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.

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.

Leslie Baker, MFT, NCC, RPT-S

Continued from blog post #2

The client is asked to develop the bullying story that they had portrayed and to act it out with the Thera-Tool™ Figure and other props. The therapist can witness and/or participate depending on the client’s choice and may suggest video recording the drama play especially if the clinician is a part of the drama play so they can watch it as a playback to explore the experience from the 3^rd person perspective.

Technology Integrated Multimodal Play Therapy creates an opportunity for a client to calm and downregulate as they explore their bullying incident, in the beginning, from the most structured moderate exposure, drawing it on a tablet. Overtime, the client exposes themselves with self-regulation, support and witnessing to two additional opportunities for more prolonged exposure to the same bullying incident. The Virtual Sandtray App and Drama Play allow the client to gain mastery and control over their world, affecting their vision of their traumatic experience. This process aids the client to develop outcomes they choose, and they decide on. The therapist provides the relationship and technology and becomes another trusted ally in their healing.

Helpful Tips:

• Be mindful to keep the clinical tablet you use free of personal information and be cautious to delete creations after printing them for your clients file.

• Video would only be appropriate with a properly signed consent form from the youth, parents and/or client and ability to manage digital assets with proper HIPPA regulations.

• If a client becomes flooded or dissociated while exploring the trauma material, stop the intervention and offer the MUSE for downregulating as needed or offer another downregulating opportunity such as bilateral tapping.

References

Gantt, L. & Tinnin, M.D., (2009). Support for a neurobiological view of trauma with implications for art therapy. The Arts in Psychotherapy. 36(3) 148-153. https://doi.org/10.1016/j.aip.2008.12.005

Hinduja, S. & Patchin, J.W., (2018) Connecting Adolescent Suicide to the Severity of Bullying and Cyberbullying, Journal of School Violence, DOI: 10.1080/15388220.2018.1492417 Abstract Retrieved from https://www.tandfonline.com/doi/full/10.1080/15388220.2018.1492417?scroll=top&needAccess=true

Perry, B.D., (2009). Examining child maltreatment through a neurodevelopmental lens: clinical application of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma 14: 240-255.

Pierce, L., (2014). The Integrative power of Dance and Movement therapy: Implications for the Treatment of dissociation and developmental trauma. Arts in Psychotherapy, 41(1): 7-15. Retrieved From: https://doi.org/10.1016/j.aip.2013.10.002

The National Academies of Sciences, (2018) Preventing Bullying Through Science, Policy, and Practice Retrieved from https://www.nap.edu/read/23482/chapter/2

Van der Kolk B., (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Sage.

Leslie Baker, MFT, NCC, RPT-S: Licensed since 1991, Leslie serves couples, families, women, men and youth who are dealing with challenges in connecting to themselves, others and to their lives. Her specialties include: depression, anxiety, trauma, grief, loss and parenting issues; and she assists couples, individuals and families facing all types of life’s transitions and challenges. She provide safe and supportive, compassionate, results-oriented sessions to help reduce symptoms, increase resilience and options and facilitate well-being and happiness. 

https://gottmanreferralnetwork.com/therapists/leslie-baker

Medibang paint: https://medibangpaint.com/en/

Virtual Sandtray: http://www.sandtrayplay.com

Thera-tool: https://www.trinaswerdlow.com/thera-tool-figure/

The post An Effective Method For Children Suffering From Bullying – Guest Blog first appeared on Jessica Stone, PhD, RPT-S.

Leslie Baker, MFT, NCC, RPT-S

The purpose of this article is to explore Technology Integrated Multimodal Play Therapy. All the steps can be integrated with technology in order to facilitate a client’s experience as a modality for change in the clinical setting.

Introduction to Technology Integrated Multimodal Play Therapy

Share with the client that over the next four to ten sessions the client will process their bullying trauma with the Multimodal Play Therapy Intervention. It involves the use of three different types of technology to allow a client to interact with the moderate-to-prolonged exposure to their choice of a bullying incident at their pace. They have the option to stop at anytime or to switch to the none technology option.

A Stepped Approach: Overview of Multimodal Play Therapy Intervention

1. Safety and downregulating with mediation/relaxation.
2. Drawing a scene from their choice of a bullying incident.
3. Creating a Virtual Sandtray®© of the bullying incident (iPad or iPhone).
4. Creating a drama play of the bullying incident with the Thera-Tool™ Figure or large toys.

• Each session includes the option for the downregulation as needed and includes witnessing, supporting and processing by the clinician.

Step I   Choose Bullying Incident

Have client choose a bullying incident that has been troubling them. If there are more than one, pick the first incident or the one that has been the most difficult for the client.

Step II Create Safety and Down Regulate

Introduce MUSE™ meditation application to assist the client with self-regulation.

The MUSE system is a medical grade EEG device that allows the client to listen to mindful mediation sounds and to simultaneously, on their phone app, track their ability to downregulate themselves and/or meditate. The objective is to slow their brain waves into a relaxed state. The client places the MUSE headband across their forehead and behind their ears. MUSE syncs up with their phone app and the session begins. The client can choose which sounds appeal to them, from ocean, forest etc.

The more they relax their brain and settle into a meditative state the quieter the sound of the storm and the more the client will hear little chirping birds fly by. The client and therapist can decide on the amount of time to try the MUSE application from as little as three minutes to more depending on the amount of time that suits a client’s need to downregulate. The MUSE app allows the client to see their progress in their ability to downregulate themselves and to see their progress. MUSE provides biofeedback for clients to see the progress they can make in self-regulation.

Step III Draw it Out

Invite your client to draw the bullying incident on the Computer/tablet or phone.

Witness as your client draws and invite them to share their story. It is important not to name or guess at the client’s creation. Let the client lead you and express what they have created if they so choose. They may choose to lend voice to a figure they have drawn or remain silent. As a clinician, remain open and supportive but refrain from interpretation. Rather be open to their interpretation if they offer one. Explore their emotional state and expressions as they offer them.

You are processing their bullying experience and you may offer the MUSE for downregulating as needed.

Clients may choose to draw one picture or over one to two sessions draw a few scenes that reflect their bullying experience. For the purpose of this modality you will have them choose one of the incidents they experienced to use throughout the rest of the process.

A clinician will need a Windows /Mac/ iPad /iPhone or Android to provide a drawing surface. A free drawing app like MediBang Paint will do a great job. A larger surface is preferable. Nothing complicated unless you are planning on doing more Art therapy-type interventions. A drawing pen is very helpful, which can be purchased separately depending on the device you own. Some will allow fingers as a pen, or special tip on a traditional pen can work well with some programs.

Step IV: Virtual Sandtray®© Creation and Processing

Invite your client to re-create the bullying incident they have chosen from drawing session(s) in the Virtual Sandtray. Choosing figures and other elements they wish to create the scene they are thinking about. A clinician should expect a change from what the client may have drawn. Metaphor often enters here but also may not show up, it really depends on the client.

Witness as your client works in the Virtual Sandtray and invite them to share their story. As in the drawing sessions, it is important not to name or guess at the client’s creation. Let the client lead you and express what they have created in the Virtual Sandtray if they so choose. They may choose to lend voice to a figure they have placed in the Virtual Sandtray or remain silent. As a clinician, remain open and supportive but refrain from interpretation. Rather be open to their interpretation if they offer one. Explore their emotional state and expressions as they offer them. You can ask “What is the title for your Virtual Sandtray?” and/or “What is the moral of your Virtual Sandtray?” or “What is your Virtual Sandtray trying to show others?”  

Clients may choose to create one Virtual Sandtray over one to two sessions and/or create a few Virtual Sandtrays that reflect their bullying experience(s).

Step V: Play It Out

Invite your client to re-create the bullying incident they have chosen from tablet drawing(s) or the Virtual Sandtray session(s) and dramatize it into live form dramatic play. For other characters, the client can utilize the Thera-Tool™ Figure as well as assign a role to the clinician. Large stuffed animals, puppets or inflatable animals can also be used as props if needed. Material provides an inexpensive way for the client to dress up and provide dress up for their characters. I recommend a basket of material 1½- 2-yard pieces in red, black, royal blue, green, pink and brown and two shear materials. I recommend various sizes of 2’wide to 1½ yard strips for tying material around themselves or the characters. The material serves as capes, covers, dresses and drapes for the client and the characters in their drama play. The ties also become several props, from blind folds to masks to various other props depending on the client’s imagination.

Leslie Baker, MFT, NCC, RPT-S: Licensed since 1991, Leslie serves couples, families, women, men and youth who are dealing with challenges in connecting to themselves, others and to their lives. Her specialties include: depression, anxiety, trauma, grief, loss and parenting issues; and she assists couples, individuals and families facing all types of life’s transitions and challenges. She provide safe and supportive, compassionate, results-oriented sessions to help reduce symptoms, increase resilience and options and facilitate well-being and happiness. https://gottmanreferralnetwork.com/therapists/leslie-baker

Medibang paint: https://medibangpaint.com/en/

Virtual Sandtray: http://www.sandtrayplay.com

Thera-tool: https://www.trinaswerdlow.com/thera-tool-figure/

The post An Effective Method For Children Suffering From Bullying – Guest Blog first appeared on Jessica Stone, PhD, RPT-S.

Leslie Baker, MFT, NCC, RPT-S

Bullying

An age-old trauma for school-age children in hallways and cafeterias, bullying continues its reign of terror. The forms and incidences of bullying, which include cruelty, exclusion, and rumormongering, have grown with the inclusion of cyberbullying now in the mix. According to the research by Hinduja & Patchin, (2018), students between the ages of 12 to 17 who were either bullied at school or online reported significantly more suicidal thoughts. The youth who experienced both school bullying and online bullying reported more suicidal thoughts and attempts. Lastly, the students who were bullied online in a way that impacted them at school suffered an increased risk of both suicidal thinking and attempts.

Understanding the effects of bullying is critical; it’s particularly insidious in childhood because it disrupts brain development, impacting self-regulation and the ability to build healthy relationships in adulthood. According to the National Academy of Science (2018) summary, “regardless of the mechanism, being bullied seems to have an impact on mental health functioning during adulthood.” The study also noted that:

…the effects of being bullied on the brain are not yet fully understood, there are changes in the stress response systems and in the brain that are associated with increased risk of mental health problems, cognitive function, self-regulation, and other physical problems (Conclusion 4.3). (para. 19)

Traumatic experience, like those noted in Acute Childhood Experience Scores  (ACE Study),  links childhood traumatic events to later serious health problems and to emotional and social difficulties such as depression and suicidal behaviors. Trauma in childhood impacts self-regulation and connection formation throughout a child’s life span changing the brain and the body.

Mitigating the Effects of Bullying

Multimodal Play Therapy Intervention incorporates Integrated Play Therapy Theory, Neuro-Sequential Model of Therapeutics by Dr. Bruce Perry, and moderate exposure training via experiential play therapy techniques such as down-regulation training with intervention including meditation, drawing, sandtray, and drama play. Multimodal Play Therapy Intervention assists trauma survivors to down regulate the stress system with mindfulness practices. Drawing desensitizes via moderate-to-prolonged exposure training and drama play leads to discovering and developing ways to move forward in connection with body movement. Throughout the process of the multimodal approach, these interventions assist in increasing the window of tolerance for traumatized clients and provide an opportunity for their brains to reintegrate trauma from a bottom up developmental neuro-sequential approach through the experiential play and expressive modalities.  (Part 1 of 3)

• References at the end of Part #3

The post An Effective Method For Children Suffering From Bullying – Guest Blog first appeared on Jessica Stone, PhD, RPT-S.

Gathering Clinical Data

A crucial aspect of therapy is the therapist’s ability to assess the client. This assessment allows the therapist to gain insight into the client’s presenting issue(s). The therapist gathers data on the client’s affect, mood, and motor skills among others. The goal of the assessment is to utilize the data gathered to diagnose and create a treatment plan with measurable goals to identify the effectiveness of the treatment. Therapists are continuously assessing in session as well as from session to session to measure progression or regression. have strong verbal skills while others may not.

Video Games

Video games provide unique opportunities for assessments. Ceranoglu (2010) argued the use of video games in psychotherapy is beneficial to building a relationship, evaluating a child’s cognitive processing style, and elaboration and clarification of conflicts. Video game play provides intense situations due to audio and visual effects, the emotional nature of the play, and the identification with characters that may bring the client and therapist together as they share similar affective states (Ceranoglu, 2010). After the relationship is established, the importance of the client’s cognitive processing style is crucial for the therapist to assess. Video game play provide a variety of measurable behaviors such as memory, motor and planning skills, visuospatial, and frustration tolerance among others (Ceranoglu, 2010). Furthermore, the therapist can assess the client’s emotional regulation and reactions to play going well or if the play is not going the way the client intended. The therapist can measure the child’s ability to work through conflict by watching the client’s self-talk, planning, and frustration tolerance. This information provides insight for the therapist to include in diagnosing and treatment planning.

Clients who struggle with verbalization and articulating conflicts in the therapeutic process may find it easier to verbalize conflicts through video game play (Ceranoglu, 2010). Video game play can facilitate insight for the therapist through the use of body positioning between the therapist and client sitting side by side allowing the client to feel free to express themselves without direct eye contact with the therapist as well as the client’s choice of game and game mode (Ceranoglu, 2010). The client’s choice of game may show the client’s inner processes to provide elaboration and clarification for the therapist. For example, a client may choose to play an aggression game to express and verbalize inner frustration or conflict. A client may choose to play an adventure game where they can modify the content such as building or destroying objects. These choices may represent a deeper meaning for the client that may not be obtained through other therapeutic approaches. The game mode is another opportunity for a therapist to gauge a client’s inner thinking. Game modes allude to a single player mode where the client is only playing, a player versus player mode (client vs. therapist), or a client and therapist team versus the computer. The selection of modes may represent different meanings or situations a client may be experiencing.

https://www.apa.org/pubs/journals/releases/gpr-14-2-141.pdf

Ceranoglu, A., T. (2010) Video Games in Psychotherapy. Review of General Psychology, 14(2), 141-146. doi:10.1037/a0019439

The post Assessing Clients with Video Games – Guest Blog first appeared on Jessica Stone, PhD, RPT-S.