play therapy: a developmentally appropriate …...play therapy: a developmentally appropriate...

Play Therapy: A Developmentally Appropriate

Intervention with Traumatized Children

And the streets of the city will be filled with boys and girls at play.

Zech. 8:5

Daniel Sweeney, PhD, LMFT, LPC, RPT-S George Fox University Portland, Oregon U.S.A.

What is Play Therapy?

. . . a dynamic interpersonal relationship between a child (or person of any age) and a therapist trained in play therapy procedures who provides selected play materials and facilitates the development of a safe relationship for the child (or person of any age) to fully express and explore self (feelings, thoughts, experiences, and behaviors) through the child's natural medium of communication, play.

(Landreth, 2012)

Why Play Therapy?

1. Adult therapy presupposes the ability to engage verbally, cognitively, and process abstract concepts.

2. Children are developmentally different than adults, and do not communicate the same way adults do.

3. Play is the child's natural medium of communication.

Why Play Therapy?

4. This is true for the verbally precocious child as well.

5. Empathy (entering the client's world) with children involves entering their world of communication – play.

6. Play therapy provides a place for the child to experience control.

Why Play Therapy?

7. The play therapy process serves to create a therapeutic distance for children, thus providing a safe place for abreaction to occur.

8. Play therapy is uniquely kinesthetic.

9. The play therapy process provides boundaries and limits, which promotes safety for the child.

Why Play Therapy?

10.Play therapy provides a needed and effective communication medium for the child with poor verbal skills.

11.Conversely, play therapy cuts through verbalization used as a defense.

12.The challenge of transference may be effectively addressed through play therapy.

Why Play Therapy?

13.Deeper intrapsychic issues may be accessed more thoroughly and more rapidly through play therapy.

14.Trauma may neurobiologically inhibit verbal expression, thus necessitating the use of an expressive intervention such as play therapy

"Christian" Child Counseling, Play Therapy, & Empathy . . .

• Empathy, the most fundamental of counseling skills, might simply be described as entering into the life of the client

• Empathy was a very lifestyle for Jesus Christ

• In fact, the greatest act of empathy ever, in the history of mankind — was the Incarnation — the God of the universe entering our world

• Since the child's world is the world of play, the greatest empathy with children involves entering into that world

"Christian" Child Counseling, Play Therapy, & Empathy . . .

• 1 Corinthians 13:11 (NLT) — "It's like this: When I was a child, I spoke and thought and reasoned as a child does. But when I grew up, I put away childish things."

• Although we as adult therapists may have "put away childish things" — our child clients have not

• Our child clients still speak, think and reason as children

• The therapist who insist on approaching child clients with adult therapy is saying: "I won't recognize you as the child you are. I won't leave my world, and I won't come into yours. For us to work, you must leave your world and enter mine" — this is neither Christian nor therapeutic

Children and Play

• CHILDREN should be invested in – they are the foundation of the world's future

• CHILDREN in every culture engage in play – only the specific toys and games differ

• CHILDREN have always played – at all times throughout history

• PLAY is crucial to children's growth and the development of their potential

• PLAY is the natural medium of communication for children, thereby the means of self-expression – it combines feelings, thought and action

Children and Play

• PLAY is intrinsically satisfying – it provides a feeling of accomplishment and achievement (mastery and control)

• PLAY is instinctive, voluntary, and spontaneous

• PLAY helps children develop physically, mentally, emotionally, socially and spiritually

• PLAY is a means of learning about life, not a mere expenditure of time

Qualities of “True" Play

• It is pleasurable.

• It is intrinsically satisfying & complete.

• It is voluntary in nature

• It is free from evaluation & judgment.

• It encourages fantasy & the use of imagination.

• It increases interest and involvement.

• It encourages the development of self.

• It is person-focused, not object-focused.

Child's Play Will Reveal

• The child's perception of what she has experienced.

• The child's concept of self, others, & the world.

• The child's expression of what she needs in her life.

• The child's emotional, spiritual, physical, & relational responses to these.

Intangibles in Play Therapy

• Is your intent to change the child?

• Do you hope the child will play?

• Are you more accepting of some behaviors than others?

• Do you have a low tolerance for messiness?

• Do you have a need to rescue the child from pain or difficulty?

(Landreth, 2012)

Intangibles in Play Therapy

• Do you have a need to be liked by the child?

• Do you expect the child to function in a certain way?

• Do you feel safe with the child?

• Do you trust the child?

• Do you expect the child to deal with certain issues?

(Landreth, 2012)

The Play Therapy Relationship is Focused On:

(Landreth, 2012)

• Person rather than Problem

• Present rather than Past

• Feelings rather than Thoughts/Acts

• Understanding rather than Explaining/Correcting

• Accepting Child’s Direction rather than Therapist’s Instruction

• Child’s Wisdom rather than Therapist’s Knowledge

Tenets for Relating to Children

1. Children are not miniature adults. 2. Children are people. 3. Children are unique and worthy of respect. 4. Children are resilient. 5. Children have an inherent tendency toward growth

and maturity. 6. Children are capable of positive self-direction. 7. Children's natural language is play. 8. Children have the right to remain silent. 9. Children will direct their play where they need to go. 10. Children's growth can not be speeded up.

[Garry Landreth]

What Children Learn in Play Therapy

• Children learn to respect themselves.

• Children learn that their feelings are acceptable.

• Children learn to express their feelings responsibly.

• Children learn to assume responsibility for themselves.

(Landreth, 2012)

What Children Learn in Play Therapy

• Children learn to be creative and resourceful in confronting problems.

• Children learn self-control and self- direction.

• Children gradually learn, at a feeling level, to accept themselves.

• Children learn to make choices and to be responsible for their choices.

(Landreth, 2012)

My Goals in Treating Traumatized Children

• Recognizing that child trauma: – Forever changes clients.

– Significantly alters their ability to cope

– Limits (or arrests) their development, & therefore hampers potential.

• My primary goals are to: – Give hope to children/parents.

– Provide children with a safe, reparative & relational experience so that development and potential may be realized.

Trauma Treatment Principles

• Trauma is by nature intrusive. Therefore, the therapist's interventions should be facilitative & not be a recapitulation of this intrusion. Promotion of client self-expression provides freedom to explore and grow.

• Trauma frequently occurs within the framework of the family, thus a family therapy/systemic approach may be a crucial element of the therapeutic milieu.


• Treatment must attend to a continuum of issues, including physiological, cognitive, psychological, and spiritual concerns. Crisis & trauma may involve damage to any and all of these areas.

• Clinical work in the area of trauma often involves direct encounters with horrible & horrifying circumstances. The professional & personal impact of this on the therapist should never be underestimated.


• The focus of treatment should never be the trauma or the client's symptomatic response. The focus of treatment should always be the client.

• Trauma treatment takes time. It is unrealistic, unreasonable, & unethical – to expect that 2, 5, or 10 years of trauma, neglect, terror, & pain – will resolve itself by an hour once a week, limited to 6 or 8 sessions by managed care.

The "Cs": Cross-Theoretical Elements Crucial to Treatment of Trauma

1. Calmness – combats fear & promotes safety/growth 2. Connective – relationship based 3. Child-appropriate – developmentally sound 4. Consistent – safety in patterned repetition 5. Cadenced – benefits of rhythm 6. Control-giving – client regains lost control 7. Courage – on the therapist’s part & the child 8. Congruent – match theory/personality of therapist 9. Culturally sensitive – respectful of culture 10. Competent – adequate training & experience

© Daniel Sweeney, PhD

Trauma

Physiological, psychological, sociological, spiritual or relational harm caused by external stimuli – or the withholding of external stimuli – usually resulting in internal & external impairment

What do Children Learn from Trauma & Treatment

Trauma • This world is unsafe, & I

should expect trauma at any time

• I can't count on anyone to protect me

• Despite what people say – laws & the legal system doesn't work

• I'm helpless & my life is without hope

Treatment • I can live & thrive, even

though this is a dangerous world

• There are people who protect & rescue

• There is support after & in the midst of trauma – even in the legal system

• I’m not helpless, I do have hope, & I have felt & can give care

Neurobiology of Trauma and Trauma Treatment?

Simply stated, traumatic & neglectful experiences … cause abnormal organization & function of important neural systems in the brain, compromising the functional capacities mediated by these systems … Matching the correct therapeutic activities to the specific developmental stage and physiological needs of a maltreated or traumatized child is the key to success.

(Perry, 2006)

Factors Affecting the Impact of Childhood Trauma

• Severity of the traumatic event • Developmental level of the child

– Younger children are more vulnerable to damage • Child's genetic predisposition/resiliency • The phenomenological experience (perception)

– Each child’s experience is unique • Premorbid functioning (trauma history?) • Quality of family functioning

– Including caregiver response/reaction • Attachment history

– Early adequate nurturance can lessen trauma impact • Onset of intervention

– Early intervention prevents strengthening of defenses

Responses to Trauma

• Abnormal & heightened response to trauma- specific stimuli

• Abnormal arousal in response to stimuli which is not trauma-related, signifying a loss of stimulus discrimination

(van der Kolk, 2014)

Neurobiological Effects of Childhood Trauma

Key point

• For children who have experienced trauma, abuse or neglect, their brains develop very adaptively to their negative environment – but maladaptively to other environments

• Effect for foster/adoptive parents?

(Perry)

Therapy in Light of Neurobiological Response

• Neuroimaging study with PTSD clients showed: – Deactivation of the prefrontal cortex (executive

functioning) − interfering with the ability to formulate a measured response to a threat

– Increased activation of the limbic system – Decreased activation in the Broca’s area in the brain

(related to verbalization)

• When PTSD clients are reliving their trauma, they have substantial difficulty putting their experiences into words

• Traumatized people suffer speechless terror.


Treatment of Trauma

“No matter how much you talk to someone, the words will not easily get translated into changes in the midbrain or the brain stem.”

(Perry & Pate, 1994)

Brain Hemispheres & the Treatment of Child Trauma

“To have a coherent story, the drive of the left to tell a logical story must draw on the information from the right. If there is a blockage, as occurs in PTSD, then the narrative may be incoherent” (Siegel, 2003).

Treatment of Trauma

• If therapy focuses directly on the emotionally charged content of the trauma, a child's basic physiological state may shift

• This shift may lead to the client essentially being what Perry (2006) calls "brainstem- driven"

• The resultant anxiety – & the possible diminished functioning of the Broca's area – leads children to act in a primitive manner

• This renders the language of therapy less accessible, or perhaps useless

Sensory Nature of Trauma

• All trauma is sensory in nature – or at least has a large sensory component.

• The diagnostic criteria (DSM-5) for PTSD is sensory in nature – Persistent re-experiencing of traumatic event

– Avoidance of cues associated with trauma

– Persistent physiological hyper-reactivity or arousal

• Perhaps – trauma treatment should be sensory in nature (play therapy?)

Variety of Trauma Interventions…

• Respite care • Filial therapy • Play therapy • Behavior management • Pharmacotherapy • Sandtray therapy • Art therapy • Massage therapy • CBT [TF-CBT]

• Drama therapy • Psychoeducational

training • Group therapy • Other expressive

therapies • Animal-assisted therapy • Music therapy • Sensory integration (OTR) • EMDR

Treatment must be Multidimensional

Possible treatment plan for PTSD child • Expressive therapy (play/sand/art/drama) • Psychopharmacology • Psychoeducation about trauma • Group therapy (Play? Peer skill building?) • Parent training (Filial? Behavior mgmt.? Token

economy?) • Coordination of tx with school, medical

professionals, etc. • Plan for & monitoring of diet, exercise, sleep

Play Therapy with Traumatized Children

• Symbolization – children can use the toys (e.g., art, puppet, miniature, etc.) to represent an abuser

• “As if” quality – children can use the pretend quality of play therapy to act out events as if they are not real life

• Projection – children can project intense emotions onto the toys, which/who can then safely act out these feelings

• Displacement – children can displace negative feelings onto the toys (art, puppet, miniatures, etc.) rather than expressing them toward family

(Schaefer, 1994)

Traumatized Children's Play

• In play, children can slowly assimilate traumatic experiences by reliving them with appropriate release of affect.

• Children deal with stress and traumas by playing out similar situations and gradually achieving mastery over them.

• In play, the child is in control of the events and there is less anxiety because it is just pretend.

Process of Play Therapy with Traumatized Children

• The play therapy process should be primarily • facilitated. • Goal of play therapy is to help process crisis/

trauma – verbally or nonverbally. • Simply reenacting trauma in therapy – without

movement towards resolution is not helpful, and may be dangerous.

• My perspective: understanding the meaning of the trauma may be important – but not as important as processing it so that life can become tolerable and manageable.

Process of Play Therapy with Traumatized Children

• As previously noted, it is my goal to provide children with a safe, reparative & relational experience.

• This takes priority over [but not to the exclusion of] focusing on insight and/or cognitive restructuring.

• My role is therapeutic, not investigative – to be fellow sojourner on the journey & a witness to the story.

• The need for safety extends beyond the therapeutic experience. There may be a need to work with family, school, etc.

Techniques in Play Therapy?

• There should not be opposition to techniques.

• However, therapists should ask themselves three questions:

1. Is this technique developmentally appropriate?

2. Does this technique have a theoretical basis?

3. Does my use of this technique have specific therapeutic intent?

Techniques in Play Therapy?

• We need to acknowledge that theory alone is inadequate, and that in fact, theory without technique is mere philosophy

• At the same time, we need to recognize that techniques alone are inadequate, and that in fact, techniques without theory is potentially reckless and dangerous

Play Therapy “Rules” - Don't

1. Don't criticize any behavior.

2. Don't praise the child.

3. Don't ask leading questions.

4. Don't allow interruptions of the session.

5. Don't offer information or teach.

6. Don't preach.

7. Don't initiate new activities.

8. Don't be passive or quiet.

(Landreth, 2002)

Praise vs. Encouragement

PRAISE is primarily given to children when they do a task well and usually involves an evaluative response. Because of this, children can learn to not trust in their own ability to evaluate and learn to depend on other's evaluations of them. Children can easily misinterpret their value as persons, their "goodness" or "badness", according to the amount of praise statements received or not received. The child can come to believe: "Only when I receive praise am I a valuable person, and if I don't receive praise that must mean I am not valuable."

Praise vs. Encouragement

ENCOURAGEMENT implies faith in the child as he is, not in his potentiality. The emphasis is on the child's actions, not on the child's worth. Encouraging statements build on the positiveness of the action and the effort — and can always be given; when a child attempts a task, fails at a task, or accomplishes a task. A child needs encouragement as a plant needs water.

Play Therapy “Rules” - Do

1. Do set the stage.

2. Do let the child lead.

3. Do track behavior.

4. Do reflect the child's feelings.

5. Do set limits.

6. Do salute the child's power and effort.

7. Do join in the play as a follower.

8. Do be verbally active.

(Landreth, 2002)

Therapeutic Responses . . .

• Are brief and interactive

• Allow child to lead

• Are personalized

– Avoid: “David really likes hitting that bop bag.”

– Use: “You really like hitting that bop bag.”

• Touch feeling (match child's affective level)

Other Characteristics of Therapeutic Responses

• Avoid asking questions

• Help child to go on – do not interrupt natural flow of child's play

• Are nonevaluative

• Do not praise!

• Build self-esteem

Facilitative Responses

• Was the response freeing to the child?

• Did the response facilitate decision making or responsibility?

• Was spontaneity or creativity facilitated?

• Did the child feel understood?

Therapists/Adults should Communicate to Children . . .

✓I am here ✓I hear you

✓I understand

✓I care

(Landreth, 2012)


• Tracking behavior – “now you’re pouring sand...”

• Reflecting feelings – “you’re really mad at the alligator...”

• Reflecting content – “those two are fighting...”

• Esteem building / encouragement / focusing on strengths – “you decided... you’ve got a plan...”


• Conveying understanding

– “You’re cooking.”

• Freeing the child

– “In here, you can spell it anyway you’d like to.”

• Setting limits

– ACT limit setting model


• Facilitating decision making & responsibility

– “In here, you can decide.”

• Facilitating spontaneity & creativity

– “It can be whatever you’d like it to be.”

• Enlarging the meaning

– “It can be scary to be all alone.”

Therapeutic Limits: Purpose & Function

• Limits define the boundaries of the relationship.

• Limits protect the child, the therapist, and the play therapy room/materials.

• Limits promote security and safety for the child — both physically and emotionally.

consistency • predictability • security

• Limits demonstrate the therapist's intent to provide safety for the child.


• Limits anchor the session to reality.

• Limits promote therapist's acceptance (maintaining a positive attitude toward the child).

• Limits allow the child to express negative feelings without causing harm and the subsequent fear of retaliation.

• Limits direct catharsis into symbolic channels.


• Limits promote the child's development of:

– Decision-making skills

– Self-control

– Self-responsibility

• Limits protect the child from guilt.

• Limits provide for the maintenance of legal, ethical, and professional standards.

What to Limit

• Harmful behavior

– The child should not harm self

– The therapist is not to be harmed

– Other children are not to be harmed

• Behavior disruptive to therapy routine

– Leaving the playroom before end of session

– Refusing to leave the playroom at end of session

What to Limit

• Play therapy materials

– Toys belong in the playroom

– Toys are not to be deliberately broken

• Other behaviors

– Socially unacceptable behavior

– Inappropriate displays of affection

When to Limit

• When needed

• Immediately prior to action requiring a limit

Therapeutic Limit Setting A.C.T.

• A - Acknowledge the child's feelings, wishes,

and wants

• C - Communicate the limit

• T - Target acceptable alternatives

(Landreth, 2012)

Therapeutic Limit Setting A.C.T.

• A - Acknowledge the child's feelings, wishes, and wants

• C - Communicate the limit

• T - Target acceptable alternatives

I know you'd like to shoot me, but I’m not for

shooting, the bop bag is for shooting.

Therapeutic Limit Setting

• The power of giving choices

– “I know you’re mad and you want to shoot me, but I’m not for shooting, the bop bag is for shooting.”

– “I know you’d like to paint the wall, but the wall’s not for painting, the paper is for painting”

Therapeutic Limit Setting

• If the ACT limit setting model is not responded to – and the choice-giving limit is not responded to…

– add the consequence

"I know you're mad and you want to shoot me, but I'm not for shooting, the bop bag is for shooting. If you choose to shoot me again, then you choose not to

play with the dart gun anymore today."

The Playroom and Toys

• ”Toys are children’s words and play is their language. Thus, toys and materials (words) should be selected that facilitate children’s expression by providing a wide range of play activity (language).”

(Garry Landreth)


• Playroom Location

– A place that is least likely to be disturbed or disturb others around.

• Playroom Size

– 12 feet x 15 feet

– Too small = restriction; too large = overwhelming (and – who’s in control about approaching?)

– Sufficient space for 2 or 3 children play at the same time


Ideal Playroom Characteristics • A sense of privacy

• Floor: Vinyl tile - Easy to clean & inexpensive to replace

• Wall: Washable (off-white) enamel - Easy to clean & cheerful

• One-way mirror - for supervision & least disturbance of the camera

• Sink (cold running water) - less disturbance & violation of confidentiality


Ideal Playroom Characteristics

• Whiteboard/shelves: Children’s height

• Shelves: bolted to wall → weight-bearing

• Available bathroom

• Sturdy, wood or hard-surface child-sized furniture, such as table, chair, etc.

• No carpet - can create restriction for freedom & exploration

• No watching for parents, unless filial therapy

Categories of Toys

• Family/nurturing toys

• Scary toys

• Aggressive toys

• Expressive toys

• Pretend/fantasy toys

(Kottman, 2011)

Examples of Toys

Creative: Play Doh, crayons (8 colors), paper, blunt scissors

Nurturing: nursing bottle (plastic), doll, small blanket, tea set for two, doctor kit

Aggressive: rubber knife, dart gun, toy soldiers (10-15), punching bag, 5' rope, toy snake

Dramatic: family of small dolls, doll house furniture, Lone Ranger type mask, hand puppet, plastic animals (2 domestic, 2 wild)

Other: small plastic car, Tinkertoys, ball (soft sponge type)

Playroom/Toys – Considerations

• Materials should be organized: this promotes order and consistency – promote a sense of security due to the predictability

• Should be a place to hide – promote the development of freedom in the relationship

• Broken toys – Generally, remove – cause confusion/frustration – However, some children relate to brokenness

• Clean up the playroom & put back play materials after the child leaves

Playroom/Toys – Considerations

• Generic → toys able to be projected upon

• Refresh paint, markers, glue, etc.

• Hygiene! → Clean/replace toys as needed

• No games – cause competition

• No mechanical or electronic toys (“The item should do only what the child describes”)

• No puzzles – causes frustration

• Generally – children shouldn’t bring own toys

• Playroom is not a place for babysitting

Neurobiological Benefits of Empathy in Play Therapy

• When children are overwhelmed with emotions, neural connections [e.g., limbic to prefrontal] can be fragile & insubstantial, leaving them vulnerable to limbic surges

• Stress systems become overactive, leaving children unable to develop self-regulation

• Without empathy, neurochemicals of stress continue to flow, as opposed to neurochemicals of connection

Neurobiological Benefits of Empathy in Play Therapy

• The therapist's communication of empathy [i.e., compassion & care] activate systems of bonding

• Empathy causes children's brains to release oxytocin and GABA, which calm fear, anxiety & anger

• New neural pathways begin to develop

• The raw circuits of pain are thus replaced by the development of resonance circuits

Neurobiological Benefits of CCPT Tracking in Play Therapy

• Children who experience neglect often experience a poverty of words

• This is in addition to the negative language they have endured

• The neural systems which mediate language & social interaction therefore do not receive adequate patterned, repetitive stimulation

• Neural systems – and, children – change with repetition (Perry, van der Kolk)

• Tracking in play therapy works on these impoverished neural systems

Neurological Benefit in Child Leading the Process?

• "When children lead the play & we follow well, they feel valued and powerful, & their brains respond be releasing opioids, which are neurochemicals supporting well-being & connection. When these cascade through the brain, stress chemicals return to normal levels, any tendency towards aggression recedes, & children are free to engage (Sunderland, 2006). On the other hand, if we take the lead, children may be thwarted as they seek to open the neural nets that need attention."

[Badenoch, 2008]

Neurobiological Benefits of Rhythmic Activities in Play Therapy

• Music, dancing, drumming, EMDR are all very rhythmic activities

• Repetitive, rhythmic, & archetypal activities have long been part of aboriginal cultures in healing & grief rituals

• The brainstem can be soothed thru rhythmic activity that provides neural stimulation at 80 beats per minute – This matches the prenatal experience of the mother's

heart rate

• Every play room should have a drum and additional musical instruments

Neurobiological Benefits of Physical Activity in Play Therapy

• Physical activity promotes serotonin and dopamine production

• Decreases dysphoric feelings & increases euphoric feelings

• Can have modulatory effects on midbrain over- reactivity

• Soothes body in chronic fight/flight mode • Promotes synaptic plasticity • Increases ability to cope with stress • Research indicates that exercise benefits hippocampal

integrity

Psychopharmacology with Child Clients

• Medications may be helpful in dampening out of control emotional/behavioral arousal

• This may create a window for psychotherapeutic interventions to succeed

• Meds can not, however, replace the specific & repetitive patterns of brain activation needed for traumatized children

• "We can contain behavior by regulating emotional dysfunction with medications, but we cannot create new, healthy neural networks" (Perry, 2006)

Sandtray Therapy with Traumatized Clients

• Another play therapy intervention, used with all ages

• Just as in play tx, where play is the language & toys are the words – sandtray tx is the language, & miniatures are the words

• Similar to art tx, but the client uses a sandtray as the palette & the miniatures as the paint

Other Play/Sandtray/Art Applications

• Kinetic Family Sandtray/Drawing

• Kinetic School Sandtray/Drawing

• Solution-Focused "miracle question"

• "Pain All Gone" Sandtray/Drawing – Adapted from Mills & Crowley (1988)

– 1st: Sandtray/Drawing of the pain

– 2nd: Sandtray/Drawing of pain all gone

– 3rd: Sandtray/Drawing of how to get from 1st to 2nd

Expressive Therapy: Puppet Play

Puppets provide a means for expression & projection – therapeutic distance – safety

• It is important to have a wide variety of puppets available

• A puppet stage is also necessary

• Process: (1) Selection of puppets; (2) Planning the puppet show; (3) Presentation of the puppet show; (4) Process

• Video?

Expressive Therapy: Scribble Technique

• Anyone can scribble!

• One variation:

– Family/group members can each be given an identical piece of paper with an identical scribble on the paper

– They are each asked to complete the scribble [not make a drawing]

– Upon completion, the pictures are shared with the family


• Another variation:

– Family/group members select single color marker

– On a large piece of paper (1x1 mtr), the therapist makes the “first” scribble

– Family/group members are asked to successively add to scribble until the picture is done

– May also have each family/group member take turns making the first scribble


• Another variation:

– Each family/group member takes single sheet of paper [writes name], and makes initial scribble

– Papers then handed around family/group until each member has had opportunity to add to scribble of every family member

– Each family/group member should work with a single color, so that each contribution can be identified

– Titles of these projects can be decided upon by the originator or the family/group

Expressive Therapy: Collage/Photo Work

• Collage work can be engaging & less threatening for child/teen clients – Pictures & photos can easily be selected for their

personal meaning

– Less artistic ability needed

– Magazine pictures are easy to collect & share, and can express a wide variety of feeling states

– Photos – either brought in by client(s) or taken in session by the therapist and/or client(s) – can also be powerful anchors or additions to the collage process


• Basic collage materials needed include: a variety of magazines, crayons and colored markers, paints, glue, scissors, tissue paper, ribbons and yarn, and basic poster board

• Other materials may also be used, including colored tape and fabrics, construction paper, leaves, feathers, etc.

• Basic materials should be supplied by the therapist, although additional materials can be brought in by client(s)


• If photos are used, the process should be structured and monitored

• For photos brought in, instruction should be given photo size & photo subject

• Photos taken in session should also be structured, balancing consistency with client(s)' individuality

• Creating a collage around such pictures can be a powerful therapeutic experience


• Individual collages

– Whether or not a photo is used to anchor the collage, it is essentially a self portrait for each child

– The child should work simultaneously on their collage projects, and are free to talk and share materials

– The final product should be titled by its creator

– Children are encouraged (not compelled) to share with the therapist and group/family how their “portrait” represents who they are

Expressive Therapy: Mask Making

• Children may communicate previously unexpressed emotions through or when wearing a mask

• Masks can be made during therapy or provided by the therapist

• Similar to other expressive therapy interventions, communication & process may occur during creation of the masks

Expressive Therapy: Mask Making

Masks provide a means for expression & projection – therapeutic distance – safety

• Need to have arts & craft materials, particularly paint [hair blow dryer?]

• A "stage" area is also necessary

• Similar process to family puppet play: (1) Creation of masks; (2) Planning the drama using masks; (3) Presentation of the drama; (4) Process

• Video record, if possible

Expressive Therapy: Doll House Play

• Doll house play provides the opportunity to use the expressive therapy intervention of sculpting, albeit in another manner

• Therapist introduces sculpting, except for asking the client(s) to move & position doll figures and doll house furniture instead of other family members

• With "traditional" sculpting, children will follow what they expect their parents or therapist is hoping for


• Materials necessary

– Doll house & furniture that are simple, durable, & adequate in size is crucial

– A doll house which is too fancy and colorful may be an obstacle for those client(s) from lower socioeconomic backgrounds

– As with puppets, it is important that the dolls demonstrate ethnic and gender diversity

– Animal families may also be helpful


• Two doll house interventions – The first is to use the doll house and dolls as a

miniature sculpting exercise

– Instead of asking each client to arrange persons & furniture in the therapy room to illustrate group/family structure and dynamics [which can be fairly overwhelming for young children], therapist asks that the same be done with doll figures/furniture

– Usually have children go first


• Two doll house interventions – The second way is to use the doll house in same

manner as the Kinetic Family Drawing

– Each client creates a scene in the doll house of the family doing something

– This can be done with each individual client, or with a group/family as a whole

– Specific direction of ”doing something” helps to ensure that each will create a scene of functioning from their own perspective

Summary Quotes . . .

• “As long as children are unable to talk about their traumatic experiences, they simply have no story, and instead, the trauma is likely to be expressed as an embodiment of what happened. . . The task of therapy is to help these children develop a sense of physical mastery and awareness of who they are and what has happened to them to learn to observe what is happening in the present time & physically respond to current demands instead of recreating the traumatic past behaviorally, emotionally, & biologically.”


Summary Quotes . . .

• "It is the 'relationship' which enables access to parts of the brain involved in social affiliation, attachment, arousal, affect, anxiety regulation and physiological hyper-reactivity. Therefore, the elements of therapy which induce positive changes will be the relationship and the ability of the child to re-experience traumatic events in the context of a safe and supportive relationship."

(Perry & Pate, 1994)

References

• Badenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal neurobiology. New York: W.W. Norton & Company.

• Gaskill, R., & Perry, B. (2014). The neurobiological power of play: Using the neurosequential model of therapeutics to guide play to guide play in the healing process. In C. Malchiodi & D. Crenshaw (Eds.), Creative arts and play therapy for attachment problems (pp. 178– 196). New York: Guilford Press.

• Gil, E. (2006). Helping abused and traumatized children: Integrating directive and nondirective approaches. New York: Guilford Press.

References

• Gil, E. (Ed.). (2010). Working with children to heal interpersonal trauma: The power of play. New York: Guilford Press.

• Homeyer, L., & Sweeney, D. (2017). Sandtray therapy: A practical manual (3rd ed.). New York: Routledge.

• Kestly, T. (2014). The interpersonal neurobiology of play: Brain-building interventions for emotional well-being. New York, NY: W.W. Norton & Company.

• Landreth, G. (2012). Play therapy: The art of the relationship (3rd ed.). New York: Routledge.

References

• Malchiodi, C. (2014). Creative interventions with traumatized children (2nd Ed.). New York: Guilford.

• O’Connor, K., & Braverman, L. (Eds.). (2009). Play therapy: Comparing theories and techniques (2nd ed.). Hoboken, NJ: John Wiley & Sons, Inc.

• Perry, B. (2014). The neurosequential model of therapeutics: Application of a developmentally

• sensitive and neurobiology-informed approach to clinical problem solving in maltreated children. In K. Brandt, B. Perry, & S. Seligman (Eds.), Infant and early childhood mental health: Core concepts and clinical practice (pp. 21-53). Arlington, V: American Psychiatric Publishing, Inc.

References

• Schaefer, C. (2011). (Ed.). Foundations of play therapy (2nd ed.). Hoboken, NJ: Wiley.

• Sweeney, D. (1997). Counseling children through the world of play. Eugene, OR: Wipf & Stock Publishers.

• Sweeney, D., Baggerly, J., & Ray, D. (2014). Group play therapy: A dynamic approach. New York:

• Routledge Publishers. • van der Kolk, B. (2014). The body keeps the score:

Brain, mind, and body in the healing of trauma. New York, NY: Penguin Group.

Thank You!

Daniel Sweeney, PhD, LMFT, LPC, RPT-S NW Center for Play Therapy Studies Graduate Department of Counseling George Fox University 12753 S.W. 68th Avenue Portland, Oregon 97223 U.S.A. [email protected] www.nwplaytherapy.org

play therapy: a developmentally appropriate …...play therapy: a developmentally appropriate...

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