Originally posted in Psychology Today online, author unknown, 2019

www.psychologytoday.com/us/therapy-types/play-therapy

Although sometimes used with adults, play therapy is a psychotherapeutic approach primarily used to help children ages 3 to 12 explore their lives and freely express repressed thoughts and emotions through play. Therapeutic play normally takes place in a safe, comfortable playroom, where very few rules or limits are imposed on the child, encouraging free expression and allowing the therapist to observe the child’s choices, decisions, and play style. The goal is to help children learn to express themselves in healthier ways, become more respectful and empathetic, and discover new and more positive ways to solve problems.

When It's Used

Therapeutic play helps children with social or emotional deficits learn to communicate better, change their behavior, develop problem-solving skills, and relate to others in positive ways. It is appropriate for children undergoing or witnessing stressful events in their lives, such as a serious illness or hospitalization, domestic violence, abuse, trauma, a family crisis, or an upsetting change in their environment. Play therapy can help children with academic and social problems, learning disabilities, behavioral disorders, anxiety, depression, grief, or anger, as well as those with attention deficit disorders or who are on the autism spectrum.

What to Expect

The parent or caregiver plays an important role in play therapy for children. After conducting an initial intake interview with the parent, when the therapist collects information about the child, and, often, a separate interview with the child, the therapist can make an assessment prior to beginning treatment. An assessment allows the therapist to decide the best treatment approach for the child. In the playroom, the child is encouraged to play with very specific types of toys that encourage self-expression and facilitate the learning of positive behaviors. Arts and crafts, music, dancing, storytelling, and other tools may also be incorporated into play therapy. Play therapy usually occurs in weekly sessions for an average of 20 sessions lasting 30 to 45 minutes each.

How It Works

Play therapy responds to the unique developmental needs of young children, who often express themselves better through play activities than through verbal communication. The therapist uses play and other creative activities to communicate with the child and observe how the child uses these activities to express thoughts and feelings that are not expressed in words. There are two approaches to play therapy:

Nondirective play therapy is based on the principle that children can resolve their own issues given the right conditions and the freedom to play with limited instruction and supervision.

Directive play therapy uses more input from the therapist to help speed up results. Play therapists use both approaches, depending on the circumstances.

What to Look for in a Play Therapist

Play therapists are well-trained in child development, attachment, and the use of play as a way to communicate with children. The play therapist should also be trained in a recognized therapeutic approach, such as child-centered, cognitive-behavioral, Adlerian, or Gestalt therapy. In addition to finding someone with the appropriate educational background and relevant experience, look for a therapist with whom you feel comfortable working on personal and family issues.

For more on play therapy visit 

https://www.psychologytoday.com/us/blog/contemporary-psychoanalysis-in-action/201601/child-s-play-how-play-therapy-works

It can be difficult to explain how Eye Movement Desensitization and Reprocessing Therapy (EMDR) can help with trauma.  I want to share an article written by my EMDR consultant who is a pioneer in EMDR and attachment trauma.  I think she provides a comprehensive explanation for how EMDR works. If you have any unanswered questions or want to inquire whether EMDR therapy might be a good fit for you or your child please email [email protected]

How Traumatic Events are Stored in the Brain EMDR Debra Wesselmann, MS, LIMHP

Trauma survivors live with a difficult phenomenon that is sometimes referred to as “trauma time.” Trauma time is a phenomenon that has grabbed and deceived almost every survivor of trauma at one point or another. Francine Shapiro, Ph.D. explains that traumatic memories are stored differently than everyday memories. They remain in an unprocessed form, encapsulated in a separate neural network along with emotions, sensations, images, and perceptions that were present at the time of the trauma. This is actually a good thing in the big picture of survival, as the unprocessed memories keep the brain on “high alert,” ready to self-protect in the face of danger. “Mother nature” assumes that if we have experienced a traumatic event, we may be living in an unsafe environment. To survive in such a world, we must remain vigilant and reactive to suspicious sounds, smells, facial expressions, and actions. We can’t allow ourselves to be fooled by the passage of time, as the danger might be just waiting for us to let down our guard. Never mind that the original source of trauma is vanished. Never mind that we are older, wiser, or beyond its reach. These concepts mean nothing to the more primitive regions of the brain. “Forever vigilant” is the motto of the survival brain. Quality of life is of no concern to this part of the brain. After all, what is quality of life if there is no life? One, two, ten, twenty, or forty years after a trauma, a sound, a smell, or a sight may activate the unprocessed memory, either consciously or subconsciously. An immediate surge of stress hormones may flood the brain. The cortisol and adrenalin speed up the heart and breath and move blood into the limbs, making the body ready to fight or run. We may find ourselves arguing or hiding for no apparent reason. Under extreme duress, we may lose sight of the present and forget the passage of time. It is not uncommon for trauma survivors to feel suddenly much younger, to experience flashes of images from the past, or to mistake memories of sounds as if they are present and real. There is hope. To be effective, therapy must help trauma survivors strengthen their connection to the present and develop skills for staying centered, self-aware, and tolerant of strong emotions. After building skills, it becomes possible to safely address the “stuck” memories and integrate those memories with helpful information, a present-day orientation, and a present-day perspective on what happened. A trusted therapeutic relationship can provide needed safety and security for addressing the past. Therapeutic approaches that reach into the emotional region of the brain help integrate the present-day perspective with memories of the past, such as Eye Movement Desensitization and Reprocessing (EMDR). Eye movements are just part of the 8-phase protocol that activates processing centers in the right and left hemispheres of the brain. Art, music, poetry and other creative methods for expressing feelings also help reach into the emotional brain for integration and resolution.

You may have heard about mindfulness from a friend, in a self-help book or in your yoga class. There is a rapidly growing body of scientific evidence supporting mindfulness as a way to reduce stress and its negative consequences on the body and mind.

Mindfulness is also an effective way for tweens and teens to learn to cope with excessive worries, anxiety, perfectionism and everyday stress. How does it work? Training in mindfulness helps children recognize their own emotions and those of others, and promotes the development of skills to communicate feelings more effectively. By helping children recognize their emotions as they arise - anxiety, sadness, elation, boredom, anger, irritation - and the bodily sensations that accompany them, we are helping them learn to self-regulate. Emotions need to be identified before they can be managed.

Teenagers are particularly vulnerable to the negative consequences of emotionality. Important areas of the brain, responsible for mood regulation and impulsivity control are rapidly developing. These are the areas needed to facilitate coping with the grip of strong emotions that accompany this period of development. Mindfulness practice can help teenagers learn to befriend themselves and explore their inner worlds with compassion and self-awareness. Stress also impacts the development of the regions of the adolescent brain responsible for executive function, working memory and emotional regulation. Since these functions influence the ability to learn, it makes sense that providing children with mindfulness tools to promote self-regulation, stress reduction and the ability to sustain attention will ultimately help to improve academic performance.

Although emphasis on academic achievement is the focus in most school settings and in some families, current research illustrates that social and emotional wellbeing are inextricably linked in the attainment of academic outcomes; academic success depends on the foundation of emotional wellness.

The best way to get tweens and teens interested in mindfulness is for you to explore the practice. Model an awareness of your own emotionality and look for ways to manage stress that can also promote present-mindedness. This can be done in everyday activities: in our parenting, our meal preparation, in our hobbies and interests. Explore the work of Jon Kabat-Zinn to learn more about mindfulness and visit www.mindfulnesscds.com for information on his audio materials.

Carol Alexander and her colleague Shahla Mazlouman MA, RCC are offering Learning to Breathe – Mindfulness for Tweens and Teens. It is a six-week course helping adolescents develop tools for coping with anxiety, perfectionism, excessive worries, improving relationships, developing empathy and enhancing personal awareness. Email [email protected] or call 604-551-3365 for registration or more information.

Over seventy years ago, Dr. Carl Rogers first presented his revolutionary theory of unconditional positive regard at a conference for educators and psychologists at the University of Minnesota (Raskin, Rogers & Witty, 2011). Dr. Rogers hypothesized that acceptance was the basis for mental health and rejection was the basis for psychological disturbances. Accepting your child as they are is one of the most powerful influences on a child’s emotional well-being. Children who are raised in an environment where they feel total acceptance for who they are and how they feel at any given time, are more likely to feel loved and valued and internalize that feeling of self acceptance. You might be reading this and thinking “wait does this mean my kid can do whatever they want?” No! Accepting your child and their FEELINGS is not the same as accepting BEHAVIOURS. At Connecting Parents and Children we counsel parents on how to incorporate acceptance into the parent child relationship while managing behaviours and setting reasonable limits at the same time.

A child’s concept of self is shaped through their relationship with their primary caregiver. Most parents, if not all profess to love their children – however we know simply loving children is not enough. Children need to be loved unconditionally for who they are in order to develop into healthy, fully functioning adults. Parental acceptance allows the child to feel valued which in turn helps to develop a more caring attitude toward him or herself leading to an internalization of self worth. Counselling parents on how to use the Rogerian principle of unconditional positive regard provides them with an additional parenting strategy, while promoting a way of relating that encourages optimal development of a healthy sense of self worth and a more solid parental foundation for the adolescent years.

The premise of this approach is that a child’s self concept emerges through his/her interaction with caregivers. In ideal conditions a child’s feelings should be fully accepted and respected by their caretakers, although certain behaviours not permitted (Fernald, 2000). Research has demonstrated a strong association between parental rejection and children’s psychopathology (Coleman , 1956). Rejection of a child’s feelings not only hurts the child’s concept of self, but also serves to undermine the feelings of relatedness the child has for his or her parents as well as results in a sense of alienation from the child’s authentic self (Dwairy, 2009). Children learn that some parts of their selves are best rejected and repressed or erased from their consciousness (Winnicott, 1965). Getting children to behave based on parental acceptance works in the short term but can have damaging long term consequences. Children parented in this way are more likely to feel stressed and conflicted by the internalization of parental expectations, exhibit a rigid and low quality performance in the domain in which the parents regard was contingent, have an overall poor sense of well being, and display a negative affect in relation to themselves; children who received conditional approval were more likely to act as their parents wanted but the compliance came at a steep price. These children tended to resent and dislike their parents, reporting their happiness after achieving something was short lived, and that they often felt guilty and ashamed (Assor & Roth, 2007). Lack of parental emotional support during childhood was associated with increased levels of depressive symptoms and chronic health problems in childhood (Shaw et al., 2004).  Cross-cultural research has found that in various cultures, children who were rejected by their parents were more aggressive and had a more negative view of the world than the non-rejected children (Rohner, 1975). Parental rejection has consistent negative effects on the psychological well being of children across race, ethnicity and culture constituting a dangerous factor affecting people’s mental health (Rohner, 1975).

Research by Shaw, Krause, Chatters, Connell and Ingersoll-Dayton (2004) explored the relationship between receiving parental emotional support early in life and an individual’s physical and mental health in adulthood. Parental emotional support was defined as gestures of caring, acceptance and assistance expressed by a parent toward a child. A study by Ross, Morowsky and Goldsteen (1990) found that adolescents who rated their parents high on parental support felt cared for, loved and valued which they then internalized as a feeling of self worth. Wickrama, Lorenz and Conger (1997) reported higher parental support was associated with few psychological and physical problems in adolescence.

Neuroscience research on the developing brain has shown the mind develops within the context of relationship. The parent child relationship is the most significant environment in a young child’s life and a positive parental influence can have a profound impact on brain development. Further, coherent interpersonal relationships have the power to produce coherent neural integration within the child, which is at the root of adaptive self-regulation (Siegel, 2001). Neurobiological research shows us that parenting in this accepting way builds brains, and that neural connections that are necessary for healthy emotional functioning are created with positive, nurturing experiences between the parent and child.

At Connecting Parents and Children we can show you how to create a parental connection that focuses on acceptance of who the child is, not how they behave, creating an optimal relationship for the child to grow and realize his or her full potential.

References

Assor, Avi & Roth, Guy. (2007). The harmful effects of parental conditional regard. Scientific Annals of the Psychological Society of Northern Greece, 5. Retrieved from www.hsf.bgu.ac.il/edu/files/eduhome/segel/avi_assor/harmful_conditional_regard_07.pdf

Coleman, J.C. (1956). Abnormal psychology and modern life. New York: Scott Foresman.

Dwairy, Marwan. (2009). Parental acceptance-rejection: a fourth cross-cultural research on parenting and psychological adjustment of children. Journal of Child and Family Studies, 19(1).

Fernald, P.S. (2000). Carl Rogers: Body-centered counselor. Journal of Counseling & Development, 78 (2).

Raskin, R., Rogers, C. & Witty M.C. (2011). Client-centered therapy. In R. Corsini & D. Wedding (Eds.), Current psychotherapies (9th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.

Rogers, C. (1959) A theory of therapy, personality and interpersonal relationships, as developed in the client-centered framework. In S. Koch (Ed.), Psychology: A study of a science. (pp. 184-256). New York: McGraw-Hill.

Rogers, Carl R. (1979). The foundations of the person-centered approach. Education 1000(2).

Rogers, Carl, R. (1992). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting & Clinical Psychology, 60(6).

Rogers, Carl, R. (1995). What understanding and acceptance means to me. Journal of Humanistic Psychology, 35 (4). Rohner, R.P. (1975). They love me, they love me not: A worldwide study of the effects of parental acceptance and rejection. New Haven, CT: HRAF Press.

Ross, C. E., Mirowsky, J., & Goldsteen, K. (1990). The impact of the family on health: The decade in review. Journal of Marriage and the Family, 52, 1059-1078.

Shaw, B. A., Krause, N., Chatters, L. M., Connell, C. M., & Ingersoll-Dayton, B. (2004). Emotional support from parents early in life, aging, and health. Psychology and Aging, 19, 4-12.

Siegel, Daniel. (2001). Toward an interpersonal neurobiology of the developing mind: Attachment relationships, “mindsight”, and neural integration. Infant Mental Health Journal, 22(1-2).

Wickrama, K. A. S., Lorenz, F. O., & Conger, R. D. (1997). Parental support and adolescent physical health status: A latent growth curve analysis. Journal of Health and Social Behavior, 38, 149-163.

Winnicott, D.W. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. New York: International Universities Press.

There are a lot of books out there on parenting and so from time to time I like to review my favourite books to make the job of choosing easier for parents.  I am a big fan of the work of Dr. Dan Siegel, and whole heartedly recommend all of his books.  His most recent release Brainstorm: The Power and Purpose of the Teenage Brain challenges parents to re-frame their thinking about a teenager's behaviours during this age and stage. A little about the author; Dr. Siegel is a clinical professor at the UCLA School of Medicine with training in pediatrics, child and adolescent psychiatry. He is a well-known expert in the neurobiology of childhood trauma and the author of many books on parenting, trauma, the brain and mindfulness.  

Many of us have the notion that parenting a teen equals rough and stormy waters! But Dr. Siegel says rather than lamenting the difficulty of the teen years, we should approach these years with optimism. His message is, that our thoughts and beliefs, when it comes to all areas of our lives, including teens, can negatively shape how they see themselves and ultimately influence their behaviour. In essence, your beliefs about the experience of parenting an adolescent will influence how you perceive your child’s behaviour and how you respond to it.

Siegel dispels the myth that hormones are to blame for everything from a teen’s moodiness to poor judgment. He writes that hormones do increase during adolescence, but that the changes teens wrestle with are actually the result of changes in the brain – not the hormones. In fact most of the challenges teens present to parents are actually a function of the development of the parts of the brain that they need in order to succeed in life – parts that eventually lead to having character and finding a purpose – all of things we want for them.

Siegel categorizes adolescence as ages 12-24. The brain changes during this time include “pruning” or a reduction in the number of neural connections and the coating of the connections called “myelination” which allows for faster flow of information. It all adds up to a remodeling process that allows for a more integrated brain. It is the stage of development when our children are at risk for the onset of major mental health disorders and are at an increased risk of suicide but it is also a stage in life that presents the greatest opportunities in growth and development.

According to Siegel teenage testing of boundaries and risk taking are actually a function of the brain’s development at this stage. Interestingly, he also asserts that teenage independence need not necessarily be a goal to strive for, rather interdependence and having adults to rely on during this time in life is more beneficial! This resonated for me both as a parent and as a therapist. We have emphasized nurturing the child parent relationship with our daughter, and I like the idea of continuing to see the importance of this relationship into the teen years rather than pushing her towards independence for our own for convenience.

Siegel uses the acronym ESSENCE to explain the changes that take place in the brain during adolescence. These changes place emphasis on parts of the brain that lead to developments in the following areas: ES refers to emotional spark or increased emotional intensity, SE is for social engagement with an emphasis on social relationships, N is for novelty seeking which can lead to increased risk taking, and CE is for creative explorations and an expanded sense of consciousness including an exploration of ideas and concepts and challenging the status quo.

Similar to his approach in Parenting from the Inside Out, Dr. Siegel wonders whether teen behaviours that he labels as developmental ESSENCE might be triggering in parents a longing for this past part of their own lives. If parents could reflect on and perhaps capture their ESSENCE, the gap might narrow and the tension might lessen.

If you anticipate the joys and pleasures of parenting during adolescence and communicate these to your child it will offer a form of connection rather than acting as a means of disconnect. Ultimately your goal is to maintain connection throughout adolescence. Your intention to do this should be communicated in your beliefs, words, and actions.

In keeping with the empathetic awareness that he is known for, Siegel fashioned the book into 4 sections that can be read in order, individually, or as appeals to the reader. There is no need to read from cover to cover or stumble through the neurobiology and then feel overwhelmed. And it’s a great read for a parent and a teenager. His reframing of what has long been described as a difficult time in the parent child relationship can provide parents with some insight and an empathetic understanding of the developmental processes. And having your daughter or son read the book can help them understand their own development in neurobiological terms and open the lines of communication. 

It is a very useful book for a parent of a teen and I recommend it thoroughly!