Integrating Play Therapy and EMDR with Children - PowerPoint Presentation

Slide1

Integrating Play Therapy and EMDR with Children

Introduction

Play Therapy and EMDR (eye movement desensitization and reprocessing) balance the interplay of opposites

Right hemisphere (experiential)

Left hemisphere (cognitive)

Play therapy and EMDR allow for both physical and mental (cognitive) expression

Themes in play therapy become targets in EMDR

Play therapy and EMDR with traumatized children

Meet with parents first to explore traumatic event from parents’ perspectiveSlide2

Integrating Play Therapy and EMDR

with Children

Play therapy and EMDR with traumatized children (cont.)

Select themes (i.e., targets) to focus on and can be accessed through

Pictures and drawings (i.e., art)

Sandtrays

Verbalizations

Parent observations

EMDR requires more verbal feedback than play therapy, but feedback can be titrated experientially to limit discomfort

In the second session, both child and parents are invited into the playroomSlide3

Integrating Play Therapy and

EMDR

with Children

Techniques used

Nondirective play therapy

Teach the word “stop!” with appropriate hand gesture

Always start with helping the child create a “safe place” or a “peaceful or happy place.”

Hand-taps

Puppets

Toys

Thera

-Tapper

Child holds an imaginary remote control to fast-forward, skip, pause, delete memories or scenes too upsetting for themSlide4

Integrating Play Therapy and EMDR

with Children

Techniques used (cont.)

Assessment

Subjective units of distress (SUDS) – thermometer and distance between hands

Validity of cognition (

VoC

) – drawing events or feelings before processing and then after EMDR processing

Introduction of EMDR technique: “’I have a game that helps with nightmares or with the bad pictures in your mind or scary feelings in your body. This game helps to make these pictures and feelings change and make them better’” (p. 200).

Considerations before beginning

Child’s age (developmental level)

Any healing already?

Quality of support

Child’s temperament

R

esilienceSlide5

Integrating Play Therapy and EMDR

with Children

Techniques used (cont.)

Teach connections among thinking, feeling, and doing

Conduct guided meditation with the child

Choose number of remaining sessions and then say goodbyeSlide6

Utilizing Bibliotherapy

within Play Therapy for Children with Anxieties and Fears

Introduction

Definition of “

bibliotherapy

”: “the use of ‘literature to bring about a therapeutic interaction between a participant and facilitator’” (p. 208).

Children’s play tells a story

Three categories of

bibliotherapy

interventions

Therapist-initiated

Interactive (collaborative)

Child-initiated

Bibliotherapy

and children with anxiety concerns

Anxiety can be normal warning sign or pathological

Short-term, structured interventions such as

bibliotherapy

are indicatedSlide7

Utilizing

Bibliotherapy

within Play Therapy for Children with Anxieties and Fears

Bibliotherapy

origins and theoretical premises

Aristotle – emotional catharsis through literature

Historically, elders and parents have used literature

To guide decision making

To strengthen character development and moral reasoning

Theory of

bibliotherapy

Children identify with storylines and characters

Children realize they have similar problems

Children align with characters, their plight, and their solutions

Children are emotionally engaged in the struggle and work through their problems

Outcomes

Decrease in sense of aloneness or isolation

Achievement of insight about their own situationsSlide8

Utilizing Bibliotherapy

within Play Therapy for Children with Anxieties and Fears

Bibliotherapy

origins and theoretical premises (cont.)

Shrodes

(1950) identified three-step process of

bibliotherapy

Identification

Catharsis

Insight

Therapist’s task – facilitate growth through facilitating verbal expression of emotions, cognitions, and concerns

A dialogue about the story takes place about the characters in the story, their feelings, thoughts, and behaviors, and their issues without forcing child to verbalize concerns directlySlide9

Utilizing Bibliotherapy

within Play Therapy for Children with Anxieties and Fears

Bibliotherapy

and play therapy

Two primary practice categories of

bibliotherapy

Developmental (educational) – normal life transitions and stages

Clinical (therapeutic) – treatment plan, intervention, mental health paradigm, specific outcomes in mind

Most mental health practitioners use both categories

Other benefits of

bibliotherapy

Enhances self-awareness

Promotes clarification of values

Assists in development of empathic understanding

Increases understanding of other cultures, people, places, and times

Encourages flexibility and tolerance of differences

Trustful, warm bond develops

Recommends advice, problem solving, decision making

Provides a buffer for emotional intensitySlide10

Utilizing Bibliotherapy

within Play Therapy for Children with Anxieties and Fears

Bibliotherapy

applications – used with a wide range of psychiatric disorders

General guidelines – what will this book do for the therapeutic movement of my patient?

One size does not fit all

Contraindications of

bibliotherapy

Attention difficulties

Learning disabilities

Visual impairment

Academic trauma

Acquired reading phobiasSlide11

Utilizing Bibliotherapy

within Play Therapy for Children with Anxieties and Fears

Bibliotherapy

applications (cont.)

Book selection

Cultural, ethnic, and religious messages must be inclusive, accurate, and respectful

Factual material (e.g., health, history) needs to be correct and current

Selection of books with characters and situations similar enough to facilitate identification

Characters must provide constructive solutions and instill hope

Bibliotherapy

cautions

Not about teaching reading

Not all children like to read or be read to

Therapist might need to share materials with parents

Use materials already approved by school library Slide12

Utilizing Bibliotherapy

within Play Therapy for Children with Anxieties and Fears

Bibliotherapy

interventions

Processing read material occurs through discussion accompanied by play, drama,

sandtray

, or art to create therapeutic movement

Reading to younger patients (ages 3-8) yields the most gain

Other considerations for book selection

Structure

Subject matter

Reading level and developmental suitability

Length

Text and pictures

Diversity factors

Therapeutic use

Context and situation

Overall impression

Is this book a good match for my patient?

Reading assignments might be made

Bibliotherapy

playroom construction

Books easily seen, easily accessed

Pictures must be facing child

Maximum of 25 books displayed

Beanbag chairs create a reading or story cornerSlide13

Integrating Cognitive-Behavioral Play Therapy and Adlerian Play Therapy into the Treatment of

Perfectionism

Introduction

Perfectionistic

children

Self-critical behavior

Anxiety and depression

Perfectionism can have adaptive components – self-esteem and well-being not compromised in pursuit of goals

CBT concept of dysfunctional attitudes and Adlerian concept of inferiority or maladaptive perfectionism are similar

Cognitive-behavioral play therapy (CBPT)

Child is an active participant

Focus on child’s environment, thoughts, feelings, beliefs, and fantasies

Focus on strategies for the development of adaptive thoughts and behaviorsSlide14

Integrating Cognitive-Behavioral Play Therapy and Adlerian Play Therapy into the Treatment of

Perfectionism

Cognitive-behavioral play therapy (CBPT; cont.)

Structured, directive, and goal-directed

Use of empirically validated techniques

Use of techniques that can be readily evaluated

Four stages of CBPT

Assessment stage

Child’s current level of development and functioning

Child’s and parents’ perceptions of presenting problem

Introduction/orientation stage - use of parent consultation,

bibliotherapy

, structured tasks to facilitate the child’s understanding of the therapy process

Middle stage – interventions to assist the child in developing adaptive responses to problems

Modeling

Role-play

Art

Bibliotherapy

Semistructured

play with puppets

Termination stage – preparation for termination

Reinforce changes

Generalize changes to other settingsSlide15

Integrating Cognitive-Behavioral Play Therapy and Adlerian Play Therapy into the Treatment of

Perfectionism

Adlerian play therapy (APT)

People are socially embedded and have a need to belong

People are creative and self-determining

Behavior is goal-directed

Reality is experienced subjectively

Four phases of APT

Building egalitarian relationship with child (similar to child-centered play therapy) and meeting with parents

Exploring the child’s lifestyle

Child’s assets

Family constellation and atmosphere

Goals of misbehavior

Crucial C’s

Connecting with others (goal of cooperation)

Being capable (goal of self-reliance)

Counting or being significant (goal of contribution)

Having courage (goal of resilience)

Private logic (mistaken beliefs)Slide16

Integrating Cognitive-Behavioral Play Therapy and Adlerian Play Therapy into the Treatment of

Perfectionism

Adlerian play therapy (APT; cont.)

Four phases of APT (cont.)

Helping the child gain insight into lifestyle

Directive techniques – metaphor

Nondirective techniques –

metacommunication

(i.e., interpretation)

Reorientation and reeducation

Help child generate new behaviors outside playroom

Teach and practice new behaviors for outside playroom

Encourage child

Use of modeling, role-play, therapeutic metaphorsSlide17

Integrating Cognitive-Behavioral Play Therapy and Adlerian Play Therapy into the Treatment of

Perfectionism

Integration of theories

CBPT and APT can be more easily integrated than many other theories

CBPT and APT have similar concepts of the origins of pathology or distress

Dysfunctional thoughts (CBPT)

Mistaken beliefs (APT)

“Both theories target these assumptions, beliefs, and thoughts that may be outside awareness as the best avenue to change” (p. 232)

Phases of treatment in CBPT and APT are similar

Consultation with parents is important in CBPT and APT

Differences between CBPT and APT

APT places more emphasis on personality/lifestyle

CBPT places more emphasis on behavioral techniques (e.g., systematic desensitization)Slide18

Integrating Cognitive-Behavioral Play Therapy and Adlerian Play Therapy into the Treatment of

Perfectionism

Treatment

Puppet

sentence-completion

task (Knell, 1993)

“I am happiest when….”

“I am afraid of….”

Kinetic family drawing

Puppet or stuffed animal play and role-play

Metaphorical stories or structured play

Metacommunications

Help parents understand themes and how they can help shift child to more adaptive, helpful assumptions about self and world

Games with no clear winner