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Experiential play therapy

  1. 1. Experiential Play Therapy Rachel Coleman
  2. 2. What is EPT? • children experience the world experientially • engages all the senses when working through doubts, fears, anger and other unresolved emotions • Firm belief in the capacity of the child to heal
  3. 3. What is EPT? (cont.) • Child is expert on his/her pain and knows how best to approach it • In therapy, therapist allows child the freedom to work through struggles at his/her own pace • child can reenact situations involving behaviors not used in precipitating events
  4. 4. How does it work? • Play is a child’s perspective on his/her experiences of the world and relationships  Child enters fantasy play as a defense mechanism to deal with anxiety when sense of self has been disrupted/threatened. • Dignity and empowerment are the primary processes of EPT o Child usually assumes power position; therapist to act/react as child • gives therapist an insight on what it's like to be child • therapist to experience feelings of powerlessness, ineffectiveness, apprehension, and insignificance
  5. 5. How does it work? • Child becomes the creator of his/her experiences with needs and fears expressed in a format he/she can control, conquer, & change • Child uses the symbolism and metaphorical expression of play to communicate confusion, doubt, & pain o EPT therapist responds to meaning of the metaphor rather than reflecting the content
  6. 6. How does it work? • Based on 3 major components: 1. The capacity of a child to use play, symbolism, and metaphorical expressions to convey internal world & expressions 2. Therapists’ skill in understanding & relaying the child’s expressions back to the child 3. Parental responsibility to learn and engage in the process of the child • Consists of 5 stages:  Exploratory Stage  Testing for Protection Stage  Dependency Stage  Therapeutic Growth Stage  Termination Stage
  7. 7. 5 stages of EPT Exploratory Stage • child gets acquainted with therapist, play room, and time together • therapist uses more observational statements ; follows child’s lead • child's behavior outside of playroom undergoes a temporary, but dramatic, improvement  indicator of child's potential for change
  8. 8. 5 Stages of EPT Testing for Protection Stage •goal: establishment of relationship •child is testing counselor's trustworthiness & safety of therapeutic alliance  therapist to reflect & validate child's feelings •Therapist should be aware of own limits of comfort •Some disruption or regression in child behavior may be evident at this stage; parents need to be informed
  9. 9. 5 Stages of EPT Dependency Stage • the emotionally intense, working stage; child is prepared to face emotional turmoil • 2 substages • Child’s disclosure of experiences • child engages in emotionally-themed fantasy play; feels safe enough to invite therapist into his/her play • Leveling of the fear object or perpetrator • Trauma is a fear of death for the child, and the child must conquer impending death fear in her play” • The metaphorical equivalent of the pain & struggle of the past being lifted off the child
  10. 10. 5 Stages of EPT Dependency Stage • child takes on aggressor/power stance o Child must possess the power to accomplish through play what s/he was unable to accomplish in reality (as long as child & therapist are safe o Therapist assigned role of child; must respond as child would at that age, using facial expressions, sounds, body movement • 2o important processes occurring simultaneously: Child develops an internal sense of empowerment & control o Child gains a “spiritual victory” over fear object/trauma/challenge • Dependency stage ends with annihilation or death of aggressor
  11. 11. 5 Stages of EPT Therapeutic Growth Stage • Child briefly grieves the lost trauma persona o Will display flattened affect o Will seem to regress to exploratory stage Use of Play for: o skill mastery o Re-experiencing lost developmental stages o Eventually age-appropriate mastery, silliness, & laughter Child no longer depends on therapist for sense of ID Play becomes more interactive & cooperative
  12. 12. 5 Stages of EPT Termination Stage • Represents loss of a significant relationship • With Introduce within therapist should:child time to react & say good termination,  firs 10-15 min to give bye to play  Communicate to child the importance of their relationship to therapist  Follow up with encouragement for the child’s ability to move forward without therapist • Ideally, child has gained the ability to interact appropriately with others & can allow self to trust in caring relationships
  13. 13. Parental Involvement in EPT • Parent involvement critical to outcome of therapy; parent- therapist relationship viewed as a key supportive component of the play therapy process • Parents need to be oriented to the concepts of healing pain & regression; they are key in providing security, support, and regulation when a child experiences a regressive episode  Children may need to exhibit behaviors representative of an earlier age  Regression indicates the child is approaching the irreconcilable internal experiences (trauma/disruption) that drives the attitude/behavior disruptions at the developmental age at which event occurred.  Each regressive episode assists the child in experiencing regulation after emotionally re-experiencing aspects of the trauma
  14. 14. Parental Involvement in EPT • Therapist meets with parents 10-15 min after every session to discuss themes expressed and emotional and security needs to be met in between sessions.  Critically important to maintaining sense of security between sessions • Therapist provides compassionate support to parents as parents learn to soothe, support, and nurture regressive response
  15. 15. Clinical Applications for EPT • A prerequisite for a child to participate in EPT is the capability for symbolic play • EPT is beneficial for children presenting with the following: o Reactive disorders o Oppositional Defiant Disorder o AD/HD o Separation Anxiety Disorder o Phobic Disorders o Attachment Disorders o Obsessive Compulsive Disorder o Dissociative Indentity Disorder o Some psychotic features ( associated with long term, high intensity trauma )
  16. 16. Clinical Applications of EPT • When using diagnostic disorders, it is really important to determine an accurate history as reactions to trauma may present as constitutional in nature • Allows children to approach memories of trauma in a way that is not overwhelming to them • Not as beneficial to children with pervasive developmental disorders, such as Autism or Asperger’s Syndrome
  17. 17. Evidence Basis for EPT • Relatively new concept in EPT • Stages developed by observing children create their own process of healing o Progression relatively consistent o Allows therapist to track child in process; can ascribe more appropriate expressions to match the child’s meaning • Focused on relationship with child, but gives more direct expression to what the child expresses in play • Brain Active form of play therapy o uses integrated Right-left & top-bottom processes in the brain
  18. 18. Evidence Basis for EPT • “Trauma is in the nervous system of the child, not the event” o Play process must be active and repetitive to dissipate trauma effects on the brain o Implicit memories and sensations + explicit or factual memory process considered during regression o Therapist must consider the stage of brain development being conveyed o Look at neurological dysfunctions fueling inappropriate behaviors
  19. 19. Challenges of EPT • Therapist must undergo a paradigm shift to understand the meaning of each expression from the child’s perspective • Can be frequently difficult to maintain credibility with other professionals who serve children • High risk of counter-transference o Self examination and growth of the EPT therapist is an constant process o Processing own experiential world • Therapist must refrain from leading the child’s play o May offer redirection to facilitate the process or to provide a safer environment
  20. 20. Case Study - *Seth, age 4 • Born prematurely at 8 months • Critical for Mom & baby o Baby punctured unsuccessfully 40 times with IV o “Mimicking death” • Referred for therapy for: o Considerable anger towards other o Anger at preschool o Difficulty relating to other children o Asthma o Awkward & coordinated; little body awareness o Little empathy or compassion for others
  21. 21. Case Study - *Seth, age 4 • Mother requested being present in the play room • Testing for protection Stage o Initially refused the leave the play room o Trust established & was able to separate from play & playroom • Dependency Stage o Depicted struggle in prenatal position o Assigned therapist role of child; Seth role of doctors o Switch roles, allow Seth to “defend himself” • Therapeutic Stage o Validated new positive sense of self

Editor's Notes

  • Bullet point 1 - Experiential Play Therapy is based on the concept that children encounter their world in an experiential manner versus a cognitive one. Bullet Point 2. EPT children engage all of the senses to work through problems, concerns
  • T4P: at this stage, the child wants to know if the therapist can be trusted with his/her story. Testing comes in many forms, most commonly boundary testing.