neurobiologically guided play therapy
DESCRIPTION
We study rationality (cognitive science), independent of emotions. Cognitive science was described as the “new science of the mind”. Minds without emotions are not really minds at all.TRANSCRIPT
Neurobiologically Guided Play Therapy
Presented by:Richard L. Gaskill, Ed.D. RPT-SSumner Mental Health Center
Wellington, KS [email protected]
.
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Our civilization is still in a middle stage, scarcely beast, in that it is no longer guided by instinct, scarcely human in that it is not yet wholly guided by reason.
Theodore Dresier
Our Brain Was
Designed for Different
Age.
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Greek Philosophers
Ancient Greeks separated reason from passion, thinking from feeling, cognition from emotion.
These aspects were viewed as an inner battle of the psyche.
LeDoux, 1996All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Plato Reasoned
Emotions are like wild horses that have to be reined in by the intellect, which is like charioteer controlling wild horses.
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
We continue to separate the two
Today, we study rationality (cognitive science), independent of emotions
Cognitive science was described as the “new science of the mind”
Behaviorists believed that inner states of the mind were not measurable.
Behaviorists were known to ridicule those who dared speak emotion and consciousness.
LeDoux, 1996
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Neither is The Full Story
Minds without emotions are not really minds at all.
They are cold lifeless creatures devoid of desires, fears, sorrows or pleasures.
They are souls on ice
LeDoux, 1996
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Critical Fundamental Principle(The Use Dependent Brain)
The brain develops and organizes as a reflection of developmental experience, organizing in response to the pattern, intensity, and nature of sensory and perceptual experience.
Perry, 2004All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy
Key Social-Emotional Trauma Facts
Psychosocial trauma negatively impacts all areas of brain development and functioning.
Social-emotional trauma arouses low brain structures, inhibiting the CNS.
The rational executive brain is largely inadequate to control emotional arousal or to change fixed low brain patterns.
Traumatic experiences can permanently alter basic brain function.
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
The Brain: a bottom up organization
Primitive brain reactions occur immediately, to stored patterns associated with threat
This is a nonverbal, illogical, unconscious association
Alarm activation occurs before Cortex processing
Brainstem and Diencephalon posses little subjective perception
Resulting dysfunctional relational interaction is beyond awareness and understanding of child, youth, or adult. (Perry,2006; Perry & Marcellus 1997)
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
An Uncomfortable Reality:Children are More Vulnerable
The organizing brain is more malleable
Trauma becomes the neural organizational set point/homeostatic state
Perry (2006); Van der Kolk, Spinazzola, Baustein,Hopper,Hopper, Korn, & Simpson (2007)
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
The Therapeutic Conundrum!
If severe enough, the child will be “brainstem” driven. They will think and act in very primitive ways, being less accessible to academic and therapeutic interventions using words or therapeutic relationships as motivational agents of change.
(Perry, 2006)
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Negative Impact of Neglect/Trauma
Attachment Marital Work Children Legal Status
Cognition Lower IQ Faulty thinking Perceptual errors
Biology Illness/ Disease Life span
Affect Regulation Emotional modulation
Dissociation Withdrawal Cutting, picking, burning Pseudo seizures
Behavioral Control Impulse control Anger control
Coordination/BalanceSelf-concept
Cook et al, 2005
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Outcomes for Adults vs Children
Onset of Trauma % Asymptomatic Ratings
Adult 75%
Childhood 33%
van der Kolk, et al., 2007
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
PTSD Affects: hippocampus, prefrontal cortex, amygdale
Declarative Verbal Memory Learning Complex Cognitive
Functions Personality Expression Decision Making Social Behavior Social Evaluative Skills Impulse Control Sensory, Visual Decision
Making Respiratory Control Hallucinations Smaller Brain Volumes
DeBellis, Baum, et al., 1999
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Brain Connectivity
IQ is not fixed at birth700 Neural connections
per second. 50% IQ abilities by 4
yrs.30% between 4 and 7
yrs80% by 8 yearsEnvironment determines
IQTrauma may decrease
working memory by 20%
Evans, 2009; Stevens, 2011
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Basic Neuro-Developmental Principles
The Human Brain is “Use Dependent” (reflects our experience)
Stress Moves The Locus of Control Down (From Thinking to Feeling to Reacting)
Neurosystems Activated Change to Reflect the Pattern of Activation
Parts of the Brain not Activated Don’t Change
All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy
Basic Neuro-Developmental Principles
The Brain Develops in a Hierarchical Order (lower functions before higher functions)
The Developing Brain Regions are Sensitive to Specific Experiences during Specific Developmental Periods
What One Part of the Brain Knows Another Part Does Not Know.
Social Mastery Grows in the Child’s Comfort Zone.
All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy
Basic Neuro-Developmental Principles
Island of Security/Comfort: Familiar Safe Predictable Routine Nurturing
The Brain is a Pattern Seeking Device (it seeks what is familiar)
All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy
Traditional Issues Treated with Play Therapy
(Landreth, Homeyer, Glover, and Sweeney, 1996)
Abuse NeglectAggression/Acting outAttachment DifficultiesAutismChronic IllnessPhysical HandicapsDissociationSchizophreniaWithdrawn ChildrenTraumatization
Emotional DisturbanceEnuresis and EncorpresisFear/AnxietyGriefHandicapped Reading DifficultiesSelf-Concept Self-EsteemSpeech Problems
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Typical Play Therapy ThemesNorton & Norton, 1992; Sweeney, 1994
Power/ControlEmpowermentConfusionLoyalty/BetrayalViolation/ProtectionAdjustment/ChangeGuilt/Self-BlameLoss/Death
Anger/SadnessFears/AnxietyTrust/Relationships/
AbandonmentBoundaries/IntrusionIdentitySelf-EsteemSelf-Worth
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Neglect of The Sensate Dimension of Trauma
Traditional therapy promotes understanding and insight into what is happening in the patient’s life that stirred up powerful emotions
Most therapies pay scant attention to traumatic changes in body experience
Brain science demonstrates the origin of emotional states is conditions of our bodies: body’s chemical profile, the state of our internal organs, muscle contractions in our face, throat, trunk, and limbs.
van der Kolk, 2004
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Decision Making; Planning; Morality/Ethics/Values; Guilt; Self- Blame; Power/Control; Adjustment/
Change; Boundaries/Intrusions; Self-esteem/Self-worth; Identity
Anger/Sadness/Fear; Trust/Relationships/Abandonment
/Nurturing; Security; Violation/Protection;
Separation/Death/Loss Loyalty/Betrayal;
Tradition Play Therapy is effective for these issues, but is not well suited for non-verbal, low brain associative learning (non-declarative memory) that is unresponsive to language, insight, logic, and or understanding
Multi Level Processing
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Difficult DSM-IV Diagnoses and Symptoms
Diagnoses:PTSDAcute Stress DisorderDepressive EpisodesDissociative ReactionsAnxiety DisordersPhobiasPanic DisordersReactive Attachment
Disorders
Symptoms:FearHorrorDisorganized ThoughtsIntrusive MemoriesIntrusive DreamsFlashbacksPsychological DistressPhysical DistressNumbingMemory Problems
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Symptoms Continued
Feeling DetachedRestricted AffectSleep DifficultiesIrritabilityHyper vigilanceExaggerated Startle
ResponseUnreasonable
Anxiety Response to Exposure
Vegetative Signs Sleep Problems Appetite Problems Loss of Energy Wt Gain/Loss Fatigue
Deteriorated Cognition
Poor Concentration
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Sleep, disturbing dreams; intrusive memories; appetite,
feeding energy, primary sensory integration; motor
coordination, balance motor planning anxiety, detachment,
numbing,
Autonomic Arousal; ANS disorders; anxiety; startle
response; physiological distress; fight/ flight response; W t
Loss/Gain; hyper vigilance; attention; concentration;
irritability breathing; BP; HR. fatigue,
Multi Level Processing
All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy
Traditional Treatments
The dorsolateral prefrontal cortex (insight, understanding, and planning) has virtually NO connecting pathways to low brain centers.
van der Kolk, (2004, 2006)
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Traditional Treatments
Psychodynamic, Experiential, & CBT Play Therapys which emphasize understanding, emotional processing, insight, and problem solving pay insufficient attention to disturbed autonomic physical sensations and preprogrammed physical actions.
These therapies fail if the brainstem and diencephlon is poorly regulated
(van der Kolk, 2004, 2006; Perry, 2006)
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
The Conundrum
Unfortunately, there is an absence of evidence-based information available on effective treatment for complex trauma in children.
Malchiodi, 2008
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
So, What Can We Do?
Rather than put all traumatized children into a one-size-fits-all, easy-to-export, 20 session group treatment protocol, we should look back.
There is something to be learned from our ancestors.
All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy
Treatment Must Access the Brain at the Level of Trauma
The Child must Feel Safe
Treatment must focus on the Disregulated brain location
Treatment must create Positive Feelings (Reward)
Interventions must be Compatible with brain level
Treatment must be Hierarchical All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Core Elements of Positive Developmental Experiences:
Relevant (Developmentally Matched)Repetitive (Patterned)Relational (Safe)Rhythm (Resonate with Neural
Patterns/Positive Entrainment)
(Processes are rooted in neurobiological elements)
Perry, 2008
All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy
Keys to Interventions
Psycho-Social Ratio/Interventions must match developmental age
Interventions must activate the brain region disorganized
Interventions must be patterned and repetitive
Interventions should be fun
Interventions must begin at the lowest disorganized brain level
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Possible History of Problems
Attention/ Tracking Problems Importance of Stimuli Identification of a Stimuli Focusing Attention on a
Stimuli Sensory Integration Issues
Core Arousal Regulation Problem Can’t Quiet Physiological
Arousal / Poor Regulation Transitioning Between
Arousal States Overly Reactivity to
stimuli Tantrums Does not sleep well Irritability
Metabolic Issues Wt/Ht gain/Obesity/Anorexic Hording, Gorging, Purging Poor Regulation of Physical
Functions Cardio/Resp/ANS
Irregularities High/Low/Erratic Heart
Rate Blood pressure Swallowing, Gag reflex Respiratory Difficulties Asthma, Allergy, Sleep
Apnea, Diabetes, Diarrhea, Constipation, IBS, Dermatitis, Hives, Rashes
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Research Has Shown:
“Self-regulation is the ability to control one’s ownemotions, behaviors, and thinking processes.”
“The growth of self-regulation is the cornerstone of
early childhood development that cuts across alldomains of behaviors…..”
Zigler,Singer,& Bishop-Josef, 2006All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Development of Self-Regulation
Requires an Attuned Caregiver:
Requires Developmentally Appropriate Activities Sensory/ Movement Regulation Relational Regulation Self-Regulation
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Attunement Through Mirror Neurons
Superior Temporal Sulcus (STS): a fold in the cortex
Integrates information regarding form, location, and motion.
Neurons are activated when we see others engaging in functional behavior
Or when we engage in these actions
Supports emotional resonance, attunement, and empathy with others
Cozolino, 2006
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
In An Attuned State
Caregiver meets child’s basic needs
Caregiver has calm, open emotional state
Through eye contact, mutual gaze, facial contact
Creates a harmonic meeting of minds
Neural activity synchronizes in right cortex
EEG’s are actually in sync Heart rates synchronize Hormonal system
synchronizes Critical to later self-
regulation Children who don’t
experience this have trouble forming healthy attachments
Stern, 1985
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Important Treatment ConceptsAGE Brain
AreaDevelopmental
GoalDev Social
RatioPlay Therapy Model
0 to 1
Brainstem
State Regulation
Core Arousal
Focus Attention
Postural Regulation
Motor Learning
Equilibrium/ Coordination/
Timing
Metabolic/ ANS Irregularities
Adult to Child1 to 1
No Play Therapy Model Fits well here.
Interventions are nonverbal, sensory, movement, rhythmic, primary experiential, and relational.
Primary process and primitive sensory experiences dominate.
•Child Centered•Experiential Therapies•Filial Therapy•Developmental Play Therapy•Floor Time•TheraplayAll rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Brain Stem InterventionFunc Age
Develop Play
Important Dev Milestones
Treatment Components
0 to 1
Relates to others 1 to 1
Solitary play
Exploration of World by Physical Contact/ nonverbal
Sensory/Motor Play: Pokes, dumps, pulls, tastes, smells, stokes
•Regulation/Attention/ Engagement with Environment:
•Eye Contact•Mutual Gaze•Smiles•Seeks Physical Contact•Enjoys Interactive Games•Sensory Play•Enjoys Humor/Teasing•Demands Personal Attention•Performs for Audience•Seeks Attuned Relation.
1. Clam your self!2. Adults must be safe
island3. Create Positive
Attunement4. Calm the child5. Routine = Safety 6. Predictable
Environment7. Limit Stimuli: lights,
sound, people, movement
8. Eye contact9. Extended gaze10.Positive, nurturing
relationship11.Relational sensory,
movement activity at heart rate.
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Importance of Ritual in Our Life
Rituals communicate unity in a relationship
The point of rituals is to create connectedness
Rituals create a sacred place for unity in a relationship
Rituals are calming and sooth lower brain levels
The glue that holds relationships together
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Human Beings are Build Through Play (Stuart Brown, MD, 2009)
Play is a Complex, Primal Process
Promotes Survival Shapes our Brain Makes us Smarter Makes us more Adaptable Fosters Empathy Develops Social Skills Develops
Creativity/Innovation Fosters Problem Solving Fosters Coping/Calming/Self-
regulatory Skills
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Brainstem Enhancements
Pacification (child’s sensory modality)
Rocking/Glider/ Swing/Holding
Touching / Stoking Massage/Wt Balls Grooming Cuddling/Hugs/Holding/
Snuggies Feeding “Motherese”
Lullabies / Songs Nursery Rhymes
Infant Games Games Fast/Slow and
Small/Large Movement
Sensory Stimulation Sand / Clay Play Shaving Cream Making Cookies Songs/Stories/Nature
Sounds Smelling for Identification Texture Bags for Touch
Sensations Tastes for Fun,
Identification Looking at
Pictures/Paintings
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Enhancements for Grade School and Above
Sensory Stimulation Sand, clay, play dough Pottery making Sculpting with clay Finger foods Songs, stories, musical Pictures, Scent identification Paintings, coloring, Water play, slides, fights
Healing Touch Massage (hand, fingers, foot) Reiki Touch Pressure Points Showing concern for
injuries/hurts Grooming
Nail manicure/painting Hair Brushing/Braiding
Rituals/Routines that say nothing has changed in our relationship Uniting; Connecting Closing
Songs, chants, activities Connecting
Nick Names Names of endearment Hand Sakes/High Fives
Commitment Manners as a
demonstration of respect Celebrations (birthdays,
graduations
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Enhancements for Grade School and Above
Attunement/Relaxing/ Calming: Listening to music Singing Listening to natural
sounds (wind, rain, crickets)
White noise Reading to the child
Dr Seuss Poetry
Rhyming Relaxation Exercises Progressive Muscle
Relaxation Breathing Exercises Autogenic Phrases Guided Imagery Swimming Yoga Marshal Arts Drumming Bathing with bubbles, bath
salts etc Massage chairs/pads
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Possible History of Problems (Vegetative Regulation, Control/Sequencing of
Motor/Balance)
Primary Sensory Perception/Organization
Arousal/ Rapid HR/ Tense Muscle Tone
Poor Coordination/ Balance/Rhythm/Clumsy
Dissociative/Pseudo-seizures/ Cutting/ Burning
Focusing, Shifting AttenMaintain Homeostasis
MemoryRemains in solitary playSleep/Wake Regulation/
Nightmares/Waking at night
Appetite/Feeding/EatingNeuroendrocrine Reg
Hypothalamic: / Stess Hormones/ Growth, Menses, Loss of hair, Sexual development
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Important Treatment Concepts
Age Brain Area Dev Goals
Dev Social Ratio
Play Therapy Model
1 to 2
Diencephalon
Sensory Percep
Coordination of Motor/ Balance
Functions
Sleep /Wake Cycle
Regulation of Need/Drive
Func
ANS Functions and Homeostasis
Adult to Child
1 to 1
Later
1 to 1 to 1
No Play Therapy Model Fits well here.Interventions Still nonverbal, sensory, movement, rhythmic, primary experiential, and relational.
Primary process and primitive sensory experiences dominate.
•Child Centered•Experiential Therapies•Filial Therapy•Developmental Play Therapy•Floor Time•Theraplay
Gaskill & CTA, 2008
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Diencephalon InterventionAge Developmental
PlayDevelopmental
MilestonesTreatment Components
1 to 2
Relates mostly 1 to 1
Solitary Play, later likes to be near others
Egocentric
Little empathy/sharing
Need for Autonomy
Poor Emotional Reg
Tantrums Short Atten Span
Purposeful Gestures to Communicate
Fantasy/ Pretend Play
Lots of Gross Motor Play
Holographic to Telegraphic speech
Likes constructive play toys
Language Skills
1. Adults must be calm
2. Create Attunement
3. Grant Autonomy When Can
4. Let the Child Lead
5. Activity and Exercise
6. Rhythm, Strong Beat
7. Motor/Movement
8. Arts Crafts Manipulative
9. Give Voice Nonverbal Cues
10. Attempt to extend Play
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Reading and Narrative Story Telling
Stories are the archetypal way we understand.
Explains HOW the world works.
Even judgments of right and wrong are understood as part of story about events that happened.
Helps form Gestalts, sequence events, and construct a reasonable representation of reality.
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Diencephalon Enhancements
Sleep Hygiene Consistent Bed time routine Go to bed and get up at the same
time Quiet time 30 minutes before bed
time. No TV to put to sleep No scary movies
Eating/Feeding (social event) Finger foods Try different textures/flavors Rice Krispy Hands Cooking together Tea party
Gross Motor: (Phys Exercise) Crawl through boxes, tubes,
mazes/follow a treasure map Fast/Slow/Small/Large Hula Hoops Balls/Bean Bags Swimming (Simon Says: Duck, Duck Goose Trampoline/Balance Discs Brain Gym Bal-A-Vis-X Hand Clapping games Jump Rope/Jumping Balls Play Ground Equipment
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Enhancements for Grade School and Above
Fine Motor Lego's/Constucts/Dominos Puzzles Tidily Winks Hop Scotch Building Blocks Stringing macaroni/popcorn Crafts/Jewelry Making Fingernail Paining Pick Up Sticks/Jacks/Marbles Bop IT Jenga Operation Perfection Blowing Bubbles/Cotton/Ping
Pong Balls back and forth
Music/Dance/Movement Music Chanting Rhyming Poems Nursery Rhymes Rhythm Bands Reading / Telling Stories (Dr. Seuss) Drum Circles Line Dances/YMCA Yoga Tae Kwon Do Tai Chi
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Diencephalon Enhancements
Simple Narrative Recall experiences Show and Tell Read Stories/Poetry I Love You Rituals Books/Pictures/
Manipulative
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Possible History of Difficulty Social Relationships, Attunement, Affect Regulation and Pleasure
Emotions Poorly Regulated
Difficulty Understanding Emotions (self and others)
Poor Social/Emotional Recognition/ Interpretation
Problems with Stress Neurotransmitters
Emotional Learning/Memory
Poor Attachments to others
Lack of EmpathyPoor Social SkillsTrouble Sharing Trouble Taking TurnsSeldom Seeks
Emotional Closeness from Caregiver
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Possible History of Difficulty Social Relationships, Attunement, Affect Regulation and
Pleasure
Fear Memory (Freezing, Tachycardia, Respiration, Stress Hormones)
Poor Memory/Learning
Poor Spatial Navigation (poor internal compass)
May Lack Motivation
Poorly Engaged in Social, Pretend
Dramatic Play May Lack Appropriate Social Content
Ability to Respond to Positive and Negative Stimuli
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Possible History of Difficulty Social Relationships, Attunement, Affect Regulation and
Pleasure
Few words Symbols to share feelings
Needs support to play with others
Antidepressants and Psychotherapy may increase the size of the Amygdala
Inhibitory influence on motor systems (Behavioral Control)
Reward/Pleasure and Learning
Assoc with Mental Disorders Anxiety Disorders OCD PTSD Separation Disorders Borderline Personality Social Phobias Depression Binge Drinking Addiction to Drugs
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Important Treatment Concepts
Age Brain Area
Developmental Goals
Develop Social Ratio
Play Therapy Model
1 to 4 Limbic
Processing Social Information
Affect Mood Regulation
Play/Pleasure
Attunement/Attachment
Consolidation of STM to LTM
Spatial Navigation
Adult to Child
1 to 1 to 3
To
2 to 1 to 5/6
Feeling and Affective modalities. Includes: language, relationally and experientially based tech.
Logical, rational, or conceptual models are contraindicated.
Begin with parallel play with adult to parallel play with child.
Individual/Family TX:Child Centered, Relationship, Filial, Adlerian, Directive, Tech, Theraplay, Experiential, Sand Tray, Developmental PT, Art, Psychodrama
Limbic InterventionAge Developmental
PlayDev Soc Milestones Treatment Components
1 to 4
Enjoy Social Play
Simple Interactive Play with others
Can be played with rather than managed
Generally Cooperative
Responds to Praise
Concerned with what is “right”
Shows Purpose to Play and Motivation
Emerging Regulation of Emotion
Holographic, to Telegraphic to Complete Sentences by 3
Toilet Trained
Pretend Play to Dramatic Play
Enjoys playing with peers
Mastery Play Begins
Able to Take Turns and Share
Using words for feelings
1. Stay Calm
2. Maintain Positive Relationship
3. Reflect Feelings in self and others
4. Use Calming Strategies
5. Improve verbal literacy
6. Let the Child Lead Play
7. Support Mastery Play
8. Use Many Positive Statements (Credit)
9. Use Expressive Media
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Nature Discovery/Play
Helps construct a model of how the world works
Bases for abstract/mathematical /scientific learning later
Decreases ADHD BehaviorStimulates Neural Growth
HormoneTeaches Problem SolvingStimulates All Senses and Calms,
Regulates
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Limbic Enhancements Social Skills Games/ Activities Sharing Games Classroom Chores Classroom family Rituals
Greeting/parting/calming/connecting
Nick names/pet names/symbols of regard
Look at Facial Expressions in the Mirror
Study Pictures in Magazines Social Group Rituals
(handshakes, songs, greetings) Therapy Dogs (empathy gentle
touch) Nature Discovery Natural Obj (shells/nests/rocks)
Traditional Play Therapies
Art / Drawing / Painting Finger painting Sculpture Paper Mache Crafts for Creative
Expression
Little Plays / Dramas Pretend Play/Dramatic Play Give and follow directions Play Hid and Seek Games of cooperation Creative Dance, Movement
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Enhancements For Grade School and Above
Emotional learning Build what is described
to you with Legos Use terms of
up/down/behind/under to have others draw what you describe
Create Mazes from boxes, sheets or in a garden
Make a compass course and follow it.
Make a treasure map to find hidden candy or prize
Have a scavenger huntPuzzles to solve of
wood/metalCard Tricks/Magic Tricks
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Games: Sorry Bingo Ungame Talking, Thinking, Doing
Game Attitude Adjustment Life Battle Ship Trouble
Complex Narative Books Stories Social Issues Aesop’s Fables
Enhancements For Grade School and Above
Aesop’s FablesRead Stories about social
skillsBooks, PoetryTherapeutic MetaphorsPuppet shows
Family, School, Group Rituals Birthdays Anniversaries
Therapy Dogs/HorsesGroom and care for
Cats/Puppies/AnimalsDramatic Play
Memory Games Concentration Old Maid Hearts Memory Simon Says
Children’s Games Duck Duck Goose Simon Says Red Light Green Light Musical Chairs Candy Land/Flower
GardenAll rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Possible History of Difficulty(Thinking, Creativity, Problem Solving, Self-
Image)
Sensory integration problems
Can’t Delay GratificationUnable to express
thoughts, wants, likes etc
Trouble with Cooperative Play
Dramatic Play Doesn’t Makes Sense
Logical sequences in conversation
Poor self-awareness/self-image
Difficulty with cause effect thinking
Unable to plan and problem solve.
Academic skill problemsPoor insight, abstractionUnderdeveloped moral
thinking, ethics, concern for others
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Important Treatment ConceptsAge Brain
AreaDevelopmental
GoalsDevelop Social Ratio
Play Therapy Model
2 to Teen
s
Cortex
Abstract Cognition, Thinking, Reasoning, Planning, Problem Solving, Insight, Foresight.
Complex Learning, Memory, Sensory Integration
Orientation in Time an Space
Language Development
Social/Emotional Competency
Adult to Child
3 to 1 to 5/6
All Play Therapy Modalities are now available (processing experiences verbally, creatively, emotionally & cognitively .
CBT, RETDirective TechniquesGame PlayPsychodramaArt, Sand Tray, MusicAdlerianChild CenteredExperientialGestaltPsychodynamic TheraplayBibliotherapyIndividual, Group, Family
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Cortex InterventionAge Developmental
PlayDevelopmental
Social Milestones Treatment Components
2 to Teens
Parallel to cooperative play
Play with peers, less dependence on adults
Play moves to mastery play and latency age play,Industrious
More competitive play (sports/games)
Gender Specific Play is more Obvious
May take risks, show off, seek recognition
Less Egocentric
Intellectual Skills Grow Rapidly, Their Arguments are More Reasoned
Join Groups/Clubs
More Aware of Social Norms /Rules/Fairness
Take Pride in doing things themselves
Develop Interest in Sexuality
1. Maintain Supportive Relationship
2. Give Positive Feedback
3. Recognize the Child’s Unique Qualities
4. Engage in Pretend Play
5. Play Cooperative Games
6. Play Competitive Games
7. Use Creative/Expressive Mediums
8. Help Solve Problems
9. Discuss Values/Beliefs
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Remember: Use Dependent Brain
How two brains interact determines the strength of the neural connections through which we feel our feelings and form bonds with each other
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Cortex Enhancements(use as age appropriate)
Bibliotherapy Stories with a lesson
Aesop’s Fables Annie's Stories Therapeutic Metaphors Story telling about moral
issues/character Jokes/humor Cartoons/humorous art, characters
Conversations about things of interest to the child
Performing/Creative Arts Musical expression Dance Art expression Writing
Field trips to see visual and performing arts, with discussion of the experience
Role play abstract themes Love, justice, jealousy, loyalty, morality
Use puppet, animals, toy people to illustrate experiences
Logical Problem Solving Riddles Logic problems 20 Questions Who or What am I I am Thinking of an Animal Guess Who What’s missing
Problem Solving Puzzles Paper Mazes Bent Nail Puzzles Toys that can be taken apart and
assembled Physical games and sports
Teach Strategy Teach Character Team Building Team Work Winning/Losing
All rights reserved © 2011 Rick Gaskill and The Child Trauma Academy
Cortex Enhancements Games
Charades Clue Master Mind Pictionary Junior Scruples Guess Who Connect Four Pick-up-Sticks Sorry Aggravation Checkers Chess Spades Old Maid Battle Ship Mine Sweeper Uno Trouble Dominos Memory Go Fish I Doubt It
Social Skills Training Boys Town Program Conscious Discipline PATHS Incredible Years Programs
Social Skills Games Angry Monster Machine Family Happenings Control Patrol Mountaineering Self-Esteem Game Social Security Ungame
Cultural Appreciation Books Pictures Museums Cultural Centers Speakers
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