| On the last track we discussed grieving the loss of
security; loss of childhood; and the benefit of using the "Story Telling"
technique
As you are aware a common technique used to unravel
the concept of "It Wasn't Your Fault" as it relates to sexual abuse
with young children, is to use play therapy.
On this track, we will look
at the ways play therapy can be used when dealing with repetitive rituals, control,
and regressive behavior. We will also look at when setting boundaries in play
therapy would be beneficial.
How Play Therapy can be Used in 3 Situations
Situation # 1 - Repeated Rituals
Blake, age 8, who had been sexually abused at the age
of four by his babysitter, loved to continually assemble, disassemble, and reassemble the same building with LEGO plastic blocks. He would come into the session, go
straight to the LEGO table, pick out the same blocks, and assemble the same six
story skyscraper. Then he would disassemble it, neatly placing the separate pieces
on the play table.
Blake would take apart his creation three or four times during
one session and then reassemble it. During the construction and destruction of
his building, I would remind Blake, "Things that are broken can be fixed
and need not stay broken. Sometimes people may feel broken, but they can get better
and feel whole again too." My purpose was to instill in Blake a different
perspective and to begin to facilitate an attitude of healing.
Prior
to the sessions, Blake had a recurring nightmare in which he was in a park, handcuffed
and being abused by a policeman. Within a few weeks, he dreamed that he became
a fire breathing dragon, melting the handcuffs. Although Blake continued to have
occasional nightmares, they did not overwhelm or devastate him. You might consider
observing your Blake and his or her patterns of repeated rituals in your next
session. Is there a way you can reframe your client's behavior?
Situation #2 -
Control
Lindsey's parents were divorced
and there wasn't stability in her life. Lindsey, age 8, had been living with her
mother, Rita who was working and unable to take care of Lindsey after school.
As a result, Lindsey stayed at a neighboring couple's house until her mother returned
home. After a few weeks, the husband, William, who was the only one home when
Lindsey first got home from school, started molesting her and eventually, raped
her. When Lindsey first told her mother about the assault, her mother did not
believe her and would scold her for accusing William. Finally, Rita reluctantly
referred Lindsey to therapy.
Lindsey, age 8, spent her play
therapy focusing on playing one particular card game, Go Fish, throughout the
course of several sessions. By repeating this game over and over, I felt it possibly
was her way of working through the trauma of her sexual abuse.
Here were my thoughts.
See if you agree? The repetition of the Go Fish card game created a predictable
relationship with me; a means of counteracting or controlling her otherwise chaotic
world.
In our sessions, Lindsey would frequently try to change
the basic rules of the game or blatantly cheat. I felt Lindsey's need to control
the game and its rules were a possible means for her to control her environment in light of the trauma of William's sexual assaults and her feelings of helplessness.
In addition to gaining control of her environment, Lindsey was able to start to
rebuild her sense of competence, simultaneously decreasing her feelings of vulnerability.
Think of your Lindsey who repeated plays the same game, changes game rules and
or blatantly cheats. Is he or she trying to transition from helpless victim to
a controller of her environment?
Situation # 3 - Regressive
Behavior
Undoing what was done through assembling and disassembling
constructed objects; changing game rules to decrease feelings of helplessness;
let's look at facilitating regressive behavior through play. Amanda, age 12, went
through a period of regressive behavior as a result of her trauma of being sexually
abused by her stepfather. As you are well aware, regressive behavior is often
displayed early in therapy.
During this regressive period, 12 year old Amanda
fed herself with the baby bottle. I interpreted this behavior for Amanda by saying,
"Sometimes when we are upset or frightened, it feels safe or helps to do
baby things for a while, and to go back to a time when things felt safe. Does
drinking from the baby bottle feel safe and comfortable for you?" Obviously,
the drinking from the baby bottle transported Amanda to a pre-trauma developmental
stage.
When a child needs to regress, I feel it is beneficial to keep a few toys
that would facilitate this behavior, such as a baby bottle, clay, finger paint,
and cuddly stuffed animals. Although I, like you, am aware of the fact that regressive
behavior is only temporary, I find that it's important to inform parents that
their son or daughter might be exhibiting these behaviors at home. I also assure
the parents that this phase will probably not last for a long period of time,
but may be important to the child as he or she works through their abuse.
2 Tools to Assist your Client in Accepting the
Abuse "Was not their Fault."
Tool #2 - Setting Boundaries
Now
let's look at setting boundaries during this play therapy. Obviously
for play therapy to be truly successful, the child must feel that he or she has
the unbridled freedom to express themselves. But the challenge is, how far should
the child be allowed to freely express him or herself and at what point would
setting boundaries benefit the client?
As you are aware, the
physical expression and channeling of destructive impulses must be directed towards
symbolic objects like punching bags or padded bats. I have these objects as focal
points in the room, so that the child will understand that this punching and hitting
is not acceptable behavior towards actual people. Thus, the limit I set is: the
only thing the child cannot do is hurt themselves or me.
In
addition to restricting destructive impulses to symbolic objects, another boundary
I set regarding expression of anger, is related to drawings. I personally feel
drawings must remain in the therapist's office when the child leaves. This
way he or she knows that none of the negative emotions being dealt with in therapy
will spill over into everyday life.
As you know, when a sexually traumatized child
does express his or her anger, it can be primitive and unpredictable. If that
anger should be displayed in any other place besides treatment, the child could
misunderstand the balance between it being OK to express their anger in therapy
and letting their emotions control them in real life. Thus I use the retention
of the art work in the office as a means of setting this limit.
It
goes with out saying letting a child know that no physical contact will occur, comforts them. I stated to Amanda, "While we're in this room, we'll only
be communicating through playing and talking. This way, you can learn to express
your feelings through words instead of violence towards other people."
Tool # 1 -Pet Therapy
In
addition to repeated rituals; helplessness versus control via card game rules;
and facilitating regressive toys, use of a pet seemed to be beneficial in reaching Doug. Doug, age five, who was seriously abused by a male while playing
unattended at a local playground. When his mother brought him to me for therapy,
she described him as almost totally mute since the day of the abuse. After his
mother left, Doug sat on the edge of the chair and stared into space. I made several
attempts to communicate with him, but he remained unresponsive until he got up
out of the chair and huddled on the floor with his back to me.
After a few minutes,
my small cocker spaniel, which had been asleep under my desk, woke up. Thinking
that Doug might feel safer around the dog, I rolled a ball in Doug's direction.
The dog noticed him sitting huddled on the floor and tried to engage Doug in a
game. At first, the dog sat quietly and then slightly nudged Doug without any
response. Finally, the dog let the ball drop and it rolled in Doug's direction.
Then Doug slowly began to pet the dog and cautiously rolled the ball back.
Over
a period of several weeks, Doug continued to play with the cocker spaniel and
soon made the transition from playing with the dog to interacting with me. What
is your agency's policy on pet therapy? If you had not thought about the use of
a pet in therapy, you might turn your CD play off and think of the pros and cons
as to the appropriateness of this tool for your practice.
On
this track we discussed some ways to use play therapy when dealing with repetitive
rituals, control, and regressive behavior; as well as looked at setting boundaries
and pet therapy as tool to assist you client in steps towards accepting that the
abuse "was not their fault."
On the next track, we
will examine the Family Stance and the Family Trance and the two techniques of
the "Other Family" exercise and the "Family Mottos" exercise.
- Duncan, K., PhD. (2004). Healing from the Trauma of Childhood Sexual Abuse. Westport, CT: The Journey for Women, Praeger.
Peer-Reviewed Journal Article References:
Ensink, K., Borelli, J. L., Normandin, L., Target, M., & Fonagy, P. (2020). Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry, 90(1), 115–124.
Misurell, J., Springer, C., Acosta, L., Liotta, L., & Kranzler, A. (2014). Game-based cognitive–behavioral therapy individual model (GB-CBT-IM) for child sexual abuse: A preliminary outcome study. Psychological Trauma: Theory, Research, Practice, and Policy, 6(3), 250–258.
Springer, C., & Misurell, J. R. (2012). Game-based cognitive-behavioral therapy individual model for child sexual abuse. International Journal of Play Therapy, 21(4), 188–201.
QUESTION
5
In play therapy what is one interpretation of a client repeatedly assembling
and reassembling the same object; changing game rules; and regressively drinking
from a baby bottle? To select and enter your answer go to .
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