Publications

2017 – Play Therapy

“Play and exploration are crucial activities for young children. They help the child’s brain develop in optimal ways… Play and exploration grow the brain – healthy play and exploration grows healthy brains.” Perry, Hogan & Marlin, 2000

Phoenix has made play therapy avail­able to children and families impacted by child sexual abuse for a number of years. Play therapy is a form of counsel­ling that is appropriate for very young children and may also be an effective intervention for older children. We have a well-appointed play therapy space, with carefully selected play and expres­sive materials, to support each child that we see in their journey towards healing and recovery.

Abuse related trauma that occurs in childhood often happens within the context of a relationship. Because chil­dren depend on safe and secure adult relationships for survival and develop­ment, abuse related trauma that occurs during critical periods of a child’s devel­opment is also known as developmental trauma. Developmental trauma changes children’s’ physiology, brain architecture and the responses of their nervous sys­tem when under stress (Australian Child­hood Foundation, 2017).

Play therapy is a form of early interven­tion for children with developmental trauma that “enhances every domain of a child’s development” (Perry, 2001, p. 24). Research has shown that children who participated in long term play ther­apy demonstrated significant improve­ment in cognitive, social and emo­tional domains as well as an increase in self-regulation and self-esteem (Muro, Ray, Schottelkorb, Smith, & Blanco, 2006).

This article considers the ASCA prac­tice guidelines for working with complex trauma, prepared by Kezelman & Stav­ropoulis (2012), with a focus on how play therapy speaks to these guidelines. At Phoenix, how do our child centred coun­selling practices match up with the ASCA practice guidelines?

1. Facilitate client safety

The starting point for play therapy with children at Phoenix is to build a thera­peutic partnership with parents + carers (more about this in guideline # 6) and to establish a therapeutic relationship of safety and trust with each child. Play therapy is a relationship-based inter­vention.

2. Recognise the centrality of affect-regulation (emotional management; ability to self-soothe) as foundational to all treatment objectives and consistently foster this ability in the client

Within a safe play therapy space, chil­dren are able to express themselves in ways that they may not be able in other contexts, such as school and home. They are able to express or ‘play out’ big emo­tions and big behaviours with safety and acceptance. The experience of develop­ing an understanding of emotions within the context of a secure (therapeutic) relationship helps children to learn to regulate their emotions independently (self-regulation) and to seek out support when they need assistance in times of distress (co-regulation) (Australian Child­hood Foundation, 2017).

3. Recognise the breadth of functioning impacted by complex trauma and that acquisition, not just restoration, of some modes of functioning may be necessary.

Play therapy allows children to make meaning from their experiences through play, rather than through words. In doing so, they build up their suite of coping strategies in ways that are self-directed and meaningful to them.

4. Regard symptoms as adaptive and work from a strengths-based approach which is empowering of the client’s existing resources

‘Symptoms’ of trauma, such as express­ing ‘big’ emotions and ‘big’ behaviours, can often be misunderstood as ‘misbe­haviour’, ‘hyperactivity’ or being ‘easily distracted’. Through a developmental trauma lens, we understand that some of these symptoms are adaptive and have helped children to tolerate and survive their trauma experiences. Play therapy provides opportunities for children to enhance their coping skills.

5. Understand how experience shapes the brain, the impacts of trauma on the brain (particularly the developing brain) and the physiology of trauma and its extensive effects

Through play therapy, children build new understandings of themselves within the context of the therapeutic relationship. They learn that their ‘big’ behaviours and emotions are tolerable to others, thereby making these ‘big’ emotions more tolerable for children and normal­ising these trauma impacts. Through play, children experiment with new ways to manage ‘big’ emotions and develop their problem-solving capacity. Because this occurs in a child-led manner, it has profound developmental impacts such as the creation of new neural pathways, expanding capacity for self-regulation and strengthening overall sense of com­petence, mastery and self-integrity.

6. Encourage establishment/ strengthening of support networks

Throughout each child’s engagement in play therapy at Phoenix, the child’s coun­sellor fosters a ‘therapeutic partnership’ with parents and carers. This strength­ens a child’s support networks in mul­tiple ways, such as through supporting parents to build healthy parent-child attachment and through opening up referral pathways for families. Parents or carers attend Caregiver Consultations with their child’s counsellor at regular intervals throughout their child’s play therapy journey.

7. Attune to attachment issues at all times and from the first contact point

Within the context of a safe and trust­ing therapeutic relationship, children are able to experience themselves in new ways: ‘I am valued’, ‘I am seen’, ‘I am lis­tened to and respected’, ‘my choices are important’, ‘my voice is valued’.

8. Understand and attune to the prevalence and varied forms of dissociative responses, the differences between hyper and hypoarousal, and the need to stay within `the window of tolerance’

Children have increased capacity to cope with every day stressors when they build their capacity to regulate strong emotions. Over time their body’s stress response system can become more calm and receptive (see also guideline # 5).

9. Expect and be prepared to work with a variety of client responses, including a sense of shame which may not be readily apparent but which is frequently present and intense

When children become dysregulated, outwardly expressing ‘big’ behaviours and ‘big’ emotions, this can be over­whelming for them and for the adults in their world. When they are unable to draw upon safe adult relationships to co-regulate and regain a sense of safety, this can trigger shame. When children feel shame, they feel that they are ‘bad’. Play therapy supports children and their carers to understand these big emotions and behaviours, increasing capacity for tolerating distress, co-regulating, restor­ing and strengthening relationships. Children learn that they are valued and valuable.

10. Embed and apply understanding of complex trauma in all interventions

As with all of the interventions we use at Phoenix, play therapy is underpinned by an understanding of the impacts of developmental trauma and complex trauma.

11 Ensure the therapeutic model/ approach promotes integration of functioning, and contains the `core elements’ consistent with research findings in the neurobiology of attachment

Play therapy supports cognitive, emo­tional and sensorimotor processing as children work through and make mean­ing from their experiences. Each child sets their own pace and is supported within the safe space of the therapeutic relationship.

12. Recognise the extent to which he above requires adaptation of, and supplements to, `traditional’ psychotherapeutic approaches (ie insight-based and cognitive behavioural)

Play therapy provides children with the space to choose how they want to ven­tilate strong emotions and make mean­ing from their experiences. They may use words, roleplay, image making, singing, games (whereby they set the rules), even solitary play.

13. Phased treatment is the `gold standard’ for therapeutic addressing of complex trauma, where Phase I is safety/stabilisation, Phase II processing and Phase III integration.

During their play therapy, children move through distinct therapeutic stages: Phase 1 is relationship building, estab­lishing safety and trust; Phase 2 includes the expressive and nurturing stages, where children increase their tolerance and regulation of strong emotions and build a sense of self-identity; Phase 3 is where we see mastery, integration of these new skills in broader life contexts and self-integrity.

14. Therapy should be tailored and in­dividualised; `one size does not fit all’

As play therapy is child-led and child-di­rected, it is a completely unique thera­peutic process for each individual child.

15. Therapists should be culturally competent and sensitive to gender, sexual orientation, ethnicity, age, and dimensions of `difference’

Counsellors at Phoenix undertake reflec­tive practice, developing their awareness that counselling (including play therapy) needs to be culturally responsive and sensitive to the diversity of our shared humanity.

16. Engage in regular professional supervision

All clinicians at Phoenix participate in both individual and group supervision for their clinical practice, reflection and growth. Supervision and clinical con­sultation with an accredited play ther­apy supervisor is also completed on a monthly basis.

17. Attend to duration and frequency of sessions

Fortunately, our sessions are not time-limited at Phoenix. That said, there are distinct phases that children move through in play therapy including a clear ‘ending’ phase. Child complete their play therapy at differing rates.

18. Recognise the importance of implementation of boundaries

Limit setting is an integral therapeutic component of play therapy. It provides safety and structure to the play session, teaching children that there are some things they cannot do and that we will protect them from: hurting themselves, hurting the counsellor, damaging the materials/room. When children under­stand these limits and boundaries, they build a sense of being able to rely on the safety of themselves, the counsellor and the play therapy space. During Care­giver Consultations, parents and care­givers are also taught how to set clear limits with their children in a relational and empathic manner.

19. Engage in collaborative care as appropriate

Working collaboratively with families is central to supporting children at Phoe­nix.

20. Facilitate continuity of care as appropriate

Endings are managed sensitively in play therapy. Children know in advance that the end of play therapy is approaching. For example, they will know that they have 5 sessions to go and they partici­pate in the count down towards the final session. This allows children a sense of control and ownership over their thera­peutic ending. Where this is not possi­ble, appropriate referral pathways may be explored with families.

21. Diversity of clients means that recovery, too, is diverse

Every child’s journey toward healing and recovery is exquisitely individual and play therapy is a form of counselling that priv­ileges each child’s voice and honours their individual process. Play therapy is grounded in the practice of ‘noticing’ children and letting them know they are seen, heard and understood. It is non-evaluative and lets children know we see their efforts and notice their curiosi­ties, we hear their words and behaviours and want to understand what they are communicating to us. ‘Noticing’ children respects the whole person of the child. Children “need to be simply noticed… appreciated for who they are right now. No woulds, ‘Wouldn’t it be nice if you just…’ No coulds. ‘I’d be really proud if you could…’ No shoulds, ‘You know you should try harder to…’ There will always be a million things that would, could or should be, but only one unique and pre­cious miracle of a life right there in front of you this very moment” (Ferguson, 2002, p. 15).

CARLEY MORRELL SENIOR COUNSELLOR & PLAY THERAPIST

For more information about Play Therapy:

• apta.asn.au/about-play-therapy What Is Play Therapy? – Australian Play Therapists Association
• www.psychology.org.au/ inpsych/2015/june/short Play Therapy: Working Creatively With Children – Australian Psychologi­cal Society (InPsych article)
• evidencebasedchildtherapy.com Evidence Based Child Therapy Resources – Evidence Based Child Therapy website

References:

• Australian Childhood Foundation (2017). Graduate Certificate in Devel­opmental Trauma [PowerPoint slides]. Retrieved from Australian Childhood Foundation, 7 June 2017.
• Ferguson, S. B. (2002). What parents need to know about children. Ludic Press: Dallas, Texas.
• Kezelman, C., & Stavropoulis, P. (2012). ‘The Last Frontier’: Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery. Adults Surviving Child Abuse (ASCA): Funded by the Australian Government Department of Health and Ageing.
• Muro, J., Ray, D., Schottelkorb, A., Smith, M. R., & Blanco, P. J. (2006). Quantitative analysis of long-term child-centered play therapy. Interna­tional Journal of Play Therapy, 15(2), 35-58.
• Perry, B. D. (2001). The importance of pleasure in play. Scholastic Early Childhood Today, April, 15(7), 24.
• Perry, B. D., Hogan, L., & Marlin, S. J. (2000). Curiosity, pleasure and play: A neurodevelopmental perspective. Haaeyc Advocate, June,2-6.

View all Articles