Thursday, October 27, 2011

If You Build It They Will Play


You Want to Build a Playroom and Wonder Where to Start

When I began to build my playroom, I was limited to a 10x10 office and a small suitcase as my portable playroom. I quickly decided less is more and the dual use of items was the key. There were a few resources to help me choose exactly which items to acquire for my playroom, and my eyes were always bigger than my space! I am fortunate to have grown into a separate playroom and a sandtray/activity room that I share with other play therapists and reflect back on building my playrooms through sharing my story with you.

A supervisee came to me and asked “I want to create a play room! Can you help me?” She was ready to create a safe and comfortable space. I’ve created my own spaces over the years. Some of you know what it in your play room and why you have each particular toy/object. It is a journey of thoughtfulness and impulse, and of necessity and joy to create your own space. As someone begins to wonder why and how you chose the toys and activities that are used daily in your playroom, there are serious considerations. Being trained in a variety of theoretical orientations and the experience in the use of a variety of techniques from directive and non-directive approaches, allows me to base my choices of treatment modalities on the child’s particular problem/issue and personality. Therefore, my playroom may appear different than yours.

Where does one start except with a list? Which list? This begs the questions, “What kind of play therapist are you--directive or non-directive or both?” Then, “What play therapy theoretical orientation is your guide? “Which theory guides you most of the time?” “How big is your space?” and finally, “How much is your budget?”

I have included a table at the end of this article with the toy categories by orientation with details of items and some pearls of wisdoms from of the orientation’s major contributor to consider when you are in search for just the right items.

Garry Landreth has done an excellent job in sharing exactly what toys are useful in a play room. Most any play therapist knows the categories of toys used in child-centered play therapy. In his trainings, he shares a story of one of his students who purchased a toy for her play room and asked him how she should use it. A most enlightening question he asked his student and you should consider, "When choosing a toy, ask yourself, what am I trying to do with this toy?"

Terry Kottman, the creator of Adlerian play therapy, shares a list of toys which are similar in types to the child-centered persuasion but she is more expansive in the categories and the many items listed are helpful in healing relationships. Kottman views toys as important in the process of healing for children, but the most important element of the playroom is the attitude of the therapist (Kottman, 2002). 

Violet Oaklander and all her wisdom in the development of gestalt play therapy has some wise advice on creating a play space for children. A Gestalt therapist will find activities to help children use their senses to develop creative intervention, motivation, and direction. Body movement is essential whether it is relaxation and meditation to calm the body or music and fantasy to get the mind to create stories and art. The body and mind work together toward healing (Oaklander, 1998).

Developmental play therapists can feel overwhelmed with all these toys. In fact, toys are viewed as a distraction in creating a safe space in which the parent/child or the child/therapist is to focus on the relationship. This is quite contradictory to some theorists although most people can admit there is no one best approach just as there are no children alike (Carmichael, 2006). 

Viola Brody developed Developmental Play Therapy with the idea that developmental play helps to create a therapeutic relationships through the dialogue of touch. Children draw experiences to themselves to get their needs for caring touch and nurturing physical affection met in their relationships with parents and caregivers. Responding to the child's invitations for caring touch in experiential play sets in motion this dialogue of touch.  It is caring touch that initiates the growth and healing process for the child (Brody, 1997).

Theraplay® (Jernberg, 1979) is a developmental play therapy approach to heal the parent-child attachment. Using fun activities, instead of toys, in order to create a greater sense of nurturing and engagement, along with structure and challenge that are necessary to create attunement with the parent and healing of trauma. These activities can be used in schools and group settings to develop and enhance the child’s sense of self and their connection with others.

Other approaches may not fit so neatly in a non-directive or directive category. The use of activities may be more directive in some instances and non-directive as needed.

Ecosystemic play therapy developed by Kevin O’Connor widens the age range and offers specific toys for each development age group. He advocates for narrowing child’s choices to approximately five play items at a time (Carmichael, 2006). The child’s goal of session is considered when deciding on the play items. It was interesting to note the age level stops at twelve years of age. This seems very practical as adolescents sometimes scoff at activities that seem below their age level. Although many children and teens who seek treatment have developmental deficits and use the “props” or play therapy toys offered to work through their issues. Often a play therapist can observe the developmental level the client is “stuck” based on the chosen toy. At times narrowing choices is needed to alleviate frustration in younger children. Limiting their choices to age appropriate activities helps build mastery rather than add to or cause distress in a child with an eroded sense of self.

Cognitive behavioral play therapy (CBPT) used a variety of activities, games, workbooks, story books, are and art to impart knowledge that will create insight about the situation in which the child finds him or herself (Carmichael, 2006). Knell (1993) states a therapist’s role is to educate the child about appropriate behaviors and cognitions about events or situations the child faces. Psycho-education is an important activity since children view the world based on their perspective with incorrect or distorted frames of reference based on their experiences and observations of the world around them.

This article is not a substitute for learning more about each theoretical orientation, but a guide of what belongs in your playroom when considering your professional orientation and if you desire to closely align with a particular theory of play therapy.
  

Toy Selection and Materials by Play Theory
Theory
Toys and Materials
Adlerian (Kottman)
Family/nurturing toys
Scary toys
Aggressive toys
Expressive toys
Pretend/fantasy toys
The most important element of the playroom is the attitude of the therapist.
Dolls, dollhouse, food, dishes, and blanket are used to explore the family constellation and family atmosphere
Snakes, rats, alligator, dinosaurs, insects help the child examine mistaken beliefs, perceived threats, and past traumas
Punching toy, toy soldiers, handcuffs, and weapons to delve into conrol and trust issues
Arts/crafts assist to open up feelings, family relationships, and expressive creativity
Masks, costumes, blocks, transportation toys, magic wands, telephones, and animals aid in examining relationships and practicing new behaviors
Child Centered (Landreth)
Real-life toys
Acting out/aggressive toys
Creative expression-emotional release toys
"When choosing a toy, ask yourself, what am I trying to do with this toy?"
Dolls, puppets, transportation toys, dollhouse, kitchen center items, toy store items, and dress up items
Bop bag, toy soldiers, aggressive animal puppets, guns, knives, swords, pounding toys, log with nail and hammer
Water, sand, blocks, and art supplies
Theory
Toys and Materials
Gestalt Play Therapy (Oaklander)
Art materials
Storytelling, poetry, and puppet materials
Musical instruments
Collage materials
Creative/sculpting materials
Find activities to help children use their senses to develop creative intervention, motivation, and direction.
Various sizes of paper, crayons, pastels, colored pencils, finger paints, any other art supplies and various gadgets used in creative projects
Storytelling, poetry, and puppet materials. Books, writing materials, tape recorder, pictures, projective tests, puppets, flannel board, sand tray,drawings, open-ended fantasies, videotapes, walkie-talkies, toy microphone, imaginary TV set
Guitar, autoharp, keyboard, recorded music
Paint, string, yarn, fabric scraps, colored sand, beads, shells, any texture or color appealing to the child
Clay and water are essential. Any moulding materials, wet sand, plastic, wax; nails, hammers, tape, glue, staples, bolts & nuts; screwdriver, hand drill, coping saw, spray paint
Developmental (Brody)
Furniture
Supplies
No toys to distract the child from the relationship with the therapist.
Rocking chair, table, chair and rug
Lotion, crayons, pencils, and paper
Theraplay (Jernberg & Booth)
Furniture
Supplies
No toys, only supplies to encourage parent-child relationship
Beanbag chairs or large pillows
Small pillows, lotion, baby powder, baby bottles, small candies, raisins, water pistols, plastic garbage bags, bandage strips, straws, beans, crepe paperstrips, newspapers, dressup hats, necklaces, shaving cream; food: popsicles, small snacks, milk or juice cartons, watermelon chunks with seeds for spitting.
Ecosystemic (O'Connor)
Level-I (age 0-2)
Level-II (age 3-6)
Level-III (age 6-11)
Level-IV (age 11-12)
Selections by developmental age group; Select toys that seem best to address the kind of goals the child has established for the session, about five at a time.
Baby bottle, baby blanket, baby powder and lotion, stuffed animals, and "attention getters" like colorful balls, blocks, noisemakers, and music intruments; one large ball, finger paints, and moulding dough, and a empty box
Toy telephone, interactive toys, costumes, miniatures, dishes,  pretend food, appliances, toy replicas of equipment from office, preschool, school, hospital, and other common places; art materials like ruler, felt-tipped pens, crayons, large sheets of paper, tempera paints, medium sized brushes, molding materials; costumes and dress up materials
Small people, animals, houses, cars, dolls, dollhouses, doll family, school-related miniatures, hospital/medical miniatures; art materials like hardening clay, plastic connecting construction toys, simple crafts, and board games. Soldier are controversial unless needed
Art materials, construction toys, model kits, sandtray; find out what the client enjoys to work with & provide those materials


Theory
Toys and Materials
Cognitive Behavioral Play Therapy (Knell)
Games
Bibliotherapy
Dollplay
Art
A therapist role is to educate the child about appropriate behaviors and cognitions about events or situations the child faces.
Board games, card games and charts
Stories and recordings that positively resolve the problem and model expression of the child's feelings; workbooks and worksheets; child prepared stories and books
Action figures, puppets
Drawings and sculpting materials

References

Brody, V. (1997) The dialogue of touch. New Jersey: Jason Aronson, Inc.
Carmichael, K. (2006) Play Therapy: An Introduction. Pearson: New Jersey.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
Jernberg, A. (1999) Theraplay. San Francisco: Jossey-Bass.
Knell, S. (1993)   Cognitive Behavioral Play Therapy. New York: Aronson. 
Landreth, G. (2002) Toys and Materials for Play Therapy. Video Presentation from "Making Contact with Children  Through Play Therapy." Play Therapy Institute, Denton TX.   
Oaklander, V. (1988) Windows to Our Children. New York: The Gestalt Journal Press.



Janet Vessels, MS LPCC RPT-S is a private practitioner in professional counseling and Owner of Center for Child and Family Counseling. She has practiced professional counseling for over fifteen years with children, adolescents and families. Her practice specialties are play therapy and a variety of trauma therapies including Eye Movement Desensitization and Reprocessing (EMDR).

Tuesday, July 19, 2011

Tell Me More About That: Professional Boundaries: When Your Client Loses a ...

Tell Me More About That: Professional Boundaries: When Your Client Loses a ...: "I am usually not surprised by anything my clients or their families share with me. Today is an exception! A client's parent arrived to infor..."

Professional Boundaries: When Your Client Loses a Parent Unexpectedly

I am usually not surprised by anything my clients or their families share with me. Today is an exception! A client's parent arrived to inform me that my client would not be able to keep his appointment this afternoon because his mother died unexpectedly a few days ago. I was stunned and the shock paralyzed me for about two minutes! I was speechless! The last time we talked she was ready to go on vacation. After exchanging how everyone is doing, offering a shoulder at any time, and assessing how my client is doing, I could only offer my time--any time they needed it. What does one do next? Do you become the family's counselor? All of them are grieving, not only your client?

Here is my suggestions for my colleagues to help a client who has lost a parent.

Your client, no matter if 10, 20, 30, 40 or 60 years old, may feel vulnerable and abandoned. Childlike tears and feelings of being "lost" may surface. Mom has always been there in his/her life.

A sense of shorten future and a sense of their own mortality with no desire to live life with their parent gone. They can't imagine life without them.

A real lack of support if your client is an adult. Other may share thoughts..."they were old...they lived a good life...think of the good they did in the world." It still doesn't "feel" fair to the client!


A loss of what they will miss in the future about their parent. He won't be there to see my graduate or walk me down the aisle at my wedding. She won't be able to enjoy her grandchildren.

Encourage your client to take the time to feel the emotions of the loss. Rationalizations, like it was "inevitable or everybody dies" is a way to push away the grief and not helpful in the healing process.


Each person mourns loss in a different way. Respect and consideration that there is no one right way is important.

Communication with siblings about the loss is essential. They lost their parent too. Although everyone remembers their parent somewhat differently, each one of your siblings has had a personal loss.

Seeking professional help can be helpful to guide you through the loss. A trusted friend can also act as a sounding board for your feelings. They don't have to have experienced the same loss to understand your pain.

Help them find an acceptable way to remember their parent. A charitable donation, planting a tree or flowers, or help them develop a permanent memorial at their parents college or place of work.

Help them decide how their spirituality can help them during this tough time. They have inner resources to guide them, and help them make sense of life.

Encourage them to find ways to remember their parent and the sense they are still with them. Theirr parent will live through them.

So next...

How does a counselor help a family when the counselor is experiencing grief too? Do you push away the grief and prioritize their needs for now?  Can you cross your personal touch boundary and hug them in consolation? Do you attend the funeral? Visitation? Do you take a dish?

We have to feel our own grief and in our own time we must feel it too. Although we are counselors, we have feelings too. It's OK to feel awful about the loss. A balance of pushing away and helping is needed here. This would be the time to consider it acceptable to offer an appropriate hug or touch. The funeral is a public ceremony--now, it is one of personal choice. You don't want your client to feel uncomfortable, nor do you want to present yourself as an uncaring person. It really depends on your comfort level. A dish taken to their home does offer some comfort in a private way and in this part of the country, it is acceptable for anyone to drop by and offer condolences.

Whatever you decide if this happens to you...remember you are human too and it's normal to feel sadness and loss.

Monday, July 18, 2011

Tell Me More About That: Healthcare Woes and the Effect on Mental Health

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Tell Me More About That: Self-injury and the lack of desire to stop

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Tell Me More About That: Transgender Youth

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Tell Me More About That: Invalidation

Tell Me More About That: Invalidation: "Many parents ask me how they can best help their child/teen open up and share their feelings. Children/teens tell me the reason they do not ..."