Experiential Play Therapy

Rachel Coleman

What is EPT?

•children experience the world experientially

•engages all the senses when working through doubts, fears, anger and other unresolved emotions

•Firm belief in the capacity of the child to heal

What is EPT? (cont.)

•Child is expert on his/her pain and knows how best to approach it

•In therapy, therapist allows child the freedom to work through struggles at his/her own pace

•child can reenact situations involving behaviors not used in precipitating events

How does it work?•Play is a child’s perspective on his/her

experiences of the world and relationships Child enters fantasy play as a defense mechanism to deal

with anxiety when sense of self has been disrupted/threatened.

•Dignity and empowerment are the primary processes of EPTo Child usually assumes power position; therapist to

act/react as child

•gives therapist an insight on what it's like to be child

•therapist to experience feelings of powerlessness, ineffectiveness, apprehension, and insignificance

How does it work?

• Child becomes the creator of his/her experiences with needs and fears expressed in a format he/she can control, conquer, & change

• Child uses the symbolism and metaphorical expression of play to communicate confusion, doubt, & paino EPT therapist responds to meaning of the metaphor

rather than reflecting the content

How does it work?• Based on 3 major components:

1. The capacity of a child to use play, symbolism, and metaphorical expressions to convey internal world & expressions

2. Therapists’ skill in understanding & relaying the child’s expressions back to the child

3. Parental responsibility to learn and engage in the process of the child

• Consists of 5 stages: Exploratory Stage Testing for Protection Stage Dependency Stage Therapeutic Growth Stage Termination Stage

5 stages of EPTExploratory Stage

•child gets acquainted with therapist, play room, and time together

•therapist uses more observational statements ; follows child’s lead

•child's behavior outside of playroom undergoes a temporary, but dramatic, improvement

indicator of child's potential for change

5 Stages of EPTTesting for Protection Stage

•goal: establishment of relationship

•child is testing counselor's trustworthiness & safety of therapeutic alliance

therapist to reflect & validate child's feelings

•Therapist should be aware of own limits of comfort

•Some disruption or regression in child behavior may be evident at this stage; parents need to be informed

5 Stages of EPTDependency Stage

•the emotionally intense, working stage; child is prepared to face emotional turmoil

•2 substages

• Child’s disclosure of experiences• child engages in emotionally-themed fantasy play; feels

safe enough to invite therapist into his/her play

• Leveling of the fear object or perpetrator• Trauma is a fear of death for the child, and the child

must conquer impending death fear in her play”

• The metaphorical equivalent of the pain & struggle of the past being lifted off the child

5 Stages of EPT Dependency Stage

•child takes on aggressor/power stanceo Child must possess the power to accomplish through play what

s/he was unable to accomplish in reality (as long as child & therapist are safe

o Therapist assigned role of child; must respond as child would at that age, using facial expressions, sounds, body movement

•2 important processes occurring simultaneously:o Child develops an internal sense of empowerment & controlo Child gains a “spiritual victory” over fear

object/trauma/challenge

• Dependency stage ends with annihilation or death of aggressor

5 Stages of EPTTherapeutic Growth Stage

•Child briefly grieves the lost trauma personao Will display flattened affecto Will seem to regress to exploratory stage

Use of Play for:o skill masteryo Re-experiencing lost developmental stageso Eventually age-appropriate mastery, silliness, & laughter

Child no longer depends on therapist for sense of ID

Play becomes more interactive & cooperative

5 Stages of EPTTermination Stage

•Represents loss of a significant relationship

•With termination, therapist should: Introduce within firs 10-15 min to give child time to react &

say good bye to playCommunicate to child the importance of their relationship

to therapistFollow up with encouragement for the child’s ability to

move forward without therapist

•Ideally, child has gained the ability to interact appropriately with others & can allow self to trust in caring relationships

Parental Involvement in EPT•Parent involvement critical to outcome of therapy;

parent-therapist relationship viewed as a key supportive component of the play therapy process

•Parents need to be oriented to the concepts of healing pain & regression; they are key in providing security, support, and regulation when a child experiences a regressive episode

Children may need to exhibit behaviors representative of an earlier age

Regression indicates the child is approaching the irreconcilable internal experiences (trauma/disruption) that drives the attitude/behavior disruptions at the developmental age at which event occurred.

Each regressive episode assists the child in experiencing regulation after emotionally re-experiencing aspects of the trauma

Parental Involvement in EPT•Therapist meets with parents 10-15 min after

every session to discuss themes expressed and emotional and security needs to be met in between sessions.

Critically important to maintaining sense of security between sessions

•Therapist provides compassionate support to parents as parents learn to soothe, support, and nurture regressive response

Clinical Applications for EPT•A prerequisite for a child to participate in EPT is the

capability for symbolic play

•EPT is beneficial for children presenting with the following:o Reactive disorderso Oppositional Defiant Disordero AD/HDo Separation Anxiety Disordero Phobic Disorderso Attachment Disorderso Obsessive Compulsive Disordero Dissociative Indentity Disordero Some psychotic features ( associated with long term, high

intensity trauma )

Clinical Applications of EPT•When using diagnostic disorders, it is really

important to determine an accurate history as reactions to trauma may present as constitutional in nature

•Allows children to approach memories of trauma in a way that is not overwhelming to them

•Not as beneficial to children with pervasive developmental disorders, such as Autism or Asperger’s Syndrome

Evidence Basis for EPT•Relatively new concept in EPT

•Stages developed by observing children create their own process of healingo Progression relatively consistento Allows therapist to track child in process; can ascribe more

appropriate expressions to match the child’s meaning

•Focused on relationship with child, but gives more direct expression to what the child expresses in play

•Brain Active form of play therapy o uses integrated Right-left & top-bottom processes in the brain

Evidence Basis for EPT•“Trauma is in the nervous system of the child,

not the event”o Play process must be active and repetitive to dissipate trauma

effects on the braino Implicit memories and sensations + explicit or factual memory

process considered during regression o Therapist must consider the stage of brain development being

conveyedo Look at neurological dysfunctions fueling inappropriate

behaviors

Challenges of EPT•Therapist must undergo a paradigm shift to

understand the meaning of each expression from the child’s perspective

•Can be frequently difficult to maintain credibility with other professionals who serve children

•High risk of counter-transferenceo Self examination and growth of the EPT therapist is an constant

processo Processing own experiential world

•Therapist must refrain from leading the child’s playo May offer redirection to facilitate the process or to provide a safer

environment

Case Study - *Seth, age 4•Born prematurely at 8 months

•Critical for Mom & babyo Baby punctured unsuccessfully 40 times with IVo “Mimicking death”

•Referred for therapy for:o Considerable anger towards othero Anger at preschoolo Difficulty relating to other childreno Asthmao Awkward & coordinated; little body awarenesso Little empathy or compassion for others

Case Study - *Seth, age 4•Mother requested being present in the play room

•Testing for protection Stageo Initially refused the leave the play roomo Trust established & was able to separate from play &

playroom

•Dependency Stageo Depicted struggle in prenatal positiono Assigned therapist role of child; Seth role of doctorso Switch roles, allow Seth to “defend himself”

•Therapeutic Stageo Validated new positive sense of self