Using Play to Connect Better with Kids in Therapy

How Modeling Play Can Help Children Heal Trauma, Alleviate Anxiety, and More

David Crenshaw

Play is the natural way that young children discharge the tensions of their daily lives. When children are picked on at school, they may come home at the end of the day and enlist siblings, friends, or even stuffed animals to play out a drama in which the child, transformed into the school principal, gets to ream out the bully and send him or her to detention.

But when children are too anxious, afraid, or traumatized to play, they can't utilize this natural resource of childhood to relieve a painful emotional state. Instead, they must use their energy to compartmentalize the trauma, keeping it out of direct awareness. Because play is both releasing and disarming, it may be too threatening for the child to give up control sufficiently to enter into it.

Child therapists can help children reclaim this vital feature of emotional self-regulation by teaching, modeling, and setting the stage for the child to play. But as when you're teaching children with attachment problems to tolerate emotions, this must be done gradually.

The child therapist approaches the child who can't play by introducing play activities one step at the time. I typically minimize the need for young children (10 and under) to talk, since they may have difficulties verbalizing their experience, particularly those who've been "incubated in terror," as child psychiatrist Bruce Perry, a senior fellow of the Child Trauma Academy in Houston, describes them. Children with serious emotional interference in their development or who have a history of exposure to trauma may function emotionally and socially at an age significantly younger than their years. It may be more natural for any child, regardless of age, who's developmentally 7 or younger, to work through trauma and other issues in the language of play.

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.

There are several elements of the play action that are instrumental to the healing process. More than 60 years ago, British psychoanalyst David Levy used methods of selecting toys that would closely resemble the traumatic experience. He called the approach Release Therapy, because his emphasis was on abreaction. In recent decades, however, due to the groundbreaking work on therapy with traumatized children of Lenore Terr, clinical professor of psychiatry at the University of California, San Francisco, and Eliana Gil, director of the Starbright Training Institute for Child and Family Play Therapy, we know that abreaction is just one of the needed steps. The children also need to derive an experience of mastery and empowerment from the play, and to engage in some corrective action. The action need not be real-world based---in fact, reality-based corrections aren't always viable or possible for trauma events. The action or solution can, instead, be fanciful and magical, which naturally appeals to children and can better provide the sense of empowerment so vital to countering the feeling of powerlessness created by the trauma.

I should note that one absolute prerequisite for being a child therapist is the willingness to make a complete fool of oneself. You must be willing to engage in the play wholeheartedly---without irony or self-consciousness---no matter how ridiculous you may appear to adults, including the parents in the room, or you'll surely fail.

This blog is excerpted from "The Healing Power of Play." Want to read more articles like this? Subscribe to Psychotherapy Networker Today!

Topic: Children/Adolescents | Attachment Theory | Trauma

Tags: family therapy | kids | parents | psychotherapy | PTSD | therapist | healing | attachment | networker | play | playfulness

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Saturday, February 20, 2016 3:47:49 AM | posted by Karen mcgilion
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