PLAY THERAPY AND THE PLAY ROOM Lisa Cowart

PLAY THERAPY AND THE PLAY ROOM Lisa Cowart LPC-S, RPT-S, NCC

COMMUNICATION IN PLAY THERAPY Toys and Materials = words Play = language The toys and materials serve a purpose If the toy does not have purpose then probably not appropriate like questions in a session Developmentally appropriate and allow for mastery of taskexpression, self-control, communicating feelings

COMMUNICATION IN PLAY THERAPY Mastery can occur in the play therapy before able to master in real world Play can help bridge gap between abstract concepts and concrete cognitions Allow for emotional expression Allow for reenactment and resolution

THEORETICAL ORIENTATION

HAVE YOU DECIDED Directive? Non-directive?

RESEARCH AND PLAY THERAPY Golding did research and found that CBT as well as nondirective psychodynamic and child-centered play therapies are effective for treating a variety of childhood mental health disorders (2016. ) So directive and nondirective are proven effective treatment modalities. Most importantly therapeutic alliance between therapist and child and caregiver impacts positive outcomes as much if not more than theoretical orientation chosen (Golding, 2016. ) Two other factors that contribute to positive outcomes are parental involvement and duration of therapy. (Reddy, Lisa A. , Files-Hall, Tara, R. , Schaefer, Charles. )

Consider which approach would best fit your clients need and treatment plan. Get training and supervision and consultation in the approaches you wish to use. Understand the purpose behind theory you chose.

INTRODUCING PLAY THERAPY ROOM

INTRODUCING PLAY ROOM TO PARENTS Intake with just parent to educate play therapy and power of play, how used, philosophy behind it, buy in to support you Express thoughts, feelings in constructive way and control behaviors and make decisions and accept responsibility (Landreth, 1991 149) Not questioning children about what they did Will meet with them before session if have concerns or schedule another meeting

INTRODUCING TO PARENTS OR CAREGIVERS Update from your philosophy of non-directive verses directive Respecting the process and discussing when they should expect updates Confidentiality and when it is broken and not specifics Special time not to be ended early i. e parent knocking on door Noises ok crying loud Remind parents to take child to bathroom in advance, not to send food, or electronics

INTRODUCING TO KIDS What you say to me is private but you can share what we say with whoever you wish When will break confidentiality Work together as team and collaborate Theoretical orientation will impact Let children know they can do most of what they would like to do in the play room They are coming because someone is worried or concerned about them

DIRECTIVE PLAY THERAPY Introduces the play room and has more specific interventions, activities, and toys they use to work on the child’s presenting concern. This type of therapist may provide homework. Like journaling or practicing techniques learned like mindfulness or certain coping skills or emotional regulation. Glow in dark pinwheels, blowing bubbles, stress balls, belly breathing. Therapy maybe less in length than non-directive therapy. Therapist may pick and choose to not include kitchen or doll house etc. Therapist chooses supplies that work for child and work for therapist such as games or stories or sand or art. More selective.

NON-DIRECTIVE PLAY THERAPY Introduce the playroom as this play room has many things you can do and the play room is a safe place. The non-directive therapist follows the child’s lead and tracks, reflects, and summarizing all the while know the child will go where they need to go in therapy and the child has the capacity to heal by being in a safe place with a safe therapeutic person. The non-directive therapist practices unconditional positive regard (accepting without judging), genuineness, empathy. The therapeutic relationship is a tool.

SUPPLIES BE SPECIFIC AND ALIGN WITH THEORETICAL ORIENTATION Puppets Sand Kitchen Games Miniatures Art supplies Books Doll House

TYPES OF TOYS

WHAT MADE YOU CHOOSE THIS TOY Purpose Directive Nondirective Elicit mastery Allow for expression of feelings To relate better with child For assessment For psychoeducation

TYPES OF TOYS FOR PLAY THERAPY LANDRETH Real life (cash register, phone) Expression (puppets, art) Acting out (daily things that occur in their life or maybe their trauma) Emotional release (bop bag)

TOYS DO NOT HAVE TO BE EXPENSIVE Dollar store Garage sells Your children’s old toys or kitchen or easel Facebook your friends Real empty cereal boxes

DO NOT FEEL YOU HAVE TO HAVE LARGE AMOUNTS Less can be better and less overwhelming Kids are good at pretending and creating what they need You can get by with few essentials

PUPPETS NONDIRECTIVE PLAY THERAPY Allow client expression of feelings in a safe way Allows client expression of aggression in safe way Allows client reenacting Allows client resolution and problem solving Allows a way for client to distance self Allows for therapist to summarize Allows therapist to reflect feelings Allows client to feel understood

PUPPETS DIRECTIVE PLAY THERAPY Allows for modeling by therapist Allows for problem solving to be introduced by therapist Allows for therapist to normalize and validate feelings Allows for psychoeducation Allows for story telling

TYPES OF PUPPETS Variety of animals Alligator so can express biting and aggression Snakes to express sneaky and mischievous Most helpful if mouth moves Different kids of people

DRESS UP IN PLAY THERAPY Allows for creative expression- nondirective Allows for role playing- directive Allows for modeling-directive Allows to explore nurturing-nondirective

DRESS UP IN PLAY THERAPY Mask Hats Police Fire fighter Doctor Jewelry Purse Boa

DOLLS IN PLAY THERAPY Allows for nurturing Allows to show caregiving at home Allows to show needs

DOLLS IN PLAY THERAPY Baby bottle Blanket Clothes Diapers Pacifier Gumby nondescript figure

KITCHEN IN PLAY THERAPY Allows for nurturing Allows for communicating needs Allows therapist insight into home Allows for nutritional assessment

KITCHEN Cups Plates Pans Food Kitchen set Empty boxes of real food items

REAL LIFE Phone Cash register Computer Wallet Money

QUESTIONS AND COMMENTS

SAND Types of sand Moon sand kinetic sand Jurassic sand- claim to be dust free and dye free Sand from home improvement stores Some say adding few drops of water keeps dust down Colors of Sand

SAND IN PLAY THERAPY Allows for metaphors A way to distance self Allows a way to express hiding a secret No right or wrong way to play with sand Can use as non-directive or directive

PROMPTS Create a world in the sand Have the client make a tray representative of a presenting concern or problem Have the client use the tray and figures to represent their family or a school environment What would you like your future to look like

PROMPTS Distancing- suggest client build a scene of a boy who was left out by his friends Create a world of before and after- like before the abuse or after the abuse Create a world of the scariest thing that has happened Create a timeline of your life Create a world of the way you would like your life to be

QUESTION OR EXPLORE Have client describe their world Ask open ended questions like I am wondering who is the strongest Point out I notice this is all the way over here I notice this looks separated from the rest If you were to name world what would you name it? I am noticing that you are not in this world Who in this world might be your allies or helpers or support

SAND TRAY IN PLAY THERAPY Variations of size Blue bottom Water or no water allowed Tub Wooden table With top or without Small pool

MINIATURES Debate as to whether to use identifiable verses not identifiable like Disney Metaphors Usually around 2 -3 inches

ANIMALS Variety of animals Zoo Domestic and farm Wild Birds Insects Sea life

PEOPLE All ages and sizes Brides and grooms Special needs Occupations Ethnicities Sports figures Religious or spiritual figures Army figures Heroes Victims and survivors Villains or dark figures Emergency or rescue figures or helpers

FANTASY Witches Wizards Wishing well Treasure box Unicorns Dragons Magic stones Fairies

TRANSPORTATION Cars Trucks Boats Emergency vehicles Motorcycle

HOUSES OR BUILDINGS Light house Schools Church House Castle Fire house Police station Hospital

OTHER Rocks connector or boundary Bushes Bridges connector Flowers Fences boundaries Rocks Treasure boxes Volcano Trees Mountain Nurturing

POPULATIONS AND SAND TRAY Adults Families Siblings Groups Individuals

SAND TRAY SUPERVISION OR CONSULTATION Cases stuck on Cases struggling with To help recognize countertransference Gain insight

QUESTIONS AND COMMENTS

ART IN PLAY THERAPY Allows for mastery Allows for expression of helplessness or inadequacy Allows for expression of connectedness Allows for expression of isolation Allows for expression of chaos or harmony

ART SUPPLIES IN PLAY THERAPY Crayons Colored pencils Markers Variety of sizes of paper including butcher block for tracing Fresh paints finger paints or no finger paints Paint brushes Glitter or no glitter Egg crates Play dough or clay or model magic

ART SUPPLIES Scissors Glue Tape Beads- necklaces, bracelet for reminders of coping skills String- boundaries Pipe cleaners- how close like others Autograph stuffed dog-self-esteem, positive traits and add

ART SUPPLIES Washable Storage Safety- nontoxic and sharp objects Table Easel

DOLL HOUSE IN PLAY THERAPY Used to act out concerns at home Nurturing themes Abuse and neglect Role of the family What does their world look like at home

AGGRESSIVE TOYS IN PLAY THERAPY Allow for expression of anger Allows for expression of frustration Allows for expression of power or control Allows for expression of mastering i. e. perp Allows for expression of hostility Allows for expression of humiliation Allows for expression of shame

AGGRESSIVE TOYS Hand cuffs- power and control Guns Knives Swords Bobo doll or bop bag Punching bag Rope Target board Jail Blocks build knock down

SELF SOOTHING EMOTIONAL REGULATION TOYS Allows for expression of feelings Allows for mastery Allows for power and control Allows therapist a way to teach coping skills and emotional regulation Allows therapist a way to redirect toward healthy coping skills

SELF-SOOTHING EMOTIONAL REGULATION IN PLAY THERAPY Sand Squishy balls- balloons rice and beans and flour Stuffed animals Rain stick Feathers Music Drumming Stuffed animal on stomach Bubbles Pin wheel

EMOTIONAL REGULATION Feeling card game Butcher block paper Feeling faces on wall Feelings Jenga, Social skills Jenga, Communication Jenga Coping skills games Balls

MEDICAL SUPPLIES IN PLAY THERAPY Allows for psychoeducation of surgery Allows for mastery Allows for child to communicate hurting emotionally or physically

MEDICAL SUPPLIES IN PLAY THERAPY Band aides Medical mask Doctor kit Directed toward doll not therapist Needles Gown Bandages Gloves Stethoscope Real and pretend

PAIN MANAGEMENT IN PLAY THERAPY O’CONNER, SCHAEFER, BRAVEMAN Goal- decrease anxiety and improve control and mastery Psychoeducation reduces acting out with treatments Deep Breathing- stuffed animal Muscle relaxation Guided imagery- 5 senses, smell Distraction- active not passive, I spy books, young mobiles, games, dev. appr. , wiggle toes, bubbles

MASTERY TOY IN PLAY THERAPY Blocks Tools Hammer, nails Link chains

GAMES IN PLAY THERAPY Non-directive therapist would say no to most games as it puts child in role to have to as therapist to manipulate and could place therapist in role of competitive or need to not be genuine Direct would want games Allows for safe place to win and lose Allow for feeling identify and exploring Allows for exploring coping skills Allows for modeling Allows for assessing Relationship building

GAMES The Ungame- communication and social skills Feeling card game Chutes and ladders- social skills winning and losing Candy land- feelings Uno and Ungame mixed together- if answer Ungame question then use as wild card Worry Web- ball of yarn, pull out how big worry is, label, put all over room to conceptualize how much space taking up in their life, process, challenge, and cut shorter as you do, pullout smaller strings 3 or 4 sessions later and see if they remember the fears sometimes they don’t realize they don’t have them anymore

GAMES IN PLAY THERAPY Social and emotional competence game Coping skills game- coping skill person used or think they should use Stop, Relax, and Think- impulsive children Bounce off- feeling faces Look up self-esteem shop- many types Hiding rocks in sand putting questions- when find must answer Trouble- land on odd answer question and even move forward Ping pong ball- feeling words and when ring basket describe time felt that way

STORIES IN PLAY THERAPY Liana Lowenstein Fill in the blank animal stories i. e. parents fighting a lot and he feels _____. And he wishes_______. And he does_______. Child interjects feelings. Brainstorming occurs and begin identifying current coping and new coping skills. Paper dolls and airplanes- Kits story cat tangled in yarn

PLACE TO SHIELD OR HIDE Divider Kitchen set away from wall Puppet theater Shield

DRY ERASE BOARD Kids will play out school themes struggling with Use for CBT List Can erase quickly because hard subject Psychoeducation

MOVEMENT Scarves Balls Dance Experiential Drumming

HOLIDAYS- CRAFTS AND GAMES Thanksgiving tree- gratitude associated with resilience Valentines to self- how special and why loved Egg hunt- in office and put questions in eggs for them to answer when they find a piece of candy Halloween- scary faces, places and things

BOOKS IN PLAY THERAPY Bibliotherapy Stories Prevention education Work books Selective and serve a purpose

MOBILE BAG ESSENTIALS IN PLAY THERAPY Allow for expression Small box of sand, rice, beans, top for it Box of Animal figures, people, fences, trees Small box of Crayons and paper, scissors Ball 3 Puppets

FIDGET TOYS Box in office – helps with ADHD and anxious children Small sand garden Squishy balls Mandalas to color

CLEANING SUPPLIES FOR PLAY THERAPY TOYS Hospital have specific Lysol Clorox Tissues Paper towels Vacuum Broom Trash can Sink or water

QUESTIONS AND COMMENTS

DOCUMENTATION

DOCUMENTATION IN PLAY THERAPY Forms Camera Themes Allow for time to clean up and doc Treatment Planning

THEMES OF THE ACTUAL TOYS PLAYED WITH Doll House Sand Transportation Blocks Army men Medical Dress Up Kitchen

PLAY THEMES (UNIVERSITY OF NORTH TEXAS, COUNSELING PROGRAM) Relationship Exploratory Power/Control Helplessness/ Inadequate Aggressive/ Revenge Safety/ Security Mastery Nurturing Loss Sexualized

FEELING THEMES Happy Confident Sad/ Depressed/ Hopeless Hesitant Hopeless Ashamed Isolated Embarrassed Angry Curious Afraid/ Anxious/ Fearful Flat Vulnerable Restricted Helpless Intrigued

COPING 0 -10 (UNIVERSITY OF NORTH TEXAS, COUNSELING PROGRAM) Maladaptive (0) Sad/depressed/angry/fearful Adaptive (10) Content/ satisfied Angry/insecure Confident/secure Dependent/needy/clingy Autonomous/ independent Immature/regressed Age appropriate Low frustration tolerance High frustration tolerance External locus of control Internal locus control or self control Impulsive/ distracted Purposeful/focused Inhibited/ constricted Creative/ expressive Isolated/ detached Connected/ sense of belonging

OTHER THINGS TO NOTE Intensity of play 0 -10 scale Child initiated Therapist initiated Limits set Safety concerns addressed/plan Interaction with therapist

WATCH OUT FOR BURN OUT As with any therapy play therapy can be exhausting if you are being fully present Challenging very difficult work Time consuming talking with parents, teachers, lawyers Liability Energy

SELF-CARE AND PLAY THERAPY Have a routine of leaving the office and letting go Meditations Clear boundaries of returning calls with clients and staff Mindfulness Have a plan walks, crafts, time to laugh Take care of your needs-doc appointments, time with family, Consult frequently Address transference issues Gratitude journals

QUESTIONS AND COMMENTS

REFERENCES Golding, Jacqueline M. (2016). Evidence-based Child and Adolescent Psychotherapy: It’s not what you think. Journal of Paediatrics and Child Health Landreth, Gary (1991) The Art of the Relationship https: //www. apa. org/pubs/books/4317066 s. pdf Reddy, Linda A. , Files-Hall, Tara R. , Schaefer, Charles. Announcing Empirically Based Play Therapy Interventions for Children. https: //digital. library. unt. edu/ark: /67531/metadc 4330/m 1/103/, University of North Texas, Counseling Program.

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