Supporting Children Who Have Been Through Trauma

Supporting Children With Trauma

Today we hear a lot about Trauma in the media, read on for more about how Play Therapy can help: 

Play Therapy helps children process traumatic experiences and upsetting events that have impacted their lives. Play is the natural way for children to communicate and express themselves, which is why Play Therapy is a beneficial non-threatening intervention for children. Play is vital to every child’s social, emotional, cognitive, physical, creative and language development. It helps make learning concrete for all children and young people including those for whom verbal communication may be difficult.
Children are likely to respond to traumatic events with multiple behavioural and emotional reactions which Play therapists recognise as survival responses helping equip children to deal with traumatic events.  Play therapists are more likely to ask, “What has happened to this child?” rather than “What’s wrong with this child?.”

Play Therapy taps into the process to affect healing and recovery for children suffering from PTSD or trauma.

“In research specifically on trauma, Play Therapy has shown positive outcomes for children who have experienced domestic violence, refugee experiences, sexual abuse, and natural disasters. In all of these studies, researchers noted that play therapy allowed children to work through their own unique reactions and perceptions to traumatic experiences through an empathic therapeutic relationship with a skilled Play Therapist and the ability to express themselves through their developmental language of play. Play therapy research clearly and consistently demonstrates the effectiveness of play therapy for children who have experienced trauma.” 
Cathy Malchiodi PhD: psychologytoday.com
Play provides a safe psychological distance from children’s problems, metaphors (super hero’s fantasy characters,  dinosaurs, monsters, villains, or police and doctors and other real-time characters are often used in role-play, art, sand and when using clay which allows expression of thoughts and feelings appropriate to their development. Traumatic events are often not saved as verbal memories, resulting in a lack of clarity and rational thought about the experience, so putting a face to an inner feeling can bring more light and understanding.                                   (Gaskill & Perry, 2012; Ogden & Minton, 2000; Porges, 2004; van der Kolk, 2014).

Play Therapy helps children in a variety of ways:

      • Play allows children to better manage their own actions, and can decrease undesirable behaviour.
      • Play allows children to develop creative problem-solving abilities.
      • Play allows children to receive emotional support. They learn about empathy and respect for the feelings of others by giving them space to get in touch with their own thoughts and feelings.
      • Children may also learn to manage relationships and conflicts in more appropriate ways. Sometimes they may act or play out traumatic or difficult life experiences in order to make sense of their past and cope better with their future.
      • The outcomes of Play Therapy may be general e.g. a reduction in anxiety and raised self-esteem, or more specific such as a change in behaviour and improved relations with family, carers and friends.

Play Therapy’s Effectiveness

                                                                                                                                                 What does a Play Therapist do?

All Play Therapists receive thorough training in child development and attachment. They are also trained to use play, a child’s natural form of expression, as a means for understanding and communicating with children about feelings, thoughts and behaviour. The therapeutic relationship that develops between a child and their Play Therapist is very important. A child must feel comfortable, safe and understood. This type of trusting environment makes it easier for the child to express his/her thoughts and feelings and to use the therapy in a useful way. It is also crucial that a child knows their parents or carers are supporting the process.
The work that happens is mainly non-directive, which means that the play is Child-led. At times more directive methods are used when appropriate (i.e. when a child might be stuck, repeating play patterns with no signs of therapeutic benefit). However, children instinctively know what they need to do in order to heal. I welcome the child into the space with unconditional positive regard and acceptance. I offer a range of play materials and engage with the child fully as we build a therapeutic relationship together. Child-led does not mean there are no boundaries or rules, we do let the child know that we have a few, but only those that are necessary.
Art and Creative Materials
I use art materials such as clay, paint, glue, collage and craft as well as a full range of toys, which facilitate expression. These include puppets, figures, role-play equipment, dressing up clothes and animals. We also use clay and sand with a range of miniatures, therapeutic storytelling and calming and relaxing visualisation techniques if a child is receptive. Children often find talking about their difficulties or worries quite challenging and play therapy gives them the opportunity to play out some of their experiences and explore issues at their own pace. Data shows that talking is used for only 7% of the time in a Play Therapy room, but using play, a child can express themselves and communicate far more extensively.  Sessions last for 45-50 minutes and are held at the same time and place each week. Consistency is very important for building a trusting relationship. Play therapy interventions can last for as little as 12 weeks and as long as a number of years (depending on the child’s needs). It is important not to hurry the process and to let the child set the pace in order that they do not become overwhelmed.

How can Play therapy help Looked After Children or those who have been Adopted?

Many Looked After Children present with attachment difficulties, where things have gone very wrong in their early relationships. This can then affect how these children cope with life and manage relationships with others in their everyday lives. Feelings of insecurity and loss can mean they behave in ‘challenging’ ways. The aim of play therapy is to build a therapeutic relationship where the child can begin to trust in consistent responses from the therapist. From here the child may feel safe enough to explore some of their early experiences and the related feelings. They may then be more able to express themselves in more ‘appropriate’ ways.
My role is to contain the difficult feelings the child is bringing and reflect and feedback some of what I am seeing and hearing in a coherent manageable way in order that the child gains a sense of being understood. Previously unexpressed thoughts and feelings can then be gently talked about and explored within the safety of the therapeutic relationship when and if the child chooses. Talking may be a very small part of the sessions, however, the toys and play materials can provide distance for the child who is in many ways telling their difficult story within the play.
Children who have suffered abuse in the past can begin to take back some control in their lives as they lead the therapist on their chosen journey, decisions are theirs to make and there is a real sense of handing back responsibility to the child. It can be very empowering.

What training do Play Therapists have?

Prior to training, Play Therapists will have previously worked with children. The Play Therapy course is a postgraduate qualification:  either a diploma in Play Therapy or a Masters in Play Therapy. Play therapists should also be members of the British Association of Play Therapists (BAPT) Play Therapy United Kingdom (PTUK) or the British Association of Counsellors and Psychotherapy (BACP). You can ask to see their membership of their professional bodies. Trainees are recommended to have personal therapy themselves and all will hold a full DBS, Insurance and have membership of the ICO (to enable them to hold your data/details).
Play Therapy sessions are a safe time and space where the child is accepted just as they are. It is a space where a child can grow in confidence, increase in self-esteem and gain insight into themselves. Children may understand more about what has happened to them and become more able to access and articulate feelings. The child can experience a relationship based on trust and unconditional positive regard and this may help them make good choices for their own relationships throughout life. The Play Therapy Space can be a place to play and have fun as well as to process more serious stuff!
As a mobile Play Therapist, I can visit schools and organisations in central Cornwall. I run Play Therapy sessions in Truro, St Austell and the surrounding areas, and further afield if requested.  Do take a look around my website if you’re interested to know more about my clinical practice and the services I can provide.

Referral

At the time of referral, an SDQ  (Goodman’s Strength and Difficulties Questionnaire )  assessment tool will be used to understand the difficulties the child is experiencing and to provide an approximate length of intervention. This will be used at defined intervals in order to assess changes and developments. For 12 to 24 sessions there are usually 3 meetings (or as many as required) with the child’s carer or parent and a further three with school staff.
Example Session Length
12 sessions  – A child who has a stable home life with a secure attachment with caregiver(s), who may have experienced a trauma such as bereavement of a non-parental figure
24 sessions  – A child whose parents are separated and there are difficulties managing the new family dynamics or transitions between homes
36 plus sessions –  A child who has attachment difficulties, has experienced or witnessed abuse or has been exposed to inconsistent or unpredictable parenting

Top Tips for Parents and Carers.

  1. Talk openly about your own feelings in order that children may become used to the language of feelings and that it is ok to have them.
  • Engage with wonder! Begin to wonder about everything. Talk to your child in an open ended way. Avoid yes/no questions. ‘I wonder what that was like for you?’ ‘I wonder how it was for her/him’ ‘I wonder what would happen if…’
  • Support your child to attend Play Therapy sessions regularly. Consistency is crucial.
  • Try not to ask your child to tell you what they have been doing. If they want to, they will. Asking your child may pressure them into trying to explain something they may have not yet understood themselves
  • Remember that as with any therapeutic intervention, behaviour may get worse before it improves. This is normal and could be a reaction to some difficult feelings and or memories coming to the surface. 
References
  • Cathy Malchiodi PhD: Trauma, Play Therapy, and Research, (April 2020) https://www.psychologytoday.com/gb/blog/arts-and-health/202004/trauma-play-therapy-and-research
  • ASSOCIATION FOR PLAY THERAPY BOARD OF DIRECTORS (April 2020) Why Play Therapy is Appropriate for Children with Symptoms of PTSD.
  • Gaskill & Perry, 2012; Ogden & Minton, 2000; Porges, 2004; van der Kolk, 2014.
  • https://www.ptsduk.org/treatment-help/ptsd-treatment-for-children-and-young-people/

Sarah Foster BAhons DipPT                                                                                                                                                                     Play and Creative Arts Therapist, Trainee Children and Young People’s Creative Counsellor, Land Play and Parent-Child Attachment Play Practioner. October 2023 info@creative-me-playtherapy.co.uk

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