FD SMS icons

https://learn.extension.org/events/2652

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family

Readiness Policy, U.S. Department of Defense under Award Numbers 2014-48770-22587 and 2015-48770-24368.

VLE 3: Rebuilding Attachments with Military

Children Utilizing Play Therapy

1

Connecting military family service providers

and Cooperative Extension professionals to research

and to each other through engaging online learning opportunities

www.extension.org/militaryfamilies

MFLN Intro

Sign up for webinar email notifications at www.extension.org/628312

3

James Corbin, MSW, LSW

• Doctoral candidate from the Clinical Social Work Institute in

Washington, DC

• Licensed Social Worker in Pennsylvania with a specialty in

childhood mental illness and individual and family therapy with

children, adolescents, and their families

• Since 2008, has served as full-time clinical faculty and

instructor in the Graduate School of Social Work at Temple

University and is the Clinical Director and Lead Developer of

the Family Center at Temple University Harrisburg

• Has written and presented extensively on the subject of

neuroscience, trauma, and attachment and the impact on

clinical practice and been a featured presenter for the National

Association of Social Workers at their Annual Conference.

• Received training in child-centered play therapy and practiced

as a child and family therapist for The Play Therapy Center and

is a former associate with D.K. Watkins Psychology Associates

in York, Pennsylvania.

Today’s Presenter

4

Attachment, Play Therapy, and the

Military ChildPresented for the Military Families Learning Network

CC0 Public Domain

https://pixabay.com/en/soldier-daughter-child-looking-870387/

5

Hall describes the Family

Fortress and Characteristics:

Secrecy

Stoicism

Denial(Hall, L.K. (2008). Counseling military families: What mental

health professionals need to know. Routledge, New York)

They are characteristics that

are helpful to the warrior and

their mission, but often

complicate matters when

problems arise.

Military family and children

CC0 Public Domain

https://pixabay.com/en/soldier-america-independence-day-1385436/

6

Type I – trauma from a

discreet incident

Type II – occurs (often) in

small increments and on

more than one occasion

Domestic Violence

Alcoholism

Military Relocation

Multiple Deployments

Types of trauma military children may

experience

CC0 Public Domain

https://pixabay.com/en/sad-child-boy-kid-crying-tears-214977/

7

Family Support Networks

– Family Readiness

Groups (FRG)

Child and Family Services

(various branches and

National Guard)

Family Readiness System (the network of agencies, programs,

services, and individuals, and the

collaboration among them, that promotes

the readiness and quality of life of service

members and their families.) DoDI 1342.22

Military Family Readiness

Forms of support for children and families

CC0 Public Domain

https://pixabay.com/en/family-love-kids-romance-emotions-1404825/

8

The Neurobiology of Attachment

Trauma and Healing

9

Infant Research and

Attachment

Bowlby (1960) in

describing the primacy

of early childhood

attachments suggested

that the biological

motive for attachment

was equal to that of the

instinctual drives.

Childhood development: Theoretical

constructs

10

Image by James Corbin used by permission

Winnicott (1952) is well-known for his idea that “there is no such thing as a baby” in describing the primacy of the early mother-infant relationship and its role in the child’s developing object-relations.

Mother-infant attachment

11

Image by James Corbin used by permission

Indeed, animal research as well as infant studies have

confirmed that neuroanatomy, neurochemical events, and

observable behaviors are all subsequently modified by

early interactions with caregivers and that these internal

processes are concurrently organized and affect each

other (Schore, 1999; Beebe & Lachmann, 2002).

The critical role of attachment

12

In the absence of appropriate dyadic attachment

experiences during infancy, a child as they grow into

adulthood may exhibit difficulties in their ability to self-

soothe, self-organize, regulate affect, and engage in

healthy relationships (Bowlby, 1969; Winnicott, 1959;

Kradin, 2004).

Some problems associated with attachment

13

It is generally agreed that attachment security protects

against psychopathology (Fonagy, 2001). Attachment

experiences include the complex physiological, biological,

genetic, and behavioral facets of the early caregiving

environment and concomitant interactive processes.

Therefore it is no surprise that there exists clear evidence

that neglect and attachment difficulties in early

development may be even more damaging than abuse

(Schore, 2003).

Problems with attachment, continued . . .

14

Gross anatomy of the brain

CC0 Public Domain

https://pixabay.com/en/brain-biology-abstract-cerebrum-951874/

15

Focus on the Brain

Its hemispheres and the effect of trauma on the brain, its

structures, and their basic functions.

16

The left hemisphere is largely

involved in language, logical

reasoning, the conscious,

sequential, mathematical,

storytelling, and verbal

processes (Simpson, 2005a).

We know that this

hemisphere is generally more

pronounced in females than

in males (Simpson, 2005c).

The left hemisphere

CC0 Public Domain

https://pixabay.com/en/face-silhouette-brain-communication-535761/

17

Generally believed to involve the processes of the unconscious, emotion, spatial awareness, abstraction and is concerned with holistic process and the Gestalt (Simpson, 2005a).

Matures faster and is larger than the left hemisphere and is actually responsible for inducing the growth and development of the left hemisphere (Simpson, 2005a).

Generally considered dominant and is larger in males than females (Simpson, 2005c). We also know that similar damage to a particular hemisphere in male and female brains affects functioning in different ways between the genders (Ornstein, 1997).

The right hemisphere

CC0 Public Domain

https://pixabay.com/en/face-silhouette-brain-communication-535761/

18

The hemispheres are joined together by

a dense formation of connections called

the corpus collosum (which means “big

bundle”).

The corpus collosum is the brain’s

“superhighway” and one of the main

avenues for the hemispheres of the

brain to communicate (Simpson,

2005a).

It was discovered that certain processes

that are affected by trauma in one area

of a hemisphere of the brain can be (on

some level) taken over by a related

structure in the opposite hemisphere

(Gazzaniga, 1999).

The corpus collosum – the brain’s

superhighway

CC0 Public Domain

https://www.flickr.com/photos/brewbooks/7780990192

19

The amygdala is also a key

structure in memory in that it

creates the “emotional

content” of memory and the

feeling responses related to

memory (Teicher, 2002).

The amygdala

20

CCO Public Domain

https://commons.wikimedia.org/wiki/File:Amygdala.jpg

This structure compares new experience with old memories and response; familiarity often evokes a predictable response comparable to novel experiences (Simpson, 2005d).

The hippocampus is an area of the brain that is affected by Alzheimer’s disease (Simpson, 2005a).

The hippocampus

CC0 via Public Domain

https://en.wikipedia.org/wiki/Hippocampus#/media/File:Gray739-emphasizing-

hippocampus.png

21

Liggan and Kay (1999) suggest that part of treatment for

children with attachment difficulties, for instance, is

focusing on the patterns and rules of implicit memory in an

effort to help the child to reveal and reflect on them more

fully.

They felt that what may be mutative in psychotherapy was

that new patterns of relationships would be explicated,

repeated, and learned so that these newly learned habits

may be “engrained in the implicit memory system” (p. 105).

Role of therapy with children

22

Play therapy and its benefits

Military children and application

23

Play therapy can be

defined in a general way

as “an interpersonal

process wherein a trained

therapist systematically

applies the curative

powers of play to help

clients resolve their

psychological difficulties.”

(Schaefer, 1993, p. 3)

Play therapy

CC0 Public Domain

https://pixabay.com/en/three-girls-female-kids-children-1325106/

24

As Landreth so pointedly reminds us about children, “toys are their words” and play is their language (1993, p. 41).

For the child, play is the medium by which they can express their feelings and gain mastery over ideas, thoughts, and conflicts that may be reflected to the child as unacceptable in the adult world.

Play therapy

CC0 Public Domain

https://pixabay.com/en/lego-toys-boy-build-creative-286232/

25

Play therapy comes in

many forms and lies

along a continuum of

activities from those

techniques that are

more directive and

focused in scope to

those that are quite

ambiguous and non-

directive.

Forms of play in therapy

CC0 Public Domain

https://pixabay.com/en/sand-pit-toys-toy-bucket-sand-780855/

26

Play that facilitates

talking

“Fishing therapy” case

“Puppet introduction”

case

“The Ungame”

Cards for teenagers

Other therapeutic

games

Direct forms

CCO Public Domain

https://en.wikipedia.org/wiki/Queen_(playing_card)#/media/File:Queen_playing_cards.jpg

27

The use of play as a

therapeutic technique is well-

established and has been

used by some of

psychotherapy’s most

prominent figures.

Play therapy – theoretical history

CC0 Public Domain

https://pixabay.com/en/boy-child-family-female-guardian-1300397/

28

Freud recognized the

importance of play and wrote:

“The opposite of play is not what

is serious but what is real. In

spite of all the emotion with

which he cathects his world of

play, the child distinguishes it

quite well from reality.”

(Freud, 1908, p. 143).

Sigmund Freud

29

Papa Freud, conflicted, with cigar by Carla 216 CC via Flickr

Freud and many psychoanalysts recognized the value

of play (1920) as did Erikson (Tyson, 1990) and

Piaget.

Anna Freud and Burlingham used play in their work

with orphans and small children in the Hampstead

War Nurseries (A. Freud, 1942).

Mahler recognized play in the “practicing phase” of

development as a means of solving problems and

understanding the world around them (Mahler, et al.,

1975).

Play therapy history

30

Winnicott believes that play

in of itself is “a therapy” and

that a child’s play has

“everything in it” (1971, p.

259)

Winnicott (1953) and

Melanie Klein recognized its

usefulness in their work with

child and young adolescent

clients.

Donald Woods Winnicott

CC0 Public Domain

https://pixabay.com/en/sculpture-child-teenagers-bench-609838/

31

Winnicott (1971) describes the relationship of play

to psychotherapy:

[I]t is play that is the universal, and that belongs to

health:

playing facilitates growth and therefore health;

playing leads into group relationships;

playing can be a form of communication in

psychotherapy;

and, lastly psychoanalysis has been developed as a

highly specialized form of playing in service of

communication with oneself and others . . . (p. 257).

D.W. Winnicott, continued

32

It also plays a crucial role in

the integration of object-related

wishes and fantasies as a

means of problem-solving and

reality testing.

Winnicott described how

babies and children

manipulate play objects in their

environment to gain mastery

over their growing object

relationships.

D.W. Winnicott, continued

CC0 Public Domain

https://pixabay.com/en/crayons-coloring-book-coloring-book-1445053/

33

Winnicott continues,

“If the patient cannot play,

then something needs to be

done to enable the patient

to become able to play,

after which psychotherapy

may begin” (1971, p. 54).

D.W. Winnicott, continued

CC0 Public Domain

https://pixabay.com/en/kid-child-young-childhood-1350663/

34

The hopeful case of

“Lava Boy”

Child-centered play therapy

CCO Public Domain

https://pixabay.com/en/volcano-erupting-mountain-krakatoa-609104/

35

Carl Rogers (1951) first

coined the term “client-

centered therapy” and was

highly influential in the

development of the

theoretical base and

techniques of play therapy.

Carl Rogers

CC0 Public Domain

https://pixabay.com/en/learning-development-looking-people-164332/

36

One of Roger’s close colleagues, Virginia Axline (1947) collaborated with him on a number of occasions and is largely recognized as one of the founders of child-centered play therapy—a very special derivative of the client-centered approach used previously by Rogers with adult clients.

Virginia Axline

CC0 Public Domain

https://pixabay.com/en/child-play-kindergarten-kita-1439032/

37

Children communicate

through play

Toys are children’s

words, and play is their

language ~G.Landreth

Child-centered play therapy

38

Image by James Corbin used by permission

Play therapy

Axline (1950) summarized her concept of play

therapy, “A play experience is therapeutic

because it provides a secure relationship

between the child and the adult, so that the child

has the freedom and room to state himself in his

own terms, exactly as he is at that moment in

his own way and in his own time” (p. 68).

39

CC0 Public Domain

https://pixabay.com/en/boys-sitting-playing-toddlers-286784/

There are eight basic principles that guide the child-centered play therapy as described by Axline (1947). They are:

1) The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.

2) The therapist accepts the child exactly as he is.

3) The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely.

4) The therapist is alert to recognize the feelings the child is expressing and reflects those feelings back to him in such a manner that he gains insight into his behavior.

The “ax”ioms of child-centered play therapy

40

5) The therapist maintains a deep respect for the child’s ability to solve his own problems if given an opportunity to do so. The responsibility to make choices and to institute change is the child’s.

6) The therapist does not attempt to direct the child’s actions or conversation in any manner. The child leads the way; the therapist follows.

7) The therapist does not attempt to hurry the therapy along. It is a gradual process and is recognized as such by the therapist.

8) The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of his responsibility in the relationship. (pp. 73-74)

The “ax”ioms of child-centered play therapy, cont’d

41

Child-centered play therapy involves free play with three

types of equipment (Landreth, 1993).

1. Real-life toys include family dolls, doll houses, puppets, cars, trucks,

a cash register, money, and other nondescript figures.

2. Play equipment may also include items that facilitate aggressive

release such as bop bags, toy soldiers, animal figurines, guns,

knives, and swords.

3. Equipment would also include items

that facilitate creative and emotional

expression including such things as

crayons, paper, clay, sand and water,

building blocks, an easel for drawing,

and paint. (pp. 56-57).

Play therapy equipment

42Image by James Corbin used by permission

Hartley and his colleagues point to nine therapeutic benefits of play therapy (1952). Play gives children a chance to:

1) imitate various adults

2) play out real life roles in an intense way

3) reflect numerous relationships and experiences

4) express immediate and pressing needs

5) release unacceptable impulses and feelings

6) reverse roles usually taken in real life

7) mirror growth

8) work out problems and conflict

9) experiment with various solutions in a safe setting

Therapeutic benefits of play therapy

43

Play therapy is well-documented

in its effectiveness for children

and early adolescents working

through a variety of loss and

grieving experiences including:

Death

Divorce

Separation from care givers

Trauma

Neglect and abuse

Play therapy and grief work with children

CC0 Public Domain

https://pixabay.com/en/divorce-parents-child-people-156444/

44

The case of “Rocket Girl

and Interplanetary Mail

Delivery”

The use of two playhouses

and the blended family

Grief work and separation

CC0 Public Domain

https://pixabay.com/en/heart-broken-patched-patch-symbol-48522/

45

Association for Play Therapy: http://www.a4pt.org/

Temple University Certificate in Play

Therapyhttp://www.temple.edu/harrisburg/Default.aspx?PageID=29

Articles/Books

V.M. Axline (1974). Play therapy. Ballantine Books: New York.

Bratton, S.C., Ray, D., Rhine, T., Jones, L. (Aug.,2005). The Efficacy of Play Therapy With Children: A

Meta-Analytic Review of Treatment Outcomes. Professional Psychology: Research and Practice, Vol

36(4), pp. 376-390.

G.L. Landreth (2012). Play Therapy: The art of the relationship. Routledge: New York.

R.VanFleet. (1994). Filial therapy: Strengthening parent–child relationships through play.

Practitioner's resource series. Sarasota, FL, US: Professional Resource Press/Professional Resource

Exchange. xvi 69

C.E. Shaefer. (1994). Play therapy for psychic trauma in children (in Handbook of play therapy:

Advances and innovations. Eds. C.E. Shaeffer, K.J. O’Connor). Wiley: Canada

Play therapy resources

46

Neuroscience references and resources

47

Amini, F., Lewis, T., Lannon, R., et. al. (1996). Affect, attachment, memory: Contributions toward psychobiological

integration. Psychiatry, 59, 213-239.

Andreasen, N. (2001). Brave new brain: Conquering mental illness in the era of the genome. New York: Oxford

University Press.

Baron-Cohen, S. (2003). The essential difference: The truth about the male and female brain. New York: Basic Books.

Beebe, B. & Lachmann, F. (2002). Infant research and adult treatment. London: Analytic Press.

Clark, J. (1989) (Ed.) The human body. New York: Arch Cape Press.

Damasio, A. (2003). Looking for Spinoza: Joy, sorrow, and the feeling brain. New York: Harcourt, Brace, and

Company.

Damasio, A. (1999). The feeling of what happens: Body and emotions in the making of consciousness. New York:

Harcourt, Brace, and Company.

Damasio, A. & Damasio, H. (1999). Brain and language. In the Scientific American: Book of the Brain (Editors of

Scientific American). New York: The Lyons Press, pp. 29-42).

Edelman, G.M. (2004). Wider than the sky: The phenomenal gift of consciousness. New Haven: Yale University Press.

Fonagy, P. & Target, M. (1996). Playing with reality II: The development of psychic reality from a theoretical

perspective. The International Journal of Psychoanalysis, 77:

Gabbard, G. (2000). A neurobiologically informed perspective on psychotherapy. British Journal of Psychiatry, 177,

117-122.

Gazzaniga, M. (1999). The split brain revisited. In the Scientific American Book of the Brain from (Eds.) from Scientific

American, New York: The Lyons Press, pp. 129-138.

References and resources, continued

48

Gruber, C. (2004, October 2). Cognition and Development. Lecture presented for The Clinical Social

Work Institute, Washington, DC.

Hedaya, R. (1996). Understanding Biological Psychiatry. New York: W.W. Norton.

Joseph, R. (1992). The limbic system: Emotion, laterality, and unconscious mind. Psychoanalytic

Review, 79: 3, 405-455.

Kandel, E.R. (1998). A new intellectual framework for psychiatry. American Journal of Psychiatry, 155,

457-469.

Liggan, D.Y., Kay, J. (1999). Some neurobiological aspects of psychotherapy: A review. Journal of

Psychotherapy Practice, 8(2), 103-114.

McGuigan, F. (1994). Biological psychology: A cybernetic science. Englewood Cliffs, New Jersey:

Prentice Hall.

Model, A. (2003). Imagination and meaningful brain. Cambridge, Massachusetts: A Bradford

Book/The MIT Press.

Ornstein, R. (1997). The right mind: Making sense of the hemispheres. New York: Harcourt Brace and

Company.

Ratey, J. (2001). A user’s guide to the brain: Perception, attention, and the four theaters of the brain.

New York: Pantheon Books.

Schore, A. (1999). Affect regulation and the origin of the self. Mahwah: Lawrence Erlbaum.

Schore, A. (2003). Affect regulation and disorders of the self. New York: Norton.

Siegel, D.J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. New York: The Guilford Press.

Simpson, G. (2005a, September 23). Neuroscience. Lecture presented for The Clinical Social Work Institute, Washington, DC.

Simpson, G. (2005b, October 6). Neurotransmitters and the neural communication process. Lecture presented for The Clinical Social Work Institute, Washington, DC.

Simpson, G. (2005c, October 21). Sex differences in the brain. Lecture presented for The Clinical Social Work Institute, Washington, DC.

Simpson, G. (2005d, December 2). Memory, image, and representation. Lecture presented for The Clinical Social Work Institute, Washington, DC.

Solms, M. & Turnbull, O. (2002). The brain and the inner world: An introduction to the neuroscience of subjective experience. New York: Other Press.

Spitz, R.A., & Wolf, K.M. (1946). Anaclitic depression: An inquiry into the genesis of psychiatric conditions in early childhood, II. Psychoanalytic Study of the Child, 2, 313-342.

Stern, D. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. New York: Basic Books.

Stern, D. (2004). The present moment in psychotherapy and everyday life. New York: W.W. Norton and Company.

References and resources, continued

49

Stolorow, R.D. & Atwood, G.E. (1992). Context of being: The intersubjective foundation of

psychological life. Hillsdale, NJ: The Analytic Press.

Teicher, M.H. (2002). Scars that won’t heal: The neurobiology of child abuse. Scientific

American, 286(3), 68-75.

Thompson, R. F. (2005). Memory: The key to consciousness. Washington, DC: Joseph

Henry Press.

Trevarthen, C. (1990). Brain circuits and functions of the mind. Cambridge: Cambridge

University Press.

Trevarthen, C. (1998). The concept and foundations of infant intersubjectivity. In Braton,

S. et, al. (Eds.) Intersubjective Communication and Emotion in Early Ontogeny: Studies in

Emotion and Social Interaction. Cambridge: Cambridge University Press.

Tyson, P.T. (2002). The challenges of psychoanalytic developmental theory. Journal of the

American Psychoanalytic Association, 50(1), 19-52.

Van der Kolk, B. (2003). Posttraumatic Stress Disorder and the nature of trauma: In

Marion, Solomon, & Daniel Siegel (Eds.). Healing trauma: Attachment, mind, body, and

brain. pp. 168-195. New York: W.W. Norton and Company.

Winnicott, D.W. (1959). The fate of the transitional object. In Psychoanalytic Explorations.

Cambridge, MA: Harvard University Press.

References and resources, continued

50

http://www.neuroguide.com/ - ground zero for any search on the internet involving the brain or neuroscience – should be one of your first stops

http://msnbc.msn.com/id/14309026/from/ET/ - contained in this article about the placebo effect is a terrific interactive demonstration about the brain

http://www.msnbc.msn.com/id/15310599/wid/11915773?GT1=8717 – this interactive site includes a interactive program that demonstrates the effect of various illegal drugs on the brain and body

http://www.brainconnection.com/ - a terrific interactive resource for education about the brain and various conditions of the brain salient to clinicians and educators – includes brain games and neuroscience in the news as well as links to numerous resources

http://quest.arc.nasa.gov/neuron/ - this site and on-line neurolab discusses the latest NASA mission and their project NeurOn that explores the effect of gravity on the nervous system – a fun site for children and educators

http://thalamus.wustl.edu/course/ - an on-line tutorial on brain and neuroscience basics sponsored by the Washington University School of Medicine – a highly educational and informative site for human service professionals

http://www.sfn.org/ - official site for the Society for Neuroscience – includes information about upcoming conferences in neuroscience, information about grants and news related to professional development

On-line resources about the brain

51

What is one significant thing

you learned today?

52

Connect with MFLN Family Development Online!

MFLN Family Development

MFLN Family Development @MFLNFD

MFLN Family Development

To subscribe to our MFLN Family Development newsletter send an email to:

MFLNfamilydevelopment@gmail.com with the Subject: Subscribe

FD SMS icons

53

MFLN Intro

We invite MFLN Service Provider Partners

to our private LinkedIn Group!

https://www.linkedin.com/groups/8409844

DoD

Branch Services

Reserve

Guard

Cooperative

Extension

54

CE Credit Information

55

• For this webinar, we are offering Early Intervention, NASW, and Georgia Marriage

and Family Therapy CE credits.

• Early Intervention CE credits are available to participants in Illinois, Georgia,

Kansas, Kentucky, Ohio (EISC & EI CE credit), North Carolina, Tennessee,

Texas, and Virginia.

• Webinar participants who want to receive a certificate of continuing education (or

just want proof of participation in the training) need to take this evaluation and

post-test: https://vte.co1.qualtrics.com/SE/?SID=SV_cGafMC3VpHHTyYd

• You must submit your certificate of completion and any other materials required to

your state/agency in order to receive credit.

• CE certificates of completion will be automatically emailed to participants upon

completion of the evaluation & post-test.

o Questions/concerns regarding EI CE credit certificates?

Contact MFLNFDEarlyIntervention@gmail.com

o Questions/concerns regarding NASW CE credit certificates

Contact MFLNFamilyDevelopment@gmail.com

Family Development

Upcoming Event

VLE 4: Exploring the Impact of Moral

Injury on Military Families

• Date: Thursday September 22nd

• Time: 11:00am-12:30pm Eastern

• Location: https://learn.extension.org/events/2653

For more information on MFLN Family Development go to: https://blogs.extension.org/militaryfamilies/family-development/

56

www.extension.org/62581

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family

Readiness Policy, U.S. Department of Defense under Award Numbers 2014-48770-22587 and 2015-48770-24368.

57