Play Therapy - Answering Your Questions

by Dr. Nia

Play is often called “the language of children.” How many times have you had a feeling and struggled to put it into words? Like adults, children experience a full range of emotions but they don’t yet have the words to express them. They are still developing the skills to be able to recognize and tolerate their emotions, especially the uncomfortable ones. 

Maybe you’ve heard of play therapy but aren’t really sure what it is and how your child can benefit from it. Of course you want the best for your child and want to make sure you are paying for a treatment that will support them. In addition to my work with adults, I’ve been doing play therapy with children for several years. Play therapy is a useful treatment approach due to children’s developmental level. Here are three of the most common questions I receive from parents and caregivers:

1. How is playing with my child actually therapy?  

 Although it looks different from traditional talk therapy with adults, play therapy with children has many of the same therapeutic benefits such as identifying and expressing feelings, problem-solving, and practicing new skills. These benefits stem from developing a trusting relationship where a child feels safe to express their unique feelings without fear of judgement. Play therapy helps children to deal with their BIG feelings. Play also gives them a level of distance so these feelings don’t feel so overwhelming. 

For example, a child of divorce may be feeling distressed but it may be too threatening to talk about directly. In session, the child may use puppets or a dollhouse to play out family conflict. The therapist can observe themes and support the child with identifying the feelings in their play. The therapist might say something like “The child puppet feels scared when the parents argue. He is worried they are angry at him.” The child learns that his feelings are normal and are okay to express. In this way a child learns language to describe and organize his experiences, which reduces distress. The child also learns that he doesn't have to deal with these difficult emotions alone. The therapist can share with the parents that the child may be feeling responsible for the divorce (a common belief in children) and needs reassurance that the divorce is not his fault, the parents will never stop loving him, and they will always keep him safe. 

2. What can you really learn about a child through playing?

A therapist who is trained in play therapy can learn so much! Children enjoy getting one-on-one attention from a supportive adult, where they get to be in control (with appropriate limits around safety). This develops a sense of safety and freedom to explore. As such, a therapist gains insight into a child’s perception of the world. For example, during doll play, are the adults and other kids kind and helpful? If so, a therapist might imagine this child feels worthy of love and care and sees other people as supportive. On the other hand, a child may create a scene in which bombs go off without notice (sometimes playfully scaring the therapist!). One possible interpretation is that their world feels scary and unpredictable. It’s important to note here that children often mimic what they see on TV, older siblings, and adults around them. Rather than make interpretations based on one interaction, a child therapist looks for repeated themes. Play gives the therapist a window into the child’s inner world. It can help therapists identify the child and family’s strengths as well as the areas where they may need more support.

3. How can play therapy support my child at home and at school? 

By observing and interacting with a child in a safe place, the therapist gathers information about tools that can support the child to be successful in other areas of their life. This information is useful for parents/caregivers, schools, and any other meaningful relationships in the child’s life. Helping adults recognize a child’s emotional needs can help prevent the behaviors that cause frustration for everyone. For example, a therapist may notice a child has difficulty with transitions and needs a few reminders before switching to a new activity. This may help explain why the child has a tantrum at school whenever recess is over or at home when bedtime is announced. 

The therapist-child relationship and how it develops can give insight about a child’s relationships with others and with themselves. Does the child have trouble taking turns? This child may need support with social skills or impulse control. Do they become really upset when they lose? A child who cheats in a game may be expressing their feeling that the odds are always against them. This can suggest some points of intervention such as strengthening the child’s self-esteem or supporting them with social communication skills. The therapist can learn about the child’s difficulties and how they are likely impacting their family relationships and their friendships with other children. 

I hope this answers your questions and you feel more confident that play therapy is useful for supporting children at home, school, and in their communities. 

Take care and be playful!

Further resources: 
Association for Play Therapy: https://www.a4pt.org/
Psychology Today: https://www.psychologytoday.com/us/therapy-types/play-therapy
Play Therapy International: http://playtherapy.org/

5 Tips for Effective Communication with Your Teen

by Nia Saunders, PhD

There are many reasons for conflict between teens and their parents/families. Teens are starting to be more independent, they become increasingly more oriented towards their friends, and they can make impulsive decisions. For parents, there can be conflict around teens challenging adult authority and exploring their identities. All of these factors make it a common time for increased tension in families with teens. The following tips will show how to improve communication with your teens and build stronger relationships. 

1. Listen and show respect for their voice: 

As a psychologist who works with teens, one of the most frequent concerns that teens share with me is that their parent or caregiver “doesn’t listen.” The examples they share include: parents judging, dismissing their opinions, or giving unasked for advice.When talking with your teen, listen attentively and hold judgment. Listening means actively trying to understand what they are saying, not just listening to respond. Ask if they need to vent or if they need advice. Sometimes, they may just want you to listen, rather than go into fix-it mode. Remember, part of their task at this stage of development is to find their voice. You can support them to do this by listening and reassuring them that their voice matters. 

2. Validate their feelings: 

Think about how it feels when you share a story about something that upset you, and the response you get is “why are you making such a big deal.” Does that make you want to share more? Probably not. One way to show teens respect is to validate their emotions. This means to show that you understand how something may be affecting them. Things that seem minor from our adult perspectives are really important to them. For example, teens tend to think about their lives as a “personal fable,” a unique story in which they are the star character. This means getting a pimple or going through a breakup can feel like the end of the world. Suggesting they are being dramatic or saying “it’s not that big a deal” invalidates their emotions and causes them to shut down. It can also cause feelings of shame.   

Using language like “That’s frustrating” or “I see why this is upsetting” makes them feel understood and encourages them to express themselves. This ultimately helps them feel more in control of their emotions. Validation doesn’t mean agreement. You may not think their recent fight with a friend is a big deal in the grand scheme of things. Validation means that you acknowledge it’s important to them and you’re recognizing their emotions in the moment. Acknowledging their feelings supports them to feel their emotions, without dismissing, minimizing, or trying to immediately fix them. Validation is a powerful strategy for helping teens feel heard and valued. 

3. Control your own emotions. 

Parents and families can be triggered by their teens’ emotions or behaviors for many reasons. There may be cultural factors, increased family stress, or the parent/caregiver’s own trauma. It’s important to check in with yourself to determine why the teen is triggering a negative emotion. Teens are still learning and growing. The prefrontal cortex (part of the brain that controls impulses and regulates emotions and behaviors) doesn’t finish developing until the age of 25! This means teens still need a calm, trusted adult to help them navigate everyday life. Teens tend to be hypersensitive to facial expressions and tone of voice. They can detect sarcasm and when they’re being criticized or judged. Staying neutral when communicating with them can prevent escalation of a situation, especially if they’re already upset. 

4. Know the common stressors for teens: 

There is so much happening during the teenage years. They deal with increased academic pressure at school. Physically, they are going through the changes of puberty and may be more self-conscious about their appearance. Socially, they may be exposed to peer pressure during a time when approval by their friends is so important to them. Friend groups change and they may begin dating. This makes them more sensitive to social rejection and how they are perceived. Teens are also aware of the social and political climate and youth of color experience distress related to current events. Teens who belong to marginalized groups, like LGB, trans, or gender nonconforming youth,  are at increased risk of bullying, homelessness, and mental health concerns like depression or anxiety. Knowing what teens are dealing with can help adults have more compassion and recognize the importance of supportive relationships with good communication. 

5. Give them credit: 

Sometimes, adults have a dismissive “you’re just a teen” attitude.This comes across as condescending. Even though teens care what their friends think, they still care about their family’s opinion of them. They want to know you think they’re great. It’s important to highlight their strengths and what you admire about them. This helps strengthen their self-esteem and motivates them to keep up the good work. Even when you disapprove of their choices or behavior, it’s important for them to know you still think they are good people. Giving teens credit and praising them for the things they are doing right helps them to feel good about themselves. 

There are so many things that are exciting about the teen years. Teens seek out new experiences, have creative ideas, and explore their identities in ways that differ from other age groups. Using these tips to communicate can help your teen in feeling valued and important. It also makes them more likely to turn towards you, rather than away, in times of need. 

Therapy reflections:

What was your experience of being a teen like?

Did you feel like you could talk to adults about what was going on? Why or why not?

How can you use these tips for talking to the teens in your life? 

Resources: 

Michaela Horn: Teen Stress from a Teen Perspective: https://youtu.be/FhG-VoRtkKY

Dr. Adriana Galvan: Insight into the Teenage Brain- Ted Talk: https://youtu.be/LWUkW4s3XxY

Dr. Dan Siegel : The Adolescent Brain: https://youtu.be/0O1u5OEc5eY

The Power of Reaching Out

by Ashley Gregory, LMFT

How many times have you heard someone say, “I’m so bad at reaching out!” Or maybe you have heard yourself say something like, “I just have such a hard time picking up the phone!” In my experience, the next phrase is something like, “It’s not personal, I do it with everyone.” For so many of us, reaching out is really hard. We can be deeply hurt when we reach out, only to feel rejected. Our feelings towards reaching out may even be confusing. 

On A Personal Note

Earlier last year I had a profound reminder about the importance of reaching out. Someone really close to me who lives in another part of California had to go into the hospital for a procedure. The purpose of the hospital visit was to determine if more intrusive measures were needed--a potentially life threatening experience. It just so happened that several family members lived near the hospital. The thing was, I had not seen them in years. Of course, there are many painful reasons why I had not been to visit my family in a long time. Would it be a mistake to reach out? Given our experiences in the past, would it be easier to just keep our distance? I checked in with my loved one. Was it okay for me to reach out and let my nearby family know about the situation? I wanted to respect the patient's wishes. We talked through the possible outcomes and concerns. Ultimately, we agreed that I would let our family in the area know. Then the unexpected happened: they went above and beyond to support the whole scary process from beginning to end. Our family offered rides when we needed them, food to keep us going and visits and calls to remind us that they care. Turns out, we even have a nurse in the family who could advocate for accommodations and offer information throughout the whole frightening process. And the results were very heartening--no need for surgery after all. What a relief! Now that we are on the other side of the unknown, we cannot imagine how we could have gotten through it without the support we received. 

From the Very Beginning

To learn more about “reaching out” we can look to attachment and development. The act of reaching is a part of our initial movements as infants, in addition to yielding, pushing, holding and pulling. Ruella Frank, Ph. D. shares in his book Somatic Awareness:

Infants rely on a developing language of body that enables them to reach out and experience the other, and in so doing, to experience themselves. Every infant’s reaching pattern evolves as a pathway toward solving developmental problems or tasks. In the process of discovering the solution, a reach is made (109). 

In essence, our very early experiences shape us--our reflexive movements and core beliefs. The ways in which our caregivers responded to our needs, at a time when getting our needs met were most dependent on others, gives form to our shape. We learn about who we are and what we can expect in the world through our relationships with others. We create adaptations to get through disappointments and abandonment. 

From infancy to old age, we all have needs. Part of what makes each of us unique is how we go about meeting our needs. Deirdre Fay, in her book Attachment-Based Yoga & Meditation, states that “Reaching is about exploring, moving toward, asking, wanting, needing (284).” Just as a child needs a sense of security to feel safe to explore their surroundings away from their caregiver, each of us wants to know that everything will be “okay” when we take the risk of reaching out. 

Somatic psychotherapy acknowledges the body-mind connection between the physical and psychological parallel of “reaching out.” You may try the experiment offered below to explore your relationship to reaching out. 

An Experiment in Reaching Out

Briefly bring to mind whatever it is you want to explore your reaching relationship to--a person or a goal, perhaps. Next find a comfortable seat with your feet on the floor, toes facing forward. Allow your back to rest in a supported position. Rest your gaze forward or close your eyes gently. Bring your attention to the top of your spine, the space between your shoulders, mid-back, lower back and tailbone. With a continued awareness on your back, recall your exploration topic and imagine it in a space a short distance from you, out of reach. Slowly, mindfully, notice what happens when you begin to think about moving an arm towards that space. Notice thoughts, sensations (weight, movement, tension, temperature) and feelings. If it feels right, begin the arm movement towards the space you are focusing on. Take time to allow your awareness to deepen, noticing what arises in your experience. When you sense the action is complete, mindfully drop the arm. Pause for a moment to reflect on your experience. 

As a reminder, mindful experiments create opportunities for clarity; opening to more choice and compassion for ourselves and others.  Using mindfulness in therapy can provide insight and clarity around important topics where you may feel stuck.