On the last track, we discussed issues of trauma flashbacks
and bodily reactions to supposed repressed memories of a trauma.
this track... we will discuss recognizing abuse internalizations and a Trauma Recall
Techinque to use once abuse has been established related to play therapy. We will
discuss two case studies regarding the child's feeling that "I am damaged"
and the ethical use of play therapy.
#1 The Internalization
As you are aware, the Internalization Model alerts the therapist
not only to what may be expressed in the play therapy but also to what needs to
be addressed if the child is to work through the abuse and reclaim a sense of
self and world unaffected by the trauma of the abuse. In this section, the Internalization
Model will be used as a framework for recognizing what the "I am a damaged
child" is expressing through play.
The following is an
example of how Cindy, age 10, was interviewed by the therapist. Cindy had been
admitted to the emergency room for vaginal bleeding. Following her sexual abuse
by her step-father, she would not talk about the incident. See what you think
about this therapist's ability to facilitate Cindy's recall. Is the therapist
boarding on ethical misconduct by misleading the client? Or does the therapist
use neutral feedback allowing the client to focus the session?
--Cindy starts scratching herself and says that she is dirty and is trying to get the
--Therapist: (Notices that there is no dirt on the
child, and therefore, she is talking about internal dirt. She also notes the word
"out," clearly indicating that Cindy is talking about something internal.)
--The therapist stated, "Listening to you talk about dirt inside, I'm wondering if you are feeling that there is dirt inside from the
abuse. (Cindy nods yes.) The therapist continues, How big is that feeling of dirt?
shows a small size with her hands and then a larger size.
The therapist stated, "That dirt doesn't belong there. The dirt belongs to the abuse, not you. And the
abuse is out, over, so let's get that feeling of dirt out, over. You could draw
it, model it out of clay, what do you want to do with it?"
picks up a pencil.
--Therapist tapes together two pieces of paper
to accommodate the size Cindy had indicated.
--Cindy scribbles all over the paper.
--The therapist stated, What now? You could tear it,
cut it, squish it, or something else. What do you want to do?
tears it up, stamps on the pieces, and then with a big smile, puts them in the
Do you see how this therapist separated Cindy's
internalization of the abuse by saying, "The dirt belongs to the abuse, not
you." Personally, I feel an ethical boundary was not crossed because the
abuse had been established, medically, prior to the session and memories were
not being implanted in Cindy's mind. To maintain this ethical boundary, the therapist
asked such neutral questions such as: "What do you want to do with it? And
What now?" Keeping the client in control.
"I am Damaged."
Here is another
example of the feeling, "I am Damaged." See if you can spot how the
therapist remains neutral and does not violate an ethical boundary. Terry
was an 8-year-old, sexually abused by her father between ages 5 to 7. Terry came
into Sandra her therapist's office and took out a paper.
On the piece of paper
she wrote, "From Terry to Sandra" and drew a heart. She then wrote "I
love Sandra" but then erases her name and wrote "love Mommy" as
a signature. So her note read, "To Sandra" with a heart and at the bottom,
she wrote "Love Mommy" as a signature.
that the very common 8-year-old activity of writing "to" notes and "love"
notes had been altered in a way that eliminated Terry's name. if you recall
Terry erased her name). According to Sandra, Terry's erasing
her name seemed to indicate Terry was possibly unable to link herself with love.
stated, "It seems as if it is really important for you to love me and love
Mommy. But I'm also noticing that you erased your name. Do you love yourself?"
shakes her head to indicate no.
--Sandra stated, "Close
your eyes for just a moment and imagine yourself. Now give yourself a hug.(I
feel this was an error by the therapist because it did not first address the internalization
expressed in the play.)
--Terry stated emphatically, "Yucky,
--Sandra asks, "Where's the yuck?"
answered, "In the heart."
--Sandra goes over to the
chalkboard and draws a heart and then draws some scribble lines inside the heart.
This is the yuck in Terry's heart. I am going to take the yuck out because it
doesn't belong to Terry. (Sandra gesturing took the yuck in her hands, she turns
to Terry.) Where shall I put the yuck?
--Terry stated, "In da trash. No,
to the devil."
--Sandra: Goes over to an empty chair in the room
and states, "Hi, Daddy," as if Terry's father were sitting in the chair,
then stated, "Terry got all this yucky feeling from your touching her.
She wants you to know how it felt."
--Sandra holds out
her hands as if putting the yuck in the chair, then after a moment, with a hand
movement, scoops the yuck back up. Sandra stated, "OK, do you know now how
--Terry, in her comment, had made it clear
that it would have been too threatening to her and her love for her father at
that point for the "yuck" to be left in the chair that represented her
--Sandra moved back to Terry, and asks, "What shall we do with it now?"
stated, "Throw it away." Then smiled slightly.
In this therapy session, the internalized feelings
regarding the memory of the abuse was made into a role play of giving the feelings
of the abuse trauma to Terry's father then taking it back and throwing it away.
Sandra asked the neutral question, "Where is the yuck?" rather than
"Is your father the yuck?" in my opinion no ethical boundaries were crossed
in this role play regarding internalization of the abuse trauma. You may disagree.
this track... we discussed recognizing abuse internalizations. Two examples were
given of ways in which a therapist can remain neutral and not violate an ethical
boundary regarding recall of a trauma via the use of play therapy and role playing.
What is one example of a neutral non-leading type of statement you might
make in a therapy session with a trauma client? To select and enter your answer
go to Answer
This CD has covered such topics as: Countertransference,
Hypnotism and Ethical Controversies, FC and Autistic Child Trauma, Dream Interpretation
and Sleep Paralysis, Vet Flashbacks, and Play Therapy and Role Playing Ethics.
hope you have found the information to be both practical and beneficial. We appreciate
that you've chosen the Healthcare Training Institute as a
means for receiving your continuing education credit. I wish you the best of luck
in your practice. Thank you. Please consider us for future home study needs.
Other Home Study Courses we offer include:
Treating Self Mutilating . . . Teen "Cutters" "Physical Pain Stops
My Pain" Treating Teen Self Mutilation; Treating Post Holiday Let-Down and
Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions
for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic
in the Therapeutic Relationship.