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Experiential play therapy

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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 its 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• childs behavior outside of playroom undergoes a temporary, but dramatic, improvement  indicator of childs potential for change
  8. 8. 5 Stages of EPT Testing for Protection Stage•goal: establishment of relationship•child is testing counselors trustworthiness & safety oftherapeutic alliance  therapist to reflect & validate childs feelings•Therapist should be aware of own limits of comfort•Some disruption or regression in child behavior maybe 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

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