Many years ago, while working towards my Bachelor of Social Work degree, I learned to NOT volunteer for public role play exercises.  “Why?”, you ask.  Well, inevitably it would turn in a direction that I really was not prepared for.  I was caught off guard and, therefore, I missed the opportunity to carefully consider my responses—feeling vulnerable and exposed.   As I became a more seasoned clinician, a ready response came more easily AND I continued in my established pattern of self-preservation. 

            Fast forward 25+ years. In 2019, I became a Registered Play Therapist.  In March 2020, I was introduced to and began a deep dive into incorporating digital tools in my play therapy practice.  In fact, it has become a passion! Through this journey of professional growth, I have also been exposed to an unexpected personal growth.  There may be more, but I attribute this shift to two primary factors: 1) healing properties of play and 2) felt safety among colleagues and friends.

Notice the picture above—one side is very tidy, while the other is very messy with a plethora of items on the floor.  These past several months I have had the opportunity to receive training in the therapeutic use of Virtual Reality.  Each training has given me a different, yet equally powerful take-away message.  In the most recent training, we utilized and discussed two games from the perspective of multi-sequential tasks and learning:  Job Simulator and Vacation Simulator.  Clinician hat on and learning brain activated—check. Well, until it wasn’t.  almost immediately my clinician hat and learning brain were replaced; instead, I was a person fully immersed in an unfamiliar setting, attempting to navigate surroundings.  I quickly became frustrated.  I could hear the tantalizing sound of the coffee pot; yet, after multiple attempts, I could not figure out how to dispense the coffee.  The more I looked around, the more things deeply resonated.  Finally, I gave up!  In fact, I became somewhat defiant—throwing things on the floor, putting my head in the copy machine to see if it would actually work (IT DID!!), randomly pushing all the buttons—trying to make sense of SOMETHING.  I quit….again—abandoning the job for a vacation.

Just a game, right? How is it possible that all of my senses could feel like I stumbled into the virtual version of my life??  On the surface, play seems like ‘just play.’ However, when considering the Therapeutic Powers of Play, it is so much deeper than that! For years, play therapists have been advocating for the profession; declaring “WE NEED MORE PLAY!  PLAY HEALS!”  So much so that, at times, I am baffled by the dichotomy.  We have fought so ardently for play therapy to be a recognized and respected modality and, yet, the acceptance of digital play can seem elusive.  In terms of traditional and digital play therapy, one does not replace the other—it is a both-and.  The goal is not for every play therapist to utilize every modality of play, including digital.  Instead, the hope is that we, as a play therapy community, will at least widely entertain the potential and acknowledge the benefits of Digital Play Therapy^TM. We owe it to ourselves, our clients, and our profession to be interested enough in the client’s world, and all it entails, to give consideration —even if it means making referrals.

Fiona Hill is a Licensed Professional Counselor-Supervisor and a Registered Play Therapist in the state of Missouri. She currently works in a group practice as a children-family therapist specializing in working with childhood trauma, attachment disruption, as well as families impacted by varying developmental needs within the family system. In addition, she has a sub-specialty of incorporating digital tools into therapeutic practice. Find more information about Ms. Hill here: https://fionahilllpc.com/

The post Stumbling Into My Life: first appeared on Jessica Stone, PhD, RPT-S.

An interview with Richard Hill of the Science of Psychotherapy https://www.thescienceofpsychotherapy.com/dr-jessica-stone-talks-about-virtual-therapy-tools/?fbclid=IwAR3g1q0a4rZoXeINXDrNHgrBUW0ERqH8uWt1e-Iup0djs2n6dOopZ1jWIfM

Check out their site – it is chock full of information! https://www.thescienceofpsychotherapy.com

The post Virtual Therapy Tools first appeared on Jessica Stone, PhD, RPT-S.

Check it out here: https://www.psychotherapy.net/interview/jessica-stone-on-play-therapy!

The post Play Therapy in the Digital Age first appeared on Jessica Stone, PhD, RPT-S.

By Fiona Hill, LPC, RPT

The Story

Feeling or being ‘stuck’ is difficult. ‘Stuckness’ can look and feel differently, depending on who you are talking to.  Personally, a common theme has been that I want to run away.  Seemingly, life starts to close in around me and breathing can become very difficult.  Then, my focus is how to get out of the situation as quickly as possible. 

Lately, I’ve been working to improve my Minecraft skills…not to perfection, but to the point I’m not bogged down by the mechanics.  At first, practicing Minecraft wasn’t really something I wanted to do.  Honestly, I would often find the game so frustrating and overwhelming that I clearly avoided playing.  However, I really felt drawn to the game for a couple of reasons: 1) In hearing other clinicians talk about it, I knew that there can be lots of therapeutic value 2) many of my clients talk about, play it, and are very drawn to the game and 3) I really do like a challenge—the best way to get me to do something is to tell me I can’t.  So, I started slowly:  googling how to work various mechanics; watching YouTube videos; informally playing with colleagues and friends; then, as I became more comfortable I began to play more on my own and ‘try things out.’  For me, a turning point away from avoidance of direct play was in playing with a colleague who had graciously volunteered to give me a Minecraft ‘lesson.’  It was described as a ‘sandbox game.’  You mention anything sand related and there is an automatic connection for me.  However, that wasn’t even really the most impactful.  I was getting a tour of the amazing realm, and we were about to cross over some very high planks.  Even though we were playing ‘just a game,’ my fear of heights kicked in and I was immobilized-stuck.  My chest became tight and I’m pretty sure I stopped breathing in that moment.  My colleague’s avatar graciously carried my avatar across the planks.  Immediately, I felt relief.  I felt safe. Now, I was ready to more deeply explore Minecraft, both as a game and as a therapeutic tool.

A few days ago I was playing Minecraft, and found myself stuck underground. It was dark. There was a tightness in my chest because I couldn’t see my way out. I literally turned my avatar in circles and all I could see was pitch black. I wanted out; so, I turned the game off.  Went back another day…same thing. The next day…same thing. Today was different, though. I went into my ‘world’ and I was stuck. My avoidance had served me well—I had forgotten about my situation.  I was more than slightly irritated.  I mentioned to friends that I was stuck in Minecraft and my exact words were ‘I just turned on my Minecraft world and remembered I’m STUCK and haven’t been able to get out…so I just keep turning it back off……#Iwillgetout.’ As I’m turning looking for a way out, I remember ‘OH! I can use a lantern for light!’ Within a matter of a minute or so I was back out into the daylight. I could see the house I had built, and the tightness in my chest was gone.

Clinical Application

What I shared above is a personal experience.  If I were to sum up my experiences in two words, they would be co-regulation and resilience.  Looking at my personal experience through a clinical lens, there are many opportunities for therapeutic work.  The same can be said for many, if not all, of our clients with whom play therapy is our mode of treatment.  Play therapy is more than ‘just play,’ whether it is traditional or digital.  How powerful it can be to immersively partner with clients in providing co-regulation and building resilience through the use of digital tools—and these are only a small glimpse into the therapeutic possibilities! 

Fiona Hill is a Licensed Professional Counselor-Supervisor and a Registered Play Therapist in the state of Missouri.  She currently works in a group practice as a children-family therapist specializing in working with childhood trauma, attachment disruption, as well as families impacted by varying developmental needs within the family system.  In addition, she has a sub-specialty of incorporating digital tools into therapeutic practice.

The post Schooled by Minecraft: The Impact of the Digital World in Therapy – Guest Blog first appeared on Jessica Stone, PhD, RPT-S.

When the world shut down at the start of the coronavirus pandemic, I worked hard to assure that my clients had continuity of care, my community had ample support, and my colleagues had a sense of direction. I learned over the years that I jump into action in times of crisis. Perhaps it’s some of the coping mechanisms that I established as a child, my personality type (Myers Briggs – ENFJ), and/or my purpose and passion in connecting with, leading, and supporting others. Whatever the reason, I found myself back in this space of intently helping when everything was seemingly falling apart.

As we all know, we cannot go full speed, indefinitely. There comes a time when our brains and bodies tell us that enough is enough. After 3 full months of pouring myself into all that I could, I experienced my first panic attack. At first, I had no idea what was going on. I thought I was going to die. It was terrifying. After my prefrontal cortex caught up with my body, I rationalized and self-therapized my way down from the attack. For several weeks following this episode, I felt emotionally fragile. My empathetic, internal container was jam packed with too much intensity, and it burst.

I always practice and preach self-care. After experiencing a life changing therapist’s self-care retreat two years ago, I intentionally prioritized tending to my mind and body more than I ever had in the past. So, when the pandemic began, I made sure to continue implementing essential self-compassion and nurturing practices. However, I gave disproportionally more to others than I gave to myself. That panic attack was a wake up call that I was not giving myself enough.

One self-care activity in particular that I thoroughly enjoy is creating sand trays. As a Licensed Psychologist and Registered Play Therapist – Supervisor, I understand how powerful and healing play and creativity are. Constructing a tray to externalize internal processes allows for a cathartic release and provides the opportunity to view, understand, and work through difficulties from a safe enough distance.

I connected, virtually, with a wonderful group of friends and colleagues who maintain a consistent holding space for one another through a fun, playful, monthly get together. We spend time talking and creating virtual sand trays through the Virtual Sandtray App (VSA). The first meeting occurred shortly after my panic attack. I knew I wanted to create a tray to depict what I was experiencing and how I could protect myself.

This tray depicts my light energy that I use to guide others. The movement of and glare from the star truly channels the constant, moving, ever-changing energy within that light. Water, signifying emotions, surrounds the light energy. The water serves as both a barrier and a method of transportation. I have the choice of who and what is allowed, depending on whether I am tending to myself or others. The palm trees surrounding the water reminds me of the essentiality of making moments for respite and replenishment. The intimidating and dark figures signify all that was occurring in the world and all I was holding on to that contributed to the overwhelm and panic. I, positioned inside the transparent shield, was actively working on implementing barriers to protect myself.

The VSA gave me the opportunity to explore and express what I felt and at times struggled to fully articulate. It also afforded me the opportunity to channel my active-oriented stance to take care of myself. When making trays in VSA, I especially favor all of the miniatures that move, because they add extra dimension and depth to the tray. What is not fully captured in the picture is the beauty and long wingspan of the dragon. Despite his active, formidable stance, he can become tame, and he is not as terrifying when you really look at him. But, isn’t that anxiety after all? Once you are able to release and see the fear from a distance, it’s not always quite as frightening as it seems.

Dr. Rachel Altvater is a Licensed Psychologist in Maryland, Washington, D.C., and Virginia, Registered Play Therapist–Supervisor, and Certified Clinical Trauma Professional. She is the owner of Creative Psychological Health Services, an affiliate faculty member at Loyola University Maryland, and the President of the Maryland/DC Association for Play Therapy. Dr. Altvater published two articles in the International Journal of Play Therapy on her research of technology use in play therapy and is a contributing author in Integrating Technology in Modern Therapies: A Clinician’s Guide to Developments and Interventions, Digital Play Therapy: A Clinician’s Guide to Comfort and Competence, and Cultural Issues in Play Therapy (in press). She is the recipient of the 2019 Emerging Leader Service Award from the Association for Play Therapy, the 2018 Outstanding Play Therapy Research Award from the Maryland/DC Association for Play Therapy, and the 2018 Distinguished Alumna of the Year from The Chicago School of Professional Psychology, Washington, D.C. Campus.

Creative Psychological Services: https://creativepsychological.com/

Virtual Sandtray:

Check out the website (in the process of being revamped): https://www.sandtrayplay.com/

Scroll through the Facebook page: https://www.facebook.com/VirtualSandtray

The post Utilizing the Virtual Sandtray App to Foster Self-Care and Healing- Guest Blog first appeared on Jessica Stone, PhD, RPT-S.

Kevin Hull, Ph.D., RPT

The play therapist and Gregory are playing Minecraft and Gregory has put the therapist into a trap and the therapist has to figure a way to get out. Gregory has explained to the therapist that the idea of being trapped and the feelings that go along with it are exactly how Gregory feels at school every day.

“Ha! I got you!” exclaimed Gregory.  “You’re my prisoner and you’ll have to figure your way out!” 

“Oh no,” said the therapist, “I’m feeling alone and a little scared. I wonder what I should do next.” 

“Ha,” said Gregory, “Now you know how I feel when I’m at school and all I want to do is go home.  Good luck figuring this one out, and I might as well tell you that there are traps all around so be careful, even though it won’t help cuz you’re not getting out and even if you do you’ll probably die!”

“Okay, I guess I’ll just have to figure this out” remarked the therapist. “Gosh, if this is what school is like for you every day then I can’t imagine how helpless you must feel, because I’m feeling really helpless right now.”

“You don’t even know!” Gregory exclaims and jumps up from the bean bag chair. “It’s like there’s all these mobs coming at me all the time and I have to fight them off” (he pretends to use his iPad like a shield while wielding an imaginary sword in the other). “Fight ‘em here, Fight ‘em there – Fight! Fight! Fight!”

“Wow, that must be hard,” said the therapist. “It sounds like you feel like you scared and tired.”

“Yeah,” said Gregory, “It’s enough to drive someone crazy,” as he flops back into the bean bag chair and looks back at the Minecraft game on the iPad. “Okay, let’s see how you get out of this prison!”

“I think I’m going to do it!” remarks the therapist, “I’m going to escape!” He makes his character open a door and step into another room and hears a hiss. “What is that noise?” asks the therapist.

“Wait for it!” exclaims Gregory.

Suddenly, there is a huge explosion. “Oh no, I blew up!” The therapist looks at Gregory.

“Ha!” says Gregory, “Yep! I got you with TNT! You didn’t know there was a booby trap. Ha ha! You should have seen your face when you blew up!”

“I felt totally happy when I thought I found a way out, but then really disappointed when I blew up” said the therapist.

“Yeah, just like me at school. Even when I think it’s gonna be a good day then BAM! something bad always happens.”

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Minecraft has provided a foundation of therapeutic trust between Gregory and his therapist because it is familiar and fun for Gregory. Gregory has created a scene by trapping the therapist and putting the therapist in the position of trying to escape, which Gregory reveals is how he feels when he has to go to school each day. Early in the therapy, Minecraft was simply a fun thing to do together, but in this working stage of play therapy, Gregory is using the game to communicate how he feels and the therapist understands just how hard it is for Gregory at school. When Gregory feels trapped at school he becomes emotionally dysregulated and lashes out. But through playing Minecraft, he can simulate a situation like how he feels at school and stay emotionally regulated because it is through a game he loves, and it is played with a person (the therapist) that he trusts. As the therapist plays with Gregory and acknowledges his feelings, Gregory feels understood and safe to release more emotions and thoughts.

This process of understanding is multidimensional in several ways. First, there is a level of safety for Gregory in knowing that he has a place to release what he thinks and feels and is not judged. Feeling understood also helps increase Gregory’s sense of self-worth by showing him that his experiences are important and that he matters. Last, feeling understood gives Gregory a boost of confidence to keep expressing himself and share how he truly feels. Using Minecraft enables Gregory to show his mastery of the game and this is something that makes Gregory feel valuable and worthy. Gregory not only can show off abilities, but he can elaborately put the therapist in a situation in which the therapist feels frustrated, unsure, and finally disappointed that the therapist’s best attempt resulted in failure. On one level, Gregory can tell the therapist how he feels at school, but through the game of Minecraft the therapist actually feels what Gregory feels. This brings the therapist to a new level of empathy for Gregory and allows the therapist to be mindful of providing encouragement and increasing Gregory’s coping skills for future situations.

As therapists we often hear about how a child experiences a situation from another’s perspective. A teacher tells us about a situation like Gregory’s at school, or a parent tells us about how a kid experienced a loss or is adjusting to a shared parenting situation from a divorce. However, technology takes this to a deeper level by offering the child the opportunity to bring us into the situation provide a shared experience. I have played games like Minecraft with kids like Gregory and emerged from the session with such respect for the child because of new awareness for what they are experiencing. I communicate this to parents and teachers to provide them with a new level of awareness and empathy for the child. For children on the spectrum who can become easily emotional dysregulated and who struggle with putting thoughts and feelings into words, technology can be a wonderful tool to help them express themselves and be understood.

My next blog (Part III) will discuss how to pull themes and metaphors from play using technology to instill self-worth, create coping skills, and create perspective-taking.

Kevin B. Hull, Ph.D., RPT https://drkevinhull.com/

Dr. Hull is a licensed counselor in Lakeland, Florida and his life’s passion is helping people. He is honored to represent the counseling profession as a therapist, professor, and author. Dr. Hull is a Registered Play Therapist (RPT) and Certified Group Psychotherapist (CGP). One of his specialties is working with children, adolescents, and adults diagnosed with neurodevelopmental disabilities. He also helps families of all kinds overcome many types of challenges. Dr. Hull use many innovative types of therapy such as play, solution-focused, and cognitive therapies and conducts groups with children and adolescents to help them understand themselves and learn to use their amazing gifts and find their place in the world.

The post Unlocking Growth in Autism Spectrum Clients through Technology and Play – Guest Blog, Part II first appeared on Jessica Stone, PhD, RPT-S.

Part 1/3

Kevin B. Hull, Ph.D., RPT

Gregory enters the therapy room briskly and flops into the bean bag chair.  

“Hurry up and get your iPad” he says to the therapist, “I have a bunch of new stuff to show you!  The therapist gets his iPad and opens the Minecraft app and joins Gregory in the ‘world’ that Gregory has created.  “Wait til you see what happens when you spawn in!” Gregory shouts.  

“Remember that we can’t play our game with loud voices,” says the therapist.  

“Fine, okay, but hurry up!” says Gregory in a loud raspy whisper.  

“Whoa! Where did I go?” exclaimed the therapist as his character joined in the game.  The therapist’s character was in a dark room with no doors or windows.  “Why am I in a dark room?  How will I get out?”  

“Ha! I got you!” exclaimed Gregory.  “You’re my prisoner and you’ll have to figure your way out!”  

“Oh no,” said the therapist, “I’m feeling alone and a little scared. I wonder what I should do next.”  

“Ha,” said Gregory, “Now you know how I feel when I’m at school and all I want to do is go home.  Good luck figuring this one out, and I might as well tell you that there are traps all around so be careful, even though it won’t help cuz you’re not getting out and even if you do you’ll probably die!”

It is no secret that clients diagnosed with Autism Spectrum Disorder (ASD) love technology.  In the past 20 years, I have incorporated technology in the form of video/computer games into my counseling work.  In recent years, smart phone and tablet apps have been very useful in helping my ASD clients overcome challenges and broaden their perspectives.  While many practitioners may fear technology and be hesitant in allowing a client to bring their tablet or video game system into the therapy room, I find that it has opened new doors of communication, growth, and change particularly when working with ASD clients.

The Challenges of ASD

            Clients with ASD face immense challenges.  Developmental delays and disruptions in emotional and cognitive functioning create a myriad of difficulties relating to others and forming relationships.  The constant rapid-fire activation of the sympathetic nervous system wreaks havoc on the ability of the individual to understand and control emotional reactions, not to mention creating many physical problems like gastrointestinal problems and auto-immune disorders (Hull, 2017).  One of the main issues that arises with ASD is a lack of perspective-taking.  The activation of the sympathetic nervous system (fight/flight/freeze) results in the individual staying stuck in a state of self-preservation as a result of not feeling safe.  Thus, the individual seeks to be in an environment that he or she can control.  When this isn’t possible, the individual often adopts a series of behaviors that help ‘soothe’ the tension of feeling out of control.  The state of self-preservation creates ‘tunnel vision’ that makes the individual seem as though they lack empathy and awareness (Hull, 2011).  Certainly, this isn’t true – in fact, many ASD clients report feeling compassion for both animals and people and have strong emotional reactions but they don’t feel safe enough or know how to express these emotions.

            A second major challenge for ASD clients is the expression and understanding of emotions, both in the self and interpreting the emotions of others.  This condition, known as alexithymia, causes problems socially, as well as internally and leads to isolative behaviors make the ASD client feel misunderstood and very alone (Hull, 2011).  Not being able to control emotions or understand what others might be feeling can lead to major disruptions in forming and sustaining relationships.  For children in particular, baffling emotions create a sense of paralysis and frustration due to delays in brain development that further disrupt relationships and peers often reject the child on the spectrum.  This results in a damaged sense of self and leaves the child feeling confused and abandoned.  Other themes of ASD include problems with impulse control, obsessive behaviors and thinking, and problems with adjusting to new people/situations or unexpected changes in routine.

Benefits of Technology and ASD

            Familiarity and a sense of control are two of the main benefits of incorporating technology with ASD clients.  In the case of Gregory, it is evident that Gregory is excited about coming to therapy because it involves a game that he enjoys and knows on his personal IPad.  For many ASD clients, a portable device such as an IPad or video game console is very much like a security blanket.  Also, Gregory is in complete control of the game play which creates a sense of safety.  This sense of safety forms a foundation of trust between Gregory and the therapist, which paves the way for future work in the form of problem solving, perspective shifting, and helping Gregory develop self-representation.  As previously mentioned, forming relationships is difficult for those with ASD, as well as adjusting to new people and places which the therapy process demands.  Through using a tool that is familiar, the therapy process is not as daunting.

            Therapeutic benefits of incorporating technology include using themes and metaphors, overcoming challenges, and increasing emotional awareness and impulse control.  For example, when the therapist tells Gregory that he feels alone and afraid, Gregory responds “Now you know how I feel when I’m at school and I want to go home.”  This interaction with the therapist and the comment reveals multiple issues with Gregory.  First, his way of playing with others is to be in complete control.  Second, the emotional content related to how he feels about school is important to note and address later on in the therapy process.  Through playing with Gregory, the therapist can model responses that can provide insight for Gregory and emotional awareness, as well as gradually shaping Gregory’s tolerance of not always having to be in control.

            My future blog posts will address these therapeutic benefits in detail and demonstrate how technology is used with ASD clients. 

References

Hull, K. (2011). Play Therapy and Asperger’s Syndrome: Helping Children and Adolescents

Grow, Connect, and Heal through the Art of Play. Lanham, MD: Jason Aronson.

Hull, K. (2017). Play therapy with children with ASD and chronic illness. In L. Rubin (Ed.), Handbook of Medical Play Therapy and Child Life: Clinical Interventions for Children and Adolescents. New York: Routledge/Taylor & Francis. 

Kevin B. Hull, Ph.D., RPT https://drkevinhull.com/

Dr. Hull is a licensed counselor in Lakeland, Florida and his life’s passion is helping people. He is honored to represent the counseling profession as a therapist, professor, and author. Dr. Hull is a Registered Play Therapist (RPT) and Certified Group Psychotherapist (CGP). One of his specialties is working with children, adolescents, and adults diagnosed with neurodevelopmental disabilities. He also helps families of all kinds overcome many types of challenges. Dr. Hull use many innovative types of therapy such as play, solution-focused, and cognitive therapies and conducts groups with children and adolescents to help them understand themselves and learn to use their amazing gifts and find their place in the world.

The post Unlocking Growth in Autism Spectrum Clients through Technology and Play – Guest Blog first appeared on Jessica Stone, PhD, RPT-S.