HOLDING THE PIECES TOGETHER: USING THERAPEUTIC PLAY WITH GRIEVING CHILDRENBen Broxterman, CCLSChild Life SpecialistWesley Medical Center

CHILD LIFE SPECIALISTS: AN OVERVIEW

Minimum of bachelor’s degree with coursework focusing on children/families

Completion of 480-hour internship under Certified Child Life Specialist

Successful completion of standardized examination to earn CCLS credential

Work to promote optimal coping for children & families through developmentally-focused, family-centered interventions

WHAT IS PLAY?

Play, in particular, is the special manifestation of freedom in childhood.

From: “White Paper #6: The State of Children’s Play.” www.academyofleisuresciences.org/alswp6.html

WHAT IS PLAY?

Webster’s definition: exercise or activity for amusement or recreation

The Association for Play Therapy, Inc. states: “… play is a natural medium for self-expression, facilitates children’s communication, is conducive to cathartic release of feelings, and can be renewing & constructive.”

WHAT IS PLAY?

Most play researchers agree that, to be called “play”, an activity must be:VoluntaryInternally motivatedPleasurable, relaxed“as if” or present textOrganism rather than object dominatedUnique, unpredictableActive, both motorically & cognitively

From: Meeting Children’s Psychosocial Needs Across the Healthcare Continuum. Rollins, J., Bolig, R., & Mahan, C.

THERAPEUTIC PLAY Therapeutic play is a term used for play in health care

settings, classified as “play that is used to prevent psychologic injury.” Its goals are to: Meet children’s ongoing developmental needs Help children cope with unfamiliar hospital environment Increase children’s understanding of their hospitalization &

treatment Promote a sense of control, mastery, positive self concept Facilitate self-expression Meet children’s needs to cope with separation &

deprivation.

From: Meeting Children’s Psychosocial Needs Across the Healthcare Continuum. Rollins, J., Bolig, R., & Mahan, C.

THERAPEUTIC PLAYThe National Association for Hospital Play Staff

(NAHPS) in England, states that play: Creates an environment where stress & anxiety are

reduced Helps child regain confidence & self-esteem Provides an outlet for feelings of anger & frustration Helps the child understand treatment & illness. Through

play, children are able to effectively learn the sensory and concrete information they need to prepare for hospital procedures and treatment

Aids in assessment& diagnosis Speeds recovery & rehabilitation

THERAPEUTIC PLAY Usually consists of at least one of the following types of

activities: Encouragement of emotional expression (ie- re-enactment of

experiences through doll play) Instructional play to educate children about medical

experiences Physiologically enhancing play (ie- blowing bubbles to improve

breathing)

From the Child Life Council Evidence-based Practice Statement: Therapeutic Play in Pediatric Health Care: The Essence of Child Life Practice. Koller, D.

THERAPEUTIC PLAY VS. PLAY THERAPY

Goal is to prevent psychological injury

Focuses on the process of play as a mechanism for mastering developmental milestones & critical events

Goal is to alleviate psychological injury

Addresses basic & persistent psychological issues

Therapeutic Play Play Therapy

USING PLAY AS A TOOL WITH GRIEVING CHILDREN

Play helps to make the grieving process more approachable

Play “normalizes” experience & can allow time for children to return to their normal state in between periods of active grief

CHILDREN’S PERCEPTION OF DEATH BY AGE

Newborns-3 years old: don’t comprehend death, but are very aware of changes in caregivers, routines, & are aware that someone in the home is missing

Preschoolers (3-5 years old): can understand biological differences between dead and living, but sees these changes as temporary & reversible. May assume responsibility for the death through magical thinking.

Young school age (6-9 years old): begin to understand the concept of death, but feel it only happens to others. Begin to worry that important people in their life might die.

CHILDREN’S PERCEPTION OF DEATH BY AGE

Middle school (10-12 years old): Understand finality of death, & develop a personal fear of death. Might be more interested in gruesome details of violent deaths, or in what happens to the body after death.

Adolescents (13+): have an adult concept of death; ability to deal with loss varies greatly depending on their personal experiences. Still see selves as invincible.

USING PLAY WITH THE FAMILY OF THE DYING PERSON

Play can help children understand in developmentally appropriate terms

Play can serve as a medium for self-expression, and an outlet for concerns, misconceptions, or other needs

Case example

PLAY AS MEDIUM FOR PARENT-CHILD OR FAMILY-CHILD INTERACTION

Case example: Sandra

Family expressed concern to medical staff, who consulted CLS Single mother, 8 y/o daughter, “very close” Mother given a few weeks to live Family stated in conversation with this CLS that mother had

shut down, & daughter was trying to understand but had become increasingly quiet after visits with her mother

PLAY WITH THE GRIEVING PATIENT

Can help the patient express questions/fears/desires that might not be brought out in other formats

Helps promote a sense of control in an otherwise “out-of-control” situation

Case examples

QUESTIONS?