Creating Predictability and Consistency in the Play Room and at Home

Play Therapy is an expressive creative intervention that aims to assist children with emotional, behavioral or social difficulties. The play therapy room is equipped with a variety of expressive mediums, which intend to assist children to project and express their inner world and their emotions. The play therapy toolkit includes elements such as art material, musical instruments, sand play, puppets, drama & role-play and more. Working therapeutically alongside with the supportive therapist shall lead to resolution and improvement of the child’s well-being.

Play Therapy intervention thus provides children a special time and space to express themselves. The therapist strives to allow the children to play and create freely. However, some boundaries will be established in this environment. These boundaries are one of the therapeutic method’s pillars. Boundaries will include safety matters, such as making sure everyone is safe in the playroom (child, therapist, and toys).

Another pillar is consistency. The therapist provides a consistent framework for the child. The play therapy sessions will be conducted on a weekly basis, on the same day and time agreed with the parents. The therapist will make sure sessions start and end on time. Before a session ends, the child will have an advanced notification that will allow him to mentally close the session. This structure allows creating and supporting consistency and safe framework for the children. Consistency and boundaries are significant to the therapy success; this allows the child to know what to expect and it reduces anxiety.

If you notice your child struggling with changes or transitions, he or she might benefit from consistency in their environment.

So the question is: How can parents cultivate this at home when the daily routine might be changing, and some flexibility is needed?

Many children can benefit from a visual weekly schedule. In this schedule, you can display the daily routines (morning, evening) as well as planned activities for the week (school, play-dates etc.).

You may consider presenting the activities in illustration or drawings (rather than words) which will increase the child’s conceptualize understanding. For example: morning routine may include drawing of a toothbrush, shirt & pants (for getting dressed), cup and plate (breakfast); if the child attends preschool/school it may be drawn as a building, teachers & kids, books etc.; evening routine may be represented in a bathtub, plate (dinner) toothbrush, and a bed.

Afternoon activities should be adjustable according to the child’s after-school activities, for example, if he attends enrichment classes (sports, drama, music, reading, math etc.), include ‘home time’ or ‘playground time’ as it’s a part of their day! When you have a special activity on a certain day – it should be portrayed as well! It is recommended that the weekly schedule will have a morning, afternoon and evening parts, at least.

The visual schedule will assist your child to know what to expect from his day and reduce uncertainty. This can support the child to be more regulated around transitions and changes during the day, as he can remember visualizing them together with the parent. This can also facilitate accepting ‘special events’ such as the absence of a family member, due to travel for example, which can be illustrated in the schedule. The child can ‘see’ when his parent is traveling and when he/she is expected to return back.

It is advised that the parents will review the visual weekly schedule with their child every morning. For children that need more support in this area, you may review the calendar once more in the early afternoon hours to prepare them for the following day.

We live in a visual world and for some children, they need visual support in order to carry out their day to day activities efficiently and effectively.

Sand in the Play Room

The Play Therapy method uses a variety of tools to allow children to express themselves; Sandplay is one of these tools.
In this blog, I will explain what is Sandplay, the history and some of Sandplay’s principles and practice, as being used in Play Therapy.

History
Sand, earth and water are ancient elements of our world and universally part of our experience since childhood.

Sand-play is a form of therapy that gives both child and adult clients the opportunity to portray non-verbal feelings and experiences often inaccessible and/or difficult to express in words. The client (child or adult) uses a blue-bottom tray and a variety of miniatures elements.

Dora Kalff (1904-1990) formulated Sand-play therapy; she based her method on Jungian ideas as well as on Margaret Lowenfeld’s work (1890-1973).

Kalff’s vision was to allow the client a “free and protected space” to create a sand world using miniature figurines and images while creating a trustful therapeutic relationship.

Principles and Practice

By using symbols and objects, the client builds, expresses and explores his or hers inner-world in a symbolic way. Kalff supported the notion that the therapist should be attuned to the client during the creation of the sand tray as part of client’s process and healing.

From a neuroscience perspective, researchers show that touching sand triggers certain brain activities; this sensation travels in the brain and produces a tactile input ( the same feeling that we feel while walking on a beach sand). As the therapist stay attuned to the client during the creation in the sand tray, the client’s inner-world (which is presented in the tray), meets positive feelings, such as empathy and kindness, in a safe space. Such a positive experience fosters carrying-out new inputs into the brain; a new sensation is being released with positive hormones and healing starts.

Moreover, using symbols to act out events and experiences can promote deeply the right-brain usage, which houses feelings and emotions, and brings them to the surface.

In Therapeutic Play (or Play Therapy), the child can choose which mediums he or she wants to play in each session: Art, Music, Clay, Movement, Drama or Sand. For sand-play, usually, there are two options: dry or wet; water can be added to the wet sand tray according to the child’s decision.

There are many figurines and symbols the child can choose from in order to play out and present his world and experiences, for example, cars and animals, stones, shells, sea creatures and insects, magical figures and superheroes to spiritual images and domestic play with houses and furniture.

In the Play Therapy method, the child is given the space to use the miniatures in any way he wants (as long as it is safe), no words are required as a must, and the child will lead the play. This allows any child (or adult) to use Sand-play therapy, no prerequisite is needed, and there are no constraints of language or “art” abilities.

The therapist’s primary goal is to give the child the confidence to express his needs without being directed by an adult, as this can miss-out the point of self-expressing and exploration of the child’s world.

However, the therapist may take an active role in the child’s play according to the child’s needs and his lead. The therapist will be curious about the child’s creation in an unthreatening way and might explore it with him (if appropriate). In any case, the therapist must give the time to the child to re-act the events he needs and will support the child to find his inner strength.

To summarise, sand-play is a rich and versatile tool. The creator can change its shape and structure, as well as use external symbols to express his inner world. Furthermore, playing with sand is a primitive experience; hence it can promote an integrative connection of body and mind.

The next time you and your child is at the beach or playground with sandpit, we can all use sand to express ourselves!

 

Group Play Therapy

Group Play Therapy is an extension of the Therapeutic Play method.
However, it differs from Individual Play Therapy and might be more beneficial for some children with social and emotional difficulties.

What is Group Play Therapy?


The Group Play Therapy provides children with the opportunity to learn and practice, on a small scale, social skills of real-life situations. Through play, they will be able to try out new communicative ways with peers and therapists, watch and learn from others’ interactions, and have a safe environment to explore and express themselves in a social context while keeping within the boundaries of safety. Children will be able to examine, modify, and enhance their self-concept.

Group Play Therapy is an extension of the individual Therapeutic Play intervention and relies on similar principles, such as: accepting the child and his or her choices in the sessions (within safety boundaries), using reflective responding towards the child, and creating trustful relations. However, all of this is instead performed in a small group.

The Group Play objective is to assist and empower children with social and emotional difficulties. These difficulties may be observed at school, with friends, in social situations, or at home (with parents and siblings).

Group Play Therapy sessions are conducted in groups of 3-4 children, together with the facilitation of a trained therapist. The children use their natural communication language – Playing. During each session, the therapist encourages them to articulate and express themselves individually and as a group, using a selection of therapeutic tools, including art, sand play, musical instruments, drama & role-play, puppets & masks and more. These tools are a part of the Play Therapy tool-kit.

Advantages of Group Play Therapy

The advantages of taking a part of a group are significant and allow each child to observe, learn, experience, and practice new ways of being and interacting with others.

Research has shown that children can gain a better understanding of themselves in a group setting; they can observe how others interact (between group members and with the therapist), and from this experience, they can learn how to cope, react and regulate. They will also perceive the regard of the therapist, and other children, towards themselves, which may give them insight. For some children, the interaction with the therapist will be less threatening and perceived safer, due to the presence of other children and the focus not on one individual.

The interactions in the unique situation of Group Play Therapy will allow children the opportunity to both receive and give help, which promotes their self-healing and improves self-concept.

In addition, taking part in activities with others will support children to master the courage to attempt similar and new activities.

Furthermore, observing others and discovering that their peers have difficulties too can help children feel they are not alone, which will reduce barriers and increase confidence.

The group setting can also promote taking responsibility in social situations and assist in fostering a sense of belonging; this will help to anchor the therapy experience into reality.

Who can benefit from Group Play Therapy?

Group Play Therapy is ideal for children from 5 to 14 years old.

Group Play Therapy can assist children who show emotional and social difficulties, as well as manifesting behavioral issues.
Examples of difficulties a child might have are: 

  • Emotional and social difficulties:

Over-shyness, social anxiety, separation anxiety, feelings of rejection and isolation, selective-mutism, not understanding social situations, non-appropriate reaction in-group or class, low interpersonal communication skills and general difficulties in interacting with others.

  • Conduct and Behavioral issues:

Aggressiveness, prone to outbursts or tantrums, bullied or bullying others, and over-attached to the teacher in school.

 

Group Play Therapy is proven to be efficient in:

  • Improving social attitude
  • Improving self-concept
  • Improving leadership skills
  • Reducing anxiety
  • Improving learning abilities
  • Improving reading ability and grades
  • Increasing non-verbal IQ

To sum,

It is often effective to bring together a small group of children who may have similar difficulties, as they benefit from sharing and exploring those difficulties together through the therapeutic support of a Play Therapist.

The child-centered Group Play Therapy experience can thus have a tremendous impact on the emotional well-being, academic performance, and appropriate behavior, as well as improving self-concept and confidence.

How to get started with Group Play Therapy?

  1. If any concerns have been raised, contact us and inquire regarding Group Play Therapy.
    The therapist will meet the parent to hear their concerns and discuss desired outcomes from therapy.
  2. Parent (and teacher if possible) will be asked to fill in a “Strengths and Difficulties Questionnaire” (SDQ) to demonstrate current difficulties and pro-social behaviors of the child.
  3. The child will be placed in a group with similar age peers.
  4. Conduct sessions: 8-10 sessions will be conducted;
  5. A follow-up review will be made with parents at the end of sessions to estimate and monitor changes.

 

What is Therapeutic Play / Play Therapy?

Play Therapy is a psychotherapy method that uses playing as a tool to resolve children’s difficulties. The play therapist toolkit combines therapeutic tools such as art, music, movement, sand-play and more.
Play Therapy believes in the power of healing that exists inside every child.

The Importance of Playing
Playing is the natural communication media for children. All around the world, in any culture, children will play if they get the opportunity to do so. Children learn about the surrounding world through play, how to communicate in a non-verbal way, how to build a relationship with others and cope with different situations.

The therapeutic play takes the advantages of playing and uses it to promote and foster children with emotional, social and behavioral difficulties. Via playing, children get the opportunity to ‘play out’ their feelings and express themselves in a non-directive way. This will lead to some reveal and healing of the unconsciousness.

Play Therapy Origin
The first record of Play Therapy is in 1919. In the 20th century, some of the most well-known psychologists used playing as a part of their practice with children (e.g. Anna Freud, Melanie Klein). They argued that play could reveal unconscious processes; they also asserted that playing for children is similar to free association used with adult therapy.

Virginia Axline, who followed Carl Rogers “Person Center” approach, founded the modern Play Therapy; she established 8 principles that are the core of the therapeutic play method (e.g. accepting the child as he is, establishing a feeling of permissiveness, reflecting back).

Play Therapy in Action
Play Therapy is a non-directive, non-judgmental and a non-interpretive therapy; the child is motivated to choose what and how he wants to use the toys, within the boundaries of safety. The therapist will follow the child, reflect and reframe. He will respond to the child’s request to enact together, guide him to work on his issues and empower him towards a resolution.

The Play Therapy tool-kit is based on the Holistic Child Approach and was carefully selected after the therapeutic abilities were proven. The toolkit includes:

  • Art materials
  • Sand play
  • Puppets and Masks
  • Drama and role play 
  • Musical instruments
  • Dance & Movement
  • Creative Visualization
  • Storytelling

Why Play Therapy works?

Neuroscience evidence shows that playing releases “good hormones” (e.g. endorphin and oxytocin) in the human brain. These hormones inflict ‘happier’ feelings, reduce aggressiveness and anxiety, bring a calmer mood, encourage openness to learn and produce a better sense of well-being. With guidance and support from a trained play therapist, a positive use of the therapeutic tools in a safe environment will create new connections in the brain that lead to behavioral change.

Who can benefit from Therapeutic Play?
Play therapy is ideal for children between 4 to 14 years old who show emotional, social and conduct difficulties.

Examples of difficulties that Play Therapy can assist:

  • Anger issues
  • Autism Spectrum Disorders
  • Communication problems
  • ADHD
  • Social exclusion
  • Underperforming (academically, socially, culturally)
  • Bereavement / loss
  • Attachment issues
  • Behavior issues
  • Separated / Divorced parents
  • Bullied / Bullying
  • Delayed development
  • Bedwetting
  • Abuse (emotional, physical, sexual)
  • Nightmares
  • Trauma
  • Withdrawn Personality

Play Therapy effectiveness:
Over 100,000 cases analyzed by PTUK showed a positive change for 75% of children. In Singapore, positive change has been shown for 81% of children.

How to get started with Play Therapy?

  1. If any concerns have been raised, a referral to a play therapist can be made. The therapist will meet the parent to share their concerns and desired outcomes from therapy.
  2. Parent (and teacher if possible) will be asked to fill in a “Strengths and Difficulties Questionnaire”(SDQ) to demonstrate current difficulties and pro-social behavior of the child.
  3. A minimum of 12 sessions is suggested on a weekly basis (45 minutes each). A mid-review with the parent will take place after every 6-8 sessions. Based on the child’s progress, a decision will be made whether to continue or finalize the therapy.

A close relationship and collaboration with the parent and the teacher are strongly advised; by working together, the child will be seen as a whole, he will be better supported and will have a higher chance to accomplish a change.

To empower children with difficulties and support their inner-core growth,
Play Therapy will be an effective intervention option.

Let’s Play Therapy!

 

Bibliography: 
[1] McMahon, L. 2007. The Handbook of Play Therapy. London and New York: Routledge
[2] Barnes, A. M. 2013. The Healing Path with Children, 3rd Edition. Uckfield, England: The Play Therapist Press Limited, The Coach House
[3] Axline, V. 1974. Play Therapy, 2nd EditionA Ballantine Book, the Random House Publication Group
[4] PTUK. 2007. The Application of Neuroscience on Play Therapy. ‘Play for Life’ Journal. Summer ed.
[5] Thomas, J. 2015. How effective is Play Therapy? ‘Play for Life’ Journal. Autumn ed.
[6] SDQInfo. What is the SDQ. http://www.sdqinfo.com.