Our Blog

Innovative therapy approaches to non-verbal children

Published on: 08/04/2025

By Erika Emerson, Family Counsellor

Counselling is part of the support we offer to everyone we care for. As a children’s hospice, we look after children and young people with a wide range of abilities and communication skills. That means we sometimes need to take an innovative approach to communication. Here, family counsellor Erika explains how technology can facilitate therapy for people who have difficulty speaking.

The power of non-verbal communication in counselling

We all communicate in countless ways. The sideways glance in a classroom that causes both parties to burst out laughing, the reassuring squeeze of a hand, even a thumbs-up – sometimes, these gestures say much more than words can express in that moment. At Chestnut Tree House, we offer confidential counselling to all the children and young people in our care – as well as their parents, carers, grandparents and siblings. Counselling can be helpful in coming to terms with a diagnosis, processing difficult thoughts and emotions, and strengthening relationships.

Understanding individual communication needs

As a children’s hospice, we care for children and young people with a wide range of abilities, and communication skills. Counsellors are trained to pay attention to their client’s posture – the way they walk into the therapy room, the way they position themselves on the chair. A hand gesture, a smile, even a flicker of the eye – all these things can provide important clues about what a person is thinking.

Some children may be visually or hearing impaired, have limited movement, or are unable to express themselves. So, sometimes we need to take an innovative approach to therapy.

As counsellors in these unique circumstances the first questions we ask are: what is this individual’s capacity, and what is their need?

Above: The Eyegaze is an invaluable device which helps our children and young people communicate, play and engage in a whole range of activities.

Utilising Eyegaze technology

Recently, I was able to establish a counselling relationship with a 17-year-old girl with the help of Eyegaze technology – a communication aid that allows her to type her thoughts quickly using just her eyes. My client could communicate verbally using basic language, but it quickly became apparent that if we wanted to have an in-depth conversation, we would need to use the Eyegaze.

How Eyegaze works

The Eyegaze technology uses cameras and sensors to track eye movement and then interprets the movement of the eye as computer commands. It first illuminates the user's eyes - so the camera can capture an image of the eye, focusing on the reflections caused by the illumination it can calculate where you're looking on the screen. once calibrated it will start to translate the gaze into commands, such as moving the mouse around a screen, or clicking to select.

Maintaining connection through non-verbal cues and technology

Counselling can still be a dialogue even when one person isn’t able to communicate verbally. An estimated 60-65 per cent of social communication is based around non-verbal communication such as facial expressions, laughter and crying.

In this case, my client was able to use those non-verbal cues. She also had normal cognitive function for her age. The Eyegaze was her usual way of communicating, so she could type very quickly, and the dialogue progressed like a normal conversation. I simply had to avoid asking long-winded questions, plus give my client extra thinking time. This set up worked well and it made both of us think more carefully about how to express our thoughts clearly.

There are a few practical steps we can take to make communication easier in this type of situation, alongside using technology like Eyegaze. For example, I positioned myself next to my client so we could both see the screen. We used online therapy tools together such as interactive worksheets focusing on specific issues such as learning how we can control our thoughts and feelings.

I made other adaptations too. Often, we’ll teach clients breathing techniques to use when they become anxious or worried. For her, we couldn’t use tools using the body, so we harnessed her imagination instead – helping her to transport herself in her mind to her favourite places in nature.

The positive impact of assistive communication technology

The use of assistive communication technology is exciting for us, because it enables more children and young people to access therapy. In this case, it helped the young person to process her feelings of boredom and isolation to a non-judgemental therapist. As time went on, she became more confident and better able to manage her needs.

One of the most important lessons I have taken away from this experience is not to make any assumptions about the children and young people that we work with. The fact that they rely on technology to communicate does not mean they are not fully engaged with therapy on a deeper level.

If you have a child being cared for by Chestnut Tree House and would like to discuss how counselling might benefit you – speak to your keyworker, or contact us: admin@chestnut-tree-house.org.uk

Zac using the Eyegaze and a Lifelites staff member

Tech that empowers children to connect

Find out how assistive communication technology is transforming lives of children with life-threatening illnesses via a charity partnership with Lifelites.

Read about life changing tech