Play as part of an overall treatment intervention

Play as part of an overall treatment intervention. Theresa Fraser, C. Y. W. , M. A. , C. P. T.

Play Therapy • Is the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development Board of Directors for Association for Play Therapy, 1997, p. 14.

Play…. . In our play, we reveal what kind of people we are. Ovid- Roman poet 43 B. C

Following this workshop attendees will: • Be able to identify why play is beneficial for children/teens/families • Be able to identify how and which types of play can enhance the parent (caregiver)/child relationship • Identify how Play (not necessarily Play Therapy) needs to be part of an overall treatment intervention when program planning

Play as part of an overall treatment intervention “The playing adult steps sideward into another reality, the playing child advances forward to new stages of mastery”. Erik Erickson

When children play they learn to: • Solve problems • Make decisions • Express themselves and communicate with others • Recognize boundaries

Play as: • the way children communicate • the way children learn and progress through developmental stages • a way in which adults can communicate with children • a way in which adults and children can learn together • a way in which we can build on the attachment relationship

Children who play. do better at school and are more successful adults. When we don’t play, we are: • Less creative and productive • More sedentary, more easily fatigued, • more susceptible to obesity • More likely to encounter social problems and emotional stress * Strong Museum of Play ( Rochester, N. Y. ).

Play helps us to understand history and culture The way we play shows: • Who we are • What we value • How we regard others • Change over time • Future possibilities

Common Play Themes for Children • Control • Power • Expression of a wide range of emotions • Good vs. Evil • Winning and losing Van Fleet, R. A parent’s handbook of filial play therapy. Boiling Springs: PA. Play Therapy Press

Do try to: • Create a feeling of permissiveness so your child feels free to express feelings freely • Watch for feelings and reflect these back • Reflect the child’s ability to solve own problems- refraining from giving advice or solving the problem Van Fleet, R. A parent’s handbook of filial play therapy. Boiling Springs: PA. Play Therapy Press

Don’t • Direct your child’s actions or conversation in any way • rush or hurry your child • All works better if you can Establish limits so everyone feels safe and to make your child aware of his/her responsibilities in their relationships Van Fleet, R. A parent’s handbook of filial play therapy. Boiling Springs: PA. Play Therapy Press

Brain Development and Play Developmental neuropsychological and neurobiological sciences have discovered that sensory stimulation, which act like nutrients, is essential for the normal development of the brain in both structure and function. Without adequate sensory stimulation during the formative periods of brain development, from all sensory modalities, brain cells either do not develop or develop with malformed cells. 
Prescott, James W. (1996). The Origins of Human Love and Violence. Pre- and Perinatal Psychology Journal. Vol 10, No 3, pp. 143 -187. (Spring).

Five Critical Conditions for Play SAFETY CONSISTENCY PREDICTABILITY ACCEPTANCE/LOVE BELONGING © Greg Lubimiv 2007 Phoenix Centre for Children

Elements of Therapeutic Milieu • “You can learn more about a person in an hour of play than a year of conversation" Plato. • Activities can be directive and non-directive (child centred) • Consistent and predictable expectations • Discipline that is developmentally appropriate Play and Play therapy Therapy • Counselling or Play Based Interventions • Family Counselling • Group Counselling Rules , Structure Education • Formal Education • Life skills • Teachable moments

Let’s Play • We will break into groups of four

Puppets With tools provided you have five minutes to create a puppet that represents a family member • Puppets can help externalize issues • Puppets can help to communicate and express feelings • Puppets can help child role-play or practice possible solutions

Games • Games with rules that are child initiated evolve from practice and symbolic play. • “When children invent games, they understand that they have to develop rules to play the games as well as rules for social functioning”. Hence, games assist kids with social interactions and help adults recognize the child’s view of themselves in these interactions. Frost, J. , Wrotham, S. , Riefel, S. (2005)Pearson Education Inc. , Saddle River, New Jersey

Games- Continued Store bought games can also be adapted to assist with feelings identification • Pop up Pirate • Guess Who • Twister Let’s try some out.

Expressive Arts • Providing the tools for your child to express themselves doesn’t need to be expensive • Paints, brushes, paper, crayons, collage media, home made play dough, glitter, wooden shapes, musical instruments, a microphone. • Each of these assists the child in creating something that may help to release or communicate feelings for themselves or to you.

Drama/Role Play • Dress up clothes, dolls, housekeeping props, doll house, Superhero Play Let’s create our own Superhero. These tools assist in expression and collaborative play between child and caregiver.

Outside Play • Hikes, kayaking, adventure play, fishing, exploring, etc. • Other ideas? • Take it outside!

Constructing • Lego, blocks, cardboard and recycling materials including large cardboard boxes • Replica play sets and other “Floor Games”. “Unit blocks address performance objectives in the cognitive, physical, social and emotional domains”. Shipley, D. (1998). Empowering Children. Nelson, Scarborough, Ont. p. 378

Formalized P/C Play Therapy Approaches • Theraplay • Filial • Child Centred • Family Play Therapy • Integrated play therapy approaches

ESNC- What is this? Theraplay approach assumes both that change is possible and that the essential ingredients of change lie in the creation of a more positive relationship between a child and her parents. Because the roots of development of the self, of self esteem and trust lie in the early years, it is essential to return to the stage at which the child's emotional development was derailed and provide the experience which can restart the healthy cycle of interaction. Activities are geared to the child's current emotional level rather than to chronological age. Parents are encouraged to respond empathically to their child's needs. The goal of treatment is to change the inner representation of the self and others from a negative to a more positive one. Retrieved from: http: //www. theraplay. org/8400. html

4 domains of Theraplay • Engagment • Structure • Nurture • Challenge

Engagement • Engagement activities help establish and maintain a connection between adult and child. These activities can be helpful for the child who may be avoidant or withdrawn.

E. Activity Ideas • Criss cross applesauce • Mirroring • Wash, power, lotion • Little piggy • Peek a boo • Push me over – pull me up • Special handshake

The theory behind E Activities • These activities assist the child who is truly struggles with allowing himself to interact with adults. He/she may have experienced adults as unsafe or unwilling to just “be” with the child.

Structure Activities • These activities help relieve the child of the burden of maintaining control of interactions. The adults sets limits, keeps the child safe, defines boundaries, and sequences the order of expectations.

S-Activity Ideas • Simon says • Ring around the Rosie • Stacking hands • Eye signals

The theory behind S Activities • Children who have experienced attachment disruptions or trauma need routines, rules and repetition. • Play activities can reinforce for the child that they don’t have to be in charge if they let the adult be the adult - it can be fun

Nurture Activities • These activities reinforce messages to the child that he/she is worthy of care and that the adults will provide care without the child needing to ask.

N- Activities • • Rock in a blanket Check ups Feeding Lotion for hurts Hair combing Cottonball touch Manicures Other

The theory behind N activities Nurture activities can help the child feel like his/her world is secure or becoming secure. This can allow the child to relax (cortisol and endorphins). These activities can help the child become more self regulated.

The Other 23 Hrs. • This book noted the importance of the treatment that occurred within therapeutic milieu. • The work that occurred outside of or in addition to that which occurred in therapy room • Children needed ESNC

The Other 23 hours • Other 23 Hours explores in detail the relationships and non-verbal behaviour needed by staff who have not been professionally trained in child care to provide a therapeutic milieu for children. While other authors had looked at the contributions such staff might make from time to time, this book focuses entirely on their contribution Albert E. Trieschman, James K. Whittaker and Larry K. Brendtro (1969) The Other 23 Hours: child-care work with emotionally disturbed children in a therapeutic milieu Chicago: Aldine 0 202 26023

Challenge Activities • Challenge activities encourage the child to take mild age- appropriate risks. These can then promote feelings of competence as well as confidence. • This can be beneficial for the anxious, timid or withdrawn child. • It is often helpful to begin and end these parent/child activities by having the child focus on the adult with a wink, predetermined clue, etc, This gives the child the message that, I am here and I will support you in this task. Taken from www. theraplay. com

C- activities • Newspaper sword fight • Newspaper punch • Thumb wrestle • Shapes on the back

The theory behind C activities • Challenge activities can provide the child with activities that can increase their feelings of self esteem with the support of a caring adult. Children who are fearful of trying new activities for fear of failure benefit from playful opportunities to succeed.

How does Play address Trauma? • Trauma refers to overwhelming, uncontrollable experiences that psychologically impact victims by creating in them feelings of : helplessness vulnerability loss of safety loss of control James, B. (1989). Treating traumatized children: new insights and creative interventions. Lexington, MA: D. C. Heath

Play to support kids with trauma experiences. • Play can provide the setting and resources for the child to gain mastery over feelings of helplessness, vulnerability, loss of safety and loss of control. The adults in play can also demonstrate to the child that they will be there to provide safety. (Clip).

Three Pillars of Trauma Informed Care • Safety • Connections • Managing emotional impulses What specific play activities can support learning in the above areas? We can use activities already discussed or new ideas.

Questions

And in the end…. . Play trains our minds, strengthens our bodies, teaches us charm, tunes our empathy. Strong Museum of Play Rochester, New York

Residential Care References Bettelheim, B (1950) Love is not enough: the treatment of emotionally disturbed children Glencoe IL: Free Press Fanshel, D and Shinn. E B (1978) Children in foster care: a longitudinal investigation Guildford: Columbia University Press Ladd, G W (2005) Children’s peer relations and social competence: a century of progress London: Yale University Press. Taylor, D and Alpert. S W (1973) Continuity and support: following residential treatment New York: Child Welfare League of America Weiss, R S (1986) Continuities and transformations in social relationships from childhood to adulthood In W W Hartup and Z Rubin (Eds) Relationships and development, pp. 95 -110 Hillsdale NJ: Lawrence Erlbaum. Winnicott, D W and Britton, C (1957). Residential management as treatment for difficult children In D W Winnicott (Ed. ) The child and the outside world: studies in developing relationships Chapter II: 6, pp. 98 -116 London: Tavistock Wolins, M (1973) Some theoretical observations on group care In D M Pappenfort, D M Kilpatrick and R W Roberts (Eds) Child caring: social policy and the institution Chicago: Aldine