To effectively help your child and adolescent clients overcome the negative impact of trauma you need to address four crucial issues in play therapy.
What are critical tasks to accomplish in play therapy when working with traumatized children and teens?
Some version of this question is one of the most frequent questions I’m asked in play therapy supervision and training I conduct. It’s a great question because you want to make sure your approach is effective. No one wants to do a terrible job when working with traumatized children and teens. I remember years ago being terrified I’d miss something or do something in play therapy to make things worse. Over the years and through lots of studying, training, and supervision/consultation, I’ve learned there are four essential tasks to accomplish in play therapy with traumatized children and teens. Let’s discuss them and why they’re important.
Safety & Security
Trauma disrupts the ability to feel safe – anywhere and with anyone. A traumatic experience by its very nature causes you to know there are scary things happening in the world that we cannot control. The task of therapy is to help your clients to overcome the impact of that traumatic experience and learn to thrive. This is also true in play therapy. Safety is the first task of play therapy because change cannot happen if safety isn’t created. This is especially true when working with children and teens who’ve experienced trauma. And - assessing your client’s level of safety throughout the play therapy process is necessary. The pacing of play therapy sessions and issues addressed in those sessions need to be adjusted to remain within your client’s window of distress tolerance. If you move too quickly addressing painful experiences then your client can become physiologically and emotionally overwhelmed. This likely manifests as emotional dysregulation in its various forms - tantrums, panic attacks, flashbacks, nightmares, self-harm, suicide ideation, and/or emotional withdrawal. While these manifestations may not occur within your sessions, it can cause your client to feel unsafe in their sessions and possibly even avoid therapy sessions.
Building therapeutic rapport is one of the foundations of good treatment. Creating therapeutic rapport requires your client to feel safe with you. Therapeutic rapport requires the activation of the social engagement circuits which means neuorception circuits must be deactivated. If you’re familiar with Stephen Porges and Polyvagal Theory, then you’ve heard of neuroception circuits. If not, neuroception circuits are neural circuitry systems that are constantly assessing the presence of threat without your conscious awareness. It’s your body’s way of keeping you safe. It’s for survival. When trauma has occurred, it’s like your neuroception circuits are on “hyperdrive” until you can learn to feel safe again.
In play therapy, we know from the work of Stephen Porges and other researchers that the play circuitry can only be activated if the social engagement circuitry is activated. Engagement requires safety so that the play circuits can be activated once the social engagement circuits are activated. That requires your clients to feel safe in play therapy, as well as in their homes. If you’ve ever worked with children in foster care, you’ll notice that children in foster care can only fully engage in the change process when they feel safe. That can take a long time. You can get a sense of your client’s sense of safety by the way they engage, or not, in the play therapy sessions. It can typically take a few play therapy sessions for children to feel comfortable. Some children are “slow to warm up” children. Children who have experienced trauma may take longer to establish therapeutic rapport with you. It’s important for you to figure out what will help your client feel safe, including feeling safe in play therapy sessions.
Identifying & Challenging Cognitive Distortions including Shame
Trauma distorts beliefs about ourselves, others, and relationships. It changes the way in which your client views the world and makes meaning of the behavior and intentions of others. Trauma impacts your client’s ability to trust others and to accurately read cues of safety. Distorted beliefs and shame are significant contributors for emotion dysregulation, unresolved grief, sadness, anxiety, and even self-harm and suicide ideation. It’s important to identify and challenge these cognitive distortions. I use the term, “lies,” with my clients. These are the lies they believe about themselves, others, and the world that interfere with their ability to enjoy life and feel safe. A common lie is that the traumatic experience was their fault. Another lie is typically that they are “bad.” Play therapy can help you to explore and challenge these cognitive distortions with your clients in a way that feels safe for them.
Identifying Trauma Triggers via Sensory Circuits
This is an important aspect of trauma that needs to be highlighted in order to be effective with your clients. Trauma is experienced through sensory systems that bypass logic and reasoning. Every traumatic experience includes sensory-based memories. For example, the smell of the room where the traumatic experience occurred, what your client saw when the trauma occurred, and/or sounds your client heard when the traumatic experience happened. All of your client’s sensory circuits were active when the traumatic experience occurred so it’s important to explore with them any sensory memories of their traumatic experience.
Why is this vitally important? Identifying memories in the body experienced through sensory systems is key to regulating emotions and establishing safety. These sensory memories will activate a flight-fight-freeze. Your client will not likely connect the activation of the traumatic memory with the sensory components of the memory so it can be disorienting to them when triggered. Providing psychoeducation about the sensory aspect of memories provides the opportunity to explore this and develop coping strategies. It will also help your client to understand what’s happening to them and decrease shame and other unhealthy cognitive distortions.
Resolving Anger, Grief & the Question of “Why”
If you’ve experienced trauma then you will also experience grief and loss. These are painful emotions that co-exist as a by-product of trauma. Healing the negative impact of trauma includes processing grief and loss issues in play therapy. Traumatic grief can be due to a variety of losses experienced as a result of the trauma, such as lost relationships, changes in physical mobility due to injuries sustained as a result of the trauma, moving to another city or home, going into foster care, and/or the negative financial impact of the trauma. Loss can also include no longer feeling safe anywhere, including feeling safe in relationships, and the challenges your client must overcome in order to thrive. These changes can be overwhelming and sometimes feel unachievable.
Another emotion that must be identified and resolved is anger. Their anger may feel overwhelming and scary. They may believe all anger is “bad” and therefore, they’re bad if they show their anger. Your client will eventually need to address their anger about life being “unfair” at some point during their healing process. They’ll need to identify what they’re angry about and work through it. They will likely feel anger about the trauma disrupting their life and causing so much pain and hurt. If the legal system is involved as a result of the traumatic experience, your client may feel fear and anger about the court process. The court process can be quite overwhelming and even re-traumatizing for victims of trauma.
When traumatic experiences occur, it’s likely the whole family is impacted by it. Trauma caused by abuse and/or neglect that results in child protective services and police involvement will heighten emotions within the family system across households. This can cause a ripple effect of fear, anger, mistrust, and shock in families. Children at the center of this will feel sadness, worry, shame, guilt, and anger. All of these emotions need to be identified and processed for healing to fully occur.
The question of WHY is always present and is critical to address during the play therapy process. In my experience over the last thirty years, this is a hallmark issue for your clients to figure out how they will come to terms with it. Why did it happen? Was it my fault? Why did God let it happen? These are typical questions victims of trauma want to know. Spirituality is usually always part of the WHY question. It makes sense if your client believes in a Higher Power in whatever form that’s meaningful to them. If this omnipotent power has so much power then why did this happen? Couldn’t God (or Universe, Higher Power) have stopped this? Was I not important enough to protect? I’ve learned it’s important to explore spirituality issues with my clients, even children, so it doesn’t get overlooked and left unresolved.
The thing to keep in mind when helping your client through the healing process is that it’s not up to you to give them the answer to their questions. You can’t. Your job is to facilitate the healing process for your young client. To assist them in finding meaning for something that makes sense to them. Or at least aid them to get to the point in which the question no longer holds them hostage.
There’s no magic wand or magic solution. It’s a process. It’s a journey and you are the wise guide. As the wise, compassionate, safe guide, your job is to help your client navigate the pain, develop coping strategies, and figure out how to thrive despite what happened. I love one of the foundational principles of Dialectical Behavior Therapy (DBT) - You may not have caused the problem. You are responsible for solving the problem. Play therapy can be a powerful way to meet the unique developmental treatment needs of your child and adolescent clients so they can heal and thrive. So, put on your wizard hat and channel your inner Gandalf (or Dumbledore) and be amazing! (couldn’t resist a little nerdy humor here)
The first task to accomplish is to create a sense of safety within the sessions and for the child in their home. Nothing can change until the child begins to feel safe because their neuroception circuits will be on hyperdrive to scan the environment for lurking threat
Identifying and challenging false beliefs and shame that activate emotion dysregulation, fearfulness, and false beliefs about one’s self, others and relationships is an important task in play therapy.
Trauma is experienced and memories are stored through sensory circuits. Sensory aspects of trauma memories are stored without language and can activate a trauma response if not identified
Trauma is a devastating and overwhelming disruption to one’s life. Anger, grief, and the question of “why” are issues that need to be resolved to allow your client to move forward with their lives.
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