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.

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.