early indicators is a critical part of the process.

Shared Values

Both Next Steps Psychology and TherapyWalks share a commitment to therapy that honors individuality, flexibility, and connection. Through thoughtful clinical formulation and alternative therapeutic environments, both practices prioritize engagement that feels authentic, supporting clients in ways that respect how they move through and exist in the world.