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The Healing Power of Play - Page 2

When a young child who's too fearful to play enters my office with the family, I typically get down on the floor and start playing with the toys myself. Even if the identified child won't join me, I can usually get the siblings and the parents to participate. Gradually, the nonplayful child—who up to then has stayed close to one parent, usually the mother—will begin experimenting with some of the toys. At that point, I slowly try to join with the child, always takings my cues from the child. I make no demands on the child to verbalize, although I may provide some narrative myself, based on the toy selected or the child's actions with the toy, such as, "Oh, I see you've discovered that the fire engine has a back compartment where the small rescue truck is stored."

If my verbalizations or physical proximity seems intrusive to the child or increases anxiety, I'll move away slightly and/or decrease the frequency of my comments. Eventually we arrive at a pace and level of intensity that the child can tolerate. Safety is the overriding concern. Unless I can establish a safe place for the child in the therapy session, nothing useful will happen.

However, what feels safe for the child will vary, not only from session to session, but even within the same session. If, for example, a child is comfortably playing with the fire truck and rescue vehicles, but then spots a school bus on the toy shelf that triggers a memory related to a traumatic event, the child may suddenly stop playing. This is what Charles Sarnoff, a psychoanalyst in Manhattan, called a "switch moment." The therapist may help the child "recover" at such a moment by taking the school bus to the garage and making sure the child understands that the school bus will stay in the garage until the child decides it's time for it to come out. Giving the child a sense of personal control in such situations is crucial because two central elements of trauma are a total lack of control and utter helplessness.

In my clinical experience, a lack of desire to play in children results from exposure to deliberate trauma, extensive or devastating abuse, or domestic or neighborhood violence. However, the inability to play can sometimes result from accidental trauma. Bobby, age 2, was an accidentally traumatized child, and the youngest child I've seen who no longer played. He and his mother were visiting family friends and the children went out to play in the back yard, where Bobby suddenly fell through the rotting boards covering an abandoned well.

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