Abuse:

Adam, a 6 year old boy, was emotionally and physically abused by his father. When he came for therapy he no longer had any contact with him but was dealing with the aftermath.

A theme emerged in Adam’s play early on in our sessions. He repeatedly used a large, intimidating looking dragon to overpower smaller, weaker characters and played out various incidents of violence he had experienced. For example, the dragon was often seen attacking the little puppy, or the pixie was often thrown in to a small room in the dollhouse by the dragon, unable to escape. The smaller creatures felt helpless, sad and vulnerable. Through repeated enactments David was able to process his feelings while I helped him verbalize what he felt and validated those feelings for him.

Once he worked through the anger and the hurt, his play was no longer aggressive and he began choosing toys that held a positive meaning for him. For example, the police officer would “rescue” the pixie and the puppy and a bigger dog (symbolizing the mom) began to play happily together

Shyness and/or anxiety:

Layla (3.5 years old) was apprehensive engaging in new activities at school and struggled with being assertive.

I included mom in the first session to help Layla feel comfortable. In the next session she was willing to come on her own but I noticed that she wanted me to lead the play. I put on a puppet show where two friends were playing with each other and a third wanted to join. I used the “whisper technique” to explore Layla’s thoughts and feelings. For example, when the two friends didn’t include the third child in their play, I whispered to Layla and asked her how that child felt, Layla whispered that the child felt sad. I asked (in a low voice) why she doesn’t want to ask if she could join, and she whispered back that she was shy and afraid they would say no. Using my “puppet” voice, I played out various possible scenarios. Through this process I was able to teach Layla what specific statements she could use to ask if she could join in and how she could respond if they said no. It also helped her recognize that being turned down didn’t mean much more than them just wanting to play alone for that moment.

I also helped Layla shake off the label of a being “shy girl,” and helped her understand the feeling of being worried. We identified the butterflies in her stomach, the hotness in her cheeks, and the lump in her throat when she felt worried. I taught her how to regulate her breathing at times like that and think of a time when she felt calm. We imagined a scene of her playing in the backyard with her mom which helped her feel safe again. We also practiced using assertive statements while looking in a mirror. Eventually we put on the puppet show again with Layla taking the lead.

Feeling more equipped to handle unfamiliar situations, Layla began taking careful steps to initiate play and stand up for herself at school. 

Culture Conflict:

Sonia, a 14 year old girl, previously an ideal student at school was becoming exceedingly rebellious toward her mother; her schoolwork was also affected.

Sonia was initially resistant to therapy particularly because she felt that I would judge her in the same way her mother did because we belong to a similar culture. However, I connected with Sonia by expressing interest in her thoughts and values and aligning with her on some of her beliefs. Without the sense of judgment that she felt at home, she shared her emotions freely. She felt conflicted about her dual cultural identity, mostly because she felt that her family’s values were prohibiting her from fitting in with her friends. As a result, she rebelled – going to the other extreme to assimilate.

I held separate sessions with mom to help her understand and prepare for normal teenage behavior. We addressed mom’s fear of losing Sonia to the “western world” and helped her find ways to accept the fact that her daughter would be a blend of both worlds. We held a joint session during which Sonia articulated her feelings of frustration and resentment while her mom expressed disappointment in her behavior. Boundary setting and realistic expectations were outlined.

Since mom now had a better understanding of where the rebellious behavior was stemming from, she was more open to freeing Sonia from the shackles of traditional values that she had been raised with. Sonia felt less burdened by those expectations and was more willing to embrace certain aspects of her culture. Through therapy she was able to reconcile her Western identity with her ethnic values, resulting in improved behavior both at home and at school.

Divorce:

4 year old Emma was having spontaneous crying spells weeks after her parents divorced. She was now living with his mother and visiting with her father.

Emma created a “family” with small plastic animal figures. There was a lion, a tiger and a kitten who either argued or retreated to their own cages in the zoo (represented by Lego structures that she built). Using the feelings chart, I helped Emma identify what each animal was feeling at different times and what their reasons were for feeling that way.

I asked what would happen if one of the animals went to a different zoo. Emma used blocks to create a new cage for the lion while the tiger and kitten remained in the Lego zoo. The tiger and the kitten began coming out of their cages to play together and when the kitten visited the lion they displayed more affection toward one another as well. When the tiger and the lion met at an “animal meeting”, they were polite to each other and there was no arguing. Emma realized that they were all happier in this new setting and it helped her accept her family's situation.

We read books on divorce and she pointed out parts to which she could relate. It helped her come to terms with the fact that even though her parents were no longer living with her, she would not be losing either parent and would remain loved by both. Now that she had a better understanding of her feelings and knew how to describe them, she no longer had any spontaneous crying spells

Aggressive behavior:

Sam (3 years) was exhibiting aggressive behavior at home and at daycare. His parents explained that he had recently moved.

When Sam first entered the office, he raced around the room knocking all the toys over. Having done so, he looked at me triumphantly. I kneeled down and said, “It seems like you really liked knocking all the toys down, would you like to find something that we can play with that allows you to do more of that?” He didn’t receive the kind of attention he was seeking and it prevented a power struggle which took away the desire to be defiant. We sat down and I gave him the pounding bench. As he hammered away, I pointed out that he seemed very angry. I gently explained the rules of the room pointing out that he was free to play with whatever he liked as long as he didn’t purposefully hurt me, himself or any of the toys. This freedom gave him space to work out his anger: he enjoyed punching the bop bag, he liked making the super heroes fight with each other, he knocked the toy soldiers down with a Lego brick. Once, while playing with darts he aimed one at me, I reminded him that it wasn’t okay for him to hurt me, instead he could throw it at the doll figure if he wanted to.

Through structured play and limit setting, Sam’s aggressive tendencies diminished and we transitioned to sensory play using play dough, finger paint and model magic. I used this time to encourage him to talk about his move, what he missed about his old home and how he felt it had been unfair. I pointed out the difference between feeling mad versus acting mad. We also talked about the exciting new things in his life now. He recognized that his family was still together and that wasn’t going to change.

Having learned how to express his anger safely and by venting his frustrations regarding the move, Sam was able to come to terms with the change and his behavior began to improve. 

Specific phobia:

During 2.5 year old Kyle’s toilet training process, he was reluctant to use the bathroom in school and it affected his behavior in school significantly.

I suggested that we play out a classroom scene using stuffed animals. First, I pretended to be the teacher while Kyle voiced the children. After finishing “circle time” I asked the “children” to take turns using the bathroom (symbolized by two small drums). While most of the “friends” followed directions, there was one reindeer who didn't want to go. Staying in the play setting, I gently probed what was holding the reindeer back and the “reindeer” stated that it was because he was afraid he would make a mess in there. I provided words such as worried and embarrassed to help him describe those feelings. As the teacher, I assured him that the mess didn't matter, it would get cleaned up and it wasn't a big deal. Later, we switched roles.

While Kyle did “story time” I pretended to be the reindeer that really needed to use the bathroom and when he did he made a big mess. I portrayed feelings of embarrassment and worry about what the teacher would say. Kyle being the teacher, came to the rescue and assured me (the reindeer) that it was all okay. Thereafter, it became easier for the reindeer (and Kyle) to use the bathroom while at school.